Fix my brain, oh ye gods of the green.

October 20, 2008 7:21 AM

I take 100mg daily of Zoloft (Sertraline). It seems to manage my anxiety/panic disorder fairly well but I'm still depressed as shit. For those unlucky folks who happen to suffer the double edged sword of anxiety and depression in tandem: what drugs or methods have helped you the most?

I know there is no easy out, yet I'm still looking. I've been on various SSRIs for 10+ years with mixed results but have never found the one that really "works for me". I'm looking to the existential angst ridden populous of this site for insights into what has helped out ya'll get the ball rolling on living your best lives. I have done a lot of research into this topic and have seen many doctors, psychiatrists and therapists so spare me the wikipedia links. I only want to know, what has worked for YOU?

p.s. I know there are tons of previous posts on medication management, but couldn't really find anything relating to my specific predicament.

thnx, xoxo, bbq, luv,

Ryan.

posted by ryaninoakland to health & fitness (19 comments total)

Hmmm...I was on Zoloft as well, but it had the opposite effect for me: it helped my depression but wasn't awesome with anxiety.

Of course IANAD, and this really is a question best for a psychopharmacologist or a psychiatrist, but I've heard that people have had good results with Wellbutrin and Zoloft in tandem. Wellbutrin affects that norepinephrine that other antidepressants don't usually get, and also can help mitigate any icky sexual side effects from Zoloft.

(Side note - if you are a smoker, Wellbutrin is also the anti-smoking aid Zyban.)

I now take Effexor after a lengthy Zoloft poopout, and it mitigates both the anxiety and depression pretty well, though it's not perfect. Effexor has insane withdrawal syndrome and a short half-life, though, so I think it's sort of a "last ditch" medication for people who don't find relief from other meds.
posted by harperpitt at 7:39 AM on October 20, 2008

Self-Medication

Effexor crunches at the back of the throat
a baby toy or distant snake warning.
If I overdose on antidepressants will I
die of happiness?
40 mgs of Prozac and a shot of Jack daily
and I feel normal
(if normal is getting out of bed today).
Take two of these and never call me again.
It takes more than Vicoden
to make the pain go away.
Zoloft is cliché and where all the kiddies
begin (if you don’t count Ritilin).
Xanax is for panic attacks, but I take it too late,
and I have unreasoning anxiety I’ll run out.
Where it says refills: my doctor put a sideways 8.
I’m on a chemical search for functionality.
A little dose of reality. The problem I have is
it attacks my rigidity,
And I can’t get myself to ask for Viagra
just so I can jerk off.

Thank God for Cialis. 4 Hour erections!


I wrote the above about 3 years ago. I've played with most of the combinations over the years. About the only thing that works for me is Wellbutrin and Cymbalta. I had Xanax for panic attacks, but honestly just knowing it was in the cabinet was enough for me. The depression was much more difficult to deal with.

Many of the drugs I tried didn't seem to do anything for me. Prozac only killed my creativity and my ability to be analytical. I didn't notice any kind of pick-me-up. It may have kept a dark time from getting darker, but there's no real way for me to know that.

Cymbalta killed my libido, which was what the Wellbutrin was prescribed for (it counters that side effect).

And I don't really have any experience with Viagra or Cialis beyond the marketing.

I know exercise helped tons, but honestly, it is near impossible to do this when you don't feel like doing anything other than lay in bed watching Deadwood.

I suffer from seasonal depression (used to make fun of it, since it seemed silly) and persistent pain. The pain is low grade but always present. I was taking a Cox 2 inhibitor that worked for this, but it was pulled from the market in the US due to increased risk of heart attack. So instead I get pain and depression. The pain isn't enough to be debilitation, but it does contribute to my depression. It gets worse in cold weather, so I get a double hit there.

I used to love winter, now I start dreading it around September.

Hope things get set up for you.
posted by cjorgensen at 7:41 AM on October 20, 2008 [3 favorites has favorites]

Effexor XR has been very helpful to my SO for both anxiety and mild depression. She's really bad at taking it on time, though, so several times a week she'll be feeling insecure because she was hours late.

