Should I give in and take the medication?
September 21, 2022 7:15 AM   Subscribe

I have been struggling with intense anxiety for almost a year. I have had very bad experiences in the past with medication like SSRI and I am extremely reluctant to go on them again. I don’t know what other options I have left though at this point as therapy isn’t helping either. Details after the jump

I’ve always been an overthinker with a predisposition to depression but over the past year, I (woman, mid thirties) have developed the most unexpected and intense anxiety I have ever felt in my life.

It started during lockdown and kept getting progressively worse. The strangest thing is that it feels as if it started literally overnight. I did all the physical check-ups to see if there was an underlying reason (hormones, thyroid, vitamin and mineral levels etc.) and everything seems to be ok. I am physically healthy, nothing sticks out as a concern.

My primary doctor initially prescribed me Klonopin to “take as needed” but I absolutely hated it and it made my anxiety much worse and unmanageable on days I wasn’t taking it, so I stopped.

Next we tried cymbalta as I mentioned to her that in my early 20s I had a not-so-great experience with Celexa (a lot of weight gain, insomnia, emotional bluntness). Cymbalta proved pretty intolerable too, severe stomach issues and intense drowsiness, I had to take 2 hour naps during the day to function. She added Wellbutrin, which didn’t help and made the anxiety worse and after 6 weeks at my request we discontinued both.

I started therapy after the GAD turned into several panic attacks but I’m not sure how much it’s actually helping. I feel like a shell of my former self most days and I dont enjoy anything anymore, I cry very very often.

Im extremely wary of SSRIs due to my experience with how brutal the first few weeks on them are and how unhelpful (sometimes harmful) they’ve been. I’ve been firm with my therapist so far that I don’t want to go the medication route but I don’t know what options I have anymore.

Anyone has experience with SSRI for anxiety? What worked for you, if anything at all? How did you manage side effects? Please share your experiences so that I can feel a bit better and less terrified of taking this kind of medication again.
posted by Riverside to Health & Fitness (27 answers total) 2 users marked this as a favorite
(I’ll just say that when I was nervous about taking medicine for my anxiety something that helped was realizing that I didn’t HAVE to take it for forever. I could take it for a few weeks, months, whatever and then reevaluate. That helped take some of the “high stakes” out of the decision)
posted by raccoon409 at 7:25 AM on September 21, 2022 [7 favorites]

I take citalopram 10mg for anxiety and it works very well. Also takes the edge off my misophonia.
posted by seanmpuckett at 7:28 AM on September 21, 2022 [2 favorites]

For anxiety, you might want to try buspirone, which is NOT an SSRI (nor a benzodiazepine like Klonopin). Not a magic bullet, but you might find it more tolerable.
posted by praemunire at 7:29 AM on September 21, 2022 [8 favorites]

I take Trintillex for my anxiety and depression. When my anxiety started getting worse (probably due to premenopause), we added clonidine, which usually treats high blood pressure but is now also used to dial anxiety down a bit. It's not an SSRI. I tried citalopram and ecitalopram but it didn't seem to do much for me. Thankfully, I haven't experienced any side effects from any of these medications.
posted by PussKillian at 7:32 AM on September 21, 2022

You need to find a psychiatrist that specializes in appropriately prescribing medications. Your primary care doctor is not making good choices. Wellbutrin should never be prescribed to GAD patients, as it's known to exacerbate symptoms.

While SSRIs are an option, there are certainly others. Tricyclics and MAOIs are some examples. Finding someone knowledgeable who can work with you to find the right medication(s) is important.

And yes, pretty much every person with anxiety is anxious about taking medication :) But when you do find the right solution, it will be life changing and totally worth it.
posted by ananci at 7:33 AM on September 21, 2022 [26 favorites]

I started taking lexapro, an SSRI, at the beginning of the year. It helped reduce my anxiety significantly, but it dampened my volition.

Like, I had a hard time getting myself to do things, and task switching became more difficult.

At the suggestion of my GP I recently switched to a SNRI called Venlafaxine.

The low volition problem disappeared while I was tapering off the Lexapro, and so far the SNRI seems to be working pretty well. Still figuring out the dosage.

I gained a lot of weight while I was on Lexapro, but that might be only incidentally because of the drug itself. I was weighing 51 kg in January, which is frighteningly thin for someone of my height.

I am now at 70kg. I think this happened because my anxiety was so bad I developed gastritis, and so could not really absorb the nutrients from my food. 😐

Do you have a doctor or a psychiatrist you trust?

If you do find the right medication, it can really help. I didn't realise how bad my anxiety was until I got it under control with the meds.

