New Member looking for advice

[BrookeM1921]

I've just become a member on this web site. I'm looking for advice on how to decide which treatment plan I should take, including medication.
I have been on Zoloft for three years for depression/anxiety. I have found in the past six months my anxiety has been getting worse. I think everyone is out to get me and have anxiety attacks. The last one being at work. Shaking, heart palpatiations, and emotional roller coaster type mood swings have become much of my life. I'm also an addict and have been clean for just over a year.
I have been talking to my doctor about needing extra help for anxiety and he wanted to double my Zoloft to 100mg or switch me to Ciprolex. I asked for some extra info including side effects and he told me to "just make a decision - quit obsessing."
I want to know if I should really double my dose if the med isn't working anymore? Will I
be tolerant on a higher dose? Will it make me drowsy? (I'm a waitress who is constantly on the go.) What are people's thoughts on Ciprolex? Why do you have to take it in the morning?
Appreciate any advice

[AJ]

I'm not in a great place right now so my response is just one of welcome. So welcome to the forum.

[paul m]

Hello BrookeM1921 and welcome. On this forum we are not supposed to give direct advice, however I can tell you what I would be tempted to do if it was my doctor talking to me that way, well on second thought as a forum moderator I better not, I would hate to have to delete my own post. Not that the doc's advice is necessarily bad, however your doc does need a lesson in bed side manners so to speak. It's your body and you are entitled to ask questions about what you put into it.

I'll preface the rest of this by stating I have no medical training and the following is only my opinion and the opinion of various articles that I have quoted. To make a long story short, if I had to make a choice between two medications, one that I knew the side effects of and one that I didn't know how it affected me, I would chose to increase the dose of the known one for a short time. No more than 30-60 days and if that didn't work or I couldn't live with the increased side effects, then I would change as quickly as possible. (under a doctors supervision).

However that is me , so first a little info on meds and then more on alternatives.

There are no rules when it comes to side effects and/or effectiveness, just generalities. It is known that on any given person the chance of any given antidepressant(here after A/D's) working is 50-50. That doesn't vary very much. Take 5 different A/D's over time and none of them work, your odds of the 6th one working are still about 50-50. In a guide to A/D medication the article states that only 30% of people will get permanently better after their first try at A/D's http://www.webmd.com/depression/guid...sion-medicines

Zoloft and cipralex are both combination medications. That is they are supposed to work on both depression and anxiety. That is a nice when they work. However the problem is when a person takes combination drugs and their illness gets worse there is no telling if it's the anti anxiety properties that don't work or the anti depressant properties that don't work or a little of both.

A variety of articles speak of depression driven anxiety and anxiety driven depression, that is one fuels the other. https://www.psychologytoday.com/arti...ssion-together. \

You can treat this with a medication like zoloft which is supposed to work on both, you can take a medication like wellbutrin which sometimes works well on depression and then a separate anti anxiety medication, like lorazepam. When you do this you can control how much of each med that you take and you have a little more variable power. The problem here is that you may run into side effects of two rather than one med and you may forget to take the anti anxiety med or not have it with you when you need it or it may not work fast enough when you need it Typically anti anxiety meds are prescribed on a take when required basis rather than being in your system all of the time. (there are exceptions).

Cognitive behavioural Therapy has the best statistical cure rate for anxieties at around 60% and even higher when combined with medication, for depression it's not so high at about 50%. for more info on CBT itself http://www.rcpsych.ac.uk/mentalhealt...altherapy.aspx

The main drawbacks to CBT is the length of time it takes and the amount of work involved. It's not a quick cure and in Canada it's very expensive although in some areas you may find a free CBT course. There are some on line, however while I found them good, I found that without a coach they were difficult for me to do on my own. (more or less I tended to procrastinate or quit rather than absorb the lesson, not because they were mentally difficult)

The best place to find out about side effects is from a good pharmacist. They really know there stuff and can be helpful in reducing or eliminating side effects. I find that the pharmacists at the smaller stores are more willing to spend time with me than the ones at the big box stores, but results may vary by region. The small drug store in my area also charges a few bucks more per prescription than the busier big box store, but that few extra dollars has been well spent in the added time the pharmacist has spent with me. However big or small, do not hesitate to ask your pharmacy for advice that is why we pay prescription fees.

I'm sure that I haven't adequately answered all of your questions, so please do not hesitate to ask more questions. Take Care. paul m p.s. whether to take your meds in the morning or at night depends on how energizing the meds make you, some interfere with sleep patterns. Also it depends on your personal habits, if you are a night owl or have a night time job, sometimes it's better to take a med at 6pm than 6am. Once again a pharmacist can give you a more detailed answer.

[AJ]

I moved this topic to treatment. I think more people will see it there.

[uni]

Hello and welcome BrookeM1921, and thanks for sharing. I'm sorry to hear you're dealing with such anxiety, especially the attacks. I wrote up a longer post but for some reason it won't go through and I seem to have lost it.

[AJ]

Let me know if that happens again Uni. Perhaps for a longer post, before you post, highlight what you've written, and Right click and copy it, so that you can paste it if you have to repost for some reason.