Low-dose SSRI for anxiety?

March 21, 2012 1:29 PM

Could a low dose (10 mg/day) of fluoxetine really help with my generalized anxiety? I can find information on its use for panic disorder, but it doesn't seem to be explicitly indicated for GAD. Has it worked for you?

I mentioned my increasing trouble with (lifelong) constant background anxiety to my doctor, and she prescribed me 10 mg/day of fluoxetine (Prozac). Leaving aside other therapeutic approaches I could take, which I assure you I am also looking into, has anyone had any success with a very low dose of SSRIs to treat generalized anxiety? I got the strange feeling that my doctor only prescribed them because she didn't want to prescribe any benzos (which is fine, I didn't ask for them) but didn't want to send me away empty-handed. From what I can find, 10 mg seems to be a sub-therapeutic dose, and most people start at 20 mg.

I have a bit of resistance to taking SSRIs in general (friends and family have had lots of terrible experiences with them, though I know each drug is different) and I don't really want to take these if it probably isn't going to help, or if I will just have to increase the dose a bunch to get any response.

I'm also curious if anyone has any experience tapering off such a low dose of SSRIs - is it likely that I could still go through the SSRI withdrawals/"discontinuation syndrome" if I decide to quit, even though I'm only taking 10 mg/day? Thanks for your advice.

posted by dialetheia to Health & Fitness (16 answers total)

To my understanding, there's not much significance to specific SSRIs being indicated for specific things (depression vs. OCD vs. anxiety and so forth). They all work via similar mechanisms and the official uses are dependent on whether anyone happens to have done a good enough study on that particular SSRI for that particular issue.

As far as sub-therapeutic doses, is it possible that since you're hesitant about SSRIs she wanted to start you off slowly, moving you up to 20mg after you've been on 10mg for a bit if you aren't experiencing side effects or improvement? That kind of thing seems pretty normal to me. Some people are more sensitive to SSRIs than others.
posted by needs more cowbell at 1:45 PM on March 21, 2012

It's a very low dose, but that doesn't necessarily mean anything. It all depends on your brain chemistry, weight, and other factors we don't have access to. It's not just that each drug is different, it's that each brain is different. Get twenty people who have taken the same SSRI in a room and ask them all about their experiences, and you're going to get a lot of overlap, but there's going to be outliers. And there's no way to tell off the bat whether you're one of them.

Psychiatry isn't an exact science; most people who have been on a single drug for a long time probably had to run the gauntlet first. Dosage and drug adjustments are par for the course as well. If Drug X at the starting dosage doesn't work, you up the dose until you reach the "if it was going to do anything it'd be doing it by now" dosage. Then you taper off and try it again with Drug Y. 10 mg can work perfectly fine for you, make you feel like shit, or not do a thing at all. Same thing with the SSRI Discontinuation Syndrome.
posted by griphus at 1:46 PM on March 21, 2012

Best answer: Only a side-point to your question, as I know nothing about efficacious dosages of fluoxetine: SSRIs and antidepressant-type drugs in general have been studied in the treatment of anxiety disorders, including GAD. A fairly recent meta-analysis suggests that specific psychopharmacology is more effective than placebos in GAD treatment with a small-to-possibly-medium effect size advantage. Cognitive-behavioral psychotherapy has also proven efficacious for many in multiple trials.
posted by Keter at 1:59 PM on March 21, 2012

Best answer: I took 10mg of fluoxetine daily for depression and anxiety, and yes, it helped. I took a month to taper off (had been taking it for eight or nine months), and had minimal side effects.

I had resistance to taking SSRIs too, but my experience was such that I regretted not having done so earlier. I will add, though, that you may find my earlier comment on treating depression/anxiety with amino acids helpful, if you really are having a lot of doubts about SSRIs.
posted by Specklet at 2:22 PM on March 21, 2012 [1 favorite]

Yes and Yes--it certainly can help, especially with GAD and follow approved protocol for tapering. You can also gradually increase dose, under supervision, if GAD is not being responsive to initial dose. Fear not and give it a fair trial.
posted by rmhsinc at 2:29 PM on March 21, 2012

I take a different SSRI (Citalopram/Celexa) at the same dosage, and it has definitely helped. I'm still taking it, but I had a few days between refills once where I didn't have any meds and I did notice some withdrawal-type symptoms. Obviously, it really depends on your height/weight/how your body metabolizes medication, but I'm not small (5'9" and around 155lbs) and have definitely noticed a difference.
posted by naturalog at 2:30 PM on March 21, 2012

Best answer: I'm currently taking 50mg Sertraline daily for pure(-ish) O type OCD.

My doctor started me at 25mg (considered equivalent to 10mg Fluoxetine) with the intention of tapering up. For me the first day taking it I felt hugely better and in general that's been the theme. I did taper up to 50mg but even if I'd stayed at 25mg it still would be substantially helpful. Side effects were present for the first four weeks after stabilizing at 50mg/day but quickly faded thereafter.

Some people respond more or less to SSRIs, and some people respond very differently from others. I've heard of people having unpleasant experiences with 25mg Sertraline but who were greatly aided by 5-10mg a day.

