Originally Posted by
bluewalls
All the SSRIs have a similar mechanism of action, and the ones I've tried haven't done much for me.
Welcome to No More Panic,
SSRIs are not the only antidepressants (ADs), nor, arguably, the most effective for anxiety though they are generally a little better for it than depression.
You and your doctor/psychiatrist, should, imho, be considering (in my order):
a tricyclic antidepressant (TCA) such as imipramine (Tofranil), or clomipramine (Anafranil). Imipramine was the 'gold standard' AD for panic until the SSRIs become available, losing its supremacy not because SSRIs are more effective, but because they are considered safer in overdose (which isn't actually true of all SSRIs and SNRIs).
the MAOI class AD tranylcypromine (Parnate). MAOIs are, ime, the most potent anti anxiety ADs, but fell out of favour because of dietary restrictions which with modern food processing techniques is now much less of an issue and can be nullified almost completely by adding a small dose of the noradrenaline, aka norepinephrine, reuptake inhibiting AD nortriptyline (Aventyl, Pamelor).
a true SNRI (Effexor/venlafaxine is really only a SSRI), either, in my order, duloxetine (Cymbalta, or desvenlafaxine (Pristiq)
Other things you can do is exercise. You don't need to run a daily marathon, a 30 minute walk 4-5 days a week can do wonders for anxiety and depression. Omega-3/fish oil supplements may also help. Both have been shown to have the same affect on the brain as antidepressants, though not to the same potency.