# best SSRI ???????



## sadedd (Dec 16, 2009)

Hi everyone

my doctor has put me on _Fluoxetine_......i have heard paraxoetine is best social phobia 
which do you guys recoomed?

thanks


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## UltraShy (Nov 8, 2003)

There isn't a best one. With meds there is so much individual difference that you're forced to try them yourself to truly know. You'll find that drugs some deem trash are treasure to another and vice versa.

There is nothing special about Paxil other than it was first to get FDA approval for treatment of SA, and reaped vast financial rewards for doing so. Such approval is largely an issue of economics rather than pharmacology.


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## meyaj (Sep 5, 2009)

UltraShy said:


> There isn't a best one. With meds there is so much individual difference that you're forced to try them yourself to truly know. You'll find that drugs some deem trash are treasure to another and vice versa.
> 
> There is nothing special about Paxil other than it was first to get FDA approval for treatment of SA, and reaped vast financial rewards for doing so. Such approval is largely an issue of economics rather than pharmacology.


Statistically speaking, escitalopram and sertraline are probably the "best" SSRIs. Of course, as an individual all this means is you have better chances with certain drugs than with others... you're totally right in that you have to try them out for yourself.

Paxil is notorious for withdrawal symptoms though... probably second only to Effexor among the SSRIs/SNRIs.


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## scarpia (Nov 23, 2009)

I know a woman who got very obnoxious while on paxil. She was hogging the stuff like candy after one of her kids killed himself. She started going on about how nobody liked me because I didn't smile enough and how I would end up killing myself like her kid and how I needed paxil too.


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## JayDontCareEh (Jul 16, 2007)

I've tried Zoloft, Paxil, and Celexa. 

Of the three I prefer Celexa.


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## soaringfalcon11 (Jun 7, 2009)

I would go with Lexapro. It's the newest and has the least side-effects. 

I take Celexa, a less refined Lexapro, and it works great at controlling my anxiety...or maybe it's all just in my head like I suspect.


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## joshweights (Dec 22, 2009)

soaringfalcon11 said:


> I would go with Lexapro. It's the newest and has the least side-effects.
> 
> I take Celexa, a less refined Lexapro, and it works great at controlling my anxiety...or maybe it's all just in my head like I suspect.


what dose works best for you and how long did it take for the anxiety to be reduced??


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## UltraShy (Nov 8, 2003)

meyaj said:


> Paxil is notorious for withdrawal symptoms though... probably second only to Effexor among the SSRIs/SNRIs.


Yeah, withdrawal is a standard complaint with Paxil. I tried it and tapered of fairly rapidly with no problems, so I can assure everyone that such problems don't happen in all cases. Withdrawal is an issue with Paxil because it has the shortest half-life of any SSRI. At the other extreme is Prozac that probably won't produce withdrawal even if you stop cold turkey because that drug has such an exceptionally long half life that it's still in you long after you take your last pill.

Paxil is also supposed to be the most sedating of the SSRIs (and Prozac is at the other extreme, supposedly being the most stimulating) -- though they both felt neutral in that regard to me. My brother had to stop Paxil when he tried it as it was too sedating for him, but didn't sedate me at all. There are vast differences in response to meds from one person to another that it's unpredictable.


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## jim_morrison (Aug 17, 2008)

UltraShy said:


> Yeah, withdrawal is a standard complaint with Paxil. I tried it and tapered of fairly rapidly with no problems, so I can assure everyone that such problems don't happen in all cases. Withdrawal is an issue with Paxil because it has the shortest half-life of any SSRI. At the other extreme is Prozac that probably won't produce withdrawal even if you stop cold turkey because that drug has such an exceptionally long half life that it's still in you long after you take your last pill.
> 
> Paxil is also supposed to be the most sedating of the SSRIs (and Prozac is at the other extreme, supposedly being the most stimulating) -- though they both felt neutral in that regard to me. My brother had to stop Paxil when he tried it as it was too sedating for him, but didn't sedate me at all. There are vast differences in response to meds from one person to another that it's unpredictable.


Yeah your absolutely right, for example I took paxil for about a year and it caused me stimulation to the point of insomnia some nights, and no withdrawl syndrome upon rapid discontinuation. So everyones different.


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## db0255 (Jul 20, 2009)

I think they all offer different things:

Paxil - noted for bad withdrawal, but is the most potent. However potency doesn't mean anything if it doesn't work for you.
Zoloft - people might prefer it because it works a little on dopamine
Prozac - probably is the most hit or miss just because you can get great results, good results, or it just plain sucks; it's probably the most quirky also
Celexa/Lexapro - mild in terms of side effects; i didn't really have any, but I didn't have any improvement either
Luvox - never tried


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## derwalrus (Dec 22, 2009)

joshweights said:


> what dose works best for you and how long did it take for the anxiety to be reduced??


