Should I up my SSRI dose or try a different brand?
July 6, 2010 12:30 AM   Subscribe

Should I up my SSRI dose or try a different brand?
I've been taking Fluoxetine 20mg for about sixteen months for my anxiety. It's helped a lot in terms of curbing panic attacks and making me less moody, short-tempered and irritable – a huge plus when you're living with someone. My OCD is also much better than pre-Fluox. CBT has also gone a long way in helping me manage the anxiety.

My problem is that I'm always clenching my teeth, day and night. I'm not sure if it's a side-effect of the Fluox or underlying anxiety (likely the latter). I've also noticed that my legs are really restless at night, sometimes to the point that I kick my girlfriend as I'm falling asleep.

I don't want to quit taking the Fluox at this point (I've taken it before, for about two years before stopping when I felt my anxiety was under control). My doctor has asked me before if I want to up my dosage because I'm only taking 20mg. That's a very low dose, I realise. I'm just concerned about the potential side-effects of taking a bigger dose as well as the adjustment period that inevitably follows. I'm a week away from second trimester Honours and have a research paper due in less than a month. I really can’t afford to be out of it. I'm sensitive to drugs and tend to take a while adjusting to chemicals.


My question is: can anyone recommend an SSRI alternative to Fluox that is particularly good for anxiety, and have (in your experience) had minimal side effects? Is my problem simply that my dosage is too low? My anxiety has mellowed in the last few years to the point that I don’t have debilitating panic attacks on an almost daily basis – hardly any panic attacks at all. But I still get those crappy disconnected episodes and I'm tense all the time. And the clenching – I think I'm finally developing TMJ. I do use a mouth guard some nights but it's really more to protect my teeth and not to help with the jaw pain.

Thanks in advance.
posted by New England Cultist to Health & Fitness (10 answers total) 2 users marked this as a favorite
Response by poster: Jeez, that post went completely nuts on me. sorry for the outlay. If anyone knows how to edit it, let me know.
posted by New England Cultist at 12:32 AM on July 6, 2010

Personal response to these drugs is so variable that anyone else's experience will be completely irrelevant to predicting how you might respond. for example, I know several people who are doing very well on Wellbutrin and one person who had a psychotic break and spent two weeks in the psych ward five days after starting.

Is your doctor a psychiatrist? If not, I high recommend that you find one - they are the only ones that knows all the ins and outs and latest options of psycho-pharmaceuticals. If you do need to find a new doctor, make an appointment now, odds are that it might be more than a month to the first opening.

Good luck. This stuff often takes some trial and error and unfortunately each trial can take a month or two or more to figure out if you are just adjusting, need a change in dose or should be a different med.
posted by metahawk at 12:41 AM on July 6, 2010

An antidepressant wouldn't usually be a first choice for treating anxiety, so I'm a bit surprised that you're on that alone. And yeah, the teeth grinding thing is a pretty common side effect.

It's definitely time for a med review - because fluoxetine has such a long half-life it tends not to be such a bitch when adjusting doses up or down - but from a specialist, not a generalist. Given that your major problem is anxiety and not depression, there's bound to be a better option for you.
posted by Lolie at 12:54 AM on July 6, 2010

Totally anecdotal- I noticed that generic Zoloft had more side effects and was less effective.
posted by gjc at 1:56 AM on July 6, 2010 [1 favorite]

Talk to your doc. In general if a drug has side effects but is otherwise working well for you, sometimes they can add a second drug that will smooth out the bad effects from the first one. This is really pretty common and no big deal.

Talk to your doc!
posted by St. Alia of the Bunnies at 4:17 AM on July 6, 2010

Unless I am mistaken the SSRIs/SNRIs, and their cognates, are the preferred first course of treatment for anxiety and depressive disorders. I do not believe "LOLI" is correct. SSRIs (etc) have a significant advantage over the typical anxiolytics (benzodiazepines ) as these are plagued with the possible problems of tolerance, dependence, impaired cognition,etc. (before any one comments benzodiazepines are excellent for the treatment of episodic or situational anxiety/panic), Anxiolytics are almost always contraindicated if there is any history of drug/alcohol abuse. SSRI'sare not without their problems but are much better tolerated and significantly safer for long term use.
Back to your SSRI-you really should consult your physician but it is quite common to slowly increase dosage and monitor changes. Also, switching to another SSRI (etc) is very common. This is usually accomplished by gradually reducing the dose of the existing drug and gradually increasing the dose of the newer drug. Before switching drugs it is usually best to play around with dosing on the original drug and conscientiously attend to other factors such as exercise, external/internal stressors , diet, sleep and appropriate talk therapy including CBT. Good luck, Of course IANYD.
posted by rmhsinc at 5:03 AM on July 6, 2010 [2 favorites]

Are there any OCD specialists in Innsmouth? You might consider seeing one, especially if your OCD has been stubborn about treatment; there may just be a better med.

And yeah, grinding/ clenching your teeth/ jaw is a serotonin thing. Probably the fluoxetine. Tell your doc and tell him you're not down with upping the dose as a result.
posted by fairytale of los angeles at 7:50 AM on July 6, 2010

I was on Fluoxetine and had to take Klonopin wafers to deal with the panic attacks. My doctor switched me to Effexor XR and I felt a lot better. It could be worth it for you to explore some other options in medication.
posted by TooFewShoes at 9:53 AM on July 6, 2010

An antidepressant wouldn't usually be a first choice for treating anxiety, so I'm a bit surprised that you're on that alone. ... Given that your major problem is anxiety and not depression, there's bound to be a better option for you.

Incorrect. Fluoxetine is indicated for anxiety, like rmhsinc said.
posted by spaceman_spiff at 9:53 AM on July 6, 2010

Response by poster: Are there any OCD specialists in Innsmouth?

No, but many of them seem to specialize in marine phobias.

Thanks everyone. As some of you pointed out Fluox is indeed prescribed for anxiety, as are other antidepressants. I think I'm veering toward asking my doctor for something else. I do want to steer clear of Benzo's because their tranquilizing effect doesn't appeal at all.
posted by New England Cultist at 1:33 PM on July 6, 2010

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