What Are The Differences Between The Ssris?

[yogini]

I have been managing my POTS on beta blockers all these years, but I always seem to be battling low BP and low energy. I am seriously thinking of giving an SSRI a try. My docs have suggested it in the past, and I have put it off. In trying option, I want to make sure I make an informed decision. A couple of docs have suggested Paxil for me, but I know that a lot of you take Lexapro or Celexa. Do any of you know what the differences are between these drugs? Also what is is the lowest possible dose I could take? I'd love to get this info in hand for my appointment on Mon or even have a website where I can find this info. Thanks!

[dsdmom]

Although SSRI's act similarly to each other, you may react differently to each. Each one has it's own set of side effects too, so maybe the doctors suggesting paxil believe that the side effects associated with that drug are the least harmful for you. Really, this can also just be a trial and error period until you find the right one for you. Good luck!

[MomtoGiuliana]

I think I have heard that Lexapro is most commonly prescribed for POTS. I have taken Prozac and it has worked wonders for me. There is an adjustment period. SSRIs can cause autonomic dysfunction as a side-effect during the adjustment time of a week to several weeks and they take a long time--several weeks--to be fully effective.

[bellaluna]

My doc prescribed Lexapro for me at my last visit. Granted, it has only been a week, but I haven't noticed any difference, other than feeling even more tired all the time. I'm hoping that it's just an adjustment thing for me... thankfully I didn't get the side effects from this drug that I did when my old doc tried putting me on Cymbalta- that was horrible. I had to come off of it after 2 weeks because I just could not deal with the side effects it was giving me... Overall though, in the reading I've done, most people on Lexapro seem to be happy with it.

Good luck with your decision!

Mary

[ellen]

This is a good question. My cardiac EP prescribed 50 mg of ZOLOFT for me last week, because I asked if I could possibly switch from Florinef to an SSRI. He didn't discuss any of the differences, just gave me the Rx.

It has been one week and I have been nauseous, fatiqued and my blood pressure is low. At an appointment with my rheumatologist yesterday, she just remarked that 50 mg is quite high to start out with, especially for someone who is sensitive. I have been cutting them in half for a few days because I'm so sick. I don't know if I can keep this up for 5 more weeks (until my next appt with the EP).

This would be a great study for the NIH to fund- which SSRI has the greatest improvement in POTS symptoms.

[amykrawciw]

I have been on Lexapro for almost 4 years now, and it is the best thing that I did. I tell you it has helped immensely with bettling this disease everyday. My husband was recently prescribed Celexa and hasn't started taking it yet because he has some reservations about SSRI's as well, but like several other people posted, and I told him, it is a trial and error. These drugs affect everyone a little bit different, and no matter what your doctor or a website says you have to trust how it makes you feel.

If it is any help at all my mom also started Lexapro about a year ago and she has done wonderfully on it. No reported side effects and it has seemed to help both of us out a great deal. I started out at 10mg, but you can go up to 20.

Anything you try, just trust yourself, and start slow, and I'm sure you'll find something that works for you. It is well worth it!

- Amy

[mvdula]

I was on Lexapro for 3 days before I couldn't take it anymore - I thought either it would kill me or I would kill myself - it was a nightmare - I know these are normal side effects - but she gave me 1/2 dose - can't remember, I think 5mg to start. I couldn't stay asleep at night, couldn't do anything, couldn't eat, was depressed and panicked. The first dose was ok, but after the third, I knew I couldn't take it anymore. I don't mean to scare you but those were the worst few days of my life. If I want to try another SSRI, I would start at a VERY low dose and very slowly.

[flop]

Hi, I have been on Paroxetine (Paxil/Seroxat) for over a year now. Initially I was prescribed 20mg daily by my cardiologist. The first tablet made me feel awful - nauseous, vertigo, like how I imagine it can be if very very drunk. I vowed never to take a second tablet! The next day I was still feeling a bit nauseous and wobbly but had an appointment with a different doctor - he advised me not to stop the paroxetine but to just take half a tablet daily until my body adjusted, then go up to the full 20mg dose. After a week I was on 20mg and after 2 weeks I had no noticable side-effects on the 20mg dose.

I suspect that paroxetine might be implicated in my slow weight gain but the benefits outweigh the cons (and I eat way too much junk / high fat foods and don't take enough exercise, so most of the blame for weight gain is probably lifestyle related!).

My cardiologist recommended Paroxetine as he said there was a randomised, double-blind, controlled study on paroxetine in POTS and there was no specific evidence for any of the other SSRIs. However that research was several years ago and I suspect that there is a class-effect (all SSRIs should be beneficial). I guess that the drug companies wouldn't make much profit from selling SSRIs to POTS patients (compared with the massive profits from selling to patients with depression / anxiety) so it is probably not financially viable for them to fund a study. We need government funding to research POTS treatments for us.

Good luck with whichever med you choose to try first - if it doesn't suit you then try a different one.

Flop

[Mrs. Burschman]

I think it's mostly just which one you can tolerate best. I tried Effexor at one point (it's an SNRI -- a close relative of SSRIs). It gave me a migraine daily! Yuck! So I went back to Paxil.

