First things first...know what you're taking, why you're taking it, how it works, and what it does:
Classifications of Anti-depressants:
1. Class Warfare Like anticonvulsants (ACs) / antiepileptic drugs (AEDs) antidepressants (ADs) are broken up into different classes based upon things like their chemical structure and how they work in your brain. Unlike AEDs the classification of ADs is relatively simple and straightforward. (1)
Antidepressants are all essentially classified by their pharmacodynamics, or what they do in your brain. Practically all drugs currently classified as (but not all drugs used as) antidepressants are based on the monoamine hypothesis (AKA the chemical imbalance theory) of depression1, or my new and improved the Communications Interference Hypothesis of psychiatric and neurological conditions. (1)
2. Reuptake Inhibitors
Reuptake inhibitors keep your brain from recycling specific neurotransmitters as quickly as it otherwise would, so those neurotransmitters stay at specific receptors longer.2Reuptake inhibitors currently on the market to treat depression are (1):
2.1 Serotonin-Selective Reuptake Inhibitors (SSRIs)
Serotonin-Selective Reuptake Inhibitors (SSRIs) are by far the most popular ADs on the planet. The most prescribed, even if they aren’t necessarily the most effective. (1) SSRIsinclude:
Celexa / Cipramil (citalopram)
Lexapro / Cipralex (escitalopram)
Luvox / Floxyfral / Faverin (fluvoxamine)
Paxil / Seroxat (paroxetine) & Pexeva (paroxetine mesylate)
Prozac (fluoxetine)
Zoloft / Lustral (sertraline)
See the SSRI page for more information about SSRIs as a class.
2.2 Norepinephrine-Selective Reuptake Inhibitors (NSRIs)
We pretty much have a choice of two Norepinephrine-Selective Reuptake Inhibitors (NSRIs) (viloxazine isn’t available in many places practically everywhere), and usually if one is available where you live, the other isn’t. Only recently has Strattera become available in countries - Canadia e.g. - where Edronax (reboxetine) was the only option. (1)
Edronax (reboxetine)
Strattera (atomoxetine)
viloxazine
Strattera doesn’t have FDA approval to treat depression, rather it’s approved to treat ADD/ADHD. But it looks and acts so much like reboxetine that it may as well be an antidepressant. See the NSRI page for more information about NSRIs as a class. (1)
2.3 Serotonin and Norepinephrine Reuptake Inhibitors (SNRIs)
Serotonin and Norepinephrine Reuptake Inhibitors (SNRIs) are the antidepressants people love to hate. Usually more effective than SSRIs, but for some people they can be a nightmare to stop taking.
Effexor (venlafaxine)
Pristiq (desvenlafaxine)
Cymbalta (duloxetine)
Savella (milnacipran) - currently approved in the US to treat fibromyalgia, but not depression. Everywhere else in the world it’s an antidepressant that is sometimes approved as a treatment for fibro or other pain-related conditions as well. (1)
See the SNRI page for more information about SNRIs as a class. (1)
3. Monoanime Oxidase Inhibitors (MAOIs)
Monoanime Oxidase Inhibitors (MAOIs) are the original modern antidepressants. (1)
Emsam (selegiline transdermal system)
Eldepryl (selegiline)
Aurorix / Manerix (moclobemide)
Marplan (isocarboxazid)
Nardil (phenelzine)
Parnate (tranylcypromine)
See the MAOI page for more information about MAOIs as a class.
4. Tricyclic & Tetracyclic Antidepressants
4.1 Tricyclic Antidepressants (TCAs)
Tricyclic Antidepressants ( TCAs) Defined by their three-ring chemical structure, almost all TCAs work in pretty much the same way: norepinephrine reuptake inhibition, alpha-1, H1 and M1 antagonism, and sodium voltage channel blocking. Some also do serotonin reuptake inhibition and some are also 5HT2A and 5HT2C antagonists. (1)
Anafranil (clomimpramine)
Elavil (amitriptyline)
Asendin (amoxapine)
clomipramine
desipramine
doxepin
Tofranil (imipramine)
Tofranil-PM (imipramine pamoate)
Pamelor (nortriptyline)
Vivactil (protriptyline)
Surmontil (trimipramine)
dosulepin / dothiepin
Antidepressants are all essentially classified by their pharmacodynamics, or what they do in your brain. Practically all drugs currently classified as (but not all drugs used as) antidepressants are based on the monoamine hypothesis (AKA the chemical imbalance theory) of depression1, or my new and improved the Communications Interference Hypothesis of psychiatric and neurological conditions. (1)
2. Reuptake Inhibitors
Reuptake inhibitors keep your brain from recycling specific neurotransmitters as quickly as it otherwise would, so those neurotransmitters stay at specific receptors longer.2Reuptake inhibitors currently on the market to treat depression are (1):
2.1 Serotonin-Selective Reuptake Inhibitors (SSRIs)
Serotonin-Selective Reuptake Inhibitors (SSRIs) are by far the most popular ADs on the planet. The most prescribed, even if they aren’t necessarily the most effective. (1) SSRIsinclude:
Celexa / Cipramil (citalopram)
Lexapro / Cipralex (escitalopram)
Luvox / Floxyfral / Faverin (fluvoxamine)
Paxil / Seroxat (paroxetine) & Pexeva (paroxetine mesylate)
Prozac (fluoxetine)
Zoloft / Lustral (sertraline)
See the SSRI page for more information about SSRIs as a class.
