The Case Against Antidepressants

[tareload]

Tolerance and dependence are building immediately with the clonazepam. If you were to stop now, you would already have rebound anxiety and withdrawal effects, albeit relatively mild. So I think what you're really asking is how long before you cross the threshold where the anti-anxiety effect of your current dose is no longer significant. I do not have any practical experience with that because I never took them consistently enough.

If you are trying to use the benzo as a bridge to get onto an antidepressant that would serve as a longer-term anxiety therapy, you would want to start the antidepressant immediately. Otherwise, you are wasting this period of optimal benzo efficacy and building more tolerance and dependence than you need to.

It will probably take at least 4-6 weeks for an SSRI to deliver substantial anxiety relief. They often make anxiety worse than baseline when you first start (occasionally much worse), which is partly why this benzo bridge concept is pretty common in the psychiatric treatment of anxiety.

Escitalopram (lexapro) is probably the most effective SSRI for anxiety with the least side effects. It is the cleanest SSRI in terms of minimal off-target pharmacological effects and would be my preference here. Sertraline is more stimulating and not as well suited for anxiety. Mirtazapine raises norepinephrine levels tremendously by antagonizing a2 autoreceptors which is not ideal for someone experiencing panic attacks. It will also make you perpetually brain fogged with its strong H1 antagonism.

I would start escitalopram at 5 mg daily which strikes a better balance between efficacy and side effects than the typical 10 mg starting dose. You can increase if needed but there are diminishing returns as you move up. I personally could not stand the strongly altered state of consciousness produced by higher doses.

Am I understanding correctly that these panic symptoms are only occurring during high intensity gym sessions? Because you are about to take on some serious neurochemical debt with these drugs. You will be borrowing heavily from your future well-being in order to induce states of chemically-induced calmness in the present, and that will debt will have to be repaid in the future with interest. It is hard for me to imagine this as worthwhile only for the ability to work out at maximum capacity. Maybe I don't have the complete picture of how anxiety is affecting you outside of the gym.

I am happy to discuss the issues you are having in this thread and it seems like perfectly relevant content.

The symptoms started in the gym and have now expanded to even seemingly benign daily events like a work meeting or going bowling or a walk. They come on quickly and render me almost incapacitated with tachycardia, profuse sweating, inability to speak. Very awkward at work meetings/zoom calls. It seems my ANS is overly sensitized to seemingly pedestrian arousal events.

Workup for adrenal tumor/catecholamine and metaphrenine surge / pheochromocytoma was negative. Rheum workup was negative for major issue. Got my T and thyroid levels dialed back in and no change to symptoms. 224 mcg/day of T4 and 5 to 10 mcg T3 /day. Symptoms were present on T4 monotherapy and on TRT as well as with castrate T levels.

 

[FunkOdyssey]

The symptoms started in the gym and have now expanded to even seemingly benign daily events like a work meeting or going bowling or a walk. They come on quickly and render me almost incapacitated with tachycardia, profuse sweating, inability to speak. Very awkward at work meetings/zoom calls. It seems my ANS is overly sensitized to seemingly pedestrian arousal events.

Workup for adrenal tumor/cstecholamine and metaphrenine surge was negative. Rheum workup was negative for major issue.

Ok. If this were happening to me I would start the escitalopram. I would also stop taking clonazepam on a regular schedule if at all possible and use it only as-needed to maintain a manageable level of discomfort. If you're taking enough clonazepam so that your symptoms are mostly gone, most of the time, I would argue that is too much. You will be grateful later for whatever you can do now to minimize the total dose taken over time.

 

[tareload]

Ok. If this were happening to me I would start the escitalopram. I would also stop taking clonazepam on a regular schedule if at all possible and use it only as-needed to maintain a manageable level of discomfort. If you're taking enough clonazepam so that your symptoms are mostly gone most of the time, I would argue that is too much. You will be grateful later for whatever you can do now to minimize the total dose taken over time.

Thank you for your thoughts. Perhaps Lexapro is best of the worst as far as options go.

 

[tareload]

Ok. If this were happening to me I would start the escitalopram. I would also stop taking clonazepam on a regular schedule if at all possible and use it only as-needed to maintain a manageable level of discomfort. If you're taking enough clonazepam so that your symptoms are mostly gone, most of the time, I would argue that is too much. You will be grateful later for whatever you can do now to minimize the total dose taken over time.

