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How to decide to switch SSRI's ? (OCD, DP)

post #1 of 12
Thread Starter 
Hello there friends,

I was diagonosed with OCD after intrusive thoughts followed severe panic attacks and depression in October of 2006. I was 'new' to the intrusive thoughts and depression, it was quite a frightful experience. The first four months I was placed on Zoloft 50 mg, and felt flaaaaaaaat. When trying to increase I went into anxiety hell, racing thoughts, insomnia, that I knew increasing wasn't the solution. After no emotions and a 4 month trial, I finally decided to make the switch to Celexa which my psychiatrist recommended for anxiety. The side effects for both of these drugs were tolerable.

I have been on Celexa 30 mg for 4-5 months. I felt the difference initially that was good. BUT, I still have residual depression, anxiety, and most recently the racing thoughts and OCD are coming back. Yes, I am also 'doing' the work with therapy and CBT. I would say I am about 75% better than when everything first hit.

I am currently taking .25 of klonopin daily, and I am feeling the urge to increase because the anxiety is still there. But, I don't want to be on a high dose of Benzos. And, would like an SSRI effective enough so that Klon wouldn't be necessary.

I am not in the black hole I was once in, the OCD isn't as frightening but I am 'dealing' with my anxiety everyday still frequently along with depersonalization. Which is hard and I can feel myself becoming 'hopeless' slowly...again.

I just want to be stable as I once was.

Since the Celexa is not doing much harm, how do I know if I should try and risk it by using a different SSRI, and which one do you even try with all the options?

I guess I have read SSRI stories where people say the right SSRI helped change their life, they felt so much better etc. I would like that feeling, I'm doing the counseling and the work, so why am I still having such hard times and a general all over feeling of anxiety still

Thanks Mamas
post #2 of 12
Thread Starter 
PS: I did try to increase to 40 mg of Celexa, with again, high anxiety , racing thoughts, and intensity of depressive thoughts. ... do i just ride those feelings out ?
post #3 of 12
Have you discussed with your pdoc? What does he/she say?
post #4 of 12
I feel your pain...am on one med for depression and now they think I am not depressed so much that I am suffering from anxiety and OCDP. I find it interesting that your symptoms increased when your dose increased? I hope it is not something you just have to suffer through. I also wish for those stories of doing the work and having the right med to make me feel "right" and am starting to think my off way of feeling is just going to be my "right"--but the stress of the "zooming thoughts" and anxiety make me feel sad that this will be my "right/normal". Sending you thoughts and hugs and hope!
post #5 of 12
I wouldn't worry about daily benzo intake so much. Anxiety can lead to worse things. What about switching benzos? Ativan is the least addictive of the lot, and safe doses range from 1mg to 10.

I would keep trying depression meds until you got it right. You deserve to feel well. Maybe an SSRI isn't the answer for you. Maybe you need a dopamine boost. Also lexapro is the SSRI of choice when also treating an anxiety disorder usually.

Also try adding fish oil to your treatment and see if that helps. You're looking for the Omega-3 called EPA, and you want to take 1200 mg of EPA (you have to look on the back of the bottle to figure out how many pills that is), which is usually between 3-6 pills of fish oil to improve depression. It often works really well in combination with other meds.
post #6 of 12
Thread Starter 
Okay, I'm going to do it. I'm going to make an appt to try and switch.

Is it NORMAL to have to be on the third SSRI try after giving 4 months on each a try ? This is so frusssstrating.

Zoloft 50mg 4 months = very activating start, helped OCD thoughts, left me flat as a board w/remaining depressive symptoms.

Celexa 30 mg 4 months = helped depressive symptoms, but OCD with behavorial therapy is still daily frustration, increase to activitating. .

I just want to give up on the meds !! But, I know there has to be a right fit....right ????? Now I've been on the net for 2 hours reading on all the available SSRI's and people's ratings, and I'm more confused then ever. And, not to be mean, but my psych is useless. You tell him what you want, he gives it.

i wish there was a match.com for SSRI's - - - I need to find a compatible ssri mate !

post #7 of 12
have you stumbled upon Crazymeds.org? I love that site!!
post #8 of 12
Originally Posted by faith21 View Post
Is it NORMAL to have to be on the third SSRI try after giving 4 months on each a try ? This is so frusssstrating.
Some doctors hypothesize that people who have recurrent episodes of depression or depression that doesn't respond to antidepressants alone may actually have a form of bipolar disorder. This may be especially true for depression with anxiety (as opposed to more lethargic depression).