2.2 Norepinephrine-Selective Reuptake Inhibitors (NSRIs)
We pretty much have a choice of two Norepinephrine-Selective Reuptake Inhibitors (NSRIs) (viloxazine isn’t available in many places practically everywhere), and usually if one is available where you live, the other isn’t. Only recently has Strattera become available in countries - Canadia e.g. - where Edronax (reboxetine) was the only option. (1)
Edronax (reboxetine)
Strattera (atomoxetine)
viloxazine
Strattera doesn’t have FDA approval to treat depression, rather it’s approved to treat ADD/ADHD. But it looks and acts so much like reboxetine that it may as well be an antidepressant. See the NSRI page for more information about NSRIs as a class. (1)
2.3 Serotonin and Norepinephrine Reuptake Inhibitors (SNRIs)
Serotonin and Norepinephrine Reuptake Inhibitors (SNRIs) are the antidepressants people love to hate. Usually more effective than SSRIs, but for some people they can be a nightmare to stop taking.
Effexor (venlafaxine)
Pristiq (desvenlafaxine)
Cymbalta (duloxetine)
Savella (milnacipran) - currently approved in the US to treat fibromyalgia, but not depression. Everywhere else in the world it’s an antidepressant that is sometimes approved as a treatment for fibro or other pain-related conditions as well. (1)
See the SNRI page for more information about SNRIs as a class. (1)
3. Monoanime Oxidase Inhibitors (MAOIs)
Monoanime Oxidase Inhibitors (MAOIs) are the original modern antidepressants. (1)
Emsam (selegiline transdermal system)
Eldepryl (selegiline)
Aurorix / Manerix (moclobemide)
Marplan (isocarboxazid)
Nardil (phenelzine)
Parnate (tranylcypromine)
See the MAOI page for more information about MAOIs as a class.
4. Tricyclic & Tetracyclic Antidepressants
4.1 Tricyclic Antidepressants (TCAs)
Tricyclic Antidepressants ( TCAs) Defined by their three-ring chemical structure, almost all TCAs work in pretty much the same way: norepinephrine reuptake inhibition, alpha-1, H1 and M1 antagonism, and sodium voltage channel blocking. Some also do serotonin reuptake inhibition and some are also 5HT2A and 5HT2C antagonists. (1)
Anafranil (clomimpramine)
Elavil (amitriptyline)
Asendin (amoxapine)
clomipramine
desipramine
doxepin
Tofranil (imipramine)
Tofranil-PM (imipramine pamoate)
Pamelor (nortriptyline)
Vivactil (protriptyline)
Surmontil (trimipramine)
dosulepin / dothiepin
4.2 Tetracyclic Antidepressants
Like Tricyclic ADs, Tetracyclic Antidepressants are defined by their four-ring chemical structure, and both classes are usually lumped together3. Unlike tricyclics, the tetracyclics don’t all work the same way. Remeron and mianserin are also classified as noradrenergic and specific serotonergic (1) antidepressants (NaSSAs)
Remeron (mirtazapine)
Ludiomil (maprotiline)
mianserin
See the TCA page for more information about TCAs as a class. (1)
5. Miscellaneous Antidepressants
Some are alike, some are unique.
5.1 Other Multiple Reuptake Inhibitors
Wellbutrin (bupropion)
Aplenzin (bupropion hydrobromide)
A few more are under development
5.2 Serotonin Antagonist and Reuptake Inhibitors (SARIs)
trazodone
nefazodone
5.3 Antidepressant and Antipsychotic combinations
Symbyax may be recent, but they’ve been around for a long, long time.
Etrafon/Triavil (amitriptyline HCl and perphenazine)
Symbyax (olanzapine and fluoxetine HCl)
5.4 Everything else
Valdoxan (agomelatine)
Stablon (tianeptine)
Lovaza (omega-3-acid ethyl esters) - AKA prescription-strength omega-3 fish oil. Treating depression is an off-label application, and practically everyone buys decent fish oil from a supplements retailer.
FDA-approved, or otherwise generally accepted, non-medication treatments for depression-spectrum disorders
Electroconvulsive therapy (ECT)
Repetitive Transcranial Magnetic Stimulation (rTMS)
Vagal Nerve Stimulator (VNS)
Cognitive Behavioral Therapy (CBT)
Light Therapy.
(1)
Like Tricyclic ADs, Tetracyclic Antidepressants are defined by their four-ring chemical structure, and both classes are usually lumped together3. Unlike tricyclics, the tetracyclics don’t all work the same way. Remeron and mianserin are also classified as noradrenergic and specific serotonergic (1) antidepressants (NaSSAs)
Remeron (mirtazapine)
Ludiomil (maprotiline)
mianserin
See the TCA page for more information about TCAs as a class. (1)
5. Miscellaneous Antidepressants
Some are alike, some are unique.
5.1 Other Multiple Reuptake Inhibitors
Wellbutrin (bupropion)
Aplenzin (bupropion hydrobromide)
A few more are under development
5.2 Serotonin Antagonist and Reuptake Inhibitors (SARIs)
trazodone
nefazodone
5.3 Antidepressant and Antipsychotic combinations
Symbyax may be recent, but they’ve been around for a long, long time.
