Med Recommendations for GAD, Panic, DP/DR & OCD?

[Jeremyc92]

I was on Zoloft for a while - it worked alright but never fully felt normal again. So I stopped a few months ago. But now my anxiety is back with vengence. So I have an appointment tomorrow to get in something.

Does anyone have suggestions for medication that doesn't have the horrible start-up effects like Zoloft? I can't afford to miss more work.

I have horrible derealization and depersonalization. I also feel lightheaded all the time. High moments of anxiety where I feel wired up. Hoping for something to work fast.

[panic_down_under]

I was on Zoloft for a while - it worked alright but never fully felt normal again.

Not 'normal' in what way?


Does anyone have suggestions for medication that doesn't have the horrible start-up effects like Zoloft? I can't afford to miss more work.

Only the benzodiazepines, but I don't recommend them as a long term solution.

Antidepressants are your best bet, but side-effects can't always be avoided, they can be limited by starting on low doses and ramping up by similar small amounts and treating the symptoms which still occur.


I have horrible derealization and depersonalization. I also feel lightheaded all the time. High moments of anxiety where I feel wired up.

Derealisation, depersonalisation and lightheadedness are anxiety symptoms. Serotonergic ADs will often worsen anxiety at the beginning and for a while after dose increases produced by greater serotonin activity. However, after a few weeks the brain and body adjusts to this by downregulating serotonin synthesis and expression and anxiety (or depression) begins to diminish.

Judicious use of meds such as the benzodiazepines (BZDs) or sedating antihistamines such as hydroxyzine (Vistaril) can ease the symptoms. However, BZDs may interfere with the neurogenesis mechanism by which ADs work so they should only be taken if needed.


Hoping for something to work fast.

Antidepressants have no direct effect on anxiety, or depression in the way say aspirin has on a headache. They work by stimulating the growth of new brain cells (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC60045/) (neurogenesis) to replace cells killed, or prevented from growing by high brain stress hormone levels. The therapeutic response is produced by these new cells and the stronger interconnections they forge, not the meds directly, and they take time to bud, grow and mature.