Lexapro? Prozac? Or...?
May 6, 2015 9:59 AM Subscribe
I'm thinking of going on medication for anxiety. Poking around on the internet has suggested that an SSRI might be best for me to try first. I'm thinking of Lexapro or Prozac. Help?
I've been having a really difficult few months (final stages of PhD dissertation, moved back in with my parents because stipend ran out, grandparent diagnosed with terminal cancer, uncertainty about my LDR, various other things), and I've been experiencing what has turned into unbearable anxiety. I wake up at night with my chest tensed up, feeling like I can't breathe, etc. I've been thinking about going on medication for this. I've done a bit of Googling, and I think an SSRI might be my best bet (?). Are there any that are most likely to work (or have fewer side effects) and are thus better to try first, or is it all down to individual biochemistry? I'm going to be seeing my doctor, obviously, but my doctor is not especially good in general and is particularly knowledgeable about mental health things in particular either, so I'd like to go in with some knowledge. I've been thinking of trying either Lexapro or Prozac, based on my internet research. My goals are: no weight gain (seriously important to me!), and lowering my level of anxiety. Obviously I'd also prefer fewer side effects in general, as well as fewer withdrawal effects. Anyone have experience with either of these and can weigh in (either on efficacy or weight gain)? Any experiences with other anxiety medications?
I've been having a really difficult few months (final stages of PhD dissertation, moved back in with my parents because stipend ran out, grandparent diagnosed with terminal cancer, uncertainty about my LDR, various other things), and I've been experiencing what has turned into unbearable anxiety. I wake up at night with my chest tensed up, feeling like I can't breathe, etc. I've been thinking about going on medication for this. I've done a bit of Googling, and I think an SSRI might be my best bet (?). Are there any that are most likely to work (or have fewer side effects) and are thus better to try first, or is it all down to individual biochemistry? I'm going to be seeing my doctor, obviously, but my doctor is not especially good in general and is particularly knowledgeable about mental health things in particular either, so I'd like to go in with some knowledge. I've been thinking of trying either Lexapro or Prozac, based on my internet research. My goals are: no weight gain (seriously important to me!), and lowering my level of anxiety. Obviously I'd also prefer fewer side effects in general, as well as fewer withdrawal effects. Anyone have experience with either of these and can weigh in (either on efficacy or weight gain)? Any experiences with other anxiety medications?
I took Prozac and it caused anxiety attacks. Many SSRIs take some time to work, during which you may have side effects. I use Xanax for short-term anxiety coping, including the cant-sleeps at 3 a.m. You have an awful lot to cope with. Some things that can help, with no negative effects, are: daily mulitvitamin, vitamin D supplement, massage, meditation, extra-god nutrition. If you can do a short outdoor walk every day, listening to meditation exercises or good music, it will help.
posted by theora55 at 10:10 AM on May 6, 2015
posted by theora55 at 10:10 AM on May 6, 2015
I took Prozac twice, around age 20 and age 30, for major depressive disorders. I was also a generally anxious person but at those times, the depression was the bigger factor so we weren't really addressing my anxiety. Prozac was great for me, absolutely helped my mood, didn't really either alleviate or aggravate my anxiety that I recall, no major side effects after the first couple of weeks where there was some jitteriness.
A month ago, I went on medication due to several months of a major anxiety spike - anxiety is definitely my big problem now, not so much depression. The psychiatrist who is treating me felt that despite my good history with Prozac, she does not think it is a good drug for people having major anxiety issues, that it quite often makes the anxiety worse rather than helping. I don't know if there's research on that or just her personal observations.
She prefers to start people with anxiety on either Celexa or Lexapro. In my case she suggested Celexa. I don't know why that vs. Lexapro. So I've been on that for a month. One month in, my weight has not changed any more than it usually bounces around in a range, and I have experienced a nearly 100% reduction in the physical symptoms of my anxiety. I still have many of the same anxious thoughts and feelings, but they don't seem to trigger the physical reactions, and without those, it seems to be much easier to get myself out of the thought/feeling spirals with some cognitive behavioral techniques and some mindfulness practice. I would obviously prefer not to have those thoughts at all, and will continue working with my therapist on reducing them, but I feel like a new person.
I did have one major side effect - major drowsiness. The first two weeks it was so bad I thought I would not be able to tolerate the medicine; I was tired all the time, going to sleep early, taking naps constantly. At this point I'm still sleepier in the mornings than I would like to be, and maybe one night a week I am still going to bed earlier than usual, but it's dramatically better. YMMV, obviously, because a lot of it is about individual biochemistry.
