High Anxiety/depression - Tricyclic and other med suggestions.

[purplepie]

Hi All

I have been a member for a long time and always find this site so helpful. At the moment I am really struggling with high anxiety - wake up sweating, heart racing wanting to retch and shaky. This continues for most of day. Out of the blue I go hot and clammy and feel sick at various times throughout the day. I am fearful of going out and have no patience or interest in anything. It started in December with crying, agitation and anxiety and has developed into a deep anxious/depression. The trigger was delayed grief and I was feeling overwhelmed in my work.

I have been on 20mg clomipramine for past 5 years (hardly a dose), GP upped the dose to 50mg on 7th Jan which I know is still not high, but I really struggle with with taking meds and think I make myself worse. I cannot tolerate SSRI's or venlafaxine (SNRI) - they made me feel so ill. Does anyone have any suggestions on tricyclic AD's and if switching to another would make a difference? Also Mirtazapine has been mentioned but unsure on this as I don't know of anyone on it for experience. I am really struggling making it through the days feeling like I do, I try to keep myself busy as I can't it still but don't want to do anything at the same time.

[KK77]

Tricyclics like clomipramine are heavy-duty meds and aren't generally tolerated well at therapeutic levels. Mirtazapine, trazodone, lofepramine and perhaps even a low-dose anti-psychotic (like quetiapine) might be better options for you.

Speak to your psych about way forward if current med is not helping.

[purplepie]

Thanks KK77 for your input. I was on lofepramine a few years ago at 70mg - couldn't get to 140mg as my pulse was constantly high on it but it did help the depression. I will discuss options with GP and maybe push for a psych appointment as I don't have a psych in place. Heard good and bad things about the other 2 meds you have mentioned but I know that everyone is different and it is sometimes trial and error.

Just want to feel well and enjoy my life.

[KK77]

Unfortunately, it is a process of trial and error. It took time for me to find right combo of meds too.

I was thinking you could add mirtazapine to clomipramine but fear it would be too sedating. Your other option is to try lofepramine again and add propranolol to help with physical symptoms like fast heart rate/palps. I had same trouble when I started venlafaxine and asked for propranolol which helped greatly. It will also reduce other physical symptoms of anxiety like tremor/internal vibration sensation.

Anti-psychotics tend to be somewhat more hit-and-miss but can be very effective for anxiety symptoms if they agree with you.

[purplepie]

I have discussed all with GP today who said that she things my symptoms seem to be still my agitation and not the meds, so I am going to 60mg for next couple of weeks and then going to try to go us again slightly after that. She said to take a diazapam 2mg for next coupld of weeks in a morning when the anxiety/agitation is sky high. Yeah it is very trial and error. propranolol helps my heart rate but not much else and to be honest, the heart rate thing doesn't bother me as much as the agitation and not being able to just sit and rest with waves of panic.