I was prescribed Lexapro 10mg after being off of SSRI's for a month and I could tell a difference in my mood and anxiety within 2 days. Though it can take up to 6 weeks to achieve full potential. I did start having really bad insomnia, which it turns out is the most common side effect of Lexapro, so now I take it in the mornings. Hope this helps.


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## Rbk (Aug 5, 2010)

Most people are saying that paroxetine. I'm taking it(ParoGen) now just from 2 weeks so it is too short to say. 

I was taking sertraline for 6 months, 50mg dosage and it was not bad for me. Bigger dosage was bad because I was too excited and it was hard to stand in one place. Now, when taking paroxetine I can tell You that paroxetine is much worse on sexual dysfunctions(probably, because sertraline is working partly on dopamine).


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## mark555666 (May 1, 2008)

I hear good things about Prozac, Zoloft and Lexapro, but I hate them all.


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## Ehsan (Mar 21, 2009)

researches say lexapro is the best however i think there is not any difference between them.
for me celexa+zoloft did the best.


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## Arisa1536 (Dec 8, 2009)

I habe tried all three as well 
Fluoxetine, Arapax (paxill) and cipromil which is celexa i think ...
For social anxiety i agree that arapax is the best but side effect and mood wise, celexa is less harmful than lexapro and paxill or zoloft. 

I would ask about a decent SNRI medication, they work better than SSRI's in my opinion
then again, not one pill works for everyone, i mean personally i find the SNRI effexor brilliant but not everyone does. 
There are a list of modern tricyclic medications as well as MAOIs your doc may put you on however MAOI meds have food restrictions unlike SSRI and SNRI and some of the tricyclic antidepressants can be too sedating and cause weight gain, then again they work like a charm for some.

Sadly its a process of trial and error until you find what is best for you
:hs


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## CopadoMexicano (Aug 21, 2004)

I like zoloft. the rest are ok too but i didnt have much luck with them personally.


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## Arisa1536 (Dec 8, 2009)

MavenMI6Agent009 said:


> I like zoloft. the rest are ok too but i didnt have much luck with them personally.


Yeah i hear zoloft has the same type of serotonin inhibitor that Paxill has and they are both more potent than celexa or lexapro


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## Bigbird (Feb 25, 2010)

What differences did you guys notice between SSRI's? I have only taken lexapro and didnt like the way it made me feel. I always thought the others would be the same since they all work the same way.


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## Noca (Jun 24, 2005)

Paxil 20mg works for me.


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## deltan144 (Mar 11, 2009)

I've only tried Lexapro and Effexor-XR, and initially lexapro was heavily sedating and made me feel like a zombie but had great effects, and still using after 2years


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## ScorpioGirl (Jul 17, 2010)

I'm on Prozac and Xanax.


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## Rbk (Aug 5, 2010)

Bigbird said:


> What differences did you guys notice between SSRI's? I have only taken lexapro and didnt like the way it made me feel. I always thought the others would be the same since they all work the same way.


Nobody knows exactly how they are working in your brain. We know only that they are serotonin/dopamine/norapherarin reuptake inhibitors and ewentually that they are working on receptors "x" or "y". More selectiv or less. There are not only differences between the drugs but also between personal reaction to the drug. So, choosing drug is partly lottery.

But of course they are drugs that have good opinion in treating social anxiety, and from what I heard the best reactions are to paroxetine. Sertraline is good, too.


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## weebeastiebaby (May 15, 2009)

I have no idea because they all feel the same to me, but lexapro is supposed to be the best since it is the "cleanest" or something. Paxil is pretty good. I was on that for a looong time, but the withdrawal is truly horrid.


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## Arisa1536 (Dec 8, 2009)

Yes paxill withdrawal is similar to benzo withdrawal, its horrible.
Celexa may be the safest to withdraw from but paxill is more effective


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## aric (Aug 6, 2010)

*ssri's and body chemistry*

No one can really tell you which ssri is the best, unfortunatley... If that were the case, all the other medicines would be losing money as everyone would switch to that particular medicine of suggestion. Every medicine is different, and works differently on others. I have taken prozac (* fluoxetine *) and I honestly can't say it helped much, my mother noticed a difference, however I was more angrier at the world whist on it. I later took Celexa, which helped me in my PTSD and major depression, but, made me significantly tired - thus nuetralizing any anti-depressant qualities - as what good is a anti-depressant if it makes you tired and just want to sleep all day lol!