1 mg/day of clonazepam has me flying through the clouds. Way too much fun. Gotcha.

 

[tareload]

Ok. If this were happening to me I would start the escitalopram. I would also stop taking clonazepam on a regular schedule if at all possible and use it only as-needed to maintain a manageable level of discomfort. If you're taking enough clonazepam so that your symptoms are mostly gone, most of the time, I would argue that is too much. You will be grateful later for whatever you can do now to minimize the total dose taken over time.

My first dance with the AD devil. Wish me luck. I will start with 5 mg daily lexapro.

 

[FunkOdyssey]

Thank you for your thoughts. Perhaps Lexapro is best of the worst as far as options go.

I'm happy to share them and I hope it is helpful. I do think escitalopram is the best drug you can treat anxiety with if you're going to take a drug for it. Ideally you would use it only long enough to break the connection between these benign daily life situations and the panic response before weaning off. Maybe 3-6 months.

It is best taken in the morning to minimize sleep disruption. It will still probably cause insomnia anyway though at first. That should subside in 1-2 weeks if it occurs.

 

[tareload]

I'm happy to share them and I hope it is helpful. I do think escitalopram is the best drug you can treat anxiety with if you're going to take a drug for it. Ideally you would use it only long enough to break the connection between these benign daily life situations and the panic response before weaning off. Maybe 3-6 months.

It is best taken in the morning to minimize sleep disruption. It will still probably cause insomnia anyway though at first. That should subside in 1-2 weeks if it occurs.

Lmao. That was the symptom I made up to explain to pcp why I didn't take the lexapro. He said he had never heard of it or had a patient suffer that.

Ok, off to squat on benzos. Wish me luck!

Thanks again.

 

[FunkOdyssey]

Lmao. That was the symptom I made up to explain to pcp why I didn't take the lexapro. He said he had never heard of it or had a patient suffer that.

Sadly typical.

Escitalopram Side Effects: Common, Severe, Long Term

Learn about the side effects of escitalopram, from common to rare, for consumers and healthcare professionals.

www.drugs.com

Psychiatric​

Very common (10% or more): Insomnia

 

[tareload]

Sadly typical.

Escitalopram Side Effects: Common, Severe, Long Term

Learn about the side effects of escitalopram, from common to rare, for consumers and healthcare professionals.

www.drugs.com

Yeah that's where I got the story from!!

LoL.

 

[tareload]

Ok much smoother at the gym on benzo 1mg plus started the lexapro. 2 min HRR was back 25 bpm so I will hope for the best with lexapro and use benzo sparingly. That clonazepam is good stuff. I mean evil stuff. Yeah, that's why I mean .

 

[tareload]

I use sometimes benzos for sleep: short acting like triazolam, and long acting like temazepam. Tolerance develops in a matter of days. They still have an effect but it plateaus to a lower level, in this case to a shorter sleep duration.

You could try Gabapentin for anxiety instead - it may be anti-orgasmic since it seems to work by suppressing the brain-muscles communication.

Gabapentin reviews for Anxiety

Thanks for sharing the info and your experience @sammmy. I appreciate it.

 

[Tn198989]

Amazing how easily one gets offered and Rx'ed an AD or SSRI in an in network PCP provider's office. They must really work. Never tried one, any recommendations....

Mirtazipine
Lexapro

Throw a little clonazepam in there too?

Serious anxiety and panic now that coincide with exercise intolerance and ectopic beats during exercise. All docs recommend an AD along with some beta blocker and maybe some benzo in there as well. Twenty years with major depression and never took the plunge down AD lane. Seriously considering it.

Amazing how easily one gets offered and Rx'ed an AD or SSRI in an in network PCP provider's office. They must really work. Never tried one, any recommendations....

Mirtazipine
Lexapro

Throw a little clonazepam in there too?

Serious anxiety and panic now that coincide with exercise intolerance and ectopic beats during exercise. All docs recommend an AD along with some beta blocker and maybe some benzo in there as well. Twenty years with major depression and never took the plunge down AD lane. Seriously considering it.

