73 replies to this topic

[hani]

Is stablon a good option or is it a better idea to start with an SSRI?

[nowayout]

It depends a lot on the menu of side effects you are willing to have. There are no comparative studies as far as I am aware for anxiety.

Edited by nowayout, 05 December 2013 - 09:42 PM.

[hani]

What's the safest option?

[nowayout]

Stablon has less (if any) of the side effects that I care about (sexual). But maybe others could tell you more about its effectiveness for anxiety.

[KimberCT]

What type of anxiety?

My general recommendation... sertraline followed by escitalopram. I am tempted to try fluoxetine though.

[hani]

Generalized anxiety mainly.

[nowayout]

Thee are some resources such as crazymeds that have some useful information. One problem is that they mostly discuss antidepressants available in the U.S. and other anglophone markets, so tianeptine is seldom mentioned or compared. Of the SSRIs, my impression is that lexapro is one of the more commonly prescribed ones for anxiety.

[Tom_]

Tianeptine actually often isn't used for a primary anxiety disorder, its mostly used for anxiety associated with another disorder (alcohol abuse/withdrawal, major depression etc)...

SSRIs are effective but rarely should be the first drugs used. In this case Trazadone (if you have significant sleep problems), Buspirone or Pregabalin are you're best options.

[Guardian4981]

I think an issue with "anxiety" is it generally is caused from either too much serotonin or too little, so one has to be mindfull what their particular issue is before trying to combat it. For a while I thought my issue was low serotonin and took stuff for it, only to find my anxiety got worse and realize my issue is low dopamine and high serotonin.

[hani]

Tianeptine actually often isn't used for a primary anxiety disorder, its mostly used for anxiety associated with another disorder (alcohol abuse/withdrawal, major depression etc)...

SSRIs are effective but rarely should be the first drugs used. In this case Trazadone (if you have significant sleep problems), Buspirone or Pregabalin are you're best options.

But aren't SSRIs typically the first line treatment for anxiety?

[nowayout]

Tianeptine actually often isn't used for a primary anxiety disorder, its mostly used for anxiety associated with another disorder (alcohol abuse/withdrawal, major depression etc)...

SSRIs are effective but rarely should be the first drugs used. In this case Trazadone (if you have significant sleep problems), Buspirone or Pregabalin are you're best options.

But aren't SSRIs typically the first line treatment for anxiety?

Around here (Northeast U.S.) benzodiazepines are the first line treatment, from my experience with three psychiatrists over the years. It doesn't mean that either benzos or SSRIs are a particularly good choice as a first line treatment.

Edited by nowayout, 07 December 2013 - 12:08 AM.

[Raptor87]

Tianeptine actually often isn't used for a primary anxiety disorder, its mostly used for anxiety associated with another disorder (alcohol abuse/withdrawal, major depression etc)...

SSRIs are effective but rarely should be the first drugs used. In this case Trazadone (if you have significant sleep problems), Buspirone or Pregabalin are you're best options.

But aren't SSRIs typically the first line treatment for anxiety?

Around here (Northeast U.S.) benzodiazepines are the first line treatment, from my experience with three psychiatrists over the years. It doesn't mean that either benzos or SSRIs are a particularly good choice as a first line treatment.

Finding the right SSRI that would work for a longer period of time is like shooting in the dark.

[fntms]

Stablon has been working well for my general anxiety, no sides at 3x12.5mg per day, 2x works when there is less stress.

[magniloquentc0unt]

try stablon first

[Tom_]

Well since nobody seems to be listening to me, you could try low dose SSRI's with Stablon (this is actually no convincing evidence that Stablon is an SSRE). However Pregabalin or Buspirone are better options. Stablon combined with low dose Buspirone would be very interesting indeed.

[hani]

Well since nobody seems to be listening to me, you could try low dose SSRI's with Stablon (this is actually no convincing evidence that Stablon is an SSRE). However Pregabalin or Buspirone are better options. Stablon combined with low dose Buspirone would be very interesting indeed.

I am listening. I will put all these options up on the table when I finally go to the psychiatrist next week (first visit ever). Stablon + Buspirone does sound like a great combo indeed. The reason I want stablon is because of its neuroprotective/neurogenerative properties as well as its anxiolytic effect. I read a lot about it and I feel like it's a great drug, at least on paper. Anxiety isn't my only problem, I also have racing thoughts, occasional sleep problems, decreased ability to handle stress and intrusive thoughts (all common symptoms for anxiety as well as depression, OCD and bipolar). And there's a history of bipolar and depression in my family. I read many cases of people with chronic anxiety developing depression or bipolar. Indeed there's a link between neuroplasticity and mood disorders:
http://www.jaoa.org/.../111/4/298.full

So with Stablon, I would be hitting two birds with one stone: Helping my anxiety and protecting me from depression. If Stablon doesn't curb my anxiety completely, adding Buspirone might kill it. I am open to all options and will keep this thread up to date. I hope Stablon will be a breakthrough for me.

