Posted 13 June 2012 - 10:25 PM
Yes, the "selective" SRIs are not all as selective as they seem. The only totally selective one is escitalopram (Lexapro). Actually, we don't really know if it's fully selective; we just assume it's fully selective because we can't find any targets for escitalopram other than the serotonin transporter. For all we know, these drugs might be affecting untested/unknown receptors without our knowledge, and this may explain many of the differences between these supposedly identical drugs.
If the citalopram has made you cold-hearted (as in "blunted/flattened social emotions"), that's a common side effect of high-dose SSRI treatment. It will probably go away if you reduce the dose, or if you switch to a different medication. Any of the SSRIs is worth a try, except that I don't normally recommend Paxil because there's a mild issue of people depending on Paxil to fall asleep at night and having withdrawal symptoms when quitting it.
As for the impulsivity, that's a bit harder to understand. SSRIs are not generally known for making people more impulsive. In fact, when dosed properly SSRIs usually increase the positive social emotions and decrease impulsivity. You could add buspirone to the citalopram, or switch to vilazodone. If you have insurance, go for the vilazodone. Don't let the doctor push you all the way up to the maximum dose of 40mg without first trying the 20mg dose -- it might work fine, and is less likely to cause side effects. If you don't have insurance, buspirone is cheaper but you have to take it several times per day.
As for non-SSRI drugs, you could always try Effexor XR, Cymbalta, or Savella for long-term use. There are also some short-term non-addictive medicines like propranolol, trazodone, and hydroxyzine which can halt anxiety flareups without the addictiveness of benzos. There are, of course, other drugs that work for GAD, but messing around with the TCAs and MAOIs tends to cause more side effects than they're worth. On the subject of fixing the problem without side effects...
There are many psychotherapies nowadays that deliver fast results for anxiety. If you're uncomfortable waiting a long time for old-fashioned therapy to work, you might be interested in a course of modern, time-limited psychotherapy. CBT, ACT, behavior modification, and brief psychodynamic therapy are all shown to deliver results in weeks to months, instead of years. In my case, I started last July with a quadruple diagnosis of ADHD, relapsed major depression, social phobia, and anxiety disorder NOS. (And circadian rhythm sleep disorder, but I wasn't in treatment for that one.)
After 8 sessions of psychotherapy, all I had left was well-controlled ADHD. In fact, halfway through the therapy, I had my doctor cut the dose of ADHD meds in half to eliminate the side effects.
But you should know that I only had this success with my third therapist -- I had seen someone in high school who didn't help me with very much despite several months of weekly sessions, and lots of money. And as I was relapsing into depression and developing the anxiety disorder, I began seeing my college's psychologist weekly and he was entirely unhelpful. Neither of those people knew how to deal effectively and rapidly with the problems I was having. So I asked a local doctor for help finding someone who knew what they were doing. She found a perfect match -- an experienced therapist who specialized in emotional and attention problems in young adults! We got along well, and the rest is history.
Summary:
1.) You don't have to tolerate the emotional side effects of high-dose citalopram. Cut the dose or switch to another med -- they are NOT all the same. SSRIs, SNRIs, and Viibryd (vilazodone) are your first options for switching, and you don't need a psychiatrist to get them.
2.) Good therapy works quickly. If you'd like to have the GAD cured so you don't need anxiety meds for the rest of your life, good therapy is the way to go. It starts working within the first month, and you'll be back to normal (or better) within 3-10 months.