Hey there,

So I've been on and off ssri's for the last 13 years. I would advise against a the use of benzos if possible.

They are far worse than ssri's. SSRIs do work for both anxiety and depression. If I didn't take them I wouldn't be able to function. If you find the one that works for you you will feel a lot better. Boosted confidence, more outgoing, less anxiety etc.

They never stopped working for me. Still work like when they kicked in.

Libido drop, delayed ejaculation are all included in the package though. And they will probably last for as long as you take the medication.

Some of them will cause weight gain. I am on prozac and it doesn't for me plus it's being prescribed to combat bulimia.

If you have anxiety and/or OCD then wellbutrin is a no go. I tried it in the past due the weight and libido neutral thing and it gave so much anxiety that I went psychotic. Thank god the psychosis was temporary. I was literally insane for a couple of months.

I was taking mitrazapine a long time ago and I was also taking zoloft so I can't comment on the mental effects but half hour after you take it, you get biggest food cravings you can imagine so you will definitely gain weight on it. For me it was too sedating too and I was tired throughout the day.

If you have been suffering for 20years you will feel like a new man.

Talk to a doctor of course but I am telling you all this cause many doctors will tell you that the weight gain is minimal or that the libido effect will go away. Bullshit

There are also calming ssris and energizing ones. Let the doc know what you are looking for and hopefully you won't need paxil. It's the strongest ssri and it has the worst weight and libido side effects, along with an even worse withdrawal.

If only I could find a way to fix the libido issues on prozac I would be a happy man

 

[tareload]

Hey there,

So I've been on and off ssri's for the last 13 years. I would advise against a the use of benzos if possible.

They are far worse than ssri's. SSRIs do work for both anxiety and depression. If I didn't take them I wouldn't be able to function. If you find the one that works for you you will feel a lot better. Boosted confidence, more outgoing, less anxiety etc.

They never stopped working for me. Still work like when they kicked in.

Libido drop, delayed ejaculation are all included in the package though. And they will probably last for as long as you take the medication.

Some of them will cause weight gain. I am on prozac and it doesn't for me plus it's being prescribed to combat bulimia.

If you have anxiety and/or OCD then wellbutrin is a no go. I tried it in the past due the weight and libido neutral thing and it gave so much anxiety that I went psychotic. Thank god the psychosis was temporary. I was literally insane for a couple of months.

I was taking mitrazapine a long time ago and I was also taking zoloft so I can't comment on the mental effects but half hour after you take it, you get biggest food cravings you can imagine so you will definitely gain weight on it. For me it was too sedating too and I was tired throughout the day.

If you have been suffering for 20years you will feel like a new man.

Talk to a doctor of course but I am telling you all this cause many doctors will tell you that the weight gain is minimal or that the libido effect will go away. Bullshit

There are also calming ssris and energizing ones. Let the doc know what you are looking for and hopefully you won't need paxil. It's the strongest ssri and it has the worst weight and libido side effects, along with an even worse withdrawal.

If only I could find a way to fix the libido issues on prozac I would be a happy man

Howdy, thank you so much for taking the time to share your experiences. I really appreciate it and glad you have one that is working for you. I am going to wean off the clonazepam and try 5 mg of lexapro daily. Gotta get this under control.

Ευχαριστώ πάρα πολύ
στην υγεία σου
χρόνια πολλά

 

[Fortunate]

@readalot, I feel for you, brother. I really hope you can get on a pathway to brings you peace. I am personally pulling for you. I would reiterate the really good comments above about the danger of benzo's. It's a really slippery slope.

Forgive me if this has already been answered, but have you tried counseling with someone you like and trust?

 

[tareload]

@readalot, I feel for you, brother. I really hope you can get on a pathway to brings you peace. I am personally pulling for you. I would reiterate the really good comments above about the danger of benzo's. It's a really slippery slope.

Forgive me if this has already been answered, but have you tried counseling with someone you like and trust?

Hey Fortunate, thank you so much for your kind words. Means a lot to me. If there were black belts given out out for counseling I should have got one by now. Clocked many years in counseling and then finally had to get into a 3 month outpatient CBT/DBT boot camp for depression years ago. It helped but that was really not comparable to the issue I am having with anxiety and panic right now. It was stopping me from working out which is a double whammy and cruel twist.

