Strategy No : Avoid Ineffective Therapies
When directly questioned by a physician, about 60 percent of patients who take SSRIs report experiencing sexual dysfunction, including delayed orgasm, anorgasmia, loss of libido, decreased lubrication, and erectile dysfunction11 that number drops to 14 percent when patients spontaneously report the information.12 Only 25 percent of these patients with sexual dysfunction report being able to tolerate this side effectpresenting a major challenge because of the long-term nature of the treatment.12
In general, the sexual dysfunction is dose-related and responds to reductions in the total amount of antidepressant medication used.11,12 Occasionally, patients can successfully alter the time of dosing or skip doses prior to sexual activity. This strategy would presumably work best with short half-life agents such as paroxetine or sertraline .11 Because sexual dysfunction is ordinarily a class effect, switching SSRIs is usually not beneficial. Unfortunately, venlafaxine has an incidence of sexual dysfunction similar to that of conventional SSRIs.11
What You Can Do
If you do feel like an antidepressant is increasing your anxiety, speak with your doctor about it. There are a number of different approaches they can take to counteract this side effect. For instance, they may lower your dose, switch you to a different medication, or prescribe another medication to counteract it.
It is not advised to stop taking your antidepressant without first consulting your doctor. Stopping your medication too quickly can create its own set problems, known as discontinuation syndrome. You also run the risk that your depression may return or become worse.
Antidepressants Wont Make You A Zombie
Again, the goal is to help you enjoy your life, not to numb you. If somebody feels in a daze or zombielike, that can mean the medication is too high, and we need to lower the dose, Dr. Cox says.
But sometimes people actually feel dazed or foggy because of high levels of anxiety or depression, she says, and taking medication helps them feel more clearheaded.
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What Causes Ssri Intolerance
The answer is in your genes.
Not all patients experiencing mood swings or depression have abnormally low levels of serotonin in the brain. Even though they have normally functioning liver enzymes that metabolize SSRIs properly, they are still unable to tolerate these medicines, even at low concentrations. They can experience side effects within a few hours of getting the first doses. People who experience such symptoms frequently carry a mutation in one of the genes that make proteins involved in the clearance of serotonin from the body, resulting in accumulated high levels of serotonin.
An excess of serotonin is commonly found in patients with bipolar disorder and other inherited mental health conditions which have anxiety and depression as part of the initial clinical presentation. The trouble for these people begins when they start taking an SSRI in combination with other medications that further elevate serotonin levels. Some patients cannot tolerate even the first few doses of SSRIs.
Based on our experience with mental health patients, we note that most of the patients with bipolar disorder and schizophrenia have normal activity of both enzymes that process SSRIs. In fact, new CANMAT guidelines for treatment of Bipolar I disorder recommend avoiding SSRIs due to high risk of symptom worsening.
What Is The Most Effective Antidepressant For Anxiety
There is no single antidepressant thats best for treating anxiety. What works for one person may not work for another. Depression symptoms will completely go away for about 1 out of every 3 people who take SSRIs, but more research still needs to be done on why SSRIs work for some people and not for others. Your healthcare provider is the best person to ask which antidepressant will be most effective for you.
Other SSRI medications can be effective for anxiety such as Prozac or Celexa or Paxil, yet each has some side effectsnotably lowered libido and weight gain, says Uma Naidoo, MD, a psychiatrist at Mass General Hospital in Boston. Benzodiazepines are very effective in the short term while under the care of a doctor, but these are potentially addicting medications and must be used with immense caution and only as a short-term measure, e.g., grief following the death of a family member, says Dr. Naidoo.
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Ssris And Sexual Side Effects
Sexual problems associated SSRIs, which are also caused by other antidepressants occur in about 50% of the patients who take SSRIs.
However, the effects of SSRIs on sexual functioning is dose-related and may therefore vary. They are the most common long-term side effects caused by SSRIs.
Paroxetine appears to be responsible for the highest rate of sexual dysfunction. Citalopram has been associated with loss of libido and is associated with a higher level of sexual dysfunction when compared with sertraline.
Fluvoxamine and fluoxetine are less likely to produce sexual side effects as compared to paroxetine and sertraline.