[Tom_]

All antidepressants show neuroprotective qualities, although what that means when looking at gross human behavior no one can answer. It certainly wouldn't be my first choice, given the family history you have. Pregabalin would, followed by an SSRI alongside an AAP or antiepileptic mood stabilizer (If there is a family history of Bi-polar type 1, if its type 2 you have a lot more wiggle room). However racing thoughts can be as much a sign of depression as they can mania, psychomotor agitation is surprisingly common in MDD and can be a diagnostic criterion for some anxiety disorders. This sounds like a primary anxiety disorder so it would be best to treat it as such. Antidepressants in people with family history of Bi-polar aren't contraindicated by require more careful use and when they can be avoided should be (Buspirone should come under this). Possible exceptions include Bupropion & Agomelatine and maybe Stablon.

[hani]

So why's Pregabalin your first choice and not Buspirone?

[Tom_]

Buspirone at the doses required for anxiolytic effects is poorly tolerated and its mechanism of action certainly doesn't suggest it presents any less risk of mania/fast cycling, it also takes a few weeks before it has any effect.

Pregabalin works as quickly as a Benzo (but its effects continue to build up over a couple of weeks), is at least as effective as Buspirone, Venlafaxine, Sertraline or Clonazepam comes with a tolerability profile no worse than that of an AD (stablon has a tolerability profile that seems no different to that of other AD's according to most research - not a drug I've tried but one I soon intend to) and its unlikely to trigger mania or fast cycling, in fact it could be a treatment for Bi-polar although research so far hasn't been performed.

[hani]

Why do you think Buspirone carries the same risk of mania/rapid cycling compared to SSRI's?

[Tom_]

partial 5ht1a agonism and at the lower doses increases dopamine output.

[Fletch]

My experience has been the MAOI Nardil (phenelzine), especially for social anxiety. It works really well for this, but also GAD. IME it has a better side effect profile than ssri's (e.g. sexual sides). Orthostatic hypotension being the most common. It is my fallback drug if I can't stay of Rx AD's- 2 months off now. The reason for the anxiolytic effect if largely because of its action on gaba transaminase (inhibitor). Lastly, although it increases epinephrine, the net effect is lowered epinephrine via some feedback mechanism I believe. The details of this are on wiki if you're interested. So net effects= increase dopamine, increase serotonin, decrease epinephrine, increase GABA. I stopped because I was to drowsy all the time, although I have a history of hypersomnia and adrenal fatigue. YMMV. I've tried a bunch of different meds over the years. Nardil has been the best for anxiety if not fully for depression.

[BlueCloud]

So why's Pregabalin your first choice and not Buspirone?

I haven't tried Pregabalin, but went thru Buspirone on and off for a year ( I've also been dealing with GAD+insomnia for a long time ). Buspirone is a lottery. It's known in the real world for having a high failure rate, but if it works for you, it can be pretty great as it induces less sleepiness than benzos, and almost no withdrawal problems. The most severe side effects you may get are dizziness and nausea. In my case I couldn't stay on it because the nausea was overwhelming. But it's certainly worth a shot. Also it doesn't really take months to know if it's working or not, usually a week will give you an idea about what to expect.

[Ark]

Nardil is good stuff, hard to find now, and a bit dangerous too.

[nowayout]

I find amitriptylene 50 mg to be an excellent remedy for generaluzed free-floating anxiety. It works quick, as in the same day or the next, so it can be taken as needed,as opposed to having to wait 4-6 weeks for the other siggestions to kick in.

Edited by nowayout, 20 December 2013 - 12:15 PM.

[Keizo]

Cerebrolysin
You got to inject it, but the effects also last a good while, and there probably only is a limited set of side-effects though many general benefits to bathing your brain in this

Edited by Nume, 01 January 2014 - 09:56 AM.

[nupi]

SSRI, it's just hard to know which one will work best for you... Benzos are actually a pretty decent option in acute situations (either those or opioids)

[Reformed-Redan]

Nardil will change your personality. I did not like that about Nardil. The jacked up feeling was a little out of hand and with all the other meds I take it was getting out of hand. I took 15mg of phenelzyne with some adderall and never felt so focused; but, thought I might get a stroke at the same time. I've never been on Lexapro; but, Sertraline is pretty good with anxiety + the modest DRI effects are nice.

[Dolph]

Opipramol without any reasonable doubt. It's awesome.

[Reformed-Redan]

Opipramol without any reasonable doubt. It's awesome.

Can you explain or qualify "awesome"? Looks interesting; but, little info on it.

Seems promising without SSRI activity:
http://www.ncbi.nlm....pubmed/11199949

Anyone know a supplier?

Also has moderate antipsychotic properties at higher doses.