Celexa and I believe Lexapro as well take quite a while to build up in the system, and a psychiatrist would likely also prescribe you a short-term course of something like Xanax or Ativan to get you through the bad spots while you get a therapeutic dose of medication in your bloodstream. I'm not sure a regular doctor knows to do that. You might need to ask or, as xingcat suggest, asking for a referral is probably an even better idea.
posted by Stacey at 10:11 AM on May 6, 2015 [1 favorite]
A month ago, I went on medication due to several months of a major anxiety spike - anxiety is definitely my big problem now, not so much depression. The psychiatrist who is treating me felt that despite my good history with Prozac, she does not think it is a good drug for people having major anxiety issues, that it quite often makes the anxiety worse rather than helping. I don't know if there's research on that or just her personal observations.
She prefers to start people with anxiety on either Celexa or Lexapro. In my case she suggested Celexa. I don't know why that vs. Lexapro. So I've been on that for a month. One month in, my weight has not changed any more than it usually bounces around in a range, and I have experienced a nearly 100% reduction in the physical symptoms of my anxiety. I still have many of the same anxious thoughts and feelings, but they don't seem to trigger the physical reactions, and without those, it seems to be much easier to get myself out of the thought/feeling spirals with some cognitive behavioral techniques and some mindfulness practice. I would obviously prefer not to have those thoughts at all, and will continue working with my therapist on reducing them, but I feel like a new person.
I did have one major side effect - major drowsiness. The first two weeks it was so bad I thought I would not be able to tolerate the medicine; I was tired all the time, going to sleep early, taking naps constantly. At this point I'm still sleepier in the mornings than I would like to be, and maybe one night a week I am still going to bed earlier than usual, but it's dramatically better. YMMV, obviously, because a lot of it is about individual biochemistry.
Celexa and I believe Lexapro as well take quite a while to build up in the system, and a psychiatrist would likely also prescribe you a short-term course of something like Xanax or Ativan to get you through the bad spots while you get a therapeutic dose of medication in your bloodstream. I'm not sure a regular doctor knows to do that. You might need to ask or, as xingcat suggest, asking for a referral is probably an even better idea.
posted by Stacey at 10:11 AM on May 6, 2015 [1 favorite]
I'm on a gentle cocktail of Buspirone (Buspar), Bupropion (Wellbutrin) and Escitalopram (Lexapro) that I developed over time with my internist, although the first time I started anti-depressants it was through a prescription from a psychopharmacologist/psychiatrist. The adjustments have generally been made to increase the effect of the SSRI while reducing the anxiety side effects. I don't have a ton of anxiety side effects but I had enough that it was a bit disruptive.
My internist is fantastic and I trust her completely. This is also a collaborative effort and she's a good listener and good at adjusting meds appropriately.
One thing to know about anti-depressants is that they're really geared toward people who have depression as a chemical imbalance, not people who are responding appropriately to difficult issues in their lives. Before treating with meds, in your case I would suggest talk therapy with a therapist who has a connection with a prescribing psychiatrist. And as theora55 mentions, a multi-vitamin is surprisingly helpful, and be sure to get one that has a B complex. B is nature's anti-depressant. You won't necessarily feel the difference, but once you've got enough B in your system, if you stop taking the multi-vitamin you will *definitely* feel the lack of them.
posted by janey47 at 10:33 AM on May 6, 2015
My internist is fantastic and I trust her completely. This is also a collaborative effort and she's a good listener and good at adjusting meds appropriately.
One thing to know about anti-depressants is that they're really geared toward people who have depression as a chemical imbalance, not people who are responding appropriately to difficult issues in their lives. Before treating with meds, in your case I would suggest talk therapy with a therapist who has a connection with a prescribing psychiatrist. And as theora55 mentions, a multi-vitamin is surprisingly helpful, and be sure to get one that has a B complex. B is nature's anti-depressant. You won't necessarily feel the difference, but once you've got enough B in your system, if you stop taking the multi-vitamin you will *definitely* feel the lack of them.
posted by janey47 at 10:33 AM on May 6, 2015
I just talked to my doctor about this yesterday and here's what she told me. If you have intermittent bouts of anxiety that are largely situational or episodic (which I think applies to your case) something like Xanax is better because it's meant to get you over a temporary hump much in the same way Tylenol or Advil helps mitigate temporary pain. If you have ongoing anxiety that never ever abates, that's when it's time to talk about using something that will restore your serotonin levels more constantly. Prozac and other drugs like it should not be taken for intermittent anxiety in my doc's opinion because they can cause severe psychotic reactions that can leave you worse off for life. I speak from experience when I say that starting on heavy duty stuff for anxiety first rather than trying something like Xanax is not a good idea. Talk to your doctor and ask for a thorough discussion first. Leave your internet research out of the conversation.
posted by Hermione Granger at 10:36 AM on May 6, 2015
posted by Hermione Granger at 10:36 AM on May 6, 2015
First of all, good for you for taking care of yourself and taking this step. It can be too easy for too many people to dismiss anxiety and allow it to keep taking a toll on theit lives for no reason.
