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Social Anxiety - Best prescription for you?
August 20, 2012 2:56 AM   Subscribe

For those of you with true social anxiety or generalized anxiety, what prescription drug worked the best for you with the fewest side effects? How much better did you feel on a daily basis, and were the side effects worth it?
posted by denverco to Health & Fitness (31 answers total) 16 users marked this as a favorite
 
Escitalopram (aka Lexapro) 20mg daily. No more crying jags! No more feeling overwhelmed by global suffering, mortality, powerlessness, perceived aloneness. No side effects, except I lost a little weight when I first started taking it. I know these things don't work for everyone, but boy did they help me.
posted by BusyBusyBusy at 2:59 AM on August 20, 2012


Cymbalta aka Duloxetine 60mg daily [At a particularly bad relapse (after an interesting year or two), dose went up to 90mg for a while until I straightened out.]

Side effects: *nausea for first 3 weeks, and if I miss a day.
*Brain doesn't work as fast. My therapist said that was part of the solution but I don't like not being as quick-brained.

BUT much better results with therapy, first CBT, then ACT, then psychoanalysis. Each had something different to teach me.
posted by b33j at 3:07 AM on August 20, 2012


Paxil has been the only one I tried and I've been on it for about 6 years and I expect to always be on it. Side effects (weight gain and body twitching) disappeared after a month or two.

Even though I'm on a high daily dosage (60mg), the effect of it is so subtle that I feel like I could just quit it, that is, I feel entirely normal. I know not to do this without a doctors orders though.

The best thing about Paxil is it allowed me to easily quit drinking (my doctor said he thought I was an alcoholic and was surprised I quit on my own).
posted by qsysopr at 3:52 AM on August 20, 2012


I tried many useless antidepressants. then i tried clonazepam. it works but the side effects are worth noting, it is extremely addictive and resultts in a slightly a dulled intelligence.
posted by Yowser at 4:10 AM on August 20, 2012 [1 favorite]


Effexor. Sleeplessness and loss of appetite for first few days, but no issues after.
No more crying for no reason, and I can sit on the balcony that was unused for eight years because people could see me when I used it. And now that you make me think about it, the little narrator in my head that tells me all the judgemental things people are saying about me has been very quiet since I started on the Effexor.
posted by L'Estrange Fruit at 4:30 AM on August 20, 2012 [1 favorite]


Opinions:
1. Benzodiazepines are much better than SSRIs for anxiety.
2. SSRIs produce mostly side effects.
3. Benzodiazepines produce mostly the intended effect.
posted by colinshark at 4:31 AM on August 20, 2012 [1 favorite]


40mg generic Celexa in the morning with 1000IU Vitamin D and 300mg trazodone with 100mg generic Lamictal in the evening after dinner and shortly before bed.

I also have depression, but this is the cocktail that make me able to go to music festivals and hang out with friends and be able to walk to the metro station without being completely panicked. I feel like a normal person now, instead of being absolutely driven crazy by what people were thinking about me and the feeling that everyone was staring at me.

The side effects are completely tolerable. When I first started, I had crazy jaw clenching at night (and wore through at least 2 mouthguards), but that could have been exacerbated by the fact that I was withdrawing from other meds at the same time, and it did go away after the other meds were out of my system and I was up to the 40mg dose. I still occasionally have night sweats, but I'm willing to put up with those in exchange for not feeling like shit all the time.

Meds that didn't work for me include: Paxil (up to 40mg, didn't do anything, good or bad), higher doses of Lamictal (made me not want to do anything), clonazepam (1mg, didn't do anything good or bad), Seroquel (600mg, didn't do anything except make me gain weight), Abilify (5mg, gave me horrible shakiness), and cogentin (don't remember the dosage, but it made my nearsightedness into farsightedness, which luckily went away after I stopped taking it).

