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Thread: Recommended medication for catastrophic thinking?

  1. #1
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    Recommended medication for catastrophic thinking?

    Long time member here, initially because of health anxiety. Close to 8 years ago started Escitalopram (20mg) + Xanax for some time and it took a couple of months but started feeling better (basically they were a life safer). Continued medication for 2-3 years and then started reducing slowly until going off. However after a couple of months started feeling again anxiety/depression. So I've been on/off for the last couple of years. Last time I got off them was 8 months ago after taking Escitalopram 10mg for a couple of months...I was feeling a bit better, but didn't look like Escitalopram was helping much (maybe the dosage was low).

    The last few weeks, especially 10 days, been feeling pretty bad due to some bad situation I found myself. It's more depression, especially catastrophic thinking than anxiety. I start imaging the worst and spiraling down as you well know. It's a bad situation and there's a chance things may go really wrong, but if I would be more rational, that chance would be lower than what I'm thinking. Have been taking 0.5mg Xanax and helps a bit, but not much and I'm thinking of starting back SSRI/SNRI.

    My question is if there's on medication that works better for catastrophic thinking or not? Would it be better to start Escitalopram (maybe 5, then 10 and then 20mg) or look for an alternative? I can consult a doctor, but my experience has been that my own feelings and feedback from people who have suffered from something similar are better than what a doctor would suggest.

    Thanks a lot

  2. #2
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    Re: Recommended medication for catastrophic thinking?

    Quote Originally Posted by matrix123 View Post
    My question is if there's on medication that works better for catastrophic thinking or not?
    No. The SSRIs are arguably better anti anxiety than anti depression meds, and some ADs are likely to be more effective than others for an individual, but none are intrinsically more effective for specific disorders, although clomipramine (Anafranil) and fluvoxamine (Luvox) for OCD may be the exceptions which prove the rule.

    Both anxiety and depression are the emotional manifestations of the same underlying brain deficit, a loss of brain cells in the hippocampal regions of the brain caused by high brain stress hormone levels killing cells and preventing the growth of replacements. Antidepressants (and psychotherapy) work by stimulating the growth of new neurons. It is the new cells and the connections they form which provide the therapeutic response, not the meds directly (this is the reason it typically takes some 4-12 weeks to see an improvement). For a more detailed explanations see: Depression and the Birth and Death of Brain Cells (PDF) and How antidepressant drugs act.

    If escitalopram worked well for you in the past then there is a reasonable chance it will again, however, the initial side-effects may be different and tend to become progressively more severe each time an AD is stopped and restarted. Progressively higher doses may be required to achieve previous levels of control too which could be a problem as 20mg is the maximum recommended dose so you have no headroom to play with. If escitalopram proves inadequate you could try supplementing it with buspirone (Buspar) a GAD specific med which has build a solid reputation for increasing the effectiveness of SSRIs/SNRIs and reinvigorating those that have stopped working if your doctor is willing to prescribe it.

    Given the above, I think you have basically 3 options, go back onto escitalopram and cross your fingers that it works well at 20mg, adding buspirone if necessary, start on another SSRI such as sertraline (Zoloft), or try one from another AD class such as the TCAs amitriptyline (Elavil) and imipramine (Tofranil), or perhaps the SNRIs milnacipran (Savella) and levomilnacipran (Fetzima) - I think they are better SNRIs than venlafaxine (Effexor), desvenlafaxine (Pristiq) and duloxetine (Cymbalta). The problem is there is no way of predicting which of these meds is going to be the most effective, indeed, there may be another even better.

    One additional point. As you have a history of needing to go back onto ADs regularly, imho, you should consider staying on one permanently as there is growing evidence antidepressants, especially the SSRIs, may become progressively less effective every time they are stopped and restarted. Two studies, Amsterdam JD, 2016 and Amsterdam JD, 2009, found the likelihood of antidepressants working after each restart drops by between 19-25% (see also: Bosman RC, 2018; Amsterdam JD, 2009; Leykin Y, 2007); Paholpak S, 2002).
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    The opinions expressed above are based on my observations and, where applicable, interpretation of cited data and are general in nature. Consult your physician before acting on anything stated.