My twp cents' worth: I take Celexa every day, and it's been the thing that saves me from near-daily anxiety and panic attacks. I'm pretty sensitive to medications and tolerate this well, much to my surprise. If you're new to antidepressants, this can be a good place to start, with a doctor's help, of course. I also second going to a psychiatrist if you can, since they can help you determine if what you're feeling is anxiety or anxiety stemming from other, undiagnosed disorders.
posted by inky_the_pinky at 10:38 AM on May 6, 2015
My twp cents' worth: I take Celexa every day, and it's been the thing that saves me from near-daily anxiety and panic attacks. I'm pretty sensitive to medications and tolerate this well, much to my surprise. If you're new to antidepressants, this can be a good place to start, with a doctor's help, of course. I also second going to a psychiatrist if you can, since they can help you determine if what you're feeling is anxiety or anxiety stemming from other, undiagnosed disorders.
posted by inky_the_pinky at 10:38 AM on May 6, 2015
SSRIs take a long time to start working, and may not work at all for anxiety. I've taken lots, and don't take one now because they didn't work for me. They really aren't as predictable as you might like and shouldn't be given by a doctor who doesn't know how to do it right. And there are other medications that work for anxiety, like beta-blockers, antihistamines, and tricyclics, that are easier to stop.
Listen to the others and get a referral to a doc or nurse practitioner who knows psych meds. If you need something sooner, to hold you over, the usual short term meds are Ativan or Klonipin, small doses as needed. Xanax is a bit trickier (can be very hard to taper off of if it is used continuously for very long), but a good second shoice if the first two don't work. Really, nothing is better than a benzo for short term anxiety control.
In this case, Doctor Google is not a substitute for the real thing. I promise.
Also, magnesium for the tight muscles. Get good stuff, like mag glycinate or citrate that can actually be absorbed. Cheap mag oxide is really more of a laxative than a supplement. Nothing has helped the physical symptoms better for me than a good mag supplement.
posted by monopas at 10:44 AM on May 6, 2015 [1 favorite]
Listen to the others and get a referral to a doc or nurse practitioner who knows psych meds. If you need something sooner, to hold you over, the usual short term meds are Ativan or Klonipin, small doses as needed. Xanax is a bit trickier (can be very hard to taper off of if it is used continuously for very long), but a good second shoice if the first two don't work. Really, nothing is better than a benzo for short term anxiety control.
In this case, Doctor Google is not a substitute for the real thing. I promise.
Also, magnesium for the tight muscles. Get good stuff, like mag glycinate or citrate that can actually be absorbed. Cheap mag oxide is really more of a laxative than a supplement. Nothing has helped the physical symptoms better for me than a good mag supplement.
posted by monopas at 10:44 AM on May 6, 2015 [1 favorite]
Celexa was the antidepressant I was started on. (I ended up not going with an SSRI long term because of hypomania symptoms.) Lexapro is very similar to celexa, but it was created more recently, so I think the drug companies were pushing it for longer since it wasn't available in a generic form, although by this point it might have gone off patent. The difference between the two is that Celexa is a mix of two stereoisomers, and Lexapro is just one stereoisomer.* I believe the jury is still out on whether Lexapro has any significant upsides compared to Celexa, but of course, everyone has different reactions.
You should really see a psychiatrist if you're going to start messing with SSRIs or any other psychiatric medication. A psychiatrist will be best suited to tell you whether an SSRI is in fact the correct choice to treat your anxiety, and they can help you determine which drug to start on. Ultimately, there's a lot of trial and error, and SSRIs can take a while to start having an effect, although sometimes people get a benefit pretty quickly.
When I was on Celexa, I didn't experience weight gain, but I did experience sexual side effects. (I'm female, fwiw.) Because it sounds like a lot of this is situational, a psychiatrist may also try out a benzo like Ativan or Xanax for short term anxiety relief, especially if you're experiencing panic attacks. I've also had a positive experience using clonidine, which originally was used as a blood pressure medication, to help with anxiety and sleep issues, although that's more of an off label thing. I know some people also take beta blockers such as propranolol. However, beta blockers and clonidine may not work if you have low blood pressure.
I think another important consideration is whether you've always had some issues with anxiety that are now being exacerbated by current circumstances, or if you've never really been an anxious person. These are the kinds of things a psychiatrist can discuss with you so that you can come up with an informed treatment plan.
