what is the best antidepressant for anxiety and panic attacks ?

[lindyloo2018]

Hi, I am suffering badly with depression and anxiety because of my RA.GP has suggested sertraline or mirtazapine.does anyone have experience of these drugs for anxiety and panic attacks?please reply with experience of the antidepressant and dosage and how long it took to work.many thanks

[AgedCrone]

You really should speak to your rheumy team about why your RA is causing you such anxiety….especially as it is accompanied by panic attacks.

No matter how many replies you get get on the efficacy of each drug,,,,it won’t necessarily affect you in the same way.

Your GP knows you, & wil have suggested what he thinks will help you…but surely it’s better to get your RA sorted so that you don’t have to take drugs to cope with either of his suggestions?

What in particular with your RA is causing you to be so distressed?

Is it the pain….the failure of the drugs you are taking being effective…or can you just not accept that you have it? If you discuss that with your rheumy nurse …..who knows you & what medication you are taking……she may well be able to help.

We all have different ways of dealing with our disease..I do hope you can find a way to cope with your RA without having to resort to antidepressants.

[lindyloo2018 in reply to AgedCrone]

it's that ever since I stopped hydroxy a year ago I have felt that my ra is not under control, I still take mtx not at a slightly higher dose. mri says I have joint effusions but now ra cons seems to be ignoring that and says it's all osteoarthritis.. I am looking to restart hydroxy but I hate the drug.

[AgedCrone in reply to lindyloo2018]

Well LL……it could be OA …again speak to your rheumy team about seeing a physio & getting some better pain control.

I was most indignant when my Rheumatologist told me the reason my hands were so painful was not RA, but OA….but I agreed to see a physio & with my two squeezy balls,I exercise my hands every day……although they aren’t perfect…..now they aren’t unbearable. They don’t look very pretty..llbut I can cope with the discomfort.

If you really feel you need to take something other than Hydroxy…try to discuss a change of meds with your rheumy team . Don’t go in all guns blazing…..just ask if there is something else you could try as you tried it before but had to stop it.

Keep at it…you will get sorted soon.

[Chockyuk in reply to AgedCrone]

I agree. Although I do have RA, the top joints of my fingers are all bent over, my Rheumatologist tells me that part of my joints is actually OA, I also have OA, in my shoulder joint. I have exercises from the Physio, they say motion is lotion, but sometimes moving it too much is painful, although I know I must, been told I’ll need a shoulder replacement at some point.

I took Hydroxy for a while, it gave me stomach issues, so now I take Sulphasalazine and Mthx, which has worked wonders. 🤞. It’s all trial and error really.

[KittyJ in reply to lindyloo2018]

My understanding is that OA can cause effusion too so it’s entirely possible you have both. unfortunately RA treatment doesn’t treat OA but I suppose it depends on the severity of effusion as to what treatment you can have. Most of us probably hate our drugs but you’ve found out the hard way that we do need them. I hope restarting hydroxy helps in all areas and that in a few months when it’s working you won’t need to take anything else 🤞🏻

[lindyloo2018 in reply to KittyJ]

Hello, how can I find out if my knees are OA and/or RA, my ra cons has not done any ukltrasound/mri/xray on my knees. He bends them and says they have crepitas so therefore are OA, but surely I need to find out if it's both?

many thanks

[AgedCrone in reply to lindyloo2018]

LL….you have to try to understand your rheumatologist is a highly qualified doctor & you would be well advised to believe him when he tells you that the pain in your knees is OA. If it was RA he would tell you…..why would he not tell you the truth.? He wants you to feel better as much as you do.

I recently had surgery on my wrist & the surgeon noticed that my elbow was swollen…& just by squeezing it he said “that is the OA”. We don’t understand how it’s possible he knew that….but there are some things we have to take on trust,

If your rheumy stopped your Hydroxy he must really have believed you don’t need it. So as I think I said before…make an appointment with your rheumy nurse & write down all you have said here. She will then discuss your worries with your rheumatologist & ask if he will prescribe another drug that could help you.