The cocktail I was on before my current one was 600mg Seroquel, 300mg Lamictal, and 1mg clonazepam and it sucked getting off that, so beware the benzos.
posted by sperose at 5:06 AM on August 20, 2012


Generalized anxiety disorder/hypochondria/obsessive thinking here. On 20mg Citalopram (Celexa in States). I've possibly put on weight because of it, and it gives you less tolerance to alcohol (you're officially not meant to drink on it), but the benefits are that I can function without obsessing over health worries and no longer have the myriad of weird physical symptoms (aches, pains, twitches) I used to have. If I miss a dose I feel horrendous though.
posted by Dorothea_in_Rome at 6:11 AM on August 20, 2012


30mg Cymbalta because I was intolerant of the side effects at 60g, which is what I was originally prescribed. I am short and slim, and often find I don't need a full dose of anything to get the full effect (I'm a cheap drunk, too).

Side effects at 60mg: frequent nausea, tingling in my hands and mouth, shaking hands, sleeplessness and constipation. Side effects at 30mg: mild sleeplessness, plus mild tingling if I miss a dose. Weight gain of a few kilos but not sure if that's from the 60 & not lost yet, or ongoing from the 30.

Worth it? Totally. I wouldn't mind trying a 45mg dose, but the 30 gives me okay results without making me feel like a sleep-deprived stupid-head. I feel calm and capable of dealing with daily stress, and am able to work on my CBT without anxiety getting in the way. As an incidental benefit, my perfectionism has lessened too. All my life people told me I needed to take a chill pill; turns out they were right. It's like having a ball and chain removed from my ankle.

I did have one major stress attack while still on the 60, caused by another person. But as my husband pointed out, it's an anti-anxiety pill, not an anti-arsehole pill :)
posted by harriet vane at 6:23 AM on August 20, 2012


Xanax for social anxiety and general anxiety. 0.5 mg. According to my doctor, this is a small dose and is unlikely to produce dependency. It only lasts a few hours for me, but that's been good because it's caused me to think about my triggers and anticipate them. Now I'm much smarter about my anxiety, and less avoidant.

Couldn't be happier with the results. I've progressed to a point where I don't feel the need to have an emergency pill on me at all times.

The intended effect works well; it really slows down my internal monologue and allows me to be present in conversations without worrying so much. No appreciable side effects except when I'm low on sleep. It's as if the anxiety is the only thing keeping me awake when I have a bad night of rest. On these days, take Xanax = remove anxiety = sleepytime.

You can balance that out with coffee, but I wouldn't recommend it. By the time the Xanax wears off, you're left with higher anxiety because of lack of sleep and the coffee still being in your system.
posted by Team of Scientists at 6:57 AM on August 20, 2012 [1 favorite]


Neurontin is not working for me at this very moment. Also taking "as needed" Xanax. Works great but is habit forming. Sigh.
posted by scratch at 6:58 AM on August 20, 2012


Buspar - 7.5mg twice a day. It works ok. It works better in conjunction with my Wellbutrin. Everything is pretty even right now, unless something really bad hits, such as a critical e-mail or something. Then shit falls down.

But the Buspar works, it's cheap, and it's a daily pill that I can remember to take.
posted by SNWidget at 7:08 AM on August 20, 2012


Seroquel, but I'm bipolar II. I think they prescribe it sometimes for anxiety/depression. My side effects were occasional heart palpitations and almost fainting, and sugar cravings. They went away after a month. My moods are more even and I'm a lot less paranoid and anxious.

A vitamin D megadose helped me tremendously. I don't think about self harm anymore.
posted by hotelechozulu at 7:33 AM on August 20, 2012


5 mg Abilify. Not commonly prescribed for anxiety, I know, but it works really well for me. I had serious trouble sleeping due to racing thoughts-- I often described it as "hamster-wheel brain" and that was gone within days of starting Abilify. I'm much more able to finish what I start, I don't get overwhelmed as easily, and I can think my way through stressful situations a lot better.

Main side effect has been difficulty waking up in the mornings, and mild sleepiness throughout the day. Also some weight loss. Although it turns out my little sister has similar symptoms and she's just anemic, so I'm about to start taking an iron supplement to see if that helps.
posted by nonasuch at 7:36 AM on August 20, 2012


Buspirone as part of a cocktail-- Wellbutrin + effexor.
turned off the intrusive thoughts.
posted by ohshenandoah at 7:51 AM on August 20, 2012


Celexa plus Buspar. But I have depression as well. The depression still comes and goes and I'm working on other methods to help control it such as exercise, but the Social Anxiety is *much* better. I also haven't noticed any side effects from the buspar. I want to get off of Celexa eventually, but wouldn't mind staying on buspar indefinitely.
posted by seraph9 at 8:07 AM on August 20, 2012


Lamictal (lamotrigine) 200 mg/day - it's prescribed off-label for anxiety. (Also bipolar, but I don't have that.) No perceptible side effects unless I miss a day, then I get nauseated and feel spacey. When I first started taking it, I got really sleepy, but I got used to it fairly quickly.

