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Questions and Answers: Antidepressants for Anxiety Disorders

by Mike on September 26, 2008 · 45 comments

prozac highway sm Questions and Answers: Antidepressants for Anxiety DisordersAntidepressants are often the medication of choice for addressing Anxiety Disorders.

Antidepressants all work because they affect serotonin, an important neurotransmitter in the brain that acts as a chemical messenger. They were first developed for depression, and later were found to be effective for treating most types of Anxiety Disorders, too.

Those taking antidepressants for the first time and even those who have been taking them a while often have many questions about them. These questions may not be answered fully by their doctor or by the information on the prescription bottle.

This post answers the most common questions that people have. If you have further questions, please do not hesitate to ask them in the comments or in a personal message using the “Contact” tab. Please note that this post does not cover the antidepressant medications in detail — there is another post entitled “Medications for Anxiety, Panic and Phobias” that does that. 

What are the antidepressants usually prescribed for Anxiety Disorder?

Not all antidepressants work with Anxiety Disorders, but most do. Any antidepressant that has an effect on the serotonin system can be helpful for patients with anxiety. 

  • The Selective Serotonin Reuptake Inhibitors (SSRI) are typically used as the first choice of medications to address Anxiety Disorders. Brands include Celexa, Lexapro, Paxil, Prozac, and Zoloft. Prozac, Zoloft, and Paxil have been approved by the FDA for a wide range of Anxiety Disorders. Other SSRI’s work only on selected Anxiety Disorders.
  • The Serotonin-Norepinephrine Reuptake Inhibitors (SNRI) are a newer class of antidepressants. Brands include Effexor and Cymbalta. They work by increasing the levels of both serotonin and norepinephrine in the brain. SNRI’s have been approved to treat a more limited number of Anxiety Disorders than SSRI’s.
  • The Tricyclic antidepressants have been around much longer than the SSRI’s and SNRI’s and are used for a limited number of Anxiety Disorders. Brands include Adapin, Anafranil, Elavil, Norpramin, Sinequan, and Vivactil. They work by affecting the concentration and activity of the neurotransmitters serotonin and norepinephrine. This class of antidepressants is not used as much as more modern medications because of their side effects.
  • Monoamine Oxidase Inhibitors (MAOI) are the oldest class of antidepressant medications