Etrafon/Triavil (amitriptyline HCl and perphenazine)
Symbyax (olanzapine and fluoxetine HCl)
5.4 Everything else
Valdoxan (agomelatine)
Stablon (tianeptine)
Lovaza (omega-3-acid ethyl esters) - AKA prescription-strength omega-3 fish oil. Treating depression is an off-label application, and practically everyone buys decent fish oil from a supplements retailer.
FDA-approved, or otherwise generally accepted, non-medication treatments for depression-spectrum disorders
Electroconvulsive therapy (ECT)
Repetitive Transcranial Magnetic Stimulation (rTMS)
Vagal Nerve Stimulator (VNS)
Cognitive Behavioral Therapy (CBT)
Light Therapy.
(1)
What is a Mood Stabilizer?
That all depends on whom you ask.
Neuroscientific Basis and Practical Applications Stahl writes that the FDA states there is no such thing as a mood stabilizer. That’s not quite true. Granted, there is no “mood stabilizer” product subcategory (under psychotherapeutic agents) in the PDR, but the old “antimanic” has been replaced with “bipolar agents.” Lamictal is approved to “delay the time to occurrence of mood episodes in patients treated for acute mood episodes with standard therapy.” Which is about as close to “mood stabilizer” as you can get. Seroquel is approved to treat bipolar mania, mixed states, and bipolar depression; and that about covers the entire tripolar disorder spectrum,1 unless someone knows of a fourth pole. (1)
If you ask PubMed you’ll get several answers. In What makes a drug a primary mood stabilizer? the answer is mainly along the antimanic definition. In What exactly is a mood stabilizer? the answer is “at least two of antimanic, antidepressant and prophylactic properties.” Using those criteria Celexaand Lexapro are mood stabilizers, as they prevent relapses better than other SSRIs. (1)
I’d prefer a more precise taxonomy of true mood stabilizers - Lamictal, Seroquel, lithium, and some others to a lesser extent - vs. antimanics such as Depakote and Risperdal. That would be both confusing to most people, since we’ve all grown up on “mood stabilizer = anticonvulsant” so it’s difficult enough to make people understand AED and “mood stabilizer” are not synonyms, and not entirely correct, as some meds that are primarily antimanics can have antidepressant qualities for some-to-many people. (1)
Practically every type of medication has been thrown at bipolar disorder at one time or another. Way back when bipolar was called “manic-depression” it seemed as if every drug in the PDR was tried. And while various things are still thrown at people for whom nothing else is working, most everyone is prescribed either an antiepileptic drug (AED)/anticonvulsant (AC) or an antipsychotic (AP), usually an atypical antipsychotic (AAP), as their primary medication to control bipolar disorder. Sometimes one is enough, sometimes one is part of a cocktail that includes anantidepressant, sometimes they need one (or more) of each, with or without other types of meds. The majority of people with bipolar disorder need one or two daily meds, and their doctors get it right the first or second time. As long as you don’t want perfection and keep the perspective that the side effects suck so much less than the insanely stupid things you can do when manic, let alone when you feel like poop due to this illness, you probably won’t have to ride the med-go-round too often or for too long. (1)
Pages about Mood Stabilizers (1)
List of Mood Stabilizers. Drugs for Bipolar Disorder currently in use; mainly in countries where most people aren’t living on a budget of US$1 a day.
First-Generation Antipsychotic drugs (FGAs) & Atypical Antipsychotic drugs (AAPs) as Mood Stabilizers The old way and new way of getting you off of the bipolar coaster.
Antiepileptic Drugs (AEDs) as Mood Stabilizers From Depakote to Lamictal, and all the others that were never approved by the FDA.
