SRI / SSRI anti-depressants, are they the right thing for anxiety?

[Ambition]

A lot of people with anxiety are prescribed anti depressant meds such as Prozac, Citralpram etc. These work by allowing serotonin levels to build up. That's why they are known as Serotonin Re uptake inhibitors or SRIs.

Look at the side effects on these meds. It states increased anxiety, panic attacks, suicidal thoughts, migraine, high blood pressure as side effects. The problem is these are the same symptoms of anxiety! Some people have these gruelling side effects for upto 6 weeks! I was prescribed Citralpram 5mg daily for anxiety. I took it for only two days and felt completely weird, depressed and spaced out. (I had never previously had depression, only panic attacks and anxiety). Two days after stopping it I went with my family to the shopping mall and felt it was like a dream. Just weird. I a
So enjoyed painting but completely lost interest in my paintings. I just felt empty. I do not ever want to feel like that again. It took a month before I got back to normal and I could concentrate on dealing with my anxiety.

Another person I knew had depression and was prescribed Prozac. A day later they had their first ever panic attack no thanks to this drug!

These drugs are also both psychologically and physically addictive giving horrible withdrawl symptoms even if reducing dose correctly by doctors advice.

It's just stupid. Inventing a medication that makes the symptoms it's suppose to treat much worse! Imagine having extreme back pain and been prescribed a pain killer that makes the pain much worse for up to 6 weeks? Or an anti cancer drug that increases the spread of cancer? Its outrageous.

Why can't better drugs be developed that reduce anxiety like pain killers reduce pain? All we anxious people have for meds are either useless SRIs or highly addictive and dangerous benzodiazepines, like Valium diazepam etc. Why is so little research done on Anxiety panic attacks etc?

Here's the mechanism of why these drugs make you worse.

Serotonin makes depressed people feel good. It's like a stimulant. It increases heart rate and blood pressure. But the problem with anxious people is that they need the exact opposite. In a panic attack heart rate and blood pressure does increase, because of the stimulant effects of adrenaline so why give anxious people a drug that allows a natural stimulant called serotonin to build up?
The serotonin system is extremely complicated, even top neurologists don't fully understand it. Look at the weird effects of LSD? That works by affecting the serotonin system too.
In some people if you allow serotonin to build up by using these drugs, the body responds by reducing serotonin out put, explaining why depression is a symptom. In some the levels get so high that they feel weird and have panic attacks.

[gypsylee]

Sometimes I think maybe SSRIs work by making you feel so bad initially that anything seems good after that lol. But no, they have helped me (and my brother) and I've been on a heap of different psych meds.

The problem is the brain is not understood very well at all, the mind-body connection even less. There is constant research into it though..

[cloroxidized]

You aren't really correct about the method of action by which SSRI/SNRI's function. In the case of SSRI's..they function to increase the relative amount of serotonin available to neurons in the brain. They really aren't terribly selective which is why typically during dose changes and upon starting there can be a little nausea. This is because 90% of the serotonin in your body is used by the digestive system. Now SSRI's function not as a stimulants which are DNRI (Dopamine-Norepinephrine) and sometimes DNSRIs and Releasing Agents for Dopamine & Norepinephrine primarily. Cocaine is a DNSRI while Amphetamine like Adderall is primarily a DNRI and releasing agent with very mild serotinergic activity. The model of depression currently focuses pharmacologically on serotonin and norepinephrine which is why you see a whole slew of drugs for the condition. Only about 40% of individuals respond to either class of drug and between the two roughly 60% respond. The response is highly varied from a substantial improvement in symptomology to only a mild improvement and we don't know the baseline of those tested. For example, someone with very severe depression may have a substantial improvement and still be moderately depressed. That tends to be the group who does have the greatest response.

Now on why it's appropriate for anxiety:
Anxiety and Depression are highly comorbid and can be better equated as being on a similar spectrum. On a more anecdotal level, many doctors and patients report that their anxiety while initiating treatment was in fact worse...but it often improved significantly along with depressive symptomology (if present). In many instances depression morphs into anxiety and they end up running concurrently. So clearing one can sometimes also clear the other. We also don't know the exact chemical triggers or causes of anxiety and much like depression people respond to different SSRIs and SNRIs. And in the case of SNRIs...where norepinephrine is involved..something that is common to anxieties physical and psychological symptoms is particularly difficult to intuit.

Benzodiazepines and Stimulants on the other hand are much more predictable from person to person in their effects.

Dose is almost always highly variable from person to person and sticking with the medication is important as many have side effects that after a few days will abate and many require 2-4 weeks for most people to respond and it may also require a higher dosage.

So those are the reasons I've come to understand why SSRIs and similar drugs are used and are effective.


The body tends not to build an exact tolerance to the drugs therapeutic effect..at least I'm not aware of any studies or anecdotal reports of tolerance occuring beyond the physical adjustment to the drug both on and off. The SSRI withdrawal syndrome is highly varied and depends on the SSRI. Fluoxetine (prozac) has an incredibly long half life and so it can be discontinued any time without risk. The ones with shorter half lives are more likely to cause the discontinuation syndrome. This can be avoided by slowly weaning the dose down over a period of time so as to not shock the body and give it a gradual adjustment. It can also simply be a sign that the dose is too high and should be adjusted lower.