With all this being said, IANAD, just someone who has taken some psych meds and done a fair amount of reading. You really, really should work with a psychiatrist on this. If you're in school right now, your university probably has a psychiatrist that you can see.
If you're not currently seeing a therapist, you might want to consider that as well. I would look for someone who specializes in CBT. This could just be a short term thing to help you get things under control. Regular exercise is also one of the best things I've tried for dealing with anxiety. I prefer aerobic exercise, although I know some people like yoga.
*A stereoisomer basically means molecules that are chemically identical but are mirror images of each other (meaning they have a different spacial arrangement).
posted by litera scripta manet at 10:45 AM on May 6, 2015
You should really see a psychiatrist if you're going to start messing with SSRIs or any other psychiatric medication. A psychiatrist will be best suited to tell you whether an SSRI is in fact the correct choice to treat your anxiety, and they can help you determine which drug to start on. Ultimately, there's a lot of trial and error, and SSRIs can take a while to start having an effect, although sometimes people get a benefit pretty quickly.
When I was on Celexa, I didn't experience weight gain, but I did experience sexual side effects. (I'm female, fwiw.) Because it sounds like a lot of this is situational, a psychiatrist may also try out a benzo like Ativan or Xanax for short term anxiety relief, especially if you're experiencing panic attacks. I've also had a positive experience using clonidine, which originally was used as a blood pressure medication, to help with anxiety and sleep issues, although that's more of an off label thing. I know some people also take beta blockers such as propranolol. However, beta blockers and clonidine may not work if you have low blood pressure.
I think another important consideration is whether you've always had some issues with anxiety that are now being exacerbated by current circumstances, or if you've never really been an anxious person. These are the kinds of things a psychiatrist can discuss with you so that you can come up with an informed treatment plan.
With all this being said, IANAD, just someone who has taken some psych meds and done a fair amount of reading. You really, really should work with a psychiatrist on this. If you're in school right now, your university probably has a psychiatrist that you can see.
If you're not currently seeing a therapist, you might want to consider that as well. I would look for someone who specializes in CBT. This could just be a short term thing to help you get things under control. Regular exercise is also one of the best things I've tried for dealing with anxiety. I prefer aerobic exercise, although I know some people like yoga.
*A stereoisomer basically means molecules that are chemically identical but are mirror images of each other (meaning they have a different spacial arrangement).
posted by litera scripta manet at 10:45 AM on May 6, 2015
I was put on Lexapro years ago (10ish?) for situational depression. However, my grandfather was on it for anxiety, and was told to take it as needed.
I think it did take a couple of weeks to kick in for depression, but it seemed to work for my grandfather on an as needed basis for anxiety.
I also had a one time prescription of xanax a couple of years ago when my house was broken into - however, that was because I was having bouts of crying/panic attacks/breakdowns, and just needed something to get through my days and enable me to finish out work and move (the remainder of my) possessions.
You can get a prescription like this from your general doctor, although I'd recommend that you see a psychiatrist, as they are likely more familiar with the drugs, I know when I went in and got the xanax prescription, they wanted to refer me, but I explained it was just a temporary situation.
posted by needlegrrl at 11:10 AM on May 6, 2015
I think it did take a couple of weeks to kick in for depression, but it seemed to work for my grandfather on an as needed basis for anxiety.
I also had a one time prescription of xanax a couple of years ago when my house was broken into - however, that was because I was having bouts of crying/panic attacks/breakdowns, and just needed something to get through my days and enable me to finish out work and move (the remainder of my) possessions.
You can get a prescription like this from your general doctor, although I'd recommend that you see a psychiatrist, as they are likely more familiar with the drugs, I know when I went in and got the xanax prescription, they wanted to refer me, but I explained it was just a temporary situation.
posted by needlegrrl at 11:10 AM on May 6, 2015
My GP has prescribed me an SSRI for anxiety (celexa) and I found it helpful.
posted by Shohn at 11:25 AM on May 6, 2015
posted by Shohn at 11:25 AM on May 6, 2015
So here's the thing with all these medications: they're black magic, and while medical science is trying to get a better grip on them and how they work, we're still not there in the way that, say, we can explicitly explain how Aspirin relieves pain. Seriously, if you look at the drug fact sheets for a lot of what's commonly prescribed you'll see lines like "Mechanism of action: Unknown". These things work differently for everyone, work differently in different combinations, and what works for a while may suddenly stop working for no apparent reason. That being said, there are a couple things to bear in mind.
First of all, think closely about what others have asked regarding whether you're dealing with a sustained pattern of emotional disturbance, or something more episodic and situational. Antidepressants may not be the best treatment for more episodic problems. Such medications are generally prescribed for the treatment of clinical depression, generalized anxiety disorder, and other perpetual afflictions; they are meant to be a long-term maintenance treatment for extended duration illness.