Bibliography
Bipolar Disorder Treatment Options Forum. If you still have questions, our forum dedicated to bipolar treatment options is the place to ask. (1)
‹ List of Antipsychotic Drugs | AP Topic Index | Common uses of Antipsychotic Drugs ›
Like antidepressants (ADs) and anticonvulsants / antiepileptic drugs (AEDs), antipsychotics (APs) are broken up into different classes based upon things like chemical structure and how they work in your brain. Like AEDs there is some overlapping membership. Currently the primary classification of APs is a combination of when they were developed and how they work (pharmacodynamics). (1)
1. First-Generation Antipsychotic Agents / Neuroleptics
With the exception of lithium carbonate and Haldol (haloperidol), all first-generation antipsychotic agents (FGAs), also known as standard antipsychotics and typical antipsychotics, were thought to work in the exact same way - binding to D2 dopamine,M1 muscarine, H1 histamine, and maybe even a little alpha-1 noradrenergic receptors to interfere with the reception of those neurotransmitters (D2, M1, H1 and α1 antagonists). The only differences being chemical structure, potency at the various receptors, where in your brain this would happen, and each drug’s pharmacokinetics. Haldol is different in that it doesn’t do much as far as M1 and H1 are concerned, and is a lot more potent in binding to alpha-1, so its side effect profile is somewhat different. (1)
With better technology and more competition for grant money, researchers are looking back at FGAs to see how they work. Turns out they all don’t work the same way after all and some (loxapine, chlorprothixene, e.g.) are like Haldol in that they are a lot more like atypical / second-generation antipsychotics than FGAs. (1)
1.1 List of First-Generation / Standard / Typical Antipsychotic Agents (1)
Thorazine (chlorpromazine HCl)
fluphenazine decanoate
Prolixin (fluphenazine HCl)
Serentil (mesoridazine besylate)
Trilafon (perphenazine)
Compazine (prochlorperazine)
Mellaril (thioridazine HCl)
Stelazine trifluoperazine HCl
Haldol (haloperidol)
haloperidol decanoate
Loxitane (loxapine succinate)
Moban (molindone HCl)
Orap (pimozide)
Navane (thiothixene)
Serpasil (reserpine)
Taractan / Truxal (chlorprothixene)
Sordinol (clopenthixol)
Depixol / Fluanxol (flupentixol)
flupentixol deconate
Clopixol / Acuphase (zuclopenthixol)
zuclopenthixol deconate
Subsets of FGAs:
1.2 Phenothiazines1
Thorazine (chlorpromazine HCl)
fluphenazine decanoate
Prolixin (fluphenazine HCl)
Serentil (mesoridazine besylate)
Trilafon (perphenazine)
Compazine (prochlorperazine)
Mellaril (thioridazine HCl)
Stelazine trifluoperazine HCl
1.3 Thioxanthenes
Navane (thiothixene)
Taractan / Truxal (chlorprothixene)
Sordinol (clopenthixol)
Depixol / Fluanxol (flupentixol)
flupentixol deconate
Clopixol / Acuphase (zuclopenthixol)
zuclopenthixol deconate
2. Second-Generation Antipsychotic Agents / Neuroleptics
Second-generation antipsychotic agents (SGAs), AKA atypical APs (AAPs) do a heck of a lot more than most FGAs. They are broad-spectrumantagonists of dopamine, alpha-noradrenergic, and serotonin receptors. Except for Risperdal (risperidone) and Invega (paliperidone) - which is Risperdal’s active metabolite (i.e. predigested Risperdal) in pill form - no two of them work the exact same way, hence the term “atypical”. Although it’s now unclear if Invega does a little more than Risperdal, or maybe they missed something that Risperdal does. Clozaril (clozapine), Zyprexa(olanzapine) and Saphris (asenapine) are fairly close in pharmacodynamics, and they bind to practically every neurotransmitter receptor you’ve got, while Risperdal / Invega don’t do much more than Haldol (haloperidol) does. Since they are now prescribed far more often than FGAs, the term “atypical” to describe them, and “standard” to describe the older APs, is counterintuitive. So FGA and SGA are the preferred terms among researchers. On most consumer-oriented mental health sites the term “atypical antipsychotic” (AAP) is still used far more often. (1)
2.1 List of Second-Generation / Atypical Antipsychotic Agents (1)
Zyprexa (olanzapine)
Seroquel (quetiapine)
Geodon (ziprasidone)
Fanapt (iloperidone)
Saphris (asenapine)
Risperdal (risperidone)
Invega (paliperidone)
Latuda (lurasidone)
Clozaril (clozapine)
Solian (amisulpride)
Asendin (amoxapine) - See below
While officially classified as a tetracyclic antidepressant (TCA), Asendin (amoxapine) is being unofficially classified as an SGA by Stahl and other pharmacologists, based upon its efficacy in treating schizophrenia and mechanism of action (1)
3. Third-Generation Antipsychotic Agents / Neuroleptics
Third-generation antipsychotic agents (TGAs) are APs that are both dopamine antagonists (interfering with dopamine reception) and partial agonists(stabilizing dopamine reception). Abilify (aripiprazole) is the first TGA on the market, several more are under development / in various clinical trial phases. Abilify (aripiprazole) (1)
using anti-anxiety drugs to treat GAD, SAnD, PTSD, OCD, PD, and other initialisms
1. Define Your Terms
Just to clear up some of the terminology used. Anxiolytic is the technical term for an anti-anxiety medication. It’s also a lot shorter. Tranquilizer and sedative are interchangeable terms for a type of anxiolytic that also puts you to sleep, or relaxes you so much you may as well be sleeping, such as a benzodiazepine. “Major tranquilizer” is a holdover from the days when consumers didn’t know anything about the meds they were taking and often refers to an antipsychotic - usually a first-generation antipsychotic - that is being used to treat anxiety and insomnia. Sedatives is a class of medications that includes barbiturates, chloral hydrate, benzodiazepines, and some modern hypnotics such as Ambien (zolpidem tartrate). (1)
2. Anxiety Spectrum Conditions
When most people think of anxiety conditions they think of conditions such as generalized anxiety disorder (GAD), social anxiety disorder (SAnD) / social phobia, and various panic disorders, especially agoraphobia. Other conditions in the anxiety spectrum include obsessive-compulsive disorder (OCD) and post-traumatic stress disorder (PTSD). Most of the time anxiety conditions can be treated without medication. When medication is required it is usually for a short duration and/or used as needed (PRN). As with depression, meds should be reserved for when someone isn’t, or is barely able to function due to their condition. (1)
1. Define Your Terms
Just to clear up some of the terminology used. Anxiolytic is the technical term for an anti-anxiety medication. It’s also a lot shorter. Tranquilizer and sedative are interchangeable terms for a type of anxiolytic that also puts you to sleep, or relaxes you so much you may as well be sleeping, such as a benzodiazepine. “Major tranquilizer” is a holdover from the days when consumers didn’t know anything about the meds they were taking and often refers to an antipsychotic - usually a first-generation antipsychotic - that is being used to treat anxiety and insomnia. Sedatives is a class of medications that includes barbiturates, chloral hydrate, benzodiazepines, and some modern hypnotics such as Ambien (zolpidem tartrate). (1)
2. Anxiety Spectrum Conditions
When most people think of anxiety conditions they think of conditions such as generalized anxiety disorder (GAD), social anxiety disorder (SAnD) / social phobia, and various panic disorders, especially agoraphobia. Other conditions in the anxiety spectrum include obsessive-compulsive disorder (OCD) and post-traumatic stress disorder (PTSD). Most of the time anxiety conditions can be treated without medication. When medication is required it is usually for a short duration and/or used as needed (PRN). As with depression, meds should be reserved for when someone isn’t, or is barely able to function due to their condition. (1)
3. First-Line Pharmacological Treatments
Benzodiazepines are the traditional pharmacological treatment for most of these conditions. These days they are mostly prescribed for someone who needs to be medicated only occasionally. *
SSRIs, along with some of the more serotonergic antidepressants from other classes, are usually the first meds of choice for anyone with an anxiety spectrum condition who needs to be medicated every day, either in the short term as part of psychological therapy, or in the long term.