I also take clonazepam on an as-needed basis, but since I started the lamotrigine, I rarely need it. Maybe once a week. The only side effect I've experienced is sleepiness. Some people will have you believe you'll turn into a drooling drug addict if you start taking this, but I have not found this to be true in the slightest.
posted by desjardins at 8:22 AM on August 20, 2012


Oh, and I went from not being able to go grocery shopping without having a panic attack, to being able to give speeches and training sessions.
posted by desjardins at 8:26 AM on August 20, 2012


Lots of exercise and forcing myself to make as much social contact as possible. Literally nothing else has ever worked without severe side effects or loss of efficacy, and I've been on more antidepressants (and in one particularly fun instance an off-label antipsychotic) than I can count.
posted by Merzbau at 8:36 AM on August 20, 2012


Celexa for GAD and depression, xanax for panic attacks.
I take Celexa at night because it can make me sleepy. Celexa does reduce my sex drive.
Besides that, no side effects or withdrawal symptoms for me.
14 years.
Tried going off my meds for 8 months and that didn't have good results.
posted by KogeLiz at 8:42 AM on August 20, 2012


Pristiq until a few days ago. I'd feel like shit if I missed it, like dizzy and dehydrated but not to the "I can't function" level.

Just started Venlafaxine yesterday. Can't speak to the side effects yet.

But if they're like Pristiq (and we went with the Venalfaxine because we figured it would be), the side effects will be worth it. Really minimal for me, which is great.
posted by theichibun at 10:15 AM on August 20, 2012


Everyone is literally different.
Vitamins (OTC or fed)
Prescriptions
Lifestyle change
Or all of the above.
An appointment with a physician will be the best answer; unfortunate not mifi
posted by Bun Surnt at 11:20 AM on August 20, 2012 [1 favorite]


Escitalopram (aka Lexapro) 20mg daily, + Buspirone 10mg twice daily. No noticeable side effects, unlike Prozac and Citalopram.
colinshark: Opinions:
1. Benzodiazepines are much better than SSRIs for anxiety.
2. SSRIs produce mostly side effects.
3. Benzodiazepines produce mostly the intended effect.
These results are intensely individual; obviously, if SSRIs produced mostly side effects, they wouldn't have survived trial testing. Escitalopram is an SSRI that works very well for me.

Without it, I suffer mild but frequent panic attacks, face a barrage of negative self-talk, and continually bite my nails. On it, I get sleepy at the appointed hour, grow 10 nails, and generally have nicer thoughts about myself.
posted by IAmBroom at 11:54 AM on August 20, 2012


Wellbutrin (Buproprion).

No side effects that I am aware of. Pretty effective on panic attacks and general anxiety / rumination for me.

As others have said, individual reactions vary greatly. I had severe reactions (hallucinations, etc) to a couple SSRIs I tried, others were simple ineffective, etc. Just have to try them and find out, unfortunately.
posted by wildcrdj at 1:40 PM on August 20, 2012


As you can see everyone has something different that works for them. That's just it, it works for them & their body. I've known people who has used the same product- one person had good results & the other had big problems tolerating the meds. The only way you'll know is trying for yourself. There doesn't seem to be any test doctors can give you to see what will work best (which sucks), it's just a checklist they're going down. Maybe your doctor has a drug they prescribe the most because it's had success, or they have a lot of samples on hand. In my experience I had horrible effects from anti depressants & couldn't think of the fact of trying some out to find the right one ever again (that's just me). My experience was not good. If you do take anything I would recommend you take a small dose & don't up it if you don't feel like your getting any results. Apparently if it's working your not supposed to feel anything. Exercise does seem to help if you can manage it, building positive experiences (volunteering or going anywhere in your world where you feel valued & needed, I found a lack of these positive experiences is where my anxiety started) & some talk therapy. I still struggle with it. Funny thing though is that your anxiety is a bigger deal to you than anyone else, most people are really focused on themselves & how they come off, and aren't thinking about you at all. I mostly sit close to a door if I find that one day I can't take it & have to leave the room. I find it comforting (& says a lot about tricks anxiety can play on you) that I've never had to do that.
You'll find that most people are feeling the way you do as well a lot of the time, & that it's a normal human reaction that we all share, more than we know. You're not the only one, if that helps at all :) I hope it does.
posted by readygo at 1:58 PM on August 20, 2012 [1 favorite]


