OK...need some help with Medication

[Jakemje]

As many meds that I have tried, there has to be some correlation between what some of them do or what chemicals/receptors they are acting on that are causing my problems. I know that most psychiatrists do a "trial and error" or a "it worked well with a alot of my patients" approach to prescribing meds. This is not working for me and there has got to be a more scientific approach.

I have had GAD/Panic for almost 20 years, and Lexapro was the first med I tried. It worked wonderfully, but, as a rule, the first AD you try has a 60-70% rate of success. I took that med for almost 12 years before it finally stopped working.
(10mg-20mg)

The doc then prescribed neurotin which was like taking a tic-tac, and had no effect.

Then on to Zoloft along with Valium (2mg x3 daily). Zoloft did not help the anxiety, and in fact made it worse by turning it into straight muscle tension and ANGER. I was taken off that and put on Prozac. The prozac worked along with the Valium for about 2 years and then pooped out.

Then the real fun began. From there, I went on Effexor xr (made me feel like I was coming out of my skin and raised my heart rate and blood pressure to the point of the doctor wanting me to take blood pressure medicine), off of that to Paxil along with increasing my valium to 17.5mg a day. Same thing, tension and anger... I would snap at the smallest of things.
At this point, the doc wanted to start trying older meds. I was on Anafranil, and at first, was feeling alittle better, but as time when on, the anxiety built up along with strong side effects (very blurry vision, constipation). I kept taking it hoping the would wear off, but it just got worse and worse.

The doc then put me back on Zoloft feeling that I may have been on to high of a dose the first time, but at the smallest dose, after about a week, the anger and rage set back in. I remember telling my doctor that I know why most of the school shootings here in the states, they would always bring up the fact that the shooter was on Zoloft....I understand why I can not begin to imagine how a child would react with the anger I feel at their age. I barely can control it at 35 and I have been in retail management of 18 years, so I deal with pissed off customers daily.

I then when through a cleaning out process and get off everything except the valium. This is did not work, I had panic and anxiety all day. I know that I will be on some time of medication for my entire life.

The next med and what I am on now is Doxepin. Once again..... ANGER, and tension in my neck and back all day...

All of this is really effecting my life, relationship with my wife and family, and even daily activities. I am at my ropes end and if something doesn't change soon, I feel there might only be one alternative.

There has got to be a connection between the meds that are causing my anxiety to increase along with the rage. I reallly feel that I am not going to be able to handle myself at some point with this anger. I am giving these meds plenty of time to work.... I am not taking them for 3 days and quiting... I am taking them for 6-8 weeks and getting worse daily.

All of these meds react to different receptors, and I can't help but feel that Zoloft, Anafranil, Doxepin, Paxil, and Effexor have something in common on what they do.

Please, any information or recommendations you can make, please help me.. Im not looking for a magical herb or root from China that may work.... I am looking for a medication that will or is known to help counter act irritability and tension that I can talk to my doctor about.

[panic_down_under]

I remember telling my doctor that I know why most of the school shootings here in the states, they would always bring up the fact that the shooter was on Zoloft.

<Ian mounts soapbox>

Which in almost every case was a lie. The NRA and its supporters are very quick to push the psych drug angle to divert attention from the real problem.

There are more people outside America taking SSRIs, so why are school shootings (and mass shootings generally) almost unheard of in Europe, Australia, Canada, etc? Or for that matter, why are shooters overwhelmingly male, given more women than men are on antidepressants? There were school shooting in America long before there were any psych meds. Lots of them. The first one was in the 1700s and they have been occurring with monotonous regularity every since.
</soapbox>

All of these meds react to different receptors, and I can't help but feel that Zoloft, Anafranil, Doxepin, Paxil, and Effexor have something in common on what they do.

Apart from doxepin, which is mostly an antihistamine, they are all primarily serotonin reuptake inhibitors. So your best bet is probably a norepinephrine, aka noradrenaline, (NE) reuptake inhibitor such as nortriptyline (Pamelor), and, maybe, desipramine (Norpramin), though this also is a fairly potent serotonin inhibitor. The two mainly NE inhibiting SNRIs milnacipran (Savella) and levomilnacipran (Fetzima) might also work, but I'd try nortriptyline first.

[Jakemje]

thank you for you the response.... I guess I need to clarify what I was meaning by the zoloft rage I was talking about. I am just saying from my personal experience on this medication, that if a child, teenager, or young adult has the rage and irritability equal to what I have endured with it, I don't know how they would react and be able to hold it it. Its just like ADD/ADHD. Up until about 20 years ago, most parents would say that the child just needed to be disciplined more. It was a form of misbehaving on the child's part. But I would say to to the part of it being male vs female, more in the USA, and been going on for centuries.... Men are prone to being more violent than women, America has a lot less strick firearm control than most countries, and they have seemed to really amped up in activity over the last 30 years, around the time that most SSRIs came on to the market. And to go a step further, there are more men in prison than women, and 90% of the ethnicity of the inmates are other than Caucasian. So from that, I would say if you are a black or spanish male, you are more predisposed for violence and/or committing a crime than a white guy. (which to me sounds completely stupid, but the numbers show it) From my understanding, the older TCAs were given out in hospitals while the patient was being hospitalized for their condition, not going to a doc-in-a-box and given a sample packet. My first AD was prescribed to me by a gastrointestinal doctor due to I was complaining of Acid Reflux... He gave me Lexapro. He was not a psychiatrist nor had any specific training in it and told me he didn't. He said it might help.