SNRIs - for a lot of people too much norepinephrine is the cause of anxiety, but there are a lot of people who can use a little boost in the adrenergic receptors to help them with their anxiety.
BuSpar (buspirone), which is in a class all its own2, is the best first choice for GAD when someone is in that nebulous area of too anxious too often for therapy alone with a PRN drug, but not so anxious for an SSRI.
Technically Luvox (fluvoxamine) is in a class of its own as well, as it is approved by the FDA to treat OCD and nothing else. But it is an SSRI, and approved as an antidepressant everywhere else in the world, so I classify it as an antidepressant. (1)
4. Second-line Pharmacological Treatments
Benzodiazepines are the traditional pharmacological treatment for most of these conditions. These days they are mostly prescribed for someone who needs to be medicated only occasionally. *
SSRIs, along with some of the more serotonergic antidepressants from other classes, are usually the first meds of choice for anyone with an anxiety spectrum condition who needs to be medicated every day, either in the short term as part of psychological therapy, or in the long term.
SNRIs - for a lot of people too much norepinephrine is the cause of anxiety, but there are a lot of people who can use a little boost in the adrenergic receptors to help them with their anxiety.
BuSpar (buspirone), which is in a class all its own2, is the best first choice for GAD when someone is in that nebulous area of too anxious too often for therapy alone with a PRN drug, but not so anxious for an SSRI.
Technically Luvox (fluvoxamine) is in a class of its own as well, as it is approved by the FDA to treat OCD and nothing else. But it is an SSRI, and approved as an antidepressant everywhere else in the world, so I classify it as an antidepressant. (1)
4. Second-line Pharmacological Treatments
Antipsychotics, either by themselves or to augment antidepressants or BuSpar, are also used to treat anxiety disorders.
Antihistamines. In addition to treating severe allergic reactions, new antihistamines were being developed in the 1950s to deal with two problems prior to surgery: anxiety and anesthesia-induced vomiting3. They’ve been used to treat anxiety ever since. While the more potent ones like Vistaril - which you’ll probably find only in hospitals - are FDA-approved to treat anxiety, OTC antihistamines like Benadryl (diphenhydramine) can work as needed for mild panic/anxiety attacks.
Beta blockers, like benzodiazepines, are good for when you only need to take a drug PRN. They are mostly used for SAnD, specifically in situations like public speaking or other cases of performance anxiety4.
5. Medications Used for Anxiety Spectrum Conditions
5.1 Drugs discussed on this site with FDA-approval to treat anxiety spectrum conditions
BuSpar (buspirone)
Lexapro (escitalopram)*
Luvox (fluvoxamine)
Paxil (paroxetine)
Prozac (fluoxetine)
Zoloft (sertraline)
Effexor (venlafaxine)*
Cymbalta (duloxetine) *
5.2 Drugs discussed on this site used off-label to treat anxiety spectrum conditions
Celexa (citalopram) - although it’s approved to treat anxiety conditions in Britain, Ireland, and South Africa. Probably elsewhere as well.
