Hi Spurs,
I too suffer from anxiety problems... I was told probably GAD, although admittedly on the milder end of the spectrum. I have had some success with medications, as well as importantly some therapy. In my mind, medication is like band-aid, it helps but if you want to make some real changes you need to compliment it with therapy.
I notice you don't mention therapy at all? Have you tried any yet?
I am interested to hear that you picked up on these commonly talked about issues with SSRIs. It is very true that sexual side effects are relatively common but they aren't a given & may only be mild; you certainly seem to realize that any long-term consequences are highly unlikely. As far as the emotional blunting goes... I think that's often the most touted reason for not taking SSRIs in people who have never tried them before... whilst in reality, it's unlikely to be a major issue. If one SSRI causes problems, another can be tried...
I'm just going to throw this out there... but do you think your anxiety of those classes of medication are impacting your decision? You may read a lot of negative remarks & horror stories with regards to anti-depressants online but it helps to remember that people are more likely to go around posting about problems than successes.
You really are shooting yourself in the foot by ruling them out without even trying them. I believe that SSRIs have a rather high success rate with GAD. Someone can correct me if I am wrong, but I assume most long term complications arise out of long term use on high doses, both of which can easily be avoided if you are proactive about your treatment.
I was fortunate in that the first SSRI I tried, Citalopram worked really well for me. I had no noticeable side effects after the first month or so & it really helped me get on top of my anxiety. They did want me on 40mg, but I opted to stay on 20mg since it seemed to work well enough at that dose without any major side effects. It was more about making symptoms manageable rather than trying to get rid of them for me.
I recently started back on it & although it's not quite working as well as before, it's certainly kept my anxiety from getting out of control. My only issue this time around has been feeling a little tired, or not sleeping as well & recently some forgetfulness. I have heard sometimes things don't work as well a second time around, but certainly I don't regret going back on it & if any problems persist will try another SSRI.
I was actually prescribed a small amount of diazepam which I haven't even worked my way through yet 3 months later. I think you are bang on the money with your reluctance to push for that route. My GP said "use them only if you need to, more than anything else they are there for your peace of mind... knowing you have an option if things get bad"
deos68 made a good suggestion with regards to propanolol. My GP wanted me to try that but unfortunately I can't because I have asthma. I believe what it is good at controlling are the physical sensations related to anxiety, which in my experience can definitely exacerbate things.
So to sum up... if you haven't yet, try some therapy & please don't rule out SSRIs without even trying them. They might make all the difference.
If you do decide to try SSRIs, bear in mind they will cause some side effects mostly in the first couple of weeks & won't take full effect for 6 weeks or so. For me personally, I think it was around 12 weeks or so before it got to the point I felt things had drastically improved.
I hope you find something that works for you.
Thank you, very thoughtful post.
Yes I have had a few rounds of therapy, currently in psychoanalytic therapy twice a week for nearly four years now, with a very empathic therapist. I am also a trained therapist myself and that's the work I do! lol. It's been a great help and if you go back 5-6 years I was agoraphobic and couldn't leave the house on my own, go back 7-8 years I had a big alcohol problem, so I have improved, though I had a set back this year and that's what led me to try medication. Just because I've tried everything else really, had two rounds of CBT and lots of other psychotherapy.
I totally agree with you about medication just being a band aid, and therapy being the best option, however therapy- whilst incredibly worthwhile- can take years, and often when you get through one problem another one awaits. I think that's what happened to me this year. I had really bad OCD for years, and through curing that with CBT (had a break from my psychoanalytic therapist last summer for 10 CBT sessions), the anxiety (which is underlying everything) "went" in a more panic disorder/GAD formulation. The work I do in therapy is about the underlying conflicts but I think it could take 10 years+.
I think you make lots of valid points about SSRIs.
I tend to have the fear of the worst thing happening, and yes this is impacting on my decision re: SSRIs. I know also that they are the main medication used at the moment for anxiety, so I am missing out on a lot of possible treatment options, and I know that they do help lots of people, including my best friend, and yourself.
However, I think there are genuine risks. There are plenty of scientific papers about PSSD, which is permanent sexual dysfunction following SSRIS, a symptom of which is permanent emotional blunting, and in extreme cases complete anhedonia. E.g.
http://www.ncbi.nlm.nih.gov/pubmed/18173768
http://www.ncbi.nlm.nih.gov/pubmed/16709553
This page,
http://rxisk.org/post-ssri-sexual-dysfunction-pssd-wikipedia-stumbles/ which used to be on wikipedia but was mysteriously deleted, includes a few studies done on rats, whereby rats given SSRIs long-term had severely decreased sex drive permanently. There is also another study I found which showed that the children of female rats on prozac had very low sex drive. Some scientists believe that SSRIs can permanently alter gene expression, and they believe this is the cause of PSSD.
This link
http://psychcentral.com/lib/sexual-dysfunction-persists-after-discontinuing-antidepressants/ cites a study of 183 people who had sexual side effects long after treatment ended, 12% of which never recovered. Plus there are literally thousands of personal testimonies of PSSD out on the internet. There are people who say they stopped feeling love for their partners due to no longer having emotions. There are people who say they were fine on the drug, but stopped having feelings when they came off it, but then going back on it didn't restore feelings either. It's true that people don't tend to go on the internet to share their positive stories, but I think it's clear PSSD is a real phenomenon and not just people who are incorrectly attributing their depression/sexual dysfunction to SSRIs- not that you were arguing that, but I've heard many doctors say this.
And the question is, could I live with myself if I took SSRIs if I took them knowing of these, probably very small risks? The answer is no.
At the same time, there is also the question of, is it worth taking them still, because the risk is so small? And I find that question difficult to answer but I keep coming back to no...I love so much of my life, and I don't want to risk losing those things. But then again I'm still not sure if this is the "right" decision!!!!
The other thing that puts me off is that it takes, as you say, 6 weeks to start feeling the effects. I don't really have 6 weeks, especially since you tend to feel more anxious at first. And there seems to be an 70-80% or so chance I will have sexual dysfunction whilst on the drug...which would cause me to change drugs anyway.
I'm glad you have had a positive experience with citalopram, and I agree with you about benzos, your doctor seems to be decent in prescribing you diazepam but with the right attitude. I've known many to be too strict with prescribing them in that way, but at the same time I think it is unethical to prescribe them for long-term use, as we see quite often in other countries (and formally in the UK), except in a very small minority of cases where it is actually a good idea for someone to be on them long-term. Then again, some people say pregabalin, which I am on, is as bad as a benzo but they haven't latched on to it yet as it is a newer drug, which scares me.
Once again, thanks for your reply, and sorry this got so long!
Edit: one more thing, yes I think you are right about long-term on higher doses usually being the case with PSSD, but not exclusively, there are lots of stories about people only on them for a few weeks or months getting it too.
