Posted by Dr. Kramer on April 4, 2002, at 11:31:36
In reply to Kramer: SAM-e and anxiety - options?, posted by lizzyg on April 3, 2002, at 4:29:49
> Dr Kramer
>
> I have been successfully treated on a few occasions for major depression plus anxiety with a tricyclic (latterly Lofepramine) and a short course of a benzodiazapine until the AD kicks in. Until a few months ago, I had been symptom free for nearly seven years. This time, I have had bad side effects with the Lofepramine (why could that be - general aging? having had three babies?) so discontinued. I tried an SSRI again but couldn't tolerate the increase in anxiety and agitation, and I found Mirtazapine too sedating. I have been on SAM-e for a few weeks now and have felt some antidepressant benefit (though not as good as with Lofepramine previously). However, the anxiety is still with me, and when I try to increase the SAM-e for a greater antidepressant effect, anxiety and agitation becomes worse.
>
> What would you recommend to counteract this anxiety? (Over here in the UK, GPs [family doctors] are extremely paranoid about benzos and are unwilling to prescribe them for longer than two weeks. Also, none of the GPs in my practice have even heard of SAM-e, but it's difficult to get a referral to a psychiatrist). Or would a better route be to try and find a more sedating AD whose side effects I can tolerate? (I haven't tried Nefazodone, for example, yet).
>
> I'd greatly appreciate your opinion as it's difficult to get access to a specialist in this country.
>
> LizzyEverybody gets less medication tolerant as we get older. I'm reluctant to recommend a single med, but I can tell you there are lots of AD's that help with anxiety, and also that BZD's are quite safe for most folks, especially if you've been on and off them before. Nefazodone is good. Have you tried Paroxetine? Some folks think that's better thanthe other SSRI's for anxiety. Drugs with Noradregeric effect like Venlafaxine are good, maybe even a 2ndary amine TCA like Nortriptyline.
...and I'd push for a psychiatrist.
Be well.
poster:Dr. Kramer
thread:101647
URL: http://www.dr-bob.org/babble/20020402/msgs/101794.html