Ready to try something different.

[CoreyCarpenter]

I have moderate to severe SA and depression. I currently have a script for Xanax 1mg. While xanax helps immensely, the half life is too short for me and I don't like taking more than 1mg a day since it makes me really tired. I've tried Klonopin once and I didn't feel much different. I know I can't really base a medication's effectiveness on one experience but I don't know if it is the right med for me.

I go to a GP doctor and he has been very helpful and open trying me out on meds. When I first went to him about SA he put me on Paxil. I hadn't done any research on anti-anxiety medication yet so I was open to anything. I tried paxil for roughly 6 months, but I could not stand the side effects. I was falling asleep at work, feeling overall terrible, and as a lonely 25 year old man, i need my orgasms! Then he put me on beta blockers, I hadn't done any research on that either so I was like ok. Now I know beta blockers are mainly for physical symptoms of anxiety, which I don't really have. I don't notice any ease in anxiety on beta blockers at all.

Here is the delima. I know my GP doctor won't go much further with trying out new meds. He doesn't seem to know very much about social anxiety. I am looking for a therapist, however my insurance is going up so much that I don't know if I can afford therapy. I can keep taking xanax, but at this point I'm taking at least 1mg every day to get through the day. I am willing to try another SSRI since Paxil actually helped me, however I don't want anything with the severity of side effects that paxil has. Any Suggestions?

[Vini Vidi Vici]

Effexor shouldn't make you as sedated as Paxil. Paxil was really sedating and not cool for me either. Pristiq does almost the same thing as Effexor...either of them should be better than Paxil. I took up to 4mg of Xanax a day....you will eventually get tolerant to it. Its good to keep the dose as low as possible. You could try Trycyclic antidepressants, such as Mianserin or Amytriptyline. The lower doses work well for anxiety and depression without as much side effects as higher doses. However the Tricyclic antidepressants can make you tired. It would be interesting to see how they work with Modafanil, which can counteract tiredness/somnolence. An interesting alternative to benzos like Xanax is Lyrica (pregabalin). it has a nearly similiar anti anxiety ability, but can cause somewhat less withdrawal symptoms. It is used in the U.S. for fibromyalgia, but it is approved in Europe for treating anxiety. It might be safer to take long term..but i don't know cuz ive never tried it. Another thing you could do, is to take Wellbutrin or Ritalin/Aderral with an SSRI or SNRI. Wellbutrin will counteract many of the side effects, and will help siginificantly with the depression. It decreases the sexual dysfuntion and apathy, and increases motivation and concentration. Many doctors are quite familiar with combining these two meds. It might be a little harder to get Adderral or ritalin to take with an SSRI, but it might work with some doctors..just tell them you cannot concentrate at all...pull the ADHD card..lol

[placigtru]

Nice.... not something I want but cool

[jim_morrison]

Originally Posted by Vini Vidi Vici

You could try Trycyclic antidepressants, such as Mianserin or Amytriptyline.

Mianserin is actually a tetracylic antidepressant and is closely related to mirtazapine.

[Vini Vidi Vici]

Originally Posted by jim_morrison

Mianserin is actually a tetracylic antidepressant and is closely related to mirtazapine.

Lol sorry i always get the two (tetracyclic and trycyclic) mixed up. there is a big difference. i was excited about mirtazapine, until i took it. Now i want to try mianserin...it seems, that maybe, it might just work better? maybe be less sedating.... i was wondering if NAT reuptake inhibition would reduce or amplify somnolence/tiredness. And do you think mianserin is safe to take with an MAOI? maybe it would reduce postural hypotension...

[jim_morrison]

Originally Posted by Vini Vidi Vici

Lol sorry i always get the two (tetracyclic and trycyclic) mixed up. there is a big difference. i was excited about mirtazapine, until i took it. Now i want to try mianserin...it seems, that maybe, it might just work better? maybe be less sedating.... i was wondering if NAT reuptake inhibition would reduce or amplify somnolence/tiredness. And do you think mianserin is safe to take with an MAOI? maybe it would reduce postural hypotension...

Hard to say, Mianserin differs from mirtazapine in a few ways, the first main difference is that mianserin is a potent alpha 1 antagonist which mirtazapine is not, this action is also sedating, so it would possibly be even more sedating than mirtazapine and also this can cause such side effects as postural hypotension and dizziness, which mirtazapine wouldn't cause. Mianserin also carrys a higher risk of agranulocytosis than mirtazapine, and as such most doctors want to give you precautionary routine blood tests for the first few months of it's use.

On the positive side, Mianserin does have additional noradrenaline reuptake as you mentioned, and it also appears to have the benefit of being a more potent alpha 2 antagonist than mirtazapine.

Here's a summary comparing the two.
http://www.psychotropical.com/Mirt_medioc_science.shtml

As for if you could combine it with an MAOI, officially it's contradicted, but thats something you'd have to discuss with your doctor. I would imagine that a low dose that selectively blocks the histamine and 5HT receptors shouldn't be a problem and would probly help with side effects, however a higher dose which starts to incorporate alpha 2 antagonism may put you at a greater risk of serotonin syndrome. Discuss with your doctor.

[Vini Vidi Vici]

sweet. i wasn't planning on getting it from my doc, i was gonna order it from Venezuela or somewhere like that. i am interested in somehow blocking 5ht2c, to enhance the effects of Parnate,.....that stinks if it would be more sedating..parnate is already sedating me. it says on Wiki that Mianserin blocks almost every bad serotonin receptor...that would be cool too see what would happen if combined with a serotonergic something.

[jim_morrison]

Originally Posted by Vini Vidi Vici

Lol sorry i always get the two (tetracyclic and trycyclic) mixed up.

From what I understand the major difference between tricyclics and tetracyclics in terms of chemical structure is that tetracyclics lack the basic side chain which is considered to be responsible for the anticholinergic and sodium channel blocking effects of the tricyclics, as such tetracyclics as a group tend to have less anticholinergic and cardiotoxic effects than the tricyclics, however they tend to carry over alot of the other effects of the tricylics, although like the tricyclics, each tetracyclic antidepressant varys slightly from the next in terms of it's mechanism of action.