Posted by linkadge on May 28, 2008, at 7:13:11
In reply to Re: The best Tricyclic for anxiety.... » linkadge, posted by torachan on May 27, 2008, at 22:14:18
>Just to give you perspective, my condition arose >in the from of panic attacks in 1994 and have >been on clonazepam ever since, with the odd SSRI >experiment here and there, and a long mildly >successful experience with Effexor. Once I was >put on clonazepam, the PA's ended abruptly; >they're certainly good for that.
Well, anxiety disorders can be of multiple biochemical origins. A 'serotonergic' anxiety disorder would probably benifit from maximal agonism of 5-ht1a in ratio to 5-ht2a/c or 5-ht3 etc. Serotonergic anxiolytics usually do not exert their full effect immediately (if they are going to work). Their delayed effect may be due to some form of neuroadaptive process or neurotrophic effect. You may benifit from a drug with strong serotonergic effect in combination with some form of receptor blocker.
Although mirtazapine does block 'bad' serotonin receptors it doesn't really have a strong serotonin boosting effect. Also noradrenergic medications like remeron, effexor desipramine can sometimes make anxiety worse.
A few things to mention.
You cannot quickly substitue an AD like remeron for a strong benzodiazapine like clonazepam since you will experience immedate withdrawl from clonazepam and little antianxiety effect from the AD.
You may want to try buspar (it doesn't work for everybody but it really helps some).
It helps to get very specific about the symptoms of anxiety you experience. Ie predominantly physical, mental, anticipatory, etc, since sometimes it give clues to which meds might help.
Finally, not everybody has a disorder responsive to serotonergic manipulation. Some people have a 'gabaergic mood' disorder. Other possibilites are:
endocannabanoid deficiancy
CNS neuropeptide imbalance
glutamate excess
overmethylation
thyroid issues
hypernoradrenergic states
excess cholinergic function
insufficiant cholinergic function
excessive 5-ht firing in dorsal raphai (ie if nicotine calms you down).
prefronal hypometabolism (if stimulants calm you down).
elevate PKC (mood stabilizers calm you down).etc.
poster:linkadge
thread:831465
URL: http://www.dr-bob.org/babble/20080528/msgs/831585.html