Paroxetine produces more orgasm delay than fluvoxamine, fluoxetine, and sertraline
Here is the statistics percentage wise for the sexual dysfunction caused by various SSRIs:
- Citalopram 72.7%
Best Ssris For Anxiety Include: Paxil Lexapro Zoloft
Below is a list of various SSRIs that have been used specifically for the purpose of treating anxiety. Although Paxil, Lexapro, Zoloft, and Luvox are the only ones FDA approved for various types of anxiety, others have been found effective as well. Additionally it should be mentioned that the SNRI drug Effexor is also approved to treat anxiety.
SNRI: This class of drugs works by inhibiting the reuptake of both serotonin and norepinephrine in the brain. The serotonin reuptake inhibition can create a sense of anxiety, but the norepinephrine reuptake inhibition can actually increase anxiety. For this reason, SNRIs are not as commonly used to treat anxiety disorders. Of all SNRIs, the drug Effexor is the only one that is approved to treat generalized anxiety disorder.
- Effexor : This is the only SNRI approved to treat generalized anxiety disorder. It is likely effective due to the fact that it acts on serotonin significantly more than other SNRIs. The ratio of serotonin to norepinephrine reuptake inhibition is approximately 30:1. Most other SNRIs have ratios 10:1 or less in favor of serotonin.
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What Else Should You Consider
The majority of side effects occur when medication concentration in the bloodstream is too high. This can happen even if you are taking a regular drug dose, but your liver is not able to eliminate the drug out of your body. Most of the commonly used antidepressants are metabolized primarily by two liver enzymes. If one of these enzymes is not working, i.e. you are a Poor Metabolizer, the level of antidepressant increases in the blood, which leads to significant side effects. If antidepressants metabolize too quickly, i.e. you are a Rapid or Ultrarapid Metabolizer, the drug is eliminated too fast. It does not achieve a high enough concentration in the blood to be effective.
The STAR*D study demonstrated that only one-third of patients respond to the first line of treatment with antidepressants. The majority of patients with depression have to undergo multiple drug trials to find the most effective medication. The ultimate goal of pharmacogenetics is to improve treatment outcomes by predicting a patients response to specific drugs before they are prescribed. This approach allows us to move away from the traditional trial method of prescribing medicines and shift towards a more evidence-based, personalized approach.
Types Of Antidepressant Medications
There are several classes of antidepressants within each class there are many individual medications. While all antidepressants work well overall, no drug or type of drug works equally well for everyone who takes it. You may be advised to try more than one type of antidepressant or to use a combination of antidepressants to seek relief from your distress.
The different types of antidepressants are listed in the order in which they are most commonly prescribed. Medications are referred to in two ways: by their generic name and by their brand or trade names. Brand names available in Canada appear in brackets.
SSRIs
This group of drugs, including fluoxetine , paroxetine , fluvoxamine , citalopram , escitalopram and sertraline , is usually the first choice for treatment of depression and anxiety disorders. These medications are known to have milder side-effects than some other antidepressants. Buspirone is similar to SSRIs and has been found to help with anxiety but not depression.
Common side-effects include nausea, vomiting, diarrhea, weight gain, dry mouth, headaches, anxiety, sedation and a decrease in sexual desire and response. This group of drugs may also cause a jittery or restless feeling and sleep difficulties, such as problems falling asleep, waking in the night, vivid dreams or nightmares.
SNRIs
NDRIs
Common side-effects are jitteriness and insomnia.
NaSSAs
Common side-effects are drowsiness and weight gain.
Nonselective cyclics
MAOIs
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Side Effects Of Antidepressant Medications
All medications can have side-effects. Some people experience no side-effects. Others may find the side-effects distressing. In most cases, side-effects lessen as treatment continues.
Treatment is usually started at a low dose, to minimize side-effects, and then slowly increased until the ideal dose is found. The ideal dose is one that provides the greatest benefit with minimum side-effects.
If you are experiencing side effects, check the information given to you by your doctor or pharmacist on the specific effects of any drug you have been prescribed. If side-effects are not mild and tolerable, it is best to continue taking your medication as prescribed but let your doctor know as soon as possible. Your doctor may:
- encourage you to wait a little longer for the side-effects to fade
- adjust your dose
- suggest you take the medication at a different time of day
- prescribe other medications to help control side-effects
- change your medication
- stop medication treatment and suggest a different type of treatment approach.
Side-effects vary depending on the type of medication. More information on side-effects is included for each type of types of antidepressant.
You can help to control possible side-effects on your own by:
Do antidepressants increase the risk of suicide?
Before starting treatment, prepare for the possibility of feeling worse before you feel better. Know what supports are available to you and who you can call.
