No motivation to go see psychiatrist

[bluewalls]

I've had panic disorder for over 7 years. I live with parents and have no job. My life is very limited. I used to have friends but not anymore. I've tried therapy as well as zoloft, lexapro, effexor, klonopin, and seroquel. I wonder all the time if there is a drug that could really help me, but I just feel like they probably won't help. All the SSRIs have a similar mechanism of action, and the ones I've tried haven't done much for me.

[Scissel]

I also live with a family member and I'm well into my 40's and can't work. I suppose my life is limited as well, although, nothing wrong with a simple life minus the drama of a complicated one.

Therapy is hit or miss, sometimes can at least give you new perspective on things. It doesn't help me much because I struggle with trust issues and I don't always open up enough. Still good to go because there is more things in addition to medication that can help you - I still recommend it. SSRI's never helped me either for the record.

I hope things improve.

Best wishes.

[panic_down_under]

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.

[bluewalls]

I also live with a family member and I'm well into my 40's and can't work. I suppose my life is limited as well, although, nothing wrong with a simple life minus the drama of a complicated one.

Therapy is hit or miss, sometimes can at least give you new perspective on things. It doesn't help me much because I struggle with trust issues and I don't always open up enough. Still good to go because there is more things in addition to medication that can help you - I still recommend it. SSRI's never helped me either for the record.

I hope things improve.

Best wishes.

How about TCAs? Have you tried any?

[roseanxiety]

a true SNRI (Effexor/venlafaxine is really only a SSRI), either, in my order, duloxetine (Cymbalta, or desvenlafaxine (Pristiq)


Hi Ian, just wondering why Effexor is not a true SNRI? I just switched over from Lexapro because of weight gain. It seems to be working but i am very worried about the weight gain with this one also.




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[panic_down_under]

Hi Ian, just wondering why Effexor is not a true SNRI?

Because it is only a very weak inhibitor of the noradrenaline (NA), aka norepinephrine, transporters even at the maximum dose. The SSRI paroxetine (Paxil) is a more potent NA reuptake inhibitor.

Receptor and transporter binding potential is measured in Ki units which is determined by now much of the drug is needed to saturate the binding sites (receptors or transporters), so the lower the value the greater the binding potential. For venlafaxine NA is ~2,500 Ki, for paroxetine ~57 Ki and for duloxetine ~5.9 Ki.

I just switched over from Lexapro because of weight gain. It seems to be working but i am very worried about the weight gain with this one also.

Only time will tell if venlafaxine will be better or worse for you. The only AD with a good track record on weight is bupropion (Wellbutrin, Zyban), however, it is generally the most stimulating AD which can have many with anxiety disorder almost literally climbing the walls. But supplementing a weight triggering AD with small doses of bupropion, <= 75mg, may counter that side-effect.