That being said, if you do think you're facing a chronic illness, they may be a solution, or a partial solution. Your best thing to do is to find a psychiatrist and talk to him about your problems and options, including your specific symptoms, comorbid illnesses, and pharmaceutical history. SSRIs are usually the first stopping point, but they are not the only drugs along these lines -- you also have NRIs (norepinephrine reuptake inhibitiors), SNRIs (seratonin / norepinephrine), tricyclics, atypicals, etc. Based upon your unique brain chemistry, any of these may or may not work for you. You absolutely need to have someone experienced with this kind of medication -- not a GP -- work with you through the process of finding a combination that works for you.
For reference, I have bipolar disorder with anxiety, and I'm currently on a cocktail of Welbutrin (atypical antidepressant), Lamictal (mood stablizer), and Buspar (anxiolytic), and I'm fortunate that it's worked well for me for an extended period of time with minimal side effects, although I do have to alter the doses and ratios between them from time to time. In the past I've been on a wider variety of each of these medications, in more combinations, than I can even remember. Some didn't work at all, some worked but had side effects I couldn't tolerate, some worked but suddenly stopped, some worked until I changed *another* medication, then didn't... it's frustrating.
Good on you for wanting to get the help you need. Find a psychiatrist and talk to him. You wont' be able to get the help you need from internet fora. Find one you like and trust, because if you do end up with a diagnosis of a chronic mood disorder, it's likely to be a long-term relationship needing a lot of communication both ways to find what works for you, and keep it working over time. It can be frustrating, especially when you're already emotionally taxed, but there's light there somewhere. You should also think about talking to a therapist, as well -- but not to the neglect of medication if it's required.
Good luck. I hope you only have something more short term and easily treated, but whatever happens, I hope it works out well for you.
posted by jammer at 11:26 AM on May 6, 2015
First of all, think closely about what others have asked regarding whether you're dealing with a sustained pattern of emotional disturbance, or something more episodic and situational. Antidepressants may not be the best treatment for more episodic problems. Such medications are generally prescribed for the treatment of clinical depression, generalized anxiety disorder, and other perpetual afflictions; they are meant to be a long-term maintenance treatment for extended duration illness.
That being said, if you do think you're facing a chronic illness, they may be a solution, or a partial solution. Your best thing to do is to find a psychiatrist and talk to him about your problems and options, including your specific symptoms, comorbid illnesses, and pharmaceutical history. SSRIs are usually the first stopping point, but they are not the only drugs along these lines -- you also have NRIs (norepinephrine reuptake inhibitiors), SNRIs (seratonin / norepinephrine), tricyclics, atypicals, etc. Based upon your unique brain chemistry, any of these may or may not work for you. You absolutely need to have someone experienced with this kind of medication -- not a GP -- work with you through the process of finding a combination that works for you.
For reference, I have bipolar disorder with anxiety, and I'm currently on a cocktail of Welbutrin (atypical antidepressant), Lamictal (mood stablizer), and Buspar (anxiolytic), and I'm fortunate that it's worked well for me for an extended period of time with minimal side effects, although I do have to alter the doses and ratios between them from time to time. In the past I've been on a wider variety of each of these medications, in more combinations, than I can even remember. Some didn't work at all, some worked but had side effects I couldn't tolerate, some worked but suddenly stopped, some worked until I changed *another* medication, then didn't... it's frustrating.
Good on you for wanting to get the help you need. Find a psychiatrist and talk to him. You wont' be able to get the help you need from internet fora. Find one you like and trust, because if you do end up with a diagnosis of a chronic mood disorder, it's likely to be a long-term relationship needing a lot of communication both ways to find what works for you, and keep it working over time. It can be frustrating, especially when you're already emotionally taxed, but there's light there somewhere. You should also think about talking to a therapist, as well -- but not to the neglect of medication if it's required.
Good luck. I hope you only have something more short term and easily treated, but whatever happens, I hope it works out well for you.
posted by jammer at 11:26 AM on May 6, 2015
I'm on generics for both Lexapro and Xanax, and they've done a huge amount to reduce my stress/anxiety, OCD, and minor depression. The Lexapro took about 3 weeks to really work, and I've since upped my dose to a point that feels like it's working good enough that haven't needed a Xanax in a while. I did have a couple side effects (minor headaches and nausea), and I some days I get sleepy a bit earlier, but they're well worth the turnaround in my attitude towards life. That being said, what works for me may not work for you, and I would definitely suggest seeing a psychiatrist if you can. They'll be able to suss out whether this is something that requires constant medication or not, and what will work best either way.