I hope that was helpful. We're all so different from one another! ❤️
posted by Zumbador at 7:36 AM on September 21, 2022 [2 favorites]

If it helps, I try to start a new medication, when possible, during a break in work or a weekend or something so I am not battling side effects and work deadlines simultaneously. Anxiety is the worst. Good luck in finding something more useful!
posted by Bella Donna at 7:37 AM on September 21, 2022 [1 favorite]

I can't cover the meds issue (good luck!) but want to second the mention of making sure you're seeing the right providers. Therapists, too, vary in their fitness to help you with your issues, and you would not be the first to switch therapists because the current one is not helping. It's okay to do that. I've seen two people in my life that I found really helpful and developed moderately long relationships with (more than a few weeks), and a handful of others that just weren't and so I didn't stay.
posted by eirias at 7:43 AM on September 21, 2022 [3 favorites]

Something I know (kind of) about!

So I started taking SSRIs for anxiety and when that didn't work, Welbutrin was added which made things way worse. My therapist mentioned SNRIs and I tried Cymbalta, which is what I'm still currently on but it doesn't fully alleviate my symptoms; it's kind of a slow burn where it takes the edge off the anxiety but it isn't really relieving it.

Here's where things got weird. I finally (20 years too late) made an appointment for myself as I thought I might have ADHD. I was put on Adderall XR and my anxiety dropped dramatically, almost immediately. I feel like my brain is finally clear, I have motivation to do things, and I feel way more productive which translates into less puritan work ethic guilt and better outcomes in general. Apparently my anxiety was somehow related to feeling like I wasn't operating at full power and once I was, the anxiety droped dramatically.

Not saying you have ADHD, but you may want to look at at this from another angle as there may be something out there you are missing by focusing on the anxiety. My doctor showed me a diagram similar to this one - that's when I realized that I was really working on two separate problems that just happened to intersect.

Good luck on your treatment - anxiety is the worst and I really hope you find that secret sauce that gets you to a better place!
posted by _DB_ at 7:46 AM on September 21, 2022 [10 favorites]

Sertraline works for me. Cymbalta gave me the worst nightmares, and I itched all over. Finally saw a psychiatrist because I couldn't stop crying, and he gave me the Rx that works.
It's hard dealing with this stuff, but when you get the right meds, you'll feel like a person again. Good luck.
posted by Enid Lareg at 7:49 AM on September 21, 2022 [3 favorites]

Just confirming that a GP is okay for a starter Rx, but if that doesn't work you need to speak with someone with expertise. I see Mental Health Nurse Practitioners through an online service (Brightside), and they're super tuned-in to whether X drug at X dosage is giving you the experience you need.

Lexapro was my first try and has been fine, I was able to make some work/lifestyle changes around the same time I started so I'm sure there's a matrix of things that helped. At night I take an old antihistamine that is now commonly used as a gentle sleep aid for anxiety (hydroxizine) to counteract a little bit of sleep disruption from the Lexapro.
posted by Lyn Never at 7:58 AM on September 21, 2022 [2 favorites]

There are so many options besides SSRIs that you can try. I agree that seeking out someone with more area expertise about this would be good. Things like propanolol and clonidine are a really good example of things a knowledgeable doctor would try with someone who is hesitant because of previous bad experiences with SSRIs. And there’s so many other options out there like biofeedback and clinical hypnotherapy. You need more options. Taking something that you feel anxious about taking isn’t particularly likely to alleviate your anxiety, something that’s validated by clinical studies.
posted by Bottlecap at 8:02 AM on September 21, 2022

I take an SSRI for anxiety and depression, heavier on the anxiety. It's worked well for me but perhaps critically in the first couple of months I was on it, I was also given a small prescription of Ativan with the understanding that the first few weeks on a new med can be rough and I was to use them on bad days or for panic attacks. I only needed to use them a few times but just having them was a really helpful cushion for my anxiety-brain. A decade or two ago when I first took meds that wasn't part of the protocol, and I think it's a really helpful addition.

Side effects for me were primarily about sleep. For the first couple of days was exceedingly sleepy, and then for a couple of weeks rather jittery. But a change in time of day for taking the med smoothed that out pretty well, and I have no ongoing long-term side effects.

In general, it sounds like meds are tricky enough for you that you probably aren't being best served by having your PCP prescribe for you, and should try to get into a psychiatrist's office. They're likely to be more familiar with some of the less-common options and potential side effects and more able to work with you on ways to alleviate side effects.
posted by Stacey at 8:04 AM on September 21, 2022 [2 favorites]

I see folks have covered the medication issue, but I just want to point out that prioritizing ourselves to be happier and healthier is the opposite of giving in!
posted by yes I said yes I will Yes at 8:44 AM on September 21, 2022 [8 favorites]

I take Lexapro for anxiety and it's been life-changing. I had a rough few weeks at the beginning (slightly increased anxiety, some side effects), but I used Ativan to get through it, and then I hit the 4 week mark and felt SO MUCH BETTER.

