Can this help checking behaviours related to health anxiety?

[olivia0703]

I haven't had much luck with SSRIs for my anxiety. At the moment, it's mainly obsessive checking behaviours related to health anxiety as well as generalised anxiety. I also have C-PTSD. Can anafranil help with this?

(I am also worried about anything that antagonises dopamine, as I have had an acute dystonic reaction to Reglan in the past.)

[panic_down_under]

I haven't had much luck with SSRIs for my anxiety. At the moment, it's mainly obsessive checking behaviours related to health anxiety as well as generalised anxiety. I also have C-PTSD. Can anafranil help with this?

Anafranil (clomipramine) was the 'gold standard' OCD med for many decades before SSRIs became available. The newer meds didn't replace it because they were more effective. They aren't.


(I am also worried about anything that antagonises dopamine, as I have had an acute dystonic reaction to Reglan in the past.)

Reglan (metoclopramide) is a fairly potent dopamine D2 and D3 receptor antagonist with a binding potential of about 7.5 *Ki for D2 and 7.8 Ki for D3 (https://www.guidetopharmacology.org/GRAC/LigandActivityRangeVisForward?ligandId=241), whereas clomipramine is much weaker D2 receptor antagonist at about 162 Ki and D3 at 30 Ki (https://www.scbt.com/p/clomipramine-hydrochloride-17321-77-6). It is therefore unlikely to affect you the same way as metoclopramide, however, there may be other factors involved so you really should discuss with your GP, Olivia.



* The Ki binding affinity of a drug to receptor or transporter molecules, is determined by the plasma concentration of the med required to saturate 50% of the receptors/transporters. The lower the Ki the stronger the affinity

[olivia0703]

Thank you! I have an appointment with a psychiatric PA on Thursday to discuss med options and I may mention this. Reading through the posts here, though, it sees increased RHR is increased, which I'm not too keen on.

[panic_down_under]

Reading through the posts here, though, it sees increased RHR is increased, which I'm not too keen on.

TCAs and some other ADs, including at least 2 SSRIs, may increase resting heart rates, but so often does anxiety/stress (also depression). Anxiety/stress/depression is by far humanity's leading cause of premature death as it often sets in train the conditions which take us out early such as cardiovascular disease and cancers.

Exercise can moderate AD cardiovascular effects and also ease anxiety and depression via the same mechanisms as ADs and therapy. There is no need to run a daily marathon. A 30 minute stroll 3-5 days a week can have a significant positive impact on both heart health and anxiety disorders and/or depression.

[olivia0703]

Thanks again for the info. It's very helpful. I am curious what this new psych guy will suggest. I wish he'd just give me a truckload of benzos (i know, I know, it's just that I am exhausted white-knuckling this and need some freaking relief. (I do have a consult with a potential new therapist tomorrow as well.)

[panic_down_under]

I wish he'd just give me a truckload of benzos

Benzodiazepines might give you temporary relief, Olivia, but they actually worsen anxiety disorders (also depression) and when taken with ADs they can block their mode of action so reducing their effectiveness. See:


Boldrini M, Butt TH, Santiago AN, et al. (2014)
Benzodiazepines and the potential trophic effect of antidepressants on dentate gyrus cells in mood disorders.
Int J Neuropsychopharmacol. Dec;17(12):1923-33 (Abstract (https://www.ncbi.nlm.nih.gov/pubmed/24969726) | Full text (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4374628/))

Sun Y, Evans J, Russell B, et al (2013)
A benzodiazepine impairs the neurogenic and behavioural effects of fluoxetine in a rodent model of chronic stress.
Neuropharmacology. Sep;72:20-8 (Abstract (https://www.ncbi.nlm.nih.gov/pubmed/23639432))

Song J, Zhong C, Bonaguidi MA, et al (2012)
Neuronal circuitry mechanism regulating adult quiescent neural stem-cell fate decision.
Nature. Sep 6;489(7414):150-4 (Article (https://www.kurzweilai.net/how-the-brains-stem-cells-find-out-when-to-make-new-neurons/comment-page-1#comment-96481) | Study full text (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3438284/))

Wu X, Castren E. (2009)
Co-treatment with diazepam prevents the effects of fluoxetine on the proliferation and survival of hippocampal dentate granule cells.
Biol Psychiatry. Jul 1;66(1):5-8 (Abstract (https://www.ncbi.nlm.nih.gov/pubmed/19251245))

See also: the 'Ugly' part of Benzodiazepines: The Good, The Bad, and the Ugly (https://journalofpsychiatryreform.com/2016/11/20/benzodiazepines-the-good-the-bad-and-the-ugly/).