posted by zombieflanders at 11:29 AM on May 6, 2015
posted by zombieflanders at 11:29 AM on May 6, 2015
I am on 30mg Buspirone (10mg 3x a day) for my GAD. I am *very* happy with how it works for me. It's been a few years since I started, so I can't remember how long exactly it took to "kick in", but I do remember I started out at 10mg once a day (before bed) and slowly titrated up from there until my doctor and I "discovered" a dose that worked for me. The only real side effect I experience from Buspirone is sleepiness, but it's not overwhelming, and I'm a heavy coffee drinker anyway. I don't drink alcohol anymore, but I've been warned not to drink while you're on Buspirone. (You shouldn't drink on any psychiatric medicine.)
I also have panic issues, for which I occasionally take 10-20mg of a beta blocker (propranolol) or .25 - .5mg of alprazolam (Xanax). If you need something to just "take the edge off" of occasional physical anxiety symptoms, I highly recommend looking into a beta blocker. It's my favorite of any drug I've ever tried for panic or anxiety, and it works wonders. Sometimes it's easier for me to control my thoughts than it is to control, say, my shaking hands or fast-paced breathing. Alprazolam is more heavy-duty; you will be very sleepy if you take it, it can be physically addictive, and you absolutely must not drink alcohol if you take it. I mostly just use that for the thoughts that won't go away no matter what therapy skills I use or if I just can't settle down into sleep at night.
Additionally... If you have the time, an anxiety therapy group might be helpful. When I was in undegrad, I was completely overwhelmed for a whole slew of reasons and joined one through student health services. The group met once a week and consisted of ten people of all different ages (undergrads, Master's students, PhD students) and backgrounds. There may also be group therapy resources specifically for PhD students.
(I also did one-on-one talk therapy for a number of years and a dialectical behavioral therapy - DBT - "course", but I know both of those things can take up a considerable amount of time, which you may not have right now.)
Good luck to you! Anxiety is just the pits; I hope your situation improves for you sooner rather than later.
posted by sc114 at 1:26 PM on May 6, 2015
I also have panic issues, for which I occasionally take 10-20mg of a beta blocker (propranolol) or .25 - .5mg of alprazolam (Xanax). If you need something to just "take the edge off" of occasional physical anxiety symptoms, I highly recommend looking into a beta blocker. It's my favorite of any drug I've ever tried for panic or anxiety, and it works wonders. Sometimes it's easier for me to control my thoughts than it is to control, say, my shaking hands or fast-paced breathing. Alprazolam is more heavy-duty; you will be very sleepy if you take it, it can be physically addictive, and you absolutely must not drink alcohol if you take it. I mostly just use that for the thoughts that won't go away no matter what therapy skills I use or if I just can't settle down into sleep at night.
Additionally... If you have the time, an anxiety therapy group might be helpful. When I was in undegrad, I was completely overwhelmed for a whole slew of reasons and joined one through student health services. The group met once a week and consisted of ten people of all different ages (undergrads, Master's students, PhD students) and backgrounds. There may also be group therapy resources specifically for PhD students.
(I also did one-on-one talk therapy for a number of years and a dialectical behavioral therapy - DBT - "course", but I know both of those things can take up a considerable amount of time, which you may not have right now.)
Good luck to you! Anxiety is just the pits; I hope your situation improves for you sooner rather than later.
posted by sc114 at 1:26 PM on May 6, 2015
Anecdata: Basic nagging anxiety that was amplified by life events into turning me into someone exceptionally difficult to live with. I'd been in counseling/therapy for a few years and had exhausted the benefits of talking about the problems. My therapist gave me a psych referral and I was started on a benzo (Klonopin) which had immediate benefits. Unfortunately it also had me in a continuous state of being two beers in and the accompanying loss of filtering/inhibition. While I felt better, it made me even more difficult to be around and quite unprofessional. I was transitioned on to sertraline (generic Prozac) at the end of last year and this has made a world of difference.
Most benzos are short term solutions and can come with some physical dependency costs. It's nothing ridiculous but going cold turkey is a bad option. I had the benefit of tapering off Klonopin while ramping up on sertraline so the taper was painless. Side effects of the benzo other than the loss of inhibition and the constant state of feeling buzzed (not a detrimental side effect if you ask me) did not exist. However relief is also short lived. You'll quickly develop a tolerance and so achieving the same relief requires continuously increasing the dosage. The junky's treadmill if you will.
I'm now on a low dose of sertraline. Immediate side effects were a disappearance of libido and jaw clenching/grinding. The side effects have faded over the course of a few months. I still find myself clenching now and again but it is a fair trade for the sense of normalcy. No weight gain. No headaches. Shit is manageable. I sleep again. I'm not an ass. I don't know what the long term consequences are and frankly don't really care. The inner peace after a life of roiling anxiety is worth having one leg end up shorter or what-have-you.
