What next after Citalopram and Sertraline didn’t help?

[NewLifePending]

Suffered general anxiety in varying degrees for about 5 years. The last year have been really hard and I took the decision to try medication. Citalopram was a no go as it stopped me sleeping and made the anxiety worse.
Then I’ve tried Sertraline. It’s had positive effects on me with regards to sleep and managing my terrible PMT anger, but the anxiety is still there. I’ve increased from 50 to 100 then 150 for the last 5 weeks and no improvement.
I’m speaking to the doctor today about changing medication but what are my next options?

I also take propranolol on and off but find that doesn’t really help either l.

Thanks in advance

Venlafaxine? I've never taken it but I work in MH and it's for treatment resistant depression. How long did you stay on the other meds?

What about fluoxetine?

I’ve been on Sertraline about 5 months now. 2 months at 50, 2 months at 100 and a month at 150.

The Citalopram was about 2 months too.

I’m just so fed up of always being in fight or flight mode, tense, heart hammering all the time.

My doctor said we'd try fluoxetine or paroxetine next if the Sertraline didn't work

I tried Venlaflaxine after trying a multitude of other medications. Initially didn't work but they increased my dose to 300mg which did wonders for me - I stabilised and have now been able to come off medication, but you can take venlaflaxine long term if required. I have a friend who also takes 150mg long term and it agrees with her. Withdrawal is hard and you have to decrease slowly to get off of it but I honestly dont think I would be here if it wasn't for Venlaflaxine.

I'd stay well away from Venlafaxine and other SNRIs personally. They may work at the time but they're horrendous to come off. It took a total of 18 months to get from maximum dose to being free of them in order to TTC. The withdrawal is absolute hell.

Duloxetine?

Used for anxiety, had it before and was prescribed it, very helpful.

Just wondering-what time of day did you take Citalopram? I’m on Escitalopram, but I can only take it last thing at night. If I take it in the morning, it keeps me awake!

I know it sounds counter-intuitive, but that’s what works for me. No other advice, I’m afraid, I don’t have knowledge of other medications. 💐

I take Duloxetine 90mg and it's helped me so much x

Are you having any accompanying therapies to help you get to the root of the anxiety?

Yes I’ve done CBT and some relaxation techniques too.

I personally think it’s peri menopause but I’m too young so it’s been dismissed.

I’ve been prescribed something beginning with M but can’t recall the name?

Mirtazpine?

*mirtazapine I meant

Yes I think that was it

I went from those to mirtazapine. It apparently works in a different way, but it makes you sleep (take it before bed) and my god it makes you eat like you've been lost in the wilderness for a week!

Is follow up the peri menopause as well, if that's what you suspect then it could be 100% worth trying. I really don't understand the GPS reluctance to support this route. It would seem to be the simplest option to explore before the anxiety drugs?

I was put onto escitalopram instead of citalopram and pregablin which was tje game changer for me

I’m 38 so it’s not completely out of the realms of possibility. I’m tempted to go
Private for some tests

Drives me spare that we are given an "age" for this and yet girls periods are starting earlier and earlier, wouldn't that dictate that menopause symptoms start younger?

Anyway I would say research symptoms, maybe grab the balance app from dr Louise newson website and testing can be a bit hit and miss as the general consensus is that a test will only show the snapshot of one day, where symptoms will be across cycles and months.

If you could get a GP to listen and trying some HRT options would seem to be a really sensible approach if your able to give some time to try that as an option, it can't do any harm.

Vortioxetine is an option too.

I take fluoxetine for depression but predominantly anxiety. It can intitally increase anxiety but on the whole works for me and its the only licenced med for PMT/PMDD which I do get panic attacks pre menstrually.

Mirtazepine is really great for some people, it tends to be the side effects that put people off e.g mainly weight gain but hey if it means your not constantly 'on' then it's worth it and your appitite is probably crap ant way feeling like that.

I think I’ve changed my mind about the mirtazepine. I’m a student midwife and work days and nights so the sleepiness it causes won’t work for me.
Back to the drawing board

I have a combination of venlafaxine and pregablin. The pregablin has been a game changer for my anxiety.

@NewLifePending

I’m on mirtazapine and I’m a student ODP.

It helps drift me off to sleep, but certainly hasn’t affected me at all with shift work. I’ve personally found it to be one of the better ones. Don’t write it off just yet.

@NewLifePending

I’m a student speech and language therapist and I take Mirtazapine. Not the same I know, because I don’t do shift work, but I wouldn’t have been able to get through my course without it. I had terrible insomnia and now I sleep every night (even during exam time!), and it’s calmed my anxiety down loads. I actually feel MORE refreshed during the day, and more able to cope with the intensity of the course, because I am so rested from a good night’s sleep.

Might be worth a go