fluoxetine and sertraline as good bets for anxiety?

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Best antidepressants for anxiety identified, 21 Mar 11.
“ . . . Out of all the drugs, fluoxetine ranked first for response and remission while sertraline was ranked first for tolerability.
"Professor David Baldwin, professor of psychiatry at Southampton University concluded: ‘Among five UK licensed treatments, duloxetine, escitalopram, and pregabalin might offer some advantages over venlafaxine and paroxetine.’"
http://www.pulsetoday.co.uk/story.asp?s ... 128885&c=2
Yes, but Professor David Baldwin does not know an individual patient and what is working for him or her.

Efficacy of drug treatments for generalised anxiety disorder: systematic review and meta-analysis, 11 March 2011.
“ . . . treatments to be ranked for effectiveness for each outcome measure, given as percentage probability of being the most effective treatment. . . ”
http://www.bmj.com/content/342/bmj.d119 ... 22d482bf3a
So, not necessarily a flat percentage whether it will work or not. Rather a percentage that it’s the best bet from among available medications.

One, as I understand it (and I am certainly not a physician), human biochem and esp the balance of neurotransmitters in the brain is a subtle thing. And no doctor in the world can predict in advance whether a particular medication will work for a particular person or not. In a very respectable sense, it is trial and error. It is trying something promising and then feel and texture whether it’s working, and sometimes it takes a while (and sometimes it doesn't, like if it's having unacceptable side effects).

And secondly, yeah, it sure helps a lot to have a doctor you can halfway talk with (doctors tending not to be great communicators, ‘halfway talk with’ is perhaps the most a person can realistic hope for!).

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Both anxiety and depression are reasonably common issues for those of us on the spectrum, and really, reasonably common issues for people in general. We can do some research with the goal of at least being informed patients and asking good questions. And we just might be able to help others in the process.

Note: I AM NOT A DOCTOR.

I’m a reasonably good guy might do some medical journalism down the road, which is a far cry from being a doctor.

The best ant-anxiety med for me was beta blockers. Non-psychotropic, inexpensive and all it does it block adrenaline receptors. That was enough for me. SSRIs make me rageful and suicidal (I've taken Zoloft and Paxil) and I refuse to take anti-psychotics because of their horrendous side affects.

I have PTSD, and not GAD or social anxiety.phobia.

Its a shame I can't take any SSRI's as these seem to have the best outcome.

Still your right, its feed back to the doctors that makes the difference. Will make sure I do my part next time I vist, although I think they are porbably sick of me by now!

im on fuoxitine for about a month so far, it hasn't helped at all, I should have felt it weeks ago.

fluoxetine interferes with my manly things. Luvox helps with my anxiety and OCD, but doesn't interfere with the other thing. So thats my drug of choice.

Not true. It often takes 6-8 weeks for people to see results on SSRIs. So, if you get to the two-month or three-month mark and still haven't seen any improvement, talk to your psychiatrist about trying something different. But not seeing a result in four weeks doesn't mean that you won't see an improvement in the near future.

I've taken both Prozac and Zoloft over the years. In fact, the first medication I tried for anxiety was Zoloft. It seemed to help a bit when I was on the lowest dosage, but I think that's just because my brain needed SOMETHING to help it. But I have severe anxiety/panic attacks and severe pure obessional OCD, and neither Prozac nor Zoloft did anything for either, overall. The only effect I had was horrible tiredness, which I still suffer from (I'm now on a stimulant patch to fix the irreversible damage SSRIs seem to have done to my sleep schedule). I was even on 250 mg of Zoloft while in CBT and was still a mess.

Klonopin helps my panic attacks, but it also makes me incredibly groggy and drugged. It was all I had to rely on for emergencies for several years.

In 2008, I started Anafranil (clomipramine), and it has been a miracle drug for me. It's the only thing to ever completely get rid of my panic attacks. It also has done wonders for my obsessions. I've done so many things in the past 2 1/2 years that I never thought I would because of the Anafranil. It's not prescribed much anymore, due to it being a tricyclic and having more side effects than the SSRIs, but for all the bother the side effects give me, I'll gladly put up with them over OCD and panic attacks!

Wow, that's real serious.

Now, in my opinion, doctors need to take the next step forward and to tell patients when to start easing back away from a medication, hopefully before it gets real bad when it's just kind of bad. This is done to some extent, some media attention. I think it should be done more, in the context of a real conversation between doctor and patient (which can be relatively brief). But the doctor should not just assume.

As we've seen abundant times here at WrongPlanet, there are both good mental health practitioners and not so good. And that ability to make that sideways step is key.

I'm glad you have found the beta-blockers which help.

Last edited by AardvarkGoodSwimmer on 09 Apr 2011, 4:44 pm, edited 1 time in total.

After years of dicking around with different SSRI's, a wise psychiatrist realized that I didn't have a seratonin problem. I had a norepinephrine problem. He prescribed Cymbalta and within two weeks, my depression lifted and anxiety diminished. That was four years ago. He also prescribed Buspar for the remaining anxiety. It works.

SSRI's caused increased anxiety and that made the depression worse.

Yes, a good doctor can use that as information, and ask, okay what is now the most promising medication to try? And hopefully get something that will help in a positive way and that will make a difference. And I understand there are different 'classes' of medication with the SSRIs being one 'class' but even within a class (well, then you get to a point where I'm obviously not a doctor). But I have made a point to experiment with and develop social skills and I do feel I have a knack for asking good questions.

Jacs, I don't think your doctor is tired of you, hopefully not. Maybe a little bit you caught her at a high water mark where she had a lot of energy, etc. But I bet she's pretty good. When I worked for H&R Block, I told myself "The hard clients are the good clients!" (I worked hard at the taxes and the computer system, I disclosed the bank products. They're not really an ethical company because they don't really meaningfully disclose the possibility of third-party debt collection. Long story. The upshot to me personally what was most significant was that it was kind of a lonely work place because no one else seemed to really care and yeah, I ended up feeling a bit like an outsider)

Anyway, wishing you a good visit where your doctor does listen and does ping-pong it back and forth with you.

Wow, that's a minor miracle. And, more than minor, for the quality of your life, this is a flat-out Miracle. And good for you!

Now, if the previous doctors hadn't tried the SSRIs, where it was information available for this guy, he may have been less likely to hit upon the possibility of a norepinephrine problem.

And for us as patients, this gives a couple of openings. 'We've already tried an SSRI. What if we try something different?' That's question number one. And more specifically, 'What if it's too little norepinephrine?'

And from just the moderate amount I've read, I strongly suspect the biochem of the human brain is a whole lot more complicated still and that serotonin and norepinephrine is just the beginning. So, it's trial and error in a respectable way, seeing what works, and good communication (or good enough communication in a nonperfectionist way). And maybe similar to the theory of the 'good enough leader,' there's a lot to be said for that. But a person needs a doctor they can at least halfway talk with.