imipramine
amitriptyline
nortriptyline
protriptyline
amoxapine - although approved to treat depression with anxiety
trazodone
Invega (paliperidone)
Risperdal (risperidone)
Seroquel (quetiapine fumarate)
Zyprexa (olanzapine) *
5.3 Other drugs with FDA-approval to treat anxiety spectrum conditions
Benzodiazepines:
Ativan (lorazepam)
Klonopin (clonazepam) (This is what I was addicted to taking 4mg-6mg/day -Stigmas and Stilettos)
Librium (chlordiazepoxide hydrochloride)
oxazepam
Tranxene (clorazepate dipotassium)
Valium (diazepam)
Xanax (alprazolam)
Antidepressants:
Anafranil (clomipramine hydrochloride)
Etrafon (perphenazine and amitriptyline hydrochloride) - combination antidepressant & antipsychotic
Nardil (phenelzine sulfate)
Parnate (tranylcypromine sulfate)
Sinequan (doxepin hydrochloride)
Antipsychotics:
Compazine (prochlorperazine)
Loxitane (loxapine succinate)
Orap (pimozide): Tourette Syndrome
Stelazine (trifluoperazine hydrochloride)
Antihistamines:
Atarax (hydroxyzine hydrochloride)
Vistaril (hydroxyzine pamoate)
Beta blockers:
acebutolol hydrochloride
metoprolol
propranolol hydrochloride
sotalol hydrochloride
timolol
Miscellaneous:
droperidol
mephobarbital
Now for the "FUN" side of meds...The side effects:
Common Serotonin-Selective Reuptake Inhibitor (SSRI) Side Effects
SSRIs are notorious for killing your libido, which in turn can be counterproductive in dealing with depression. Especially if you’re in a relationship. Most especially if you’re in a relationship with someone with bipolar hypersexuality, but no point in opening up some of our old issues. Of course the only thing I liked about SSRIs was that they dealt with my bipolar hypersexuality by eliminating my libido. Sometimes they’ll leave your libido alone but interfere with you in other ways, like render you impotent or unable to have an orgasm.
Paxil (paroxetine hydrochloride) and Prozac (fluoxetine hydrochloride) are the worst offenders when it comes to this and Lexapro (escitalopram oxalate) seems to have the least problem with it. (1)
Just to prove that anything is possible with these crazy meds, these case studies show how some SSRIs, including Paxil (paroxetine hydrochloride) and Prozac (fluoxetine hydrochloride), can be aphrodisiacs. (1)
Weight gain is a frequent side effect of the SSRIs. Sometimes it’s a coin-toss with Prozac (fluoxetine hydrochloride) and isn’t a common concern with Zoloft. if you’re going to gain or lose weight, but all the others tend to make you put on the pounds. (1)
Other common side effects when starting SSRIs are headache, nausea, sweating, dry mouth, sleepiness or insomnia, and diarrhea or constipation. Sometimes it’s a coin-toss on the last sets, as you might get to alternate. These are generally transitory effects and pass within a couple weeks. These are incorrectly known as anticholinergic, the term actually applies to another class of meds that affects other neurotransmitters. But you get the exact same side effects, so what the hell. It’s like calling someone who breaks into a computer a hacker.
Once again Lexapro (escitalopram oxalate) seems to have the least problems with these common effects. It may not work better than any of the others but the consensus is that it sucks less that all of them! (1)
While not a side effect per se, SSRIs and SNRIs all have a drug-drug interaction with blood-thinners such as aspirin and other NSAIDs, and warfarin, the drug that interacts with everything. It’s one of those interactions where one drug, in this case the SSRI or SNRI, affects how the other drug works. In this case SSRI/SNRI + blood-thinner = even thinner blood, with an increased risk of ulcers and internal bleeding. (1)
Antihistamines. In addition to treating severe allergic reactions, new antihistamines were being developed in the 1950s to deal with two problems prior to surgery: anxiety and anesthesia-induced vomiting3. They’ve been used to treat anxiety ever since. While the more potent ones like Vistaril - which you’ll probably find only in hospitals - are FDA-approved to treat anxiety, OTC antihistamines like Benadryl (diphenhydramine) can work as needed for mild panic/anxiety attacks.
Beta blockers, like benzodiazepines, are good for when you only need to take a drug PRN. They are mostly used for SAnD, specifically in situations like public speaking or other cases of performance anxiety4.
5. Medications Used for Anxiety Spectrum Conditions
5.1 Drugs discussed on this site with FDA-approval to treat anxiety spectrum conditions
BuSpar (buspirone)
Lexapro (escitalopram)*
Luvox (fluvoxamine)
Paxil (paroxetine)
Prozac (fluoxetine)
Zoloft (sertraline)
Effexor (venlafaxine)*
Cymbalta (duloxetine) *
5.2 Drugs discussed on this site used off-label to treat anxiety spectrum conditions
Celexa (citalopram) - although it’s approved to treat anxiety conditions in Britain, Ireland, and South Africa. Probably elsewhere as well.
imipramine
amitriptyline
nortriptyline
protriptyline
amoxapine - although approved to treat depression with anxiety
trazodone
Invega (paliperidone)
Risperdal (risperidone)
Seroquel (quetiapine fumarate)
Zyprexa (olanzapine) *
5.3 Other drugs with FDA-approval to treat anxiety spectrum conditions
Benzodiazepines:
Ativan (lorazepam)
Klonopin (clonazepam) (This is what I was addicted to taking 4mg-6mg/day -Stigmas and Stilettos)
Librium (chlordiazepoxide hydrochloride)
oxazepam
Tranxene (clorazepate dipotassium)
Valium (diazepam)
Xanax (alprazolam)
Antidepressants:
Anafranil (clomipramine hydrochloride)
Etrafon (perphenazine and amitriptyline hydrochloride) - combination antidepressant & antipsychotic
Nardil (phenelzine sulfate)
Parnate (tranylcypromine sulfate)
Sinequan (doxepin hydrochloride)
Antipsychotics:
Compazine (prochlorperazine)
Loxitane (loxapine succinate)
Orap (pimozide): Tourette Syndrome
Stelazine (trifluoperazine hydrochloride)
Antihistamines:
Atarax (hydroxyzine hydrochloride)
Vistaril (hydroxyzine pamoate)
Beta blockers:
acebutolol hydrochloride
metoprolol
propranolol hydrochloride
sotalol hydrochloride
timolol
Miscellaneous:
droperidol
mephobarbital
Now for the "FUN" side of meds...The side effects:
Common Serotonin-Selective Reuptake Inhibitor (SSRI) Side Effects
SSRIs are notorious for killing your libido, which in turn can be counterproductive in dealing with depression. Especially if you’re in a relationship. Most especially if you’re in a relationship with someone with bipolar hypersexuality, but no point in opening up some of our old issues. Of course the only thing I liked about SSRIs was that they dealt with my bipolar hypersexuality by eliminating my libido. Sometimes they’ll leave your libido alone but interfere with you in other ways, like render you impotent or unable to have an orgasm.