She doesn't have any serious side effects from it, though, like some people do.

As a bonus, it doesn't seem to do anything bad to her sex drive.

She's also doing CBT, but so far it's only adding to her anxiety (but not in an awful way now that she's on Effexor) since she is a procrastinator at heart and doesn't do her "homework." I expect it will be very helpful if she sticks with it.
posted by wierdo at 7:50 AM on October 20, 2008

I take lithium along with Zoloft as a "booster" to the SSRI. Works for me.
posted by Carol Anne at 8:22 AM on October 20, 2008

I have heard about taking wellbutrin in conjunction with more anti-anxiety directed drugs (such as zoloft.) perhaps I shall inquire about that next time I go to a doctor. What about Celexa? The principal of being a more focused SSRI sounds appealing, but I don't know anyone with direct experience with it. The low sex drive; or no boner; or no orgasm element of SSRIs is such a cruel component to the whole thing. Nothing is more of a bummer than hooking up with some hot thang and not being able to seal the deal, amiright?
posted by ryaninoakland at 8:35 AM on October 20, 2008

Lamictal + Klonopin works for me. No side effects for me, except drowsiness in the ramping-up period. I'm female, so your sexual side effects may vary.
posted by desjardins at 9:13 AM on October 20, 2008

My experience on Zoloft was much like harperpitt's. I switched to Cymbalta a few months back and it's been the holy grail so far.

IANAD, but AFAIK Effexor isn't quite a last ditch option. It and Cymbalta, both SNRIs, are the drugs your doctor might have you try if regular SSRIs aren't working. If Effexor isn't doing the trick for you either, then you might need to have it augmented with a benzo or move on to an MAOI or atypical antipsychotic, but those have their own more complicated set of implications.
posted by thisjax at 9:31 AM on October 20, 2008

Currently on Sertraline, though at half your dosage. It worked for a while, but I can feel it having less effect on my depression than half a year ago. Worked for my anxiety though: I'm not 100% anxiety-free, but I feel less inclined to run away from people nowadays (with the very occasional panic attack).

Really, for me, what truly works is not medication but people in general. As long as I'm around friends, the medication I'm on doesn't mean shit.
posted by curagea at 9:40 AM on October 20, 2008

SSRIs never worked for me. Seroquel has been prescribed for years, mostly off-label, though I believe it's either approved or in phase 3 trials right now, to treat generalized anxiety disorder and unipolar depression. It'll likely make you sleepy, especially at the outset, but it doesn't cause anorgasmia.

One thing that helped me was realizing that my depression was mostly caused by my anxiety. I was sad and lethargic all the time mostly because I couldn't deal with life, couldn't leave my house or form relationships or do my work without freaking out. Getting the anxiety under control, on its own, caused a lot of the depression to lift. So for me, at least, it was far more important to find an effective anti-anxiety treatment and then do talk therapy than it was to try to treat both symptoms with drugs equally at the same time.
posted by decathecting at 9:59 AM on October 20, 2008

Effexor XR for me as well, with an emergency bottle of Xanax in my purse - just in case. (Though I never need them.)
posted by Kloryne at 10:02 AM on October 20, 2008 [1 favorite has favorites]

Effexor works for me for both depression and anxiety, but taking it even four hours late results in a headache followed by a tightness in the throat, a feeling of being on edge, and (not long after) severe emotional reactions to things that I can take in stride when I've had the medicine on time.
posted by johnofjack at 10:15 AM on October 20, 2008

Zoloft has been decent for my depression and aggravating for my anxiety. But every brain is different, and so the advice most of us are giving you might not lead you to an answer.

I'd recommend asking your primary physician (assuming you have one) for a recommendation to several therapists who work in Cognitive Behavioral Therapy and/or a psychiatrist who has real expertise in calibrating meds for conditions that occur together. Not all practitioners are created equal, so you might have to "shop around" until you find a good fit.

