Do you still have anxiety with your antidepressent

[Mermaid16]

I'm the same as you. I thought when I changed to Nortriptyline that the anxiety would go. It is manageable most days, but still there. I am still on the clonazepam as well. I'm waiting for the psych to come back from holidays, in two weeks. To see if I should persevere. I was going to see if swapping to Clomipramine would make any difference (even though it is a tricyclic as well). Sometimes I think it's just easier to accept that this is my life now...It's hard, but I have been like this for 12 months now. I just can't see stopping the clonazepam until I have something that works.

[panic_down_under]

I thought when I changed to Nortriptyline that the anxiety would go. It is manageable most days, but still there.

...I was going to see if swapping to Clomipramine would make any difference (even though it is a tricyclic as well).

Unlike the SSRIs, the TCAs don't all do basically the same thing. Nortriptyline is mostly a noradrenaline reuptake inhibitor having little impact on serotonin, whereas clomipramine is a potent inhibitor of both neurotransmitters, much more so than any of the SNRIs.

If nortriptyline is getting you most of the way to where you want to be then maybe adding some sertraline might be a better option as it will allow fine tuning of the serotonin:noradrenaline inhibiting ratio. Something to explore with your psychiatrist anyway.

[Mermaid16]

Thanks PDU. I have just tapered off sertraline (was on it for over 10 years and it pooped). I was taking sertraline, nortriptyline and Mirtazapine...a few too many anti d's. So I wouldn't go back on sert after just tapering off it. Any other suggestions? Would the clomipramine be worth shot? Is it similar to Nort in start up effect eg doesn't really affect you that much apart from constipation and thirst?

[panic_down_under]

I have just tapered off sertraline (was on it for over 10 years and it pooped).

Ooops. Sorry. That escaped my memory. darn Russian hackers!

Would the clomipramine be worth shot?

Sure is. It is arguably the most potent antidepressant apart from the MAOIs.

Is it similar to Nort in start up effect eg doesn't really affect you that much apart from constipation and thirst?

Usually yes. But you shouldn't need to quit nortriptyline first. In most cases switching via a short cross-taper goes fairly smoothly and avoids/limits most of the usual unpleasant initial side-effects. Your psychiatrist will explain the best way of doing it.

[Ethansmom]

Thank you PDU, mermaid, antsyvee, and all of the others who have chimed in. You know, I mentioned the trycyclics to of the veteran doctors while I was in the hospital and he said they don't really prescribe those anymore. He tends to use SSRI's--- depending on the person.

My new younger doctor said she has patients on them and still prescribes them every now and then. My questions is- why don't they prescribe them-? Just because there are newer drugs to replace the older ones? I'm wonder if I should talk to my doctor about the TCA's. I googled them and it seems there's a long list of side effects. DO they usually cause increased anxiety? Or would I be okay since i'm already taken an SSRI? Meaning, could I just transition over smoothly?

[AntsyVee]

Ian, can answer more of that, because he's on a TCA...but the reason they don't prescribe them is because they have more drug interactions and diet interactions. There's just a lot more things you have to take into consideration when taking them. But hey, if nothing else works for you, then to me it's worth the annoyance.

[panic_down_under]

You know, I mentioned the trycyclics to of the veteran doctors while I was in the hospital and he said they don't really prescribe those anymore. He tends to use SSRI's--- depending on the person.

They prefer SSRIs because they are safer in overdose (not actually true for all) and because they believe being the newer drugs they must be better. The first is moot as there is not much evidence those taking SSRIs are less likely to harm themselves than those on TCAs, they just take something else to do so, and despite the claims, the TCAs appear to be generally more effective with the older MAOIs being even more so.

One of the methods used to compare drugs is the Number-Needed-to-Treat (NNT). This measures the effectiveness of a med by estimating the number of patients needing to be treated in order to have an impact on one person. The lower the number, the better. De Lima MS, 2003, found it to be MAOIs 2.9, TCAs 4.3, SSRIs 5.1. Arroll B, 2005 came up with TCAs 4, SSRIs 6. However, there is no way of predicting whether this will be so for an individual. In the end the most effective med is the one which best meshes with individual biology, not which class it's from.

I googled them and it seems there's a long list of side effects. DO they usually cause increased anxiety?

Yes, but anxiety is also a listed SSRI side-effect. My observation is those taking SSRIs tend to experience more severe side-effects when first taking them and after dose increases, while those on TCAs have more ongoing ones, usually nuisance ones such as dry-mouth and constipation, however, the secondary TCAs nortriptyline (Pamelor) and desipramine (Norpramin) have similar side-effects profiles to the SSRIs/SNRIs. The TCAs also seem to be generally a little easier to quit than SSRIs and SNRIs.

One thing to be aware of is TCAs can be more cardio-toxic than the SSRIs - except citalopram (Celexa) and escitalopram (Lexapro) - which may be a problem in the case of some types of heart disease, but usually isn't for those in reasonably good health. Clomipramine has a better safety rating than citalopram/escitalopram in this regard, according the the CredibleMeds data base.

[Ethansmom]

Thank you, Ian. I'm just having so many setbacks with Celexa that I don't think it's working. The Clonazapam it's what's holding me up.

[panic_down_under]

Thank you, Ian. I'm just having so many setbacks with Celexa that I don't think it's working. The Clonazapam it's what's holding me up.

Unfortunately, I think you're right.

[AntsyVee]

Ethansmom, have you tried Paxil (paroxetine)?