Paxil (paroxetine hydrochloride) and Prozac (fluoxetine hydrochloride) are the worst offenders when it comes to this and Lexapro (escitalopram oxalate) seems to have the least problem with it. (1)
Just to prove that anything is possible with these crazy meds, these case studies show how some SSRIs, including Paxil (paroxetine hydrochloride) and Prozac (fluoxetine hydrochloride), can be aphrodisiacs. (1)
Weight gain is a frequent side effect of the SSRIs. Sometimes it’s a coin-toss with Prozac (fluoxetine hydrochloride) and isn’t a common concern with Zoloft. if you’re going to gain or lose weight, but all the others tend to make you put on the pounds. (1)
Other common side effects when starting SSRIs are headache, nausea, sweating, dry mouth, sleepiness or insomnia, and diarrhea or constipation. Sometimes it’s a coin-toss on the last sets, as you might get to alternate. These are generally transitory effects and pass within a couple weeks. These are incorrectly known as anticholinergic, the term actually applies to another class of meds that affects other neurotransmitters. But you get the exact same side effects, so what the hell. It’s like calling someone who breaks into a computer a hacker.
Once again Lexapro (escitalopram oxalate) seems to have the least problems with these common effects. It may not work better than any of the others but the consensus is that it sucks less that all of them! (1)
While not a side effect per se, SSRIs and SNRIs all have a drug-drug interaction with blood-thinners such as aspirin and other NSAIDs, and warfarin, the drug that interacts with everything. It’s one of those interactions where one drug, in this case the SSRI or SNRI, affects how the other drug works. In this case SSRI/SNRI + blood-thinner = even thinner blood, with an increased risk of ulcers and internal bleeding. (1)
Serotonin and Norepinephrine Reuptake Inhibitor (SNRI) Antidepressants
1. The Antidepressants People Love to Hate.
The data are contradictory regarding how effective Serotonin and NorepinephrineReuptake Inhibitors (SNRIs) are compared with Serotonin-Selective Reuptake Inhibitors (SSRIs). When it comes to treating neuropathic pain SNRIs generally work a lot better, especially the ones that have more of an effect on norepinephrine. Savella (milnacipran) has a practically equal effect on serotonin and norepinephrine1, while Effexor is essentially an SSRI until you’re taking 187.5–225 mg a day, give or take 37.5 mg. Depression and anxiety are something else. On one hand SSRIsare easier to deal with, on the other SNRIs are far less likely to poop out (tachyphylaxis). (1)
Cymbalta (duloxetine)
Effexor (venlafaxine)
Pristiq (desvenlafaxine)
Savella (milnacipran)
Interesting Stuff your Doctor Probably didn’t Tell You about Effexor
Raw, freebase4 venlafaxine is actually one of, if not the least potent of all the antidepressants on the market. If venlafaxine hydrochloride weren’t so well absorbed and distributed Let’s see if I can write it down correctly this time. If the active ingredient were as well-absorbed and distributed when compared with the other ADs I could understand why it is so effective. As it is, I can’t understand why the heck it isn’t be practically a placebo. Those awesome sketchy pharmacokinetics may have something to do with why the discontinuation syndrome sucks so much donkey dong, but that’s still just a guess of mine and there’s no research to back it up. Just like Paxil, the short half-lives of venlafaxine HCl and its active metabolite are a known reason why Effexor withdrawal is so awful. And why some people experience SSRI/SNRI discontinuation syndrome if they miss a single dose, or are a few hours late in taking a dose! (1) (I experienced this many times-Stigmas and Stilettos)
It could be that it’s like bupropion, another weak-as-water drug that is surprisingly effective. According to Dr. Stahl, bupropion might be transformed into one or more of its three (so far known) active metabolites by the CYP450 genes in your brain instead of in your liver. So what it doesn’t have in the way of raw, pharmacological power, it makes up for by being undiluted by plasma. Perhaps venlafaxine HCl does the same thing. (1)
Although an SNRI, because its effect on norepinephrine usually isn’t noticeable until you reach a dosage somewhere north of 150mg a day, its initial, and mostly short-term, side effects are more like an SSRI. Not that there’s all that much difference between the two classes. So expect a few of:
headache, nausea, dry mouth, sweating, sleepiness or insomnia (with insomnia a little more likely), constipation or diarrhea (constipation is somewhat more likely), weight gain (although less likely and severe than most SSRIs), and assorted sexual dysfunctions. While sexual dysfunction is also a little less likely than SSRIs, some women will get a sexual boost at the higher dosages instead of a sexual dampening. It’s neither as frequent nor as pronounced (usually) as with the other SNRIs or the NSRIs (Strattera and reboxetine), but it does happen. (1)
Sorry guys, but a higher dosage usually means whatever problems you had in that area will probably just get worse.
