Question: I am a 24 year old who has suffered anxiety and depression since the age 15. Nothing has worked. I have mostly taken Zoloft. Recently I have switched to Cymbalta. I am in my second week of Cymbalta and feel very keyed up, irritable, anxious, and feel as if I could loose my mind. My quality of life gets worse from day to day. I am pretty much begging someone to help me! I have tried therapy, psychologist, psychiatrist and a few other medicines. Could you please lend me some advice??
Answer: Without doing an evaluation or having a doctor patient relationship with you, I can’t give you specific medical advice. I can only discuss general principles.
First, make only one medication change at a time. When you stop one and start another at the same time you can’t be sure if you have problems due to side effects of the new medication or discontinuation of the original one.
When starting an SSRI (like Zoloft) or and SNRI (like Cymbalta) they can make anxiety symptoms worse for the first 2-3 weeks or longer.
In general it works better to use a benzodiazepine with them at least for the first 3-4 weeks (e.g., Alprazolam, Clonazepam, Lorazepam) See Best Meds for Anxiety
There are patients who don’t seem to tolerate any norepinephrine enhancing medication. They usually do better on Lexapro or Celexa, the most purely serotonin modulating antidepressants now available.
