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I just did the GeneSight test (fwiw) and the only SSRI that got flagged for me was Zoloft, which is the one I am taking with no positive results after more than three months.
Since it doesn't feel like it's working (compared to how I felt on citalopram) I am going to ask my doctor to switch me. If you happen to read this, Ian, which SSRI is the best for anxiety? Is there one that is objectively better? Should I try lexapro, since I did OK on citalopram?
That's not a surprise. The claims are way ahead of the science on this with the success rate being no better than from random chance from what I've observed. I think the best way of choosing one's first AD is to put their names in a hat...Quote:
Originally Posted by olivia0703
No AD is intrinsically better than the others, either generally, or for a particular disorder, though there are two which seem to have an edge with the OCD spectrum disorders.Quote:
which SSRI is the best for anxiety? Is there one that is objectively better?
Citalopram is made up of two isomers, the 'S' form of citalopram which is the active component, and a 'R' mirror image form which is a poorer fit biologically and so is mostly inactive. Lexapro (escitalopram) is more refined and only contains the 'S' isomer. The small difference in chemistry can produce differences in their side-effects, but if one doesn't work then the other probably won't either.Quote:
Should I try lexapro, since I did OK on citalopram?
Imo, if two SSRIs have failed then it's better to try something from one of the other AD classes. Your GP will probably recommend a SNRI, most likely venlafaxine, but I'd go with one of the older TCAs. The problem with the SNRIs is they can produce significant side-effects and also be hard to quit, especially venlafaxine because it has a very short half-life.
TCAs are typically more benign both initially and when tapering off them and are usually less likely to poop-out. I've been on my current one since 1996. The downside is that they tend to produce more ongoing side-effects, mostly just nuisance ones such as dry-mouth and constipation which can be managed. Either amitriptyline, or imipramine would be a good initial choice. Imipramine was my first AD and before the arrival of SSRIs was the gold-standard AD for panic disorder and PTSD. The SSRIs didn't replace TCAs because they were more effective, they aren't, but because they are safer in overdose and usually have fewer ongoing side-effects.
Thanks, Ian, helpful as always