Good luck!
posted by dryad at 12:18 PM on October 20, 2008

I was depressed with anxiety about 5-6 years ago. Started on Paxil, which helped the depression and took the panicky edge off my anxiety, but over the months I noticed that I still had an underlying anxiousness. (including my heart pounding hard somewhat frequently.) I thought it might be related to the Paxil, so I switched to Lexapro, which worked for me so I stuck with it the next few years and eventually tapered off.

It can take time to find what works right for you. Good luck!
posted by inatizzy at 12:27 PM on October 20, 2008

I had the same experience with Zoloft, eventually (at first it was great at wrangling with my depression). I switched to Lexapro four years ago, which I'm still taking. Meanwhile, I tried adding Cymbalta, which just had me falling asleep at work every day, and now Wellbutrin, which I love. I'm also taking Adderall XR and that helps kick up my mood, too.

Really, though, every answer you get will be some variation on the above. Until more precise science comes through, finding the right meds is an obnoxious exercise in trial and error.

Here's another thread that you might find helpful, if you haven't seen it already: What is the single best thing you have done to help control your depression?
posted by granted at 12:56 PM on October 20, 2008 [1 favorite has favorites]

the thing that mostly works for me is effexor and wellbutrin. apparently they are a common combo. i was on effexor for a couple years, and it helped with the depression, but i told my doc it wasn't really helping with anxiety (which is what i care about fixing), so she added the wellbutrin to the mix. i suppose it helps some. my 2-4 acupuncture appointments have really helped lately though, fwiw, and i'm going to those for headaches.

ymmv.
posted by misanthropicsarah at 1:30 PM on October 20, 2008

i want to add that if i sleep in late and therefore miss my effexor dose by even two hours, i have a MASSIVE headache for most of the day. i dread the day when it poops out and i have to switch to something else.

also, get a script for xanax. i used to have Really Horrible Anxiety (which is now just Anxiety) and just knowing that i had the xanax if i needed it was enough to keep the anxiety manageable 98% of the time. just a thought.
posted by misanthropicsarah at 1:35 PM on October 20, 2008

I've gone through all the SSRIs over the years. Right now I'm on Wellbutrin and Celexa (after Lexapro crashed and burned on me, leading to a weeklong panic attack and subsequent hospitalization). I have Klonopin for emergencies

Plus: I haven't had a panic attack or major depressive episode in the last two years, since I've been on the combo.

Minus: Orgasms happen occasionally, but they're still few and far between. Most of the time I just have no interest in sex.

When I get insurance, I want to try Cymbalta. I'm hoping that'll improve the sexual dysfunction.
posted by cereselle at 5:28 PM on October 20, 2008

i'm on celexa and wellbutrin right now for combo anxiety and depression. i noticed recently that the addition of wellb made a huge difference in my anxiety level but nothing has worked yet for my depression. celexa was making a small dent but when i went up to 60mg it made me manic and going back down to 40 seemed to render it totally ineffective. dunno why i'm even still on it -- i guess for the concern that i could possibly get worse than i am without it, which is sort of frightening. anyway. not much info to help you here sorry. i just got a script for valium last night (which omg works compared to ativan or klonofriends -- "valentines from the valley of torpor" indeed -- dunno where that quote comes from but it popped into my mind as quite valid.). anyway. guess i'm just sharing my experience. good luck.
posted by Soulbee at 6:37 AM on October 21, 2008

Wellbutrin extended release for the depression, Zoloft for the anxiety. I had tried a number of other replacements for my beloved Serzone after it acquired its black box and my psych stopped prescribing it, but the Wellbutrin+Zoloft pair worked a treat.

Anecdotal Wellbutrin observation: I know a lot of people, mostly women, on Wellbutrin. About a third of them had significant appetite suppression, another third had huge leaps in libido (and one of them experienced spontaneous orgasms, which is not nearly as cool as it sounds), and then there were those of us who were free of side effects.
posted by catlet at 1:15 PM on October 21, 2008