TCAs work differently from SSRIs, it's not just affecting the serotonin reuptake. They're not selective, so they can be more effective but have a larger room for error, from my understanding. MAOIs also use a different mechanism than SSRIs, so I'm not sure why you're thinking it's the same, am I missing something..? I'm not as familiar with MAOIs compared to the others from personal experience, so I very well could be missing something lol
Ah sorry, yes of course they are different, but I meant that they target the same system in the end. The mechanism how they do that plays a role for sure, but if your anxiety simply isn't impacted by changes in serotonin activity, or just of a different nature then it doesn't matter much whether you're ihibiting reuptake or directly agonise specific receptors.
I don't really like this classification stuff tbh, because, especially for TCAs, there is a ton of variance. Admittedly some SSRIs are very clean and almost exclusively inhibit SERT, but lets take venlafaxine which is marketed as SNRI,.. it's so much more selective for SERT that it only starts acting as NET a little bit at high doses.
Compare that to the other popular SNRI, Duloxetine, which is way more balanced in its targeting.
MAOIs inhibit the enzyme monoamine oxidase, which is responsible for breaking down monoamine neurotransmitters, so rather than being broken down after reuptake, they stay available, basically, the availability of neurotransmitters is increased.
I also feel like a lot of psychiatrists are very quick to halt a treatment rather than play with dosing because it's a pain for them, not sure if that's been your experience though! It's certainly been mine with past psychs, and I think that's made me believe certain medications were not going to work rather than just the dosing was wrong. The difference a good doctor makes is crazy...
Mhh basically I've been on a med, if there was no response raise the dose until max dose is reached, if there is still no response after like 6 weeks, then its out the window.
Alternatively of course if side effects were intolerable its also out the window.
F.e. with Pregabalin I didn't go til max (600mg / day) because it would literally make me go crazy. 450 was fine, I was on that for like 2 months, but well, aside from feeling a little tired occasionally there was nothing. 600mg was then enough to really show its effect,... just that the effect was pretty awful for me.
And yea, I feel like if I have had a good doctor from the beginning that asked the right questions, we could've guessed pretty quickly that the nature of my problems isn't due to some serotonergic dysregulation and rather because of something more in the direction of neuronal hyperexcitability / dysregulation in inhibitory control.
But you'd have to spend many hours on a patient to figure that out and my past doctors simply didn't.
For sure definitely worth looking into. I had best luck with lithium personally, but there's a lot more wiggle room with mood stabilizers for dosing etc in my experience.
Pretty scared of lithium ngl, also I heard once ure on it ure usually not getting off it again? but clearly that worked for you so?
I was more thinking in the direction of Lamotrigine, as it's sorta the same area as BZDs (which have been the only thing to work so far), just from the opposite end (like rather than increasing inhibition what BZDs do, it's reducing neuronal excitation).
I've also seen mixed messages on daily benzodiazapines, but from everyone I've seen who actively takes them, they seem to work well long term. Makes me wonder if doctors strictly don't want to bother dealing with the potential issues that a controlled prescription can bring so they say they don't continue to work. However you're absolutely right they are very hard on the body even at a low dose, so it's definitely a risk vs reward situation, a very personal decision! And I mean I guess all medication is individual to some extent, everyone metabolizes differently, so I feel like it's not really a bad thing to only be seeing success stories on a person by person basis, especially with something that's not commonly used.
But I digress! I hope anyone else stumbling across this thread might get some insight from it, haha
oops, guilty of the same here I suppose.....
oh one thing to add, for all women out there,.. Progesterone is important,.. hormonal birth control is no joke like for realsies.
If you wanna learn more look up the role allopregnanolone plays in stress and anxiety, and look up zuranolone trials.
