Feeling worse than ever on lexapro

[millymichelle]

Been on and off Ativan (as needed) for 10ish years. As needed meant sometimes only like 20 pills/year were taken. Mostly able to regulate on my own. In 2019 my general practitioner said they could no longer RX habit-forming meds because of the opioid crisis. I was told they could only treat my anxiety with an SSRI. They gave me a reference to a psychiatrist I could see that day (all out of Ativan) who also RXed me Zoloft. That didn’t really move the needle. So switched to lexapro and a couple months in having the worst depression of my life. Hard to tell what’s what—what’s COVID lifestyle depression, what’s hormonal, what’s related to existential dread. But don’t remember feeling this “bad” before. I am trying to find a new medication but and am seriously upset at how long the process to find the “right one” may take—and sometimes regretting I started this SSRI journey at all.

Can anyone provide some support or does anyone relate? I feel I got thrown onto SSRI with no due diligence and now I’m stuck trying to find the right one, IF the right one exists?

[blackcat64013]

Thanks for your post.

Research shows that psychological therapies, usually CBT, are the most effective 1st line treatment option for people with anxiety. However, if symptoms persist and more severe, some medical treatments may be helpful.

I am not a doctor but have put together a quick list of medication available. I have tried nearly all of them before settling on a combination to address my symptoms.

Antidepressant medication

Some types of antidepressant medication can help people to manage anxiety, even if they are not experiencing symptoms of depression.

Research indicates that when people have an anxiety condition, specific changes occur in their brain's chemicals – serotonin, noradrenaline and dopamine.

Antidepressant medication is designed to correct the imbalance of chemical messages between nerve cells (neurones) in the brain.

Confusion is common about the best medication. Every person has a different chemistry so that is why "it" is often hard to find. Mostly it is a matter of trial and error.

It helps to learn about the different classes of antidepressant medication and possible side effects.

I have put together a small description of the different classes of antidepressants used (some of the names are different in various countries) to help you review what's available in your doctor's toolkit.

As with all medicines there are a range of side-effects, and interactions with other medicines so you should discuss it with your doctor.

Selective Serotonin Reuptake Inhibitors (SSRIs)

This class includes sertraline; citalopram; escitalopram; paroxetine; fluoxetine; fluvoxamine. SSRIs are:

the most commonly prescribed antidepressants

often a doctor's first choice for most types of depression

generally well tolerated by most people

generally non-sedating.

Serotonin and Noradrenalin Reuptake Inhibitors (SNRIs)

This class includes venlafaxine; desvenlafaxine; duloxetine.

SNRIs:

have fewer side effects compared to the older antidepressants

are often prescribed for severe depression

are safer if a person overdoses.

Reversible Inhibitors of MonoAmine oxidase (RIMAs)

are a subclass of MAOIs that selectively and reversibly inhibit the MAO-A enzyme.

The class includes moclobemide.

RIMAs:

have fewer side effects

are non-sedating

may be less effective in treating more severe forms of depression than other antidepressants

are helpful for people who are experiencing anxiety or sleeping difficulties.

TriCyclic Antidepressants (TCAs)

The class includes nortriptyline; clomipramine; dothiepin; imipramine; amitriptyline.

TCAs are:

effective, but have more harmful side effects than newer drugs (i.e. SSRIs)

more likely to cause low blood pressure – so this should be monitored by a doctor.

Noradrenaline-Serotonin Specific Antidepressants (NaSSAs)

This class includes mirtazapine.

NaSSAs are:

relatively new antidepressants

helpful when there are problems with anxiety or sleeping

generally low in sexual side effects, but may cause weight gain.

Noradrenalin Reuptake Inhibitors (NARIs)

This class includes reboxetine.

NARIs are:

designed to act selectively on one type of brain chemical – noradrenalin

less likely to cause sleepiness or drowsiness than some other antidepressants

more likely to:

make it difficult for people to sleep

cause increased sweating after the initial doses

cause sexual difficulties after the initial doses

cause difficulty urinating after the initial doses

cause increased heart rate after the initial doses.

Monoamine Oxidase Inhibitors (MAOIs)

MAOIs are prescribed only under exceptional circumstances as they require a special diet and have adverse effects. This class includes tranylcypromine

Agomelatine

The first melatonergic antidepressant, was designed to improve depressed states by resynchronizing biological / ciradian rhythms.

This is an atypical antidepressant that works in part by stimulating melatonin receptors.

not recommended for patients with liver problems

I hope this snapshot is useful.

[millymichelle in reply to blackcat64013]

Thank you so much for this detailed report. I see a new psychiatrist Thursday so I can chat all this through with them

[Daveacr1959]

Same thing happened to me in 1993 when diagnosed with generalized anxiety disorder and panic attacks. Tried 6-7 different antidepressants one at a time. It made things worse. Went on klonopin and daily cardio exercise to help produce endorphins. And I have been functioning since. They tried me on mirtazapine a few times since. And Paxil a couple more times. I can’t tolerate any s s r I . I was able to stay on the mirtazapine but it helped me sleep but didn’t do much for my anxiety.

Here is what helps me. 6-8 hours of sleep each night. I do the Wim Hof guided breathing exercises free on you tube before I get out of bed. I will do it before a meal if I need to again later in the day. I take a 5-10-15 minute pure cold shower daily. It took me a few months to get to fully cold. And I stay in longer when the water is not as cold. Then I get 40 minutes of cardio exercise to produce endorphins. Google cold shower therapy for mental health. And cardio exercise for mental health.

[millymichelle in reply to Daveacr1959]

I’ve coincidently also been into Wim Hof techniques. I did the breath everyday and even the cold shower (until the drain got clogged). Thank you—this is a reminder that I need to get back to that. It did end up helping rather immediately but for more sustained results I guess I should consider doing it multiple times a day.

[Daveacr1959]

Good job! I do 30 minutes before I get out of bed. I do the 3 round beginner. And the 5 round right after. Then I eat and walk the dog. Then it’s the cold water. When I get out of the cold water I’m almost my old self. Then I go swim laps at the gym. My pool at home has been 42-60 the past 4 months so I plunge in there for 2-3 songs on my phone. The colder the shorter .

[Daveacr1959]

I don’t think 20-30 Ativan per year is anything a good dr will have a problem with. I think you should go to a physiatrist and let them know about what you are going through. It’s what I had to do last year too.

[qru55]

Do a genetic test for figuring out exactly what kind antidepressant you need or start Tms therapy. Good luck.