The scoop on SSRIs minus the depression
September 28, 2011 11:26 AM   Subscribe

Looking for experiences with SSRIs prescribed for occasional intense panic attacks and anxiety (some social anxiety too) WITHOUT any pre-existing depression, suicidal, or bipolar symptoms. Xanax hasn't worked well (lowers anxiety but seems to increase irritability). My friend has seen a therapist, who recommended this after several months of sessions, and is going to talk with a doctor about options. He's concerned with doctors' tendency to overprescribe SSRIs and monkeying around with something that's probably not intended for this.
posted by crapmatic to Health & Fitness (13 answers total) 4 users marked this as a favorite
We tend to use "anti-depressants" as shorthand for SSRIs, but that doesn't mean they're only prescribed for depressive disorders. They are very commonly used in the treatment of anxiety disorders. Some are considered better than others for anxiety; a well-informed doctor will be aware of which ones are your friend's best bet.
posted by keever at 11:39 AM on September 28, 2011

I have been taking sertraline (Zoloft) since May to treat generalized anxiety disorder. For me, it has been very effective with few negative side effects, and in fact is commonly prescribed as a treatment for anxiety, which surprised me.
posted by trunk muffins at 12:12 PM on September 28, 2011

I can only really echo trunk muffins here, although weakly. I've been taking citalopram for generalised anxiety for about a month. Side effects have been limited to some minor stomach discomfort in the first week. It's perhaps hard to tell in the earlier stages (given normal fluctuations in my anxiety), but my impression is of a considerable reduction in my symptoms.

Notably, I seem to be sleeping both more easily and more soundly. My wife tells me that my snoring has reduced considerably, which seems indicative of higher sleep quality.

SSRIs are now so widely prescribed for anxiety disorders that regarding it as an off-label application is probably somewhat misleading. The potential for dependence is no greater than for Xanax, and (given the lack of risk of abuse) probably significantly less. It seems your friend is open to a pharmaceutical approach; if this is so, I don't see any strong case for ruling out SSRIs as an option.
posted by howfar at 12:40 PM on September 28, 2011

Echoing trunk muffins and howfar. Zoloft is very commonly prescribed for anxiety disorders (and other SSRIs as well, though Zoloft is the one I have personal experience with.) I've been taking it for slightly over a year now for anxiety. I've had a significant decrease in my symptoms since I started taking it--I still have "normal" amounts of anxiety, but no panic attacks since I adjusted to the meds and the day to day stress/fear is infinitely more manageable. Like howfar, my sleep patterns changed completely (for the better).

I have both generalized anxiety and social anxiety and no history of depression or bi-polar disorder, and since starting the medication I've gone from being almost paralyzed in high-stress or highly-social situations to being very effective in two very people-oriented professions (customer service and teaching college).

Word of warning, though--some people do have pretty extreme side effects when first starting SSRIs for anxiety.The first month or so I was on it was probably the worst of my life. But after the adjustment period the side effects disappeared completely.
posted by kittenmarlowe at 1:05 PM on September 28, 2011

monkeying around with something that's probably not intended for this.

The classes to which we assign psychotropic medications (anti-depressant, anti-psychotic, mood stabilizer) are largely matters of convenience. They are prescribed by psychiatrists for their usefulness for specific symptoms sets, sometimes ones that have very little to do with the class to which the medication "belongs." Certainly SSRIs are often prescribed for anxiety.
posted by OmieWise at 1:11 PM on September 28, 2011 [1 favorite]

Can only add to the anecdotal evidence. I've been taking Effexor for anxiety for a number of years. Tried to go off it a couple of years ago and found that my anxiety returned. Aside from a nasty case of discontinuation syndrome if I am late with a dose, I haven't had any noticable side effects.
posted by dchrssyr at 1:17 PM on September 28, 2011

I know only enough about this to be dangerous, BUT -- perhaps your friend could discuss Buspar with your doctor? I happened to do some research about non-addicting anxiety medications a while back, and it looked to my ignorant eye like a good option.
posted by Andrhia at 1:21 PM on September 28, 2011

> SSRIs are now so widely prescribed for anxiety disorders that regarding it as an off-label application is probably somewhat misleading.

In fact most if not all SSRIs are FDA approved for things other than depressive disorders, many of them for various anxiety disorders. The first sentence on the wikipedia page for SSRIs reads: "Selective serotonin re-uptake inhibitors [...] are a class of compounds typically used as antidepressants in the treatment of depression, anxiety disorders, and some personality disorders." So an SSRI is definitely a valid option.

And another anecdotal point: I know of SSRIs being prescribed for anxiety disorders, with an addition of an anxiolytic (such as Xanax, but given your friend's history with that particular medicine a different one would probably be a good idea) to take when necessary, like an intense panic attack.

And I'd definitely suggest that your friend see a psychiatrist, it's good to have a specialist in these matters.
posted by bjrn at 1:41 PM on September 28, 2011

Consult a professional, of course, but more anecdata in the meantime.

I started having panic attacks out of the blue three years ago. I had myself evaluated by a trusted psych (recommended by close friends) and she put me on 10mg of citalopram (Celexa). It helped to break the feedback loop of always being worried about the next attack, because I now had a security blanket which I knew would catch me from falling all the way down the rabbit hole. She also gave me a single scrip of Xanax for the occasional times when I'd experience above-average anxiety (particularly in stressful situations like flying or interviews).

Once my brain stopped believing I was constantly at risk of another attack, the broad panic disorder subsided. After a year, I was able to reduce the Celexa to 5mg, which is next to nothing considering the usual minimum dose is 20mg. I disposed of the Xanax after a single transcontinental flight. Once I had well and truly convinced my brain that I was in no danger, and with my therapist's full approval, I weaned myself off the stuff altogether. I haven't had a panic attack since February of 2009, and my general anxiety is almost entirely gone. I still get a little twitchy when under extreme duress, but that feels far more natural to me than the hair-trigger conditions I was living with before.

And, of course, all the usual lifestyle stuff can help: cut out the caffeine, exercise regularly, etc. etc.
posted by mykescipark at 4:04 PM on September 28, 2011

I'm having good luck with Lexapro now, but that's mostly for depression. It has stopped my panic attacks, though it increased them when I first got on them.
posted by Lovecraft In Brooklyn at 5:01 PM on September 28, 2011

I'm doing well with Zoloft. Lexapro was not as helpful, so newer apparently isn't always better.
posted by thinkingwoman at 6:04 PM on September 28, 2011

If your friend is worrying about being prescribed something that won't work for them, I'd suggest a trip to the psychiatrist instead of the family doctor. Because they specialize they can spend more time focusing on psychotropic medication and are less likely to just go with something familiar. Some family doctors are better than others at this.

A good psychiatrist can help your friend find the medication that is right for them, but may have to try a few to find the right balance. They are more likely to have experience with adjusting dosages and recommending medications based on the effects needed and the side effects experienced. The downside is that it often is more difficult to get in to see the psychiatrist the first time around, but I think its worth it in terms of expertise. SSRIs are commonly used for anxiety treatment, and could be a useful complement to her therapy.
posted by gilsonal at 1:07 AM on September 29, 2011 [1 favorite]

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