Another option: my sister has a lifelong history of trauma and severe depression, and she's never had good luck with meds. Finally, our psychiatrist (we see the same doc!) performed some kind of test on her to determine which meds would work best with her body. I really don't know much about it, but you could ask a doctor or psychiatrist about it. It turns out that SSRIs are contraindicated for her, but that SNRIs were not. She ended up going on Pristiq and it really helped her. Something to look into!
posted by leftover_scrabble_rack at 9:00 AM on September 21, 2022 [3 favorites]

I came to recommend newer meds (specifically SNRIs, but definitely talk to a specialist) combined with therapy once the meds start to make a difference, but I see that’s covered.
Just as not all doctors are identical, neither are therapists. If you find a med regime that helps, but your therapist isn’t making progress, don’t be afraid to ask for recommendations for different approaches and different therapists.
posted by Kreiger at 9:15 AM on September 21, 2022

I too had a horrible experience with SSRIs (celexa specifically - it made me manic, even though I'm not bipolar.) I then went on Wellbutrin, which made me super anxious. I then ended up getting diagnosed with ADHD, and went on meds for that and was fine for awhile.

But my anxiety ramped up over the past couple years, so I ended up trying Buspar/buspirone. As far as I understand, it tends to have a relatively low side effect profile/is generally well tolerated. It ended up working extremely well for me. I went in with low expectations, mostly picked it b/c I respond weirdly to meds and it seemed least likely to be bad. It's made a huge difference. The only side effect is I sometimes get sleepy like 30 minutes after taking it, but that goes away after another 30 minutes, and it's not bad enough to make it impossible to function or anything.

Definitely try to get in to see a psychiatrist. There are definitely a lot of options out there. I also was on hydroxizine (sp?), which is a first gen antihistamine similar to benadryl, but is also used for anxiety, mainly as a PRN. I didn't stick with it (flared up my asthma, ironic since it's an antihistamine), but there are also PRN's that aren't benzos.
posted by litera scripta manet at 9:16 AM on September 21, 2022 [2 favorites]

Maybe look at a different class of medication? I have no symptoms of bipolar disorder, but after not responding to/feeling worse on a number of antidepressants, my doctor put me on Lithium and it was a complete and almost immediate game changer. The same was true for another friend of mine who was put on Lamictal under similar circumstances. (My doc tried me on Lamictal first but I had a drug reaction.) It took me a second to make my peace with the internalized stigma around Lithium, but once I wrapped my head around it and got used to the idea, it really has been great. Wishing you the best of luck!
posted by jeszac at 9:46 AM on September 21, 2022 [1 favorite]

> You need to find a psychiatrist that specializes in appropriately prescribing medications.

Just wanting to nth this. A good psychiatrist should be able to listen to your experiences with various medication so far and make some helpful recommendations. It still might take a few tries to find something that really works with minimal side effects - a bit of trial and error is just par for the course - but a really knowledgeable doctor can speed up the process significantly.

Also, hate to say it, but the fact that you have so much anxiety about trying something new (and keep in mind it is just trying - whatever you try, if it doesn't work you can just stop it and/or try something different) is a good indication that you do indeed need to do something - if not a new medication then something. So I'm glad you're considering it!
posted by flug at 10:09 AM on September 21, 2022 [2 favorites]

Hey there -- I'm a person who has never had success with medication (with or without therapy) myself, after years and years of trying. I was resistant to the idea of trying again (because I felt hopeless, and scared of side effects that I'd experienced in the past) but found myself increasingly challenged in managing my mental wellness about year ago. I did try a new (to me) med and it didn't work out, but still...

My advice is not to think of it as giving in, but to reframe it as not giving up. Nope, it's not fun getting back on and off the merry-go-round but I believe that when you find the right combination of things, it will be so worth it. That right combination may or may not include medication.
posted by sm1tten at 10:18 AM on September 21, 2022 [5 favorites]

I'm on propranolol; I have mild anxiety. For me it's been effective- it's originally a blood pressure medication/ is a beta blocker which basically means it helps with the physical anxiety symptoms (heart racing, shaking, general adrenaline rush), rather than the mental stuff, but it can help break the mind/body feedback loop (oh no I'm feeling anxious so now I'm more anxious) so it can help dampen down panicky thoughts, at least for me.