A great site to read up on this is: www.psycheducation.org.

I know that after 10 years of partial success taking a variety of antidepressants, my cycles of depression only abated when I added lithium to my med regime. It has been more than 14 months since I have had an episode, which is quite a long time for me.
post #9 of 12
Thread Starter 
kaydee - -

so you don't necessarily have to feel full on 'manic' episode to be bi-polar ? I have not had any euphoric or symptoms of mania since this all started...

how has your body handled the lithium ?
post #10 of 12
I was thinking about you today and the fact that I forgot to mention magnolia bark.

In studies in Japan, magnolia bark has been shown to be as affective as valium in reducing stress and anxiety, only without the sedating effect (at the dosage required to reduce anxiety, at higher doses it is sedating). I don't know what that dosage is, but I do know that relacore and corti-slim and other similar diet pills targeting cortisol are primarily magnolia bark. And many people report not actually losing weight on them, but feeling great. It might be a good alternative for you since you don't want to be on a benzo. Relacore is the one I'm most familiar with, and I believe you only need to take the recommended daily dosage to have the anti-anxiety affect.
post #11 of 12
Originally Posted by faith21 View Post
kaydee - -

so you don't necessarily have to feel full on 'manic' episode to be bi-polar ? I have not had any euphoric or symptoms of mania since this all started...

how has your body handled the lithium ?

There are two "officially recognized" types of Bipolar: Bipolar I (which features episodes of mania and of depression) and Bipolar II (which features episodes of hypomania and of depression). There are also an increasing number of researchers who believe the Bipolar spectrum is even larger, and may include people who have periods of intense anxiety--who are keyed up, but not to the level of mania or even hypomania. The website I recommended explains it better and in more detail, but that is the nutshell. It makes a lot of sense to me, because it describes my experience (multiple, recurrent/cyclical episodes of anxiety crashing into anxious depression; failure to respond to antidepressants alone).

As for the lithium, I am on a pretty low dose (900 mg/day), which keeps my blood levels at the lowest end of what is considered a "therapeutic" level.

For the first couple of months, I did experience increased thirst and occasional hand tremors. Both of these side effects stopped by three months. I do find I need to drink more when I am exercising, and that I can get a bit lightheaded when I am standing for long periods of time (but I also have low blood pressure, so it may be unrelated to the lithium).

I have my kidney and thyroid functions monitored every 4-6 months, as lithium can have an impact (esp. on the kidneys if you don't drink enough water). So far, everything is fine.

I don't know if lithium will keep my moods stable forever--but, in combination with the Paxil, it has worked better than anything else I have tried in the last 10 years.
post #12 of 12
Thread Starter 
Kaydee - -

Thank you for the link to the website, it is very informative and I will be on the lookout for even slight highs / lows or any type of cycling. So far, I am not able to really identify with most of the symptoms. Really, my OCD is what's keeping me anxious and the past few days have been better. I cut down my nightly trazadone by just .125 , now I'm trying to only take .125 but my body is so sensitive I could feel the change in the day, but at least I wasn't feeling hungover. I also am down to .125 of Klonopin every other day. So, this might be increasing my anxiety also. My mother is diagnosed bi-polar, so it's definitely something for me to be aware of...I will keep you updated. I haven't actually made the appointment yet to try another SSRI, I just don't want to go through the switch again, so we'll see if my cognitive skills I'm learning in therapy can help me further recover...

Anymama - -

I'm weining off my .25 Klonopin ...I hope to make it all the way ! so far I'm down to 0.125 tab, every other day...But it's only been a week since I've cut back. I notice it's harder to fall asleep, so we'll see if I have an adverse withdraw reaction. I just want to get down to ONLY an SSRI so at least I can tell what's working, what's withdraw, what's not working..and to only be medicated to the minimum ..... THANK YOU for the recommendation of Magnolia Bark..I am going to look into that right now ! I'll keep you updated also
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