Posted by linkadge on May 30, 2008, at 8:20:30
In reply to Re: The best Tricyclic for anxiety.... » linkadge, posted by johnj on May 29, 2008, at 19:07:59
>Remeron helped me sleep but cause a lot of >physcial anixety as did seroquel (especially at >50 mg). Seroquel also made me wake up almost >every hour. Do you have an idea what mechanism >may cause this physical anxiety from REM and >seroquel?
Were you taking them alone? Its hard to say. Neither are pure 5-ht blockers. Some people don't do well with the alpha-2 adrenoreceptor blockade of mirtazapine (which ehnances norepiniephrine release). Not sure about the seroquel. Some people are very sensitive to dopamine blockade. Seroquel also has a metabolite which is a norepinephrine reuptake inhibitor. Its hard to say.
Seroquel affected my sleep in two ways. If I was very depressed it improved sleep considerably, but as I started to feel better I noticed that it made sleep very fragmented.
>Does this suggest that certain TCA's may be good >or not good for me? I know drug trials tell the >real story but I would appreciate your thoughts.
It is hard to say. They can be good augmenting agents and can help anxiety, but some people are sensitive to certain effects. They may help anxiety best when it is associated with some degree of depression. Nevertheless, elavil or trimipramine might make a good trial.
>It seemed any doses of REM did not help and >anything over 15mg was really bad. REM also made >it hard for me to let things go and increased >irritability. I sure don't need that.
This may be a sign that you are actually benifitting from some degree of 5-ht2a/c *agonsm*.
It gets a little complicated when OCD type problems are comorbid. While 5-ht2a/c blockers usually are good for depression augmentation, they can sometimes make obsessions worse. (Apparently 5-ht2a/c blockers reduce some of the antiOCD effects of serotonergic medications).
Remeron monotherapy can also cause irritability like you mentioned.Amitryptaline may be similar to remeron in some respects. A number of studies have shown however, that amitryptaline is superior as an AD. I'm not sure how it compares for anxiety.
You you mind me asking your main symptoms and the meds you've tried?
Linkadge
poster:linkadge
thread:831465
URL: http://www.dr-bob.org/babble/20080528/msgs/832054.html