Like, I used to get a little adrenaline rush/panic everytime my inbox pinged; that's gone now. I still can get nervous about answering/sending emails sometimes but not having that physical reaction really helps me get over the hump and just do what needs to be done.
posted by damayanti at 11:31 AM on September 21, 2022 [3 favorites]

I'm on escitalopram 10mg. I have been on it 6ish years, after having anxiety so bad that I really wanted to kill myself. Like you, it came on really quickly (there was a triggering event and in retrospect I'd always been an anxious person without realising it).

I've never taken anything else. I will stay on this medication, likely for the rest of my life. If you look at my previous answers, you'll see that I found the first week really difficult and called my psychiatrist to see if I should go off them. I'm so glad I persevered.

One thing I would say, is that it takes time to go completely back to normal baseline on them. At first, I was euphoric because I felt so much better. I felt happier than usual and more connected to everyone (I think this may have been hypomania, which I understand is a mild form of mania that doesn't interfere with your functioning, mainly just creating an energised and happy 'you'). However, this passed and I slowly went back to normal me. Looking back, I think this process actually took the first year or two of being on the meds. Like I was much better immediately, but not back to normal for a while. It was all pleasant though, so I didn't care at all.

I wouldn't say I feel a bluntness of emotions on the meds, but I would say I can let go of bad emotions more easily. And the most important thing is that I can function as my normal self. I completed a PhD on the meds, I fell in love on the meds. If anything I feel more 'me' than before, when I had all the angst. *I know that people's responses vary though.
posted by thereader at 12:07 PM on September 21, 2022 [2 favorites]

SSRIs did nothing for my anxiety (I've been on several for depression) and will be trying one (at a low dose) for chronic pain starting next week. So I'm not opposed to them--they just didn't do anything for my GAD/SAD/panic disorder. The only thing that worked for me was beta blockers--basically the physical symptoms of anxiety would amp up my sense of being out of control emotionally, creating a feedback loop of increasing panic. The beta blocker means I just don't experience those sensations of heart racing/skipping a beat, elevated respiration, or numb/crawling extremities anymore and it's much easier to stop the anxiety spiral when I sense that I am experiencing the emotional symptoms. I also find it much easier to get over what I call the "hump of anxious resistance," that avoidance behavior where I put something off until the pain of not doing the thing is more unbearable than the pain of doing it. Those humps are much smaller or even nonexistent at times because I don't have to mop sweat and do deep breathing just to get going.
posted by MagnificentVacuum at 12:14 PM on September 21, 2022 [1 favorite]

I agree that you need to see a real psychiatrist, not just your primary doctor, and I wonder if you can reframe that as "standing up for yourself by demanding better care than last time" rather than "giving in."
posted by nebulawindphone at 1:30 PM on September 21, 2022

Hey, I'm so sorry you're going through this. It sounds really hard.

Have you considered ECT? It has a bad reputation because in the past it was scary and pop-culture representations continue to be inaccurate. But these days it is actually a safe and reliable treatment for anxiety and depression. Of all the non-medication treatments for mental health, ECT has been around the longest and therefore is well established and researched. It can also be done outpatient.

I work in inpatient psych and ECT is regularly offered to patients with treatment resistant depression or anxiety, or people who can't (for whatever reason) take medications. Similar to most treatments, on ECT I would say for roughly 10% of our patients get no benefit at all, about 80% see improvement in their symptoms, and for the last 10% its like a magic miracle cure. The vast majority of our patients have no side effects, and are up and about like normal a few hours after they have their treatment.

I don't really know why ECT is not talked about more, given its non-invasive and so many people have difficulties with anti-depressant or anti-anxiety medications. I'd never really heard of it until I started this current job. But you might want to ask a psychiatrist about it and see if you'd be a good candidate.

Best of luck to you.
posted by EllaEm at 1:41 PM on September 21, 2022 [1 favorite]

I took sertraline for about half a year and it worked really well for me. I eventually went off it on account of the (mild but annoying) sexual side effects, but in the interim I did all this work in therapy and am in a much better place now. I was so buried under anxiety when I started that therapy was just not helping at all, but with the medication it was like I got to do a reset on my brain.
I hope you find something that works for you, navigating this stuff while you are already in a crisis is the absolutely worst part, but it's worth it.
posted by velebita at 6:49 AM on September 22, 2022

I tried SSRIs in the past and couldn't stay awake for the life of me. Then my doctor prescribed a low dose of an SNRI and the side effects were not that bad and my symptoms improved a lot. It's called effexor, YMMV of course
posted by winterportage at 1:06 PM on September 22, 2022

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