Return to Table of Contents
6.2 Uncommon Side Effects
increased or lowered blood pressure
sweating
farting
anorexia
twitching
shock-like sensations (while you’re still taking it)
alcohol intolerance and/or alcohol abuse
making it just the thing to talk about at AA meetings (Yes, I fully experienced this- S&S)(1)
Common Side Effects of Antipsychotic Drugs (APs)
The next page in this series is about the common side effects that can potentially cause you real problems. While the adverse reactions discussed on this page aren’t particularly fun, they usually don’t suck more than whatever condition they are treating. (1)
Side effects common to all second-generation / atypical antipsychotics are short-term nausea and other gastric distress, headaches and dizziness. Not so short-term is the sleepiness. Most of the atypicals make you very tired, something you may or may not get over.
In general the anticholinergic side effects, especially constipation, are very popular with most APs. What is responsible for that is also responsible for keeping EPS in check.
All crazy meds can mess with your dreams while you sleep. Antipsychotics are the most likely to do so. It’s impossible to predict the effects, intensity or duration of this side effect. (1)
Like the anticonvulsants, the atypical antipsychotics make you photosensitive and can mess with your hormones, usually to a lesser extent on both counts. Risperdal (risperidone) is the hormonal exception, so ladies need to especially watch out with Risperdal (risperidone), as it is notorious for messing with prolactin. (1)
While we’re on the subject of hormones, a large Spanish study has Risperdal (risperidone), the standard antipsychotic Haldol (haloperidol) and Zyprexa (olanzapine) the worst offenders for sexual side effects. They all seem to be dosage-related, so the higher the dosage the worse the sexual dysfunction will be. (1)
The very nature of the drugs are such that they can cause odd effects at times, like extrapyramidal symptoms (EPS) (I experienced this with Trileptal and Geodon- Stigmas and Stilettos), depersonalization and/or derealization; so you do this weird hand-jive, you’re not who you are and nothing is real. Only you get to feel that way with federally approved drugs, and not that questionable mescaline you purchased from some guy you met at a rave the other night. Many people complain of “feeling like a zombie.” Except for the EPS, these other wacky feelings usually pass within a matter of a couple of weeks. (1)
Sadly, the antipsychotics can make one psychotic. It doesn’t happen often, but it does happen. Especially if you’re bipolar and subject to the paradoxical reaction to medications. You really do have to keep a close watch on yourself when you first take them. Fortunately you can just stop taking them at the doses used for anxiety, high-functioning autism, most adjunctive bipolar therapy, and as part of a cocktail for refractory depression. When taken as monotherapy for bipolar and the schizophrenia spectrum they’d have to be reduced in dosage like most other meds. (1)
Common Side Effects of Benzodiazepines (benzos)
Benzodiazepines have a really low side effect profile (Except for AWFUL withdrawal-Stigmas and Stilettos), which is one reason they are so popular. (1)
They universally mess with your memory, but are otherwise generally side effect free. Sometimes doctors will use that stupid memory trick with some particularly anxious patients and give them a high dosage of a benzo in an injectable form prior to an operation. The result is not only a calm patient, but one who frequently can’t remember that a surgical procedure even happened! As long as you realize that the sedation is an expected side effect that may or may not go away, which is why you can’t rely upon them as a nightly sleep aid. The benzodiazepines are the safest of all psychiatric medications. You can’t overdose on them alone, although they can make other drugs, like alcohol, work a lot better. It’s not the Valium that kills you when you wash it down with Whiskey, it’s alcohol poisoning. (1)
While popular as a sleep aid, tolerance to them builds up quickly for a lot of people (Yes, hence me getting addicted, "needing more and more"-Stigmas and Stilettos) They’re great for occasional insomnia, but you’re probably better off looking into something else if you can’t get to sleep every night. Some people can take them every night for as a sleep aid, especially if taking the ones approved for sleep disorders. Keep in mind that the sedation thing is a side effect of the benzos not approved, yet frequently prescribed for insomnia, and you can expect it to go away with continued use. (1)
Because benzos feel really nice, and for some people they feel especially nice, they shouldn’t be used by anyone with a history of substance abuse. Or a family history of substance abuse. Let’s be clear here about what substance abuse is. Past use of illegal drugs alone is not substance abuse, past use of illegal drugs is breaking the law. Physical and/or psychological dependence on recreational substances, be they legal or illegal, that’s substance abuse. A diagnosis of OCD makes things a bit tricky, and a long talk with your doctor is in order when going over the pros and cons of benzos, because you could wind up taking too many, using up your prescription, not being able to get a refill and then getting to enjoy the withdrawal syndrome. (1)
(1) Crazy Meds - Finding the Treatment Options that Suck Less ... (2014, January 1). Retrieved August 11, 2014.
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