Considering anxiety medication but don't want SSRI's

[CreatingHavoc]

I have anxiety issues, mainly health anxiety but also some general anxiety too. It's starting to cause a real problem in my life. When I'm feeling ill I find it hard to know if I'm making the right decision, for example do I call gp, 111 or go to A&E or just wait it out. I sometimes end up panicking and end up in A&E when I didn't really need to be there. Yet also a gp recently told me I was right to go A&E when I described my symptoms. The problem is my anxiety makes me feel much more ill than I actually am. I'd like to be able to get on top of this somehow.

I'm awaiting cbt (starting next week) but I was wondering if anyone has has had any success with medication that is not SSRI's. I also don't particularly want anything addictive or with withdrawal issues (so no pregabalin, no diazepam etc).

I'm aware that I'm probably ruling out a lot of stuff here but medication side effects are a big part of my anxiety as well. I am extremely sensitive to most medicines and can't even take codeine as it spaces me out to much and I feel like a dead weight. All antibiotics seem to ruin me as well. My body seems to process meds very efficiently for some reason! So with all this in mind, I'm keen to hear what has worked for people that fits my awkward criteria.

Propranolol might work for you, assuming you don't have asthma or blood pressure issues. It works by preventing your body expressing the physical symptoms of anxiety (increased heart rate, shaking, sweating etc.) which helps to disrupt the cycle of mental and physical symptoms reinforcing each other. I don't get on with it personally because I'm prone to blood pressure drops when I stand up, but a close friend finds it very helpful. It can be taken every day to prevent symptoms, or as-and-when to combat symptoms, and doesn't have addiction or withdrawal issues in the same way as things like pregabalin.

I know this isn't helpful but any medication with effects will have side effects, that's the nature of effective medication. Lots of people are sensitive to codeine, I am, really badly.

@FurryDandelionSeekingMissile I always have slightly low blood pressure so propranolol probably won't work for me either. I get the dizziness when standing up etc.

@MrsTerryPratchett I know all meds have side effects but I'm very suspicious of ssri's. So many people I know have been ruined by them unfortunately.

Not to be defeatist but you might struggle if you’re ruling out SSRIs. The older and atypical antidepressants tend to have more side effects, and aren’t first line treatments in the main. Marked sedation is likely with tricyclic antidepressants if you can’t manage codeine. I think CBT is a good choice for health anxiety and possibly group sessions too if you’re prepared to take part.

In that case I guess propranolol might not work for you, though I guess it depends on just how low your blood pressure is, and you could still ask your doctor about it if you wanted to — it might be your BP isn't so low as to rule it out. Since like me you already have low blood pressure and are prone to blood pressure dropping on standing, it will naturally exacerbate that, but there may be some precautions you can take.

Incidentally the reason you can't (usually) take it if you have asthma is that beta-blockers like propranolol are essentially doing the exact opposite of what beta agonists — the blue asthma reliever inhalers like Ventolin/salbutamol — do.

If you're unwilling to try SSRIs (and I assume that rules out other classes of antidepressant too) or things with dependence potential like pregabalin, which I do understand, and propranolol is out for other reasons, then it limits your options a bit.

You could try promethazine as an as-and-when medication, which is usually sold as an antihistamine but can also have sedative effects and is sometimes recommended by psychiatrists for anxiety. I would personally only use that at times when you don't have to be alert, as it does help with agitation and anxiety but can affect your ability to think and concentrate clearly.

Or some people have success with herbal remedies? Haven't tried any of those myself but I've heard they can help some people.

Also please don't take this the wrong way because I am fed up to the back teeth of people wanging on about exercise for mental health problems, but really vigorous cardio can help with getting some of the anxious energy out of you, both in the moment and over the subsequent hours. Be aware of postural/orthostatic hypotension being increased in the period immediately after vigorous exercise — it's entirely normal for those of us who are already prone to it, but can take you by surprise. (Says the woman who would go for a run, get home, flop on the sofa for ten minutes, stand up to go for a bath, and fall flat on her face, every damn time.)

Did you see the latest meta-analysis on SSRI's? It looked at multiple RCT around SSRI's use on depression (not anxiety) and disputed the claim that this is a chemical imbalance issue associated with low serotonin

From the conclusion:

"The main areas of serotonin research provide no consistent evidence of there being an association between serotonin and depression, and no support for the hypothesis that depression is caused by lowered serotonin activity or concentrations. Some evidence was consistent with the possibility that long-term antidepressant use reduces serotonin concentration"

www.nature.com/articles/s41380-022-01661-0

All I am trying to point out that before pharma hijacked psychology with it's quick fixes, it would be common to believe that anxiety / depression was a way in which the mind was telling you something was wrong - or as Jung wrote - "The foundation of all mental illness is the unwillingness to experience legitimate suffering" or "psychiatrists classify a person as neurotic if he suffers from his problems in living and a psychotic if he makes others suffer".

Coming up for your CBT (that's a whole other world of exaggerated claims) I would ask yourself the question what may be causing you to have anxiety? Where did it start? How has it manifested over time? What do you do to explore it and heal it?

These meds don't cure you, they might mask it for a short period of time but I don't think anyone should be looking to them to save them. The fact that people can be on them literally for decades tells you something.

@FurryDandelionSeekingMissile thanks for the info! That's really helpful. I think I might just see how it goes with the cbt first before trying any meds. It's such a minefield and I don't want to make myself feel worse while trying cbt as it might negate any positive effects.

I might research some herbal remedies in the meantime though.