Both times on Zoloft, I went from a Retail Service Manager that had to deal with customer problems and help them daily, being yelled at and cursed at, but still having to smile, to just the other day, my passenger in the car with me having to grab my arm to stop me from getting out of my car to pull and elderly lady out of her car for giving me a bad look at a stop sign. There is something definitely in some of these meds that cause people's personalities to change if they are not given to the correct people. I feel there should be a more scientific method behind handing them out, rather than trial and error. This is not a headache the doctors are treating, this is a mental condition that if it is not treated correctly can end in the patient hurting someone or themselves. To make an analogy, it would be like trying to get a child to ride a bike....and if they can't, give them a motorcycle to try on...and if they cant lets get them a corvette.. they are all modes of transportation and by "trail and error", we should find one they can handle...or they may hurt themselves... live and learn.

But as for the stigmata of people thinking that some of these meds cause suicidal tendencies and/or people's moods changing to the point they could hurt someone... yes its there. And its there for a reason. It happens. I have had two friends in the last 3 years commit suicide while being treated by doctors with medication. I, myself, never cry. Not because I am manly or think bad of it, I just don't. I do not get sad. But since this roller coaster of drug changes by two different doctors, I will cry watching a soap commercial. I will lose my temper over the grass outside not being as green as I think it should be. My two friends had both spoke up to the doctors about their thoughts, and was just given another pill to pop. And as for me, who in the last 8 months swapping under a doctors care between different medications with no relief, and in all actually, getting worse, it scares me.

I am beginning to really question the reason there are psychiatrist in that I can look up medication and say, "give me a prescription for _____" and trail and error myself. Why do I need to pay $120.00/hour for them to do it? They don't know how the medicine is going to react with the patient and are only going on either; 1. they had people in the past react well to it 2. they heard about the med from a pharmaceutical rep and said give it a try.

[panic_down_under]

and 90% of the ethnicity of the inmates are other than Caucasian. So from that, I would say if you are a black or spanish male, you are more predisposed for violence and/or committing a crime than a white guy. (which to me sounds completely stupid, but the numbers show it)

This is off-topic, but non whites are far more likely to be imprisoned than whites for the same crimes. It is a racism issue, not a genetic or mental health issue one.

My first AD was prescribed to me by a gastrointestinal doctor due to I was complaining of Acid Reflux... He gave me Lexapro. He was not a psychiatrist nor had any specific training in it and told me he didn't. He said it might help.

Which may have been the very worst treatment as the enteric nervous system, the mini brain which controls the gut, is by far the most serotonergic organ of the body making and using about 50 times more serotonin than the brain and is thus likely to be far more affected by SSRIs initially.

I feel there should be a more scientific method behind handing them out, rather than trial and error.

Researchers have been looking for a reliable tool to predict antidepressant response for decades, so far without much success.

[Jakemje]

So basically.... me looking up a medication and asking a regular general practitioner to prescribe it has just as much weight as a psychiatrist doing it. They have no greater knowledge of how it will or will not work over what can be found on Google. At least if I ask for the medication, I can't blame the doctor for ignorance when it doesn't work. I go to the psychiatrist for their knowledge and education on the problem.... not for guess work.

(on the point of the prison population, it is off topic, but does show that just because numbers point to something, does not make it true. Right now, we are going though a race war of police brutality on the black population. Even though more whites by a great margin are shot and killed by police ever year than any other race in America. But on that front, the numbers don't matter....that is where the racism comes in)

[panic_down_under]

I go to the psychiatrist for their knowledge and education on the problem.... not for guess work.

But their guess work is more educated than that of a PCP. And they are usually less likely to prescribe inappropriate med combinations.

Even though more whites by a great margin are shot and killed by police ever year than any other race in America.

As of today, out of 574 people shot by police so far this year, 240 were White, 122 Black and 90 Hispanic. So on raw numbers you're right, but given Blacks are only 13% of the population their death rate is extraordinary per capita. The ratios were the same in 2015 and 2016 too. But, imho, the most telling stat is how many were unarmed, compared to Whites.

[Jakemje]

So your best bet is probably a norepinephrine, aka noradrenaline, (NE) reuptake inhibitor such as nortriptyline (Pamelor), , but I'd try nortriptyline first.

This is the one thing about these meds that I have never understood... Its my understanding that any NRI would actually increase anxiety instead of lowering it.

If, like me, depression is not a problem, it seems this type of med would have me climbing the walls by allowing there to be more adrenaline available. Of course, I am talking out my butt due to I do not know the true nature of how these meds work.