10mg celexa per day -- killed the depression and 90% of the anxiety -- side effects: weight gain and hair loss. been on it for 6 years. Dr just figured out the hair loss bit -- (new doc)

so now switching to zoloft...

i'd much prefer wellbutrin + xanax as needed.
posted by thatgirld at 2:23 PM on August 20, 2012


Just say no to paxil. It has some pretty nasty withdraw effects. Similar to heroin withdraw.
posted by jmd97 at 6:57 PM on August 20, 2012


I've had severe general anxiety disorder / cyclothymia / panic attacks since I was in high school. Having exhausted all other options, I started working with a psychiatrist about 5 years ago, now.

First I was on zoloft. It took about 2-3 weeks to notice effects, and gradually wore off in about 6-8 months.

I've been using venlafaxine a.k.a. Effexor XR (extended release) for the past ... probably 4 years now? It works very well. I also have insomnia, so I take quetiapine (Seroquel) at night, which acts as both a sleeping aid and a mood stabilizer.

For emergency situations I have clonazepam (klonopin) on standby. I keep a couple pills at my desk at work and of course at the house. How much clonazepam I need varies from month to month. This month I've taken 0 pills. A few months ago, I needed 1-2 a week.

Pills aren't perfect, and never will be; it's a constant process of evaluation and dose adjustment. It takes a lot of work and persistence to find the dosage / combination that works for you, and it may not always work. A lot of people have to titrate between meds after a while. I've been extremely lucky in that I've experienced hardly any side effects - when starting Effexor, I was light-headed a couple of days, and I had one "brain zap" (hard to explain - imagine you're just minding your own business when suddenly your brain feels like it's touching an electric fence for just a second. Not really painful, just jolting and unexpected).

Med efficacy and side effects vary greatly between individuals. It's really hard to predict how a med will affect you. Literally, the same med can make one person feel like a zombie, and another feel energized. Like I mentioned, hang in there, work with your psychiatrist; you'll find a combo that works for you!
posted by blahtsk at 7:31 PM on August 20, 2012


You may also want to check out crazymeds.us.
posted by blahtsk at 7:32 PM on August 20, 2012


Lamictal (off-label for depression, cyclothymia, and anxiety), 150 mg/day (but I think I need to go up a bit-- no psychiatrist in the UK yet, but I'm working on it). Ativan as needed. I usually go through about 1mg of that a week, in halves, but some weeks I take a lot more. The Lamictal takes things down quite a bit, and the Ativan smooths the spikes I still get.

I have no side effects whatsoever from Lamictal, which is a bloody revelation after everything else I've tried. The only thing I get with Ativan is sleepy, and that only if I take more than I actually need at the time. I don't find it to be addictive at all, or remotely recreational, despite a tendency toward substance-abuse. I guess some people do, though.
posted by Because at 6:27 AM on August 21, 2012


One that hasn't been mentioned is gabapentin. Use for anxiety is off-label, but the closely related pregabalin is approved for anxiety in the EU. I think the main reason that gabapentin isn't approved for anxiety is that its usefulness was discovered too close to the gabapentin patent running out for the approval process to be worth it (that plus the hot water that Pfizer got into for promoting off-label use of gabapentin). Anyway, I take 300 mg per day of gabapenting for generalized anxiety (on top of an SSRI, which didn't do the job by itself), and it definitely helps. I also take a benzodiazepene as needed for when I have an anxiety attack in spite of the meds, but I don't need it very often when I'm taking the gabapentin.
posted by The pets.com Mascot at 8:26 AM on September 1, 2012


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