If I had to start over again, I'd try Celexa. Paxil works well for me, but the side effects are supposed to be the worst, and it's also the hardest of the SSRIs to get off of if you decide to in the future, due to its very short half-life.

Good luck! Let us know what you decide and how it goes.

[flop]

Ooops just thought of an important difference with some of the meds that have been mentioned.

SSRIs increase the amount of Serotonin (a neurotransmitter) in your body.

SNRIs increase the amount of Noradrenaline / Norepinepherine (a different neurotransmitter) in your body.

Some meds act on both Serotonin and Noradrenaline so have a dual action. These meds include Venlafaxine (Efexor) and Duloxetine (Cymbalta / Yentreve).

Flop

[Megan]

I've been on Prozac for a long time, however, I started it when I was just being treated from depression (coming from not knowing what was wrong with me, before the pots diagnosis) so I'm not really willing to change to a different SSRI when this one seems to be working so well. I've been on lexapro, but that didn't seem to help the depression, so I didn't stay on it. Meg

[doctorguest]

The key to trying SSRIs is that unless you try it, you wouldn't know how you react/tolerate this class of drugs. In addition, you may not be able to tolerate one type of SSRI, but may tolerate and respond very well to another. It's very individual and requires patience and a trial-and-error approach. For POTS, I would start an SSRI with a very low dose - a quarter of the smallest adult dose - and increase as tolerated. It does require 2-4 weeks for SSRIs to produce a noticable effect, but if you're feeling very sick after a few days taking it (usually 3-5 days for my patients), this is when I either decrease the dose or try another SSRI. This is just MY way of dealing with SSRIs for POTS, and your doctors may have other ways/methods for working with these medications.

I will say that there are some people who cannot tolerate any SSRIs, even at very small doses. This may be due to the type of genetic phenotype they have, and hopefully, in the future, we may be able to test for these genetic markers in order to stratify the SSRI responders from the non-responders, but until that time, a good old-fashioned trial-and-error method is all we have to offer to our patients. Good luck!

[morgan617]

I haven't been able to tolerate any SSRI's, but my son, who shows OI symptoms has done well on several. He started on Paxil and never had any problems, but after several years, they felt he have become "tolerant" to it, and was switched to Celexa, which he also did really well on, except he could not raise the dose past 20 mg, without becoming really ill.

The Effexor was a total nightmare, but he started on Lexapro and we have noticed a huge difference in him. He was started on a fairly high dose to try to counter the effects of effexor withdrawal, but just tolerates it really well. No weight gain, no sleepiness, no weight loss. He is really pleased with it.

It seems if a med gives me bad side effects, no matter how long I take it, they just won't go away. The SSRI's just seem to exacerbate the symptoms I'm trying to get rid of by taking them. I wish I could though, it would be nice to lose some of this sadness....morgan

[yogini]

Thanks so much everyone for your responses! I guess I was wondering whether any particular SSRI was more recommended for POTS than others? For example, Mayo Clinic told me that they recommend inderal for POTS but that since I was already on atenolol (luckily their second choice) they would keep me on it. I just wanted try the best option first (if there is one), but it seems that maybe for SSRIs it's more personalized. I did read that Lexapro is a new and improved version of Celexa, so maybe I'll try that first if my doc agrees.

I haven't had too much problem tolerating the POTS meds (though I haven't tried many). My biggest problem is actually weaning off the stupid meds. So I'm really, really hoping that the first SSRI works because I'm not sure I have the steam to try more than one...especially since I have managed all this time on just a BB. I've resisted trying SSRIs for 4 years for this reason. At the same time, I'm so TIRED of feeling tired all the time, and the BB just makes it worse. I need to give this a try once and for all to see if it helps - and (in my wildest dreams) maybe it could help me go off atenolol totally.

I actually haven't seen my dr in several months, though the past 2 times I saw him, he suggested Paxil. So I hope the offer will be still be open! I'll be going away for a couple of weeks and so I won't be starting any new meds until I get back in mid-March, just to be safe. And Doctorguest thank you for your suggestion - I'll definitely start at 1/4 of the adult dose - hopefully that'll help with side effects and weaning off, if need be.

[mom4cem]

I originally started with a 5mg pill of lexapro. I could not tolerate the side effects. I went off and when I was bold enough again to try, I tried the oral solution of lexapro. I started with 1mg of liquid and then went to 2.5 mg., which to this day I take. Some say it can't possibly have any effect on me, but I do know that after a weeks of taking it I started to have less adrenaline/tachy episodes. It's been over a year now and I still take the same dose without any side effect. I know that if things worsen I can increase my dose.

[yogini]

Just wanted to give an update. I had my dr's appointment today and got Paxil - I asked about Lexapro, but they wanted to give me Paxil since that is what has been studied. He wanted to give me 20 mg, but I asked for the lowest dose, so I got 10 mg and my pharmacist says I can cut it in 1/2. I'm feeling optimistic and am excited to try it...but am going to be away for 3 weeks...so I won't be able to start until I get back. I'll post another upate once I've tried it.

[Mrs. Burschman]

Good luck!

It probably will take a few weeks for you to notice a difference if it's going to help. Be patient!

Amy