[medway-lady in reply to lindyloo2018]

Perhaps they can feel a sound when examining the bones. Like with Morton’s they can hear a click in their hands no need for any other tests but it’s often now confirmed with ultrasound.

[Chockyuk in reply to lindyloo2018]

I’ve had x-rays on my hands and shoulder, which confirmed those joints are OA, but also two MRI’s and a nuclear bone scan which confirmed the inflammation in my hips.

[Jackie1947 in reply to lindyloo2018]

I have both RA and OA . RA is in remission but never OA. You could try cold treatment or a hot wax hand bath. Exercising them. There should be some on line.

[Vonnie10 in reply to lindyloo2018]

I'm in similar position with my ra not so much panic or anxiety but I went clinic 8 months ago thinking a was having a flare up of my ra convinced myself my dmward Needed changing I had the usual scan bloods all normal clinic says mine is now osteo it was hell for months I also had carpel join in waitjng surgery for the carpel . For months I was in denial about ostro because it was so similar to ra I've seen physio had resting splints done . I'm afraid nothing you can do but live with it have you had any recent steriod injection or tablets I only say this as when I'm given steriod injection they send me loopy my anxiety goes through the roof gets pretty horrific I ant function my gp gives me a short course of lorazpam until it settles down. You have my sympathy anxiety & depression isn't at all nice . Consultant usually deals with ra gp deals with everything else pain depression anxiety .

[KittyJ]

I agree with what AgedCrone has said and that taking tablets won’t do much if you don’t deal with what it is about your RA that’s causing your anxiety/panic attacks in the first place. Did you explain to the doctor what about your RA is causing you to feel like this? You might get more help from your rheumy nurse if it’s RA related as they will most likely have seen this before.

[lindyloo2018 in reply to KittyJ]

yes I did tell my ra cons that the ra problems are causing depression etc, all he said was take antidepressants with no reference as to how to solve the ra problems

[KittyJ in reply to lindyloo2018]

if it’s all related to stopping hydroxy then hopefully you will see improvement once you’re back on it but it will take a while. 🤞🏻for you.

[medway-lady]

Do you have a local branch of NRAS ? It might help to talk to a real person. I agree talk to your RA team but also it might be worth joining a local group. I hope your feeling better soon and I’m sorry I don’t know about the type of meds you are thinking about.

[AgedCrone in reply to medway-lady]

That is a really good suggestion ML.

When we are trying to deal with something on our own..it’s very easy to convince ourselves we are the only one to ever have these doubts…& speaking to fellow RA/OA sufferers …who have experienced the same problems & found a solution…..can put things in to perspective .

So LL…if you are reading this…please do as Medway Lady suggests, & give NRAS a call & see if they can tell you where you might find a local group….where you can have some face to face chats.

[lindyloo2018 in reply to AgedCrone]

thanks, I looked online, no local group in my area..but there is one about 5 miles away

[AgedCrone in reply to lindyloo2018]

Oh that sounds positive. Why don’t you give the group a call & see if there is some way you could have a chat with whoever runs the group……There maybe some sort of telephone help line….or at least a suggestion of some way you get some support.

[wilbertjellyfish]

Perhaps your GP could organise knee x-rays to assess the OA and perhaps look at better pain management. It's horrendous that you have to fight RA. OA and for better treatment. I've learnt the hard way that if you try to ignore it, it bites back.

Hope you can get better help soon.

[Amnesiac3637]

Couldn’t add any more to the sensible and helpful replies you’ve already had. Panic and anxiety skews your perspective and that probably needs to be addressed first so phone NRAS as has been suggested - and accept your rheumatologist knows better than any of us about your particular set of health circumstances. Do hope you can get some sort of calm restored soon.

[cyberbarn]

There has been a change of thinking around what causes anxiety and depression in some people. It can be caused by inflammation affecting the brain. When the inflammation is under control, the anxiety and depression goes away.

But there are other physical causes of anxiety too. We label a raised heart rate and the accompanying sensations that go with it as anxiety, something that is emotional and driven by the brain. But sometimes it is driven by the body. There are different cardiac conditions that can have the same sensations, such as the dysautonomias which physical raise the heart rate for no reason other than the system is dis regulated, and that gives a sensation we call anxiety. Fix the reason why the heart is racing, and the anxiety goes away.

This happened to a friend of mine. She was young, healthy, very fit. But she started having panic attacks and anxiety for no reason. Eventually one of the older GPs at the surgery realised that she had high blood pressure which wasn't being treated. The younger GPs said be more healthy, exercise more, eat better, divorce your husband, blaming it all on her and her lifestyle. But she already ate healthy foods, cooked from scratch, exercised a lot.

The old GP put her on medication to lower her blood pressure and all anxiety disappeared! It was the high blood pressure, not her lifestyle or mood that was causing the problem.

Now, that might not be the same as your problem, but if you have uncontrolled RA and lots of inflammation, that could be if not adding to the problem, it could be the source of it. worth just keeping in mind.

[Flinda in reply to cyberbarn]

Now that's very interesting because I had too experienced terrible anxiety during the peri-menopause, which only lasted a week (in every month) but was uncontrollable and debilitating but at the same time, totally predictable.

That anxiety was triggered by hormone changes or other chemical surges drowning my body! Nothing to do with external environments or personal circumstances - but my GP still gave me anti-depressants, and I had to take them or my bosses wouldn't support any of the health issues I had! Now that made me depressed - the total lack of management support.

Thankfully, more and more is known about "the changes" women experience - but that's another topic.

[J1707- in reply to Flinda]

Many friends and family suffered panic attacks/ anxiety with depression and it was the peri menopause HRT worked wonders.

[Evie3]

NRAS has a helpline ….worth a call

[Chockyuk]

Hi Lindyloo, firstly I’m sorry you are feeling like this 😔

I was prescribed Sertraline, I took 100mg per day. For me, it was a slow steady build up of lots of things, not just being in pain from RA, so I had lots of other issues going on. I had separated from my husband, then just as my son, who I’m really close to went off to Uni, I was diagnosed with RA. Over the past few years, I have been through a very acrimonious divorce, selling my home and moving. It finally came too much and I broke down to my GP, I had tried to resist taking medication for my depression and anxiety, but I felt in the end I needed some help. I went through quite a bit of counselling as well.

It took I’d say a few months for Sertraline to kick in, but it did really help, for me anyway, just to smooth and even things out, it also helped to stop me bursting into tears every few minutes 😳 Luckily enough my employers were also very supportive and understanding.

You can also self refer yourself (I’m in the UK) at first I went to CBT through my local NHS authority, personally for me it didn’t really help, but the 1:1 counselling did. Have a chat to your doctor about talking to someone, the NRAS helpline are also great.

A few months ago I took the decision to come off the antidepressants, as I felt strong enough, but I would say they did work for me and help get me through a tough period. But definitely talk to your doctor about what might be best for you, there is no one size fits all solution.

My Rheumatologist, who is AMAZING, was also supportive, and she didn’t have an issue with me going on Sertraline, although as I found out, along with the Methotrexate, Sertraline can be harsh on your liver, and it did raise my liver enzymes so I eventually had to cut the dose of Sertraline to 50mg.

You also have us all on here.

I hope you get something that helps and there will be a light at the end of the tunnel.

Take care 💕

[lindyloo2018 in reply to Chockyuk]

hi,do you take hydroxychloroquine as well as mtx ? thanks

[Chockyuk in reply to lindyloo2018]

Hi - not now, I used to, but it gave me stomach problems.

[lindyloo2018 in reply to Chockyuk]

ok thanks, I needed to know if you were taking hydroxy when you were on sertraline ?

and when you stopped hydroxy did they give you another drug instead ? I am trying to find a replacement for my hydroxy as I don't really want to go back on it...but the RA out of control is causing depression..

[Chockyuk]

Hi - I wasn’t on Sertraline when taking Hydroxy. I’m now on 20mg Mthx and 4 x 500mg of Sulphasalazine per day. For me anyway, the Sulphasalazine has been a great addition. I hope you get everything sorted. 👍