  3. #3
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    Re: Recommended medication for catastrophic thinking?

    Thanks a lot for the detailed explanation. I'll read the materials and it seems I have to made up my mind on sticking to a SSRI or being med free.

  4. #4
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    Re: Recommended medication for catastrophic thinking?

    I just want to say I知 a catastrophic thinker and worrier here. Horrible healthy anxiety and hypochondria. I知 in therapy and I知 recovering from abuse in childhood so I also have PTSD and panic with severe anxiety. I知 currently taking Zoloft and Xanax as needed. I知 also on Wellbutrin. Does it cure the catastrophic thinking? No but it helps. Therapy helps with that too. I can relate to what you池e saying and I wanted you to know you池e not alone. Hope you find the solution that works for you.

  5. #5
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    Re: Recommended medication for catastrophic thinking?

    Thank you for the message. I got out of Escitalopram again since it wasn't working anymore. I'm considering Zoloft and using Xanax as needed.

  6. #6
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    Re: Recommended medication for catastrophic thinking?

    Quote Originally Posted by matrix123 View Post
    Thank you for the message. I got out of Escitalopram again since it wasn't working anymore. I'm considering Zoloft and using Xanax as needed.
    Sertraline (Zoloft) might be a good choice. It has fewer interactions with other meds than is the case with other SSRIs and if it falls a little short on effectiveness can be more easily supplemented with a noradrenaline/norepinephrine (NA) reuptake inhibiting AD such as nortriptyline, or desipramine to create a bespoke SNRI turned to your biology (it is already a more potent NA inhibitor than venlafaxine, albeit still only a weak one). The sertraline+nortriptyline combo was popular before SNRIs became available and is arguably still a better option than venlafaxine, desvenlafaxine and duloxetine. The problem is many GPs and even psychiatrists lack the confidence and/or experience to prescribe outside the box, or are hampered by government guidelines.

    Dependence tends to build sooner with alprazolam (Xanax) than with lorazepam (Ativan) so all other factors such as effectiveness being equal, lorazepam is the better option, imho. In both cases definitely take it when needed - whiteknuckling through anxiety is counterproductive - but limit taking it 'just in case' as BZDs inhibit AD effectiveness.
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  7. #7
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    Re: Recommended medication for catastrophic thinking?

    Thank you for the detailed explanation. I've always used Xanax and even though it's true that it build dependence it has helped in a lot in bad situations. Either will try and find a good psychiatrist here (not easy) or will start myself with Zoloft with nortriptyline / desipramine.

  8. #8
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    Re: Recommended medication for catastrophic thinking?

    Quote Originally Posted by matrix123 View Post
    Either will try and find a good psychiatrist here (not easy) or will start myself with Zoloft with nortriptyline / desipramine.
    I urge you NOT to try self-medicating with any AD, and especially not when taking two. This is one area when you really need a doctor supervising. Also, if you're not confident in the doctor's ability I suggest you ask for nortriptyline. Desipramine is a much more potent noradrenaline/norepinephrine reuptake inhibitor so much less forgiving if things go wrong. The old time psychiatrists preferred the sertraline+nortriptyline combination.
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    The opinions expressed above are based on my observations and, where applicable, interpretation of cited data and are general in nature. Consult your physician before acting on anything stated.

  9. #9
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    Re: Recommended medication for catastrophic thinking?

    I agree in principle, however I've got bad advice from doctors when it comes to anxiety/depression medication, that's why I'm skeptical. Thanks for recommendation on nortriptyline.

  10. #10
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    Re: Recommended medication for catastrophic thinking?

    Met with a doctor a few days ago and was prescribed Sertraline. Was generally satisfied with her approach. Starting with 25mg for 1 week, next week 50mg, next 75mg and then on 100mg. I'm feeling the side effects now, but hope it will improve in the next couple of days....

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