Anyhow, I wouldn't consider it to be a sub-therapeutic dose -- for many people 10mg is probably plenty and you really don't want to take any more of a drug than you need to achieve the desired effects. My experience with anxiety + SSRIs suggests that you may benefit quite a bit.
posted by Matt Oneiros at 2:33 PM on March 21, 2012 [1 favorite]

Best answer: Prozac withdrawal is really not bad at all. I've taken some meds that were, like Cymbalta, but I never even tapered off when I stopped taking Prozac (I believe I was at the 20mg dose), and had no ill effects at all. I actually liked everything about Prozac EXCEPT it gave me headaches (because I clenched my jaw, a common side effect), and it messed with my libido (sadly, can also common with SSRI's), so I switched to Serzone (which is now off the market, but was awesome for NOT messing with my sex life when I took it).

As far as the low dose, it is pretty weak, but Prozac has a long half life. It starts out at about 2 days and with prolonged use, it actually appears to double. So most doctors start you out on the lowest possible dose, because of the cumulative effect of taking Prozac over several weeks.
posted by misha at 2:38 PM on March 21, 2012

Best answer: I have been taking 10 mg of fluoxetine daily for about 3 years, almost exclusively for anxiety, and I have found that it helps quite a bit. I was resistant to taking anything for a long time because I heard horror stories about withdrawal, etc. I made a one-time appointment with a psychiatrist specifically to discuss those issues and he said straight-up Prozac (fluoxetine) was safest and had the fewest side effects and withdrawal symptoms. (In fact he said it has none but I've never tested it.) You will feel really anxious for a week or two, but ride it out. It passes.
posted by Clustercuss at 2:42 PM on March 21, 2012 [1 favorite]

Best answer: I started 20 mg fluoxetine for anxiety mid-January and experienced improvement in symptoms within a few days. I also steadily lost my ability to orgasm over about two weeks. My psychiatrist explained that fluoxetine takes a very long time (5-9 weeks?) to ramp up to its steady blood concentration, partly because it inhibits its own metabolism. (She also said this is why there's a weekly pill available and why at low doses many people can stop cold turkey with no withdrawal. IANA biochemist or medical professional, of course.) Because I had responded so quickly (before reaching the steady-state blood level for a 20 mg dosage), and because my mother has responded to 10 mg for anxiety/depression, she took me down to 10 mg. The reduction in anxiety is not quite as good, but the anorgasmia is gone, which is a reasonable compromise for me. I haven't tried stopping completely but had no trouble dropping from 20 mg to 10 mg after 3 weeks.
posted by ecsh at 2:59 PM on March 21, 2012

1.) It didn't work for me, at various doses, tried three times over the years. Getting off of it was no problem, zero symptoms.

2.) It didn't work for my boyfriend either. Panic disorder was not helped at 10, 20 or 40+ mg doses by this medication. Not sure if he had any withdrawal symptoms.

4.) Exercise alleviated the symptoms much better.
posted by devymetal at 3:01 PM on March 21, 2012

Best answer: Fluoxetine has a really long half life, and I think the metabolites of it are active too, so lower doses should generally work better than lower doses of faster-metabolizing drugs. Because a faster metabolizing drug won't give you a steady, low level of blood concentration. Rather, you'd get more like a half of a day of therapeutic goodness, and then it would be effectively gone for the rest of the day until you dose again. The area under the curve might be the same, but the shape of the curve with a fast drug would be pointy, and the slow drug would be flatter. Which should mean that it will do something.

Which it should. It won't float you off into space like a benzodiazepine, but it ought to raise the threshold for being able to "shake things off" and also slow down your emotional flight or flight reactions so that you can take a moment to analyze a stressor and determine if you are going to let it bother you or not.

Withdrawal- I only took prozac for a short time a while back, and when the prescription ran out I just quit and had no problems. And I am prone to the SSRI withdrawal symptoms, as Zoloft got me good. Regardless, it is tolerable because you can blame it on the drug and more or less ignore it.
posted by gjc at 4:02 PM on March 21, 2012

Best answer: I took fluoxetine for OCD at several different levels before settling on 40mg daily.

It did wonders for my anxiety and the intrusive thoughts caused by anxiety + OCD. It didn't affect my libido or related bodily functions. The only problem I had was it made me sweat quite a bit more.

I also quit taking it without any sort of tapering and had no side effects.
posted by tacodave at 4:06 PM on March 21, 2012 [1 favorite]

Best answer: I've been on the same dosage you mention for almost a year. It's my first experience with an SSRI, and I now wish I'd mentioned my initial symptoms to my doctor sooner. I've seen a huge difference in my coping strategies, and my mood swings have leveled off dramatically. YMMV, but it's been a hugely positive experience for me.
posted by bookmammal at 4:53 PM on March 21, 2012

If you haven't started taking it, and you don't want to take it, don't. Things will stay like they are, for better or worse.

That said, keep this in mind:
- Why did your doctor prescribe it? Anxiety.
- Why don't you want to take it? Anxiety.

Maybe you should give it a fair shot.
posted by Sys Rq at 10:17 PM on March 21, 2012 [1 favorite]

Response by poster: Thanks for your great comments, everyone! It was really helpful for me to hear that this has worked for other people - like I said, I got the mild impression that she was either prescribing it as a mostly-placebo, or that I'd need to raise the dose a bunch to get any response. I'm really glad to hear that my impressions (and anxieties...) were unfounded. I'll definitely give it a shot. Thanks again!
posted by dialetheia at 11:49 AM on March 22, 2012