To reiterate advice from above, you should approach this from the angle of getting a psych referral from your GP. Ideally you'd address this with a counselor and get the psych referral from there after establishing that therapy alone isn't going to get you home. However when you're in the hole, it's best to attack that before it gets out of control. So do what you need to do.
Also, good luck to you.
posted by Fezboy! at 1:43 PM on May 6, 2015
Most benzos are short term solutions and can come with some physical dependency costs. It's nothing ridiculous but going cold turkey is a bad option. I had the benefit of tapering off Klonopin while ramping up on sertraline so the taper was painless. Side effects of the benzo other than the loss of inhibition and the constant state of feeling buzzed (not a detrimental side effect if you ask me) did not exist. However relief is also short lived. You'll quickly develop a tolerance and so achieving the same relief requires continuously increasing the dosage. The junky's treadmill if you will.
I'm now on a low dose of sertraline. Immediate side effects were a disappearance of libido and jaw clenching/grinding. The side effects have faded over the course of a few months. I still find myself clenching now and again but it is a fair trade for the sense of normalcy. No weight gain. No headaches. Shit is manageable. I sleep again. I'm not an ass. I don't know what the long term consequences are and frankly don't really care. The inner peace after a life of roiling anxiety is worth having one leg end up shorter or what-have-you.
To reiterate advice from above, you should approach this from the angle of getting a psych referral from your GP. Ideally you'd address this with a counselor and get the psych referral from there after establishing that therapy alone isn't going to get you home. However when you're in the hole, it's best to attack that before it gets out of control. So do what you need to do.
Also, good luck to you.
posted by Fezboy! at 1:43 PM on May 6, 2015
I am on Lexapro and weaning off of it after about a year on. I've had depression on and off starting in my late teens (I'm now in my mid-20s) and anxiety runs in my family. I had a few panic attacks and lots of general anxiety. I kind of always felt like I was about to go into an important interview or be on stage, even if I was in the bathtub reading a book.
I gained weight during my year on it, but there were also other changes in my life in the last 12-ish months so I'm not sure I can blame it on that (I moved cross-country, started a new career, started dating someone new who likes to cook...).
The first 2-3 weeks I was on it, I was sleepy a lot. I went from being anxious and kind of hyper-aware and worried about everyone to almost seeming like I just woke up from a nap all the time.
Getting off of the medication has been really difficult for me. When I am withdrawing from it I get "brain zaps" which are really unpleasant. I was on 20 mg and if I missed a dose I started getting them. Now I'm on 10mg and moving toward taking 10mg every other day, so I am experiencing them more. I'm also sleepy again like I was when I was beginning the meds, and occasionally am feeling anxious again. I may end up staying on the 10mg for a while. It's been lots of doctor appointments and annoying back-and-forth mentally about what I should do.
I feel like the Lexapro helped me out a lot, but I would try other non-drug modifications as much as you can bear before getting on meds. You'll avoid any possible negative side effects AND you won't have to deal with getting on and off of these meds...
posted by Donuts at 1:44 PM on May 6, 2015 [1 favorite]
I gained weight during my year on it, but there were also other changes in my life in the last 12-ish months so I'm not sure I can blame it on that (I moved cross-country, started a new career, started dating someone new who likes to cook...).
The first 2-3 weeks I was on it, I was sleepy a lot. I went from being anxious and kind of hyper-aware and worried about everyone to almost seeming like I just woke up from a nap all the time.
Getting off of the medication has been really difficult for me. When I am withdrawing from it I get "brain zaps" which are really unpleasant. I was on 20 mg and if I missed a dose I started getting them. Now I'm on 10mg and moving toward taking 10mg every other day, so I am experiencing them more. I'm also sleepy again like I was when I was beginning the meds, and occasionally am feeling anxious again. I may end up staying on the 10mg for a while. It's been lots of doctor appointments and annoying back-and-forth mentally about what I should do.