Depression I learned how to live with. This new stuff is hard-core. It isn't something I feel I can think my way out of. Feels chemical and hard wired if you can understand that. Like a wire got messed up.

So I dropped off the clonazepam and added in the lexapro at 10 mg each day for last two days. I told myself I will use a loading dose to get to the 5 mg/day steady state faster. Haha.

So @FunkOdyssey Was Correct the SSRI gives me a slight buzz and I have never dropped X but I can see how it must feel comparable based on watching other people. My sig other really noticed a difference. Very different feeling in gym where even if I want to freak out I can't. Maybe something is working or placebo but so far I will take it.

Bless all you guys for your feedback. If this stuff works I am going to be really grateful.

And if it doesn't I am still grateful for such a great group of humans on here trying to help their fellow human.

The clinical pharmacokinetics of escitalopram - PubMed

Escitalopram is the (S)-enantiomer of the racemic selective serotonin reuptake inhibitor antidepressant citalopram. Clinical studies have shown that escitalopram is effective and well tolerated in the treatment of depression and anxiety disorders. Following oral administration, escitalopram is...

pubmed.ncbi.nlm.nih.gov

 

[Fortunate]

Hey Fortunate, thank you so much for your kind words. Means a lot to me. If there were black belts given out out for counseling I should have got one by now. Clocked many years in counseling and then finally had to get into a 3 month outpatient CBT/DBT boot camp for depression years ago. It helped but that was really not comparable to the issue I am having with anxiety and panic right now. It was stopping me from working out which is a double whammy and cruel twist.

Depression I learned how to live with. This new stuff is hard-core. It isn't something I feel I can think my way out of. Feels chemical and hard wired if you can understand that. Like a wire got messed up.

So I dropped off the clonazepam and added in the lexapro at 10 mg each day for last two days. I told myself I will use a loading dose to get to the 5 mg/day steady state faster. Haha.

So @FunkOdyssey Was Correct the SSRI gives me a slight buzz and I have never dropped X but I can see how it must feel comparable based on watching other people. My sig other really noticed a difference. Very different feeling in gym where even if I want to freak out I can't. Maybe something is working or placebo but so far I will take it.

Bless all you guys for your feedback. If this stuff works I am going to be really grateful.

And if it doesn't I am still grateful for such a great group of humans on here trying to help their fellow human.

The clinical pharmacokinetics of escitalopram - PubMed

Escitalopram is the (S)-enantiomer of the racemic selective serotonin reuptake inhibitor antidepressant citalopram. Clinical studies have shown that escitalopram is effective and well tolerated in the treatment of depression and anxiety disorders. Following oral administration, escitalopram is...

pubmed.ncbi.nlm.nih.gov

Have you spent any time learning about any contemplative traditions? If not, I can give some thoughts.

Also, based one what I have been reading, I have legitimate hope in some of the new research in psyilocibin and related compounds.

 

[tareload]

I have been guilty of this. Hard to face your biases sometimes.

Pride can make you sit and suffer in silence for 25 years rather than trial a medication for a month. Small consolation if you tried everything else first and got all other ducks in a row ( perhaps some synergy with medication if it shows itself effective).

 

[Charliebizz]

Hey there,

So I've been on and off ssri's for the last 13 years. I would advise against a the use of benzos if possible.

They are far worse than ssri's. SSRIs do work for both anxiety and depression. If I didn't take them I wouldn't be able to function. If you find the one that works for you you will feel a lot better. Boosted confidence, more outgoing, less anxiety etc.

They never stopped working for me. Still work like when they kicked in.

Libido drop, delayed ejaculation are all included in the package though. And they will probably last for as long as you take the medication.

Some of them will cause weight gain. I am on prozac and it doesn't for me plus it's being prescribed to combat bulimia.

If you have anxiety and/or OCD then wellbutrin is a no go. I tried it in the past due the weight and libido neutral thing and it gave so much anxiety that I went psychotic. Thank god the psychosis was temporary. I was literally insane for a couple of months.

