Posted by zeugma on April 30, 2004, at 18:17:58
I started taking klonopin in November after the total failure of six months of CBT to alleviate in any way my debilitating symptoms of social anxiety/avoidant personality disorder. Klonopin at low dose has alleviated the drastic anxiety somewhat, but at the cost of some side effects of its own (increased fatigue, sleep disruption) and I hardly feel like my anxiety is in a satisfactory state. It also may in small degree contribute to depression (not sure). Or maybe I'm just having a relapse because of stress.
In any case, I just got off the phone with my therapist. I said to her that maybe I need a new antidepressant, one that has more efficacy in anxiety, and she said she'd been thinking the same thing. I said I'd been considering Anafranil. She sounded shocked and said that was a "hard one to take" (referring to side effects) and suggested lexapro instead. I said that Lex wouldn't help me sleep, unlike Anafranil, which is quite sedating (I currently take nortriptyline which, in conjunction with buspirone, has given me the first sustained relief from insomnia in my life.) She said that if I added lexapro, I could keep the nortriptyline and drop the buspirone (four is my limit for psychotropics, and besides 75 mg nortriptyline, .5 mg Klonopin (qd) and 30 mg buspirone I also take 80 mg Strattera for ADD).
My idea was that I could slowly mix the Anafranil in with the nortriptyline, maybe taking 25 mg Anafranil along with the nortrip to see how i tolerated it. I know tricyclics can be harsh at first but nortriptyline has always agreed with me and SSRI's haven't. Anafranil could then replace the nortriptyline if it went over ok, and i could have the sedative benefits of the TCA plus the serotonergetic effect of Anafranil on social phobia/AvPD/depression. Plus I would be taking one less drug (I'm planning on dropping the buspirone too, whichever alternative I choose. If and when gepirone ER comes out, I might try that, but I am skeptical thait will offer much of an improvement on the existing drug.) Anafranil or Lexapro? Comments please.
poster:zeugma
thread:341936
URL: http://www.dr-bob.org/babble/20040429/msgs/341936.html