Posted by SLS on May 28, 2008, at 20:32:24
In reply to Re: The best Tricyclic for anxiety.... » SLS, posted by torachan on May 28, 2008, at 19:58:02
> Thanks Scott. Well the Remeron is what I was initially on after dropping Effexor and finding out that I do need an AD with my benzo for anxiety, or if I'm going to attempt to drop the benzo which ultimately is my goal. I've decided now that Effexor really did help with anxiety, and I'm thinking of keeping the Remeron for sleep, as I noticed with Effexor sleep tends to be disturbed.
>
> You say up to 300mgs? I've read that around 225 mgs the norepinephrine effect kicks in which is detrimental for anxiety. I believe the highest I've ever went was 150mgs. And with that dose I was almost able to free myself from the benzo grip.
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> Anyways, I'll consider going up depending on how I feel. Incidentally, do you feel an SNRI like Effexor is better for anxiety, generally speaking, than any tricyclic available?It depends on the disorder being treated. Agoraphobia and panic disorder might be particularly treatable with imipramine.
I could not come up with any investigative comparisons between Effexor and Paxil that demonstrated a clear advantage to either drug when treating GAD. As of now, Zoloft, Paxil, Lexapro, and Effexor are considered to be equipotent treatment alternatives. You always have Nardil to fall back on if all else fails. I have personally seen this drug work remarkably well for GAD and SAD as well as depression. Nardil is also touted as having efficacy when treating OCD.
It seems that the various anxiety disorders respond differentially to specific antidepressants. Effexor might not be worth trying if social anxiety disorder (SAD) is the illness being treated. Here, the potentiation of NE might account for this. So, here we have two different anxiety disorders (GAD versus SAD) responding best to different antidepressants. Paxil seems to be better than Effexor when treating SAD. Effexor might even exacerbate SAD.
You would know better than I whether or not increasing the dosage beyond 225mg is any more effective when treating GAD. However, 300mg seems to be a magic number with Effexor when treating depression.
So, I would say that for GAD, the SSRIs and Effexor are better than the tricyclics.
The more they refine the definitions of the anxiety disorders and their symptom clusters, the more these disorders seem to be distinct in their responsivity to various antidepressants.
- Scott
poster:SLS
thread:831465
URL: http://www.dr-bob.org/babble/20080528/msgs/831768.html