I feel like the Lexapro helped me out a lot, but I would try other non-drug modifications as much as you can bear before getting on meds. You'll avoid any possible negative side effects AND you won't have to deal with getting on and off of these meds...
posted by Donuts at 1:44 PM on May 6, 2015 [1 favorite]
I was prescribed Celexa for anxiety when I was younger after a major anxiety episode - I took it for several months, with increases in dosage, and experienced no effect. I didn't want to continue going to the doctor to try something else (I didn't have insurance at the time), so I just kind of dealt with my anxiety through exercise and as my life's circumstances improved, it abated. My anxiety has recurred in the past year or so - I was prescribed Prozac and didn't take it for a long time because I was afraid of side effects and (paradoxically) because I didn't think it would do anything. I started taking it after my anxiety and its physical manifestation grew so intense and draining that I couldn't see any other option...and it's changed my life dramatically for the better, with no side effects. So this is just to say that even if the first thing that you try doesn't work, stay hopeful (though I know being anxious makes it hard)
posted by raisindebt at 1:56 PM on May 6, 2015
posted by raisindebt at 1:56 PM on May 6, 2015
I was transitioned on to sertraline (generic Prozac) at the end of last year and this has made a world of difference.
Sertraline is generic Zoloft, not Prozac (which is fluoxetine).
posted by jaguar at 1:59 PM on May 6, 2015
Sertraline is generic Zoloft, not Prozac (which is fluoxetine).
posted by jaguar at 1:59 PM on May 6, 2015
Damn. I always do that! Thanks, jaguar.
posted by Fezboy! at 2:01 PM on May 6, 2015 [1 favorite]
posted by Fezboy! at 2:01 PM on May 6, 2015 [1 favorite]
I highly recommend talking to a psychiatrist about what medication to take. If you are insured the co-pay should be about the same as general practitioner. You don't have to go on meds, you don't have to go on the meds they say, you don't have to go back to the psychiatrist, but you shouldn't be prescribing for yourself. You wouldn't prescribe your own heart medication - don't mess with your brain without talking to a professional.
posted by maryr at 9:32 AM on May 7, 2015 [1 favorite]
posted by maryr at 9:32 AM on May 7, 2015 [1 favorite]
You shouldn't be making any of these decisions. If your doctor "is not especially good in general and is[n't] particularly knowledgeable about mental health things in particular either," then he's the wrong doctor to see.
"I think my transmission is shot based on some googling I've done about the noises I'm hearing in my engine and some of the weird ways it's behaving. My mechanic is crappy and isn't particularly knowledgeable about transmissions, but I'm taking the car in to him anyway. Can you tell me what I should be angling for?" This is just the wrong approach.
Speak to someone who knows what they're talking about. Tell them what's happening. Tell them how you feel. Tell them what your goal is. See what they recommend. Ask questions about some of the things you hope to avoid. Go from there.
I have a feeling you put those provisos about your doctor in your question because you know how questions get derailed here by responses like mine and you wanted to throw us off the scent and keep us focused on the particulars of the different medications, but that really is the answer. GP/psychiatrist/therapist first, their assessment and recommendations second, then maybe see whether it makes sense to compare notes with other people on various options.
These medications affect different people differently, are appropriate for different situations differently, can be used in some cocktail combinations and not others, may or may not be what you need, and might or might not work even if prescribed and taken. You're not equipped to make any of those decisions except whether or not you feel like you're receiving the intended effect.
Source: Spent years taking most of the major medicines in different combinations and have worked with GPs, therapists, and a psychiatrist in various ways on various manifestations of depression, anxiety, and OCD. You have to grab the wheel sometimes when things aren't working after too long, but in general you have to let them drive because it's what they do and isn't what you do.
posted by Askr at 9:52 AM on May 7, 2015
"I think my transmission is shot based on some googling I've done about the noises I'm hearing in my engine and some of the weird ways it's behaving. My mechanic is crappy and isn't particularly knowledgeable about transmissions, but I'm taking the car in to him anyway. Can you tell me what I should be angling for?" This is just the wrong approach.
Speak to someone who knows what they're talking about. Tell them what's happening. Tell them how you feel. Tell them what your goal is. See what they recommend. Ask questions about some of the things you hope to avoid. Go from there.
I have a feeling you put those provisos about your doctor in your question because you know how questions get derailed here by responses like mine and you wanted to throw us off the scent and keep us focused on the particulars of the different medications, but that really is the answer. GP/psychiatrist/therapist first, their assessment and recommendations second, then maybe see whether it makes sense to compare notes with other people on various options.
These medications affect different people differently, are appropriate for different situations differently, can be used in some cocktail combinations and not others, may or may not be what you need, and might or might not work even if prescribed and taken. You're not equipped to make any of those decisions except whether or not you feel like you're receiving the intended effect.
Source: Spent years taking most of the major medicines in different combinations and have worked with GPs, therapists, and a psychiatrist in various ways on various manifestations of depression, anxiety, and OCD. You have to grab the wheel sometimes when things aren't working after too long, but in general you have to let them drive because it's what they do and isn't what you do.
posted by Askr at 9:52 AM on May 7, 2015
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posted by xingcat at 10:07 AM on May 6, 2015 [1 favorite]