This sort of disorder takes a long time - in finding the right medication that is for some. There are so many medications out there that all say they're great for treating depression, so that leaves people like us wondering which one to choose.. Don't give up if fluoxetine doesn't work for you. BUT what I will SUGGEST - is that you are adding enough appropriate excercise and enough sleep (* moderate sleep, not excessive sleeping - which makes depression worse *) while following a healthy diet. You can still eat junk food, just not as much as you'd normally like to, I've followed this while drinking at least half my body weight in fluid ounces of water per day and have felt a whole lot better!


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## swedenmeds (Aug 7, 2010)

*Lexapro - best ssri*

Escitalopram is the most advanced ssri-substance. It´s a developement of citalopram and was actually an medical break-through when it was released.

Users of Lexapro... How much do you pay for it?


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## gordonjohnson008 (Nov 2, 2008)

I like Paxil, personally. I've tried Zoloft, St. John's Wort, and Lexapro. All were extremely effective for depression, but only Lexapro and Paxil were effective for SA. Lexapro is a cleaner med, but Paxil seemed slightly more effective for my personal SA & depression. It's great stuff.


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## CopadoMexicano (Aug 21, 2004)

swedenmeds said:


> Users of Lexapro... How much do you pay for it?


 I pay 150.00 bucks for 20mg tablets for a quantity of 30.


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## Rbk (Aug 5, 2010)

I pay something about 5 dollars for 30X20mg of paroxetine :b


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## Noca (Jun 24, 2005)

I pay $2 for 120 x 20mg of generic Paxil


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## areq1987 (Jul 10, 2010)

Dr House said:


> I pay $2 for 120 x 20mg of generic Paxil


cheap like candys! :clap


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## McMillan (Sep 7, 2009)

swedenmeds said:


> *Escitalopram is the most advanced ssri-substance. It´s a developement of citalopram and was actually an medical break-through when it was released*.
> 
> Users of Lexapro... How much do you pay for it?


Just curious but how so?


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## meyaj (Sep 5, 2009)

McMillan said:


> Just curious but how so?


It's incredibly clean and "targeted", easily the most elective of the SRIs.

That said, from an anti-depressant perspective (that is, to fight depression), numerous studies have placed both escitalopram and sertraline (Zoloft) as being virtual equals (statistically), but clearly ahead of the rest of the pack. Again, this is statistically speaking, and surprisingly, holds for BOTH efficacy and tolerability, separately, and thus combined as well. I should add that Effexor has been demonstrated to be up there as well in terms of efficacy, but not tolerability, but it's not even strictly an SSRI. All this means though is that these drugs tend to be more effective and better tolerated for more people than any of the other SSRIs, but not necessarily the BEST for everybody - on an individual level it really is all about trial and error, but it certainly provides the most promising starting point UNLESS you have a family history of success with a specific drug. One theory for the apparent difference between escitalopram/sertraline and the rest, is a certain degree of activity on the sigma-1 receptor. As Rbk mentioned though, we actually know VERY LITTLE about these drugs, much less be able to reliably explain WHY some are better than others.

Unfortunately, the number and quality of head-to-head comparison studies and meta-analyses for social anxiety are not so great, so if you're not trying to tackle depression, the scientific evidence for the superior efficacy of the two mentioned drugs doesn't necessarily apply. But because it IS a matter of trial and error anyways, and since it's reasonable to assume that the better tolerability will apply just as much to people with SA as it does to those with depression, they can still suggest a decent starting point. Your psychiatrist MIGHT have a better recommendation though, based on lots of experience. Trying to infer things from anecdotal reports (especially if you don't apply any sort of statistical analysis, which is generally safe to assume) is easily the most useless unless it's from a blood relative, although at worst it will just lead to wasting more of your time, and finding success with a drug that has worse side effects, and sticking with it when another SSRI that is more easily tolerated would have worked just as well... you _almost_ definitely (there are exceptions, I suppose) don't want to be stuck on Paxil if Lexapro would have been equally effective.


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## wane (Jun 9, 2010)

Taking medication (paroxetine) was the best decision i made. It has helped enormously. I feel awake during the whole day and sleep well at night. It took away a lot of the physical symptoms of anxiety as well. Being able to stay awake means i can spend evenings working on thought processes/meditating. Before medication i was like a zombie tired continuously and when i came home from school or college i would just lie down. I was physically exhausted. The tightness in my chest and stomach around others has gone. I still get sweaty palms. I no longer get that lump in the throat feeling i used to but i find i am paranoid when i do swallow as of the memory of how awful it used to feel.

Thats just my experience anyway. I didnt want to go on medication originally but it has helped immensely. I mean i developed the problem after the death of my grandpa when i was 8 years old and for the next 12 years each and everyday had severe depression/anxiety and i still denied to myself there was a problem. The last two years have easily been my best (on medication). I only wish i had taken it earlier.


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