Starting An Antidepressant Doesnt Mean Youll Be On It Foreverbut Dont Go Off Cold Turkey
People who take antidepressants dont need to feel trapped, Dr. Cox says. Some people need medication indefinitely, but many do not. Their life circumstances change, or they make progress in therapy, and the antidepressants arent as critical anymore.
Just because youre struggling and you reach out to your doctor about medication doesnt mean youre signing up to take something for the rest of your life, she says.
If you are interested in stopping your medication, its important to do so in consultation with your doctor, who will tell you how to taper off slowly. This has two purposes, Dr. Cox says: One, it reduces the chance of withdrawal symptoms. Two, if you start to decrease your dose and your anxiety or depression worsens, you can increase back to your previous dose easily.
Think you might be dealing with depression or anxiety? Talk to your doctor or find one near you.
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Why Ssris And Snris May Cause More Anxiety
October 1, 2016 by Dr. Carlo
SSRIs and SNRIs are prescribed for depression and anxiety, but they commonly cause more fear and anxiety when first taking the medication for the first few weeks of treatment. After this period of increased anxiety symptoms on the SSRI or SNRI, then the anxiety subsides and eventually the medication treats the baseline anxiety symptoms that were present before treatment with the medication.
So how does this exactly occur in the brain, where SSRIs and SNRIs trigger anxiety? A recent study found a pathway in the brain which may be responsible for this treatment side effect. When mice are subjected to a mild shock on their paws, this induces stress and anxiety. So the shock activates the dorsal raphe nucleus in the brainstem to release serotonin to the bed nucleus of the stria terminalis . Subsequently, the serotonin released from the DRN serotonin neurons bind to the serotonin 2C receptors on the BNST, which in turn inhibits the ventral tegmental area and lateral hypothalamus . This inhibition of the VTA and LH worsens fear and anxiety. When the VTA and LH were not inhibited, then this led to reduced anxiety symptoms.
The next step is to determine if there are DRN to BNST serotonin pathways in humans. If this does exist in humans, then medications such as CRF antagonists might be prescribed concurrently with SSRIs/SNRIs to prevent the anxiety triggered by the SSRI/SNRI during the first few weeks.
Cannabidiol & Medical Marijuana
Lets address the skeptics here first, but also look at the big picture in an unbiased way. We clearly need more research on this topic. Marijuana can clearly be addictive for some. Our society has had a puritanical basis against marijauna research in the past. Its clearly safer on average than alcohol and benzos in terms of overdose and fatality. Typically, overdose on these products has not ever been described as fatal. Only very recently has a coroner said there may have been a fatal overdose on marijuana. Even if this is not an accurate report, with the legalization of marijuana and development of higher potency strains, it would not surprise me that this does occur in time. But for now, in the big picture, the #1 drug that kills in our society is nicotine, and alcohol is #2.
The mechanism of action here concerns the endocannabinoid system in the human body. Like the other classes of medicines discussed, the exact mechanism is not completely understood. This can have various different effects including reducing seizures, anxiety, and gastrointestinal symptoms. The first ever CBD product was approved last year for severe seizure disorders.
I tend to refer my patients to someone who specializes in medical marijuana and CBD when other classes of medications like antidepressants have failed them.
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Starting To Take An Antidepressant For The First Time
Selective serotonin reuptake inhibitors And did you get side effects when you first started taking them?And did you have any side effects at all from it?So youve now realised thats its a much more gradual process than what you first thought?Initial side effects of antidepressantsAdjusting to antidepressantsYou could escape from the thoughts?Would you see that as a weakness or as being able to be kind to yourself?
Data Capture And Interpretation
Although information about the side effect profile of a given drug is available in both the drug manufacturer’s package insert and the Physicians’ Desk Reference , this method of obtaining drug information has limitations. Data included in product labeling are derived from the company-sponsored studies that have been reviewed by the U.S. Food and Drug Administration. Uncommon, rare, and unpredictable drug-related adverse effects may not have emerged in clinical trials and may not be included in the PDR until the drug has been available for several years.
One measure of tolerability of any drug is continued patient use. Consequently, discontinuation rates during clinical trials have been used to measure the tolerability of a given drug. Fluvoxamine is associated with the highest discontinuation rates because of adverse events in clinical trials , followed by fluoxetine and sertraline . Discontinuation rates for any drug after release can be continually redefined using product labeling, published clinical trials, postmarketing surveillance, current literature, case reports, and clinical experience.
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