I was taking mitrazapine a long time ago and I was also taking zoloft so I can't comment on the mental effects but half hour after you take it, you get biggest food cravings you can imagine so you will definitely gain weight on it. For me it was too sedating too and I was tired throughout the day.

If you have been suffering for 20years you will feel like a new man.

Talk to a doctor of course but I am telling you all this cause many doctors will tell you that the weight gain is minimal or that the libido effect will go away. Bullshit

There are also calming ssris and energizing ones. Let the doc know what you are looking for and hopefully you won't need paxil. It's the strongest ssri and it has the worst weight and libido side effects, along with an even worse withdrawal.

If only I could find a way to fix the libido issues on prozac I would be a happy man

What’s funny is back in my early 20s I had crippling anxiety. And paxil legitimately cured my issues. I was on it for 2 years. Highest dose. I gained so much weight. I had a little delayed ejaculation. But libido was still great. I actually quit it cold turkey, didn’t know any better. And I never looked back. Had no side effects and anxiety was gone. I’m not sure if it actually did anything or the Placebo made me realize the panic wasn’t going to kill me and was able to not over think it.

then in my mid 30s I jumped on low dose lexapro. I used it because dr Mariano said it could help people with cortisol issues tolerate trt. I stayed on it for 4 years. i was only on 2.5 mg. Didn’t have any side effects. i Was mmostly off trt those 4 years. But when I finally committed to trt 6 months in I started to get some emotional flatness and thought maybe it was ssri. I got off the lexapro and had pretty annoying withdrawal. A lot of brain zaps and some depression. Took about 3 months for the acute symptoms to get better. Then slowly over the last year I’ve become more and more depressed on trt alone. Trt is great for my libido, nocturnal erections,glycemic control. But my moods and way of thinking about life are just off. I’ve been toying with the idea of going on low dose Prozac for some time. I even started it for a week and then bailed again. I’ve read a lot of the things @FunkOdyssey has posted and looked into them myself for years. part of the reason I got off them.

im not sure what to do but I have been absolutely miserable lately. I have admittedly Been messing with my trt way too much. And that does mess with my mental state. But I almost feel stuck like I need a reset. I’m not sure if I got here from the 4 year ssri use And withdrawal. Or the trt it self. I been off the ssri for little over 2 years. And on trt for same time.

sorry if my grammar and punctuation is off. Kids are screaming in the back round driving me nuts lol.

 

[FunkOdyssey]

... when I finally committed to trt 6 months in I started to get some emotional flatness ...

My current belief is that this is pretty common and associated most often with either high dose or high frequency long ester injections. It's early and might be placebo but I've been feeling more "like myself" as I've progressed through a transition from cypionate to daily SC propionate. By that I mean my cognition and overall consciousness feels more like pre-TRT, except with a better mood and more energy than pre-TRT.

The long-term SSRI use may have contributed to the depressive state that has developed. As you know, past use seems to increase vulnerability to future depressive episodes. This is not a reason to despair though, all it means is that you have to counterbalance it with a bit more antidepressive factors in your life than someone who is SSRI-naive. There is less margin for error and a more comprehensive approach may be necessary.

 

[Charliebizz]

My current belief is that this is pretty common and associated most often with either high dose or high frequency long ester injections. It's early and might be placebo but I've been feeling more "like myself" as I've progressed through a transition from cypionate to daily SC propionate. By that I mean my cognition and overall consciousness feels more like pre-TRT, except with a better mood and more energy than pre-TRT.

The long-term SSRI use may have contributed to the depressive state that has developed. As you know, past use seems to increase vulnerability to future depressive episodes. This is not a reason to despair though, all it means is that you have to counterbalance it with a bit more antidepressive factors in your life than someone who is SSRI-naive. There is less margin for error and a more comprehensive approach may be necessary.

I actually feel worse mentally the more I increase frequency of my trt. I was doing ok on 3x a week. I’ve tried daily’s a few times. And every time I do around week 2 I become a depressed mess. I also seem to get depressed more when my levels are too high. Just like when I use the transcrotal cream.

that said do you think a trial of low dose ssri would be detrimental long term ? I feel like I did feel better overall on ssri. Even without trt. And my friend and wife say the same. But now I’m so worried about long term sides and becoming dependent on them. And them possibly making me worse off in the future.