There are loads if herbal things you could try

St. John's wort
GABA
5-htp
ashwaghanda

Or buspirone from the doc though I don't know anyone who has tried this

I take Atarax for anxiety. it's a non addictive antihistimine which has the side effect of reducing anxiety and helping sleep, so now it gets prescribed for those too. I have autism so anxiety is always high for me. The meds are to bring me back from the edge.

To be honest if you don't want to take SSRIs or anything that could be addictive, I don't think there are many options left.

Have you tried CBD oil? It helps me a little. Non addictive and you can just buy it online or from Holland and Barrett.

By the way I take SSRIs for anxiety and they are one of the best decisions I've ever made. Side effects very minimal for me. However I am not very sensitive to meds (I can take 2 cocodamol with zero side effects) so I can't say how you'd react. But over time the side effects go away, and then once they're working for you your symptoms of anxiety should go too, which would hopefully help to end the cycle of health anxiety.

@hamstersarse all that that study is doing is trying to establish the truth or otherwise of one particular academic hypothesis about the precise mechanism of action of these drugs. Incidentally, it's a hypothesis that most psychiatrists have disclaimed for a very long time (at least, in its simplistic "depression is a chemical imbalance" form that circulates in the popular press and the general culture), and which is in any case not very important to the question of whether the drugs work. I don't see how it's relevant, especially here with an OP who's not asking about depression anyway.

@hamstersarse I have seen that and it is one of the many reasons I'm not keen on them at all.

My issues with anxiety have been present since childhood. I intend to have counselling after my cbt to try and deal with the trauma I experienced in childhood. I see cbt as being a coping mechanism more than anything. I think proper trauma focused counselling is what I need but the cbt came through first and I can't do both at the same time.

Good luck with the CBT — I hope it gives you some useful strategies.

@FurryDandelionSeekingMissile

She is asking about SSRI's.

Incidentally, I am not sure how the current psychiatric community can make any claims about what 'works' given the levels of anxiety and depression we have to contend with in our communities.

I understand that you are wary of SSRIs. I was too, but I found that a short course of low-dose Cymbalta (duloxetine) really helped me find the clarity and energy I needed to deal with a very difficult time in my life.

This is similar to SSRIs but different and I did not experienceany side effectsat all. It's a selective serotonin and norepinephrine reuptake inhibitor antidepressant (SSNRI). See what your doctor says, but I'd say it's worth a try. I was only on it for about 6 months, but it really helped.

And, as a PP suggested, EXERCISE !!! This, more than anything helped me start each day with a more positive outlook. Added benefit that I'm now superfit and slim, which in itself is a good thing and a powerful motivator to sort out my life. Try Growingannanas - lots of free workouts on YouTube, with and without weights. Highly recommended!!

She specifically asked about things that aren't SSRIs.

@CreatingHavoc

Exploring your trauma is exactly the right way to go, IMO. It has a way of coming out into your life with all sorts of symptoms at unusual times unless you take the steps to explore it and reconcile the suffering you experienced.

Good luck, and I'd say trust your instincts on this one!

@hamstersarse thanks, hopefully working through it will help a lot.

Thanks to everyone who has given advice, I really need to start exercising. Thinking perhaps some pilates might be in order. I'm also going to try ashwagandha.

I didn’t get on with SSRIs. After some trial and error I found Lofepramine stabilised me, however I did get dizziness on standing in the first few weeks so maybe that won’t be for you.
I recently got diagnosed with ADHD and started on meds for that. My anxiety is greatly reduced. Regular exercise doing something I love (weights) has helped too. I think that’s why SSRIs didn’t work for me, because of the ADHD.
I hope you find something that works for you.

My husband takes trazadone and I take mirtazipine - both work perfectly for us with no side effects. Both share some characteristics with SSRIs but are not actual SSRIs -it's definitely worth talking it through with your doctor.

I don't have withdrawals from mirtazipine - if I miss a few doses for whatever reason I'm noticeably more stressed/ grouchy but that's what I was like generally before taking them haha. Mirtazipine makes me just like ME but with reduced negative emotions etc. My husband does have some withdrawals from trazadone but not terrible and also he is on the highest dose so that probably makes a difference.

5htp helped me for a bit but stopped having any effect after a couple of months. I've tried a few things and mirtazipine is the only thing that's helped consistently and with no side effects.

Good luck OP!

I have low BP and take propranolol for anxiety but only as required, not regularly. I don’t have any problems with it lowering my BP when I’m feeling anxious, the only effect is the required one. It dampens all of that horrible fight or flight feelings. I took it once as a precaution and definitely did feel a bit dizzy then, but otherwise it’s brilliant.

If the anxiety stems from childhood you might want to consider schema therapy, it really helped my anxiety that came from childhood traumas.

Valerian root is supposed to help with anxiety (at least, I saw it listed on the box when I was using it for insomnia). I used opamox as and when but that doesn't fit your requirements (I didn't find it addictive though, no trouble stopping cold turkey when I got pregnant).

I am pretty much the same use described.
Have anxiety since 16. But meds changed my life and made me feel myself even though there were some initial side effects.
Took paxil for an year, made me stable but i gained weight. After an year i weaned off.
In 2009, when I was 19 yrs and in university, i got back on antidepressants this time prozac. Took them for 4 years till 2013.

In beginning of 2015, had moderate to mid anxiety so got back on prozac and it made me stable.
I got married in 2015 and had kids in 2018 and moved to the uk in 2020 pre pandemic. No major anxiety.
I was born in India and there was some stigma attached to meds there. I was initially worried about my in laws since my husband's father, grandfather were very strict and were from warrior clans but they didn't make me feel off.

Incidentally, my elder sister also has anxiety - probably runs in the family. She tried ssri's but they didn't do much for her. She is now stable on tricyclic ADs