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  • #1470

    I have taken only one SSRI and that was lexapro. The level of agitation was so intense I had to get off of it. Even on a reduced dose I had very high anxiety and agitation as well as insomnia. I have had some relief since starting TRT therapy and changing my thyroid protocol 5 months ago. Unfortunately I still need help. Is there an SSRI that is not as agitating as Lexapro? I have been terrified to try another one due to this experience. Thanks

    #4083
    clloyd
    Member

    I take Lexapro because it seems to have the least side effects. The only other one that may be beneficial because it is not as strong as Lexapro as an SSRI is Wellbutrin. However, Wellbutrin is also a SNRI. Some people prone to anxiety have problems with it. Many love it. I have never taken it.

    @Downthelanetheycome 2475 wrote:

    I have taken only one SSRI and that was lexapro. The level of agitation was so intense I had to get off of it. Even on a reduced dose I had very high anxiety and agitation as well as insomnia. I have had some relief since starting TRT therapy and changing my thyroid protocol 5 months ago. Unfortunately I still need help. Is there an SSRI that is not as agitating as Lexapro? I have been terrified to try another one due to this experience. Thanks

    #4085

    Wow Lexapro has the least side effects? For me it was worse than the condition itself. I better stay away from these things.

    #4084
    Mebigusmall
    Member

    I have tried both lexapro and zoloft. They were completely different. When I hear you say lexapro was bad, It makes me realize how different we all are, since I can’t picture it being agitating at all.

    #4081
    DrMariano2
    Participant

    @Downthelanetheycome 2475 wrote:

    I have taken only one SSRI and that was lexapro. The level of agitation was so intense I had to get off of it. Even on a reduced dose I had very high anxiety and agitation as well as insomnia. I have had some relief since starting TRT therapy and changing my thyroid protocol 5 months ago. Unfortunately I still need help. Is there an SSRI that is not as agitating as Lexapro? I have been terrified to try another one due to this experience. Thanks

    Agitation depends on the dose (e.g. how strongly it increases serotonin), how quickly the liver gets rid of the medication, whether or not there is optimal iron, a person’s native dopamine signaling level (e.g. their tendency for Parkinson’s syndrome), other genetic factors, and whether or not the SSRI also has an antihistaminic or anticholinergic effects, which may possible self-correct the dopamine-reducing effects of the SSRI. As a result of individual difference in the status of these parameters, patients may have different responses to the same medication.

    The biggest determinant is dose. This is why it is important to use as low a dose as possible that avoids reaching a point that causes agitation. Some patients use 1/8th of a 10 mg dose of Lexapro, for example, to avoid agitation.

    I like Lexapro in that it is fairly specific in its signaling actions and tends to be low in regard to adverse effects compared to other SSRIs – particularly when it comes to weight gain / obesity. But individual differences occur. Thus other SSRIs should also be considered. Some patients, for example, respond better to Zoloft than Lexapro. Some prefer Paxil or Prozac. Etc.

    Once a decision is made to change a particular signal – such as serotonin, dopamine, thyroid, etc. – then there is some trial and error to determine what particular treatment will work best due to individual differences in response. Trends can guide you. But individual response may vary.

    #4086
    tin soldier
    Member

    Don’t mean to hijack, but while on this subject, I have a question (at the bottom)

    My wife has severe anxiety and not the kind that has obvious environmental stressors. Her cortisol is elevated and has been for about 3 months due to a stressor in the family, that is gone though. She sleeps about 4 hours per night, has no appetite, and has boughts of severe depression. She started benzos early in the process, but has been taking low doses and wants to stop. We are not sure if she has true physiologic benzo withdrawal or a psychological dependence. She’s never had an addictive personality, nor has she ever had anxiety or depression.

    I think the depression and continued anxiety is partially caused by the benzos. She’s tried both Lexapro (3 days before severe akathisa) and Celexa (6 days before severe akathisia), but no other SSRIs. Both of which caused akathisia, and no sleep. I think the most likely cause of the depression (full-blown suicidal ideation) is either the benzos or the continuous elevated levels of cortisol (which have been analyzed a couple times). This whole thing stemmed from insomnia associated with a very consistent pattern where she felt pretty normal and stable at night when going to bed, then out of the blue at about 2 or 3 am she’d wake for no reason and be highly agitated and then unable to sleep.

    Thyroid, blood sugar, female hormones, and HPA-axis endocrinology all came out within normal ranges.

    This seems to be a psychological reaction to having elevated cortisol for a sustained period, potentially aided by depressed neurotransmitters from benzos.

    Is there an SSRI or other type of antidepressant that doesn’t have a period of agitation at the beginning? Tricyclics might be worthwhile, but excessive sedation comes with trazadone, don’t know about the others. Also, are there any studies that one knows of that looks at restless legs syndrome and effect of SSRI’s? She has had RLS in the past and it may be worth looking at increasing dopamine to decrease the agitation/akathisia.

    Sorry for the long post, I miss my wife. Thanks

    #4082
    DrMariano2
    Participant

    Why do you miss your wife?

    SSRIs generally do not have a period of agitation in the beginning. If agitation occurs, it is an abnormal response. Usually this means there are other problems in the system which predisposes the person to agitation when an SSRI is added. For example, if a person has suboptimal iron, such a person may be more susceptible to agitation or akathisia on an SSRI – depending on the dose.

    The key is “suboptimal”. When doing lab testing, a level can be “within normal range” but can still be suboptimal and can thus represent a problem. For example, from my point of view, Vitamin B12 is suboptimal right in the middle of the range. This is because neuron demyelination starts right in the middle of the range. One can even say that B12 is deficient when its level is in the middle of the range. Laboratory ranges can be fairly arbitrary – e.g. set so that some people will fall out of range, rather than set to determine if one is ill or not. Thus, when interpreting lab tests, it is important to correlate the level with the physiologic meaning of the test, rather than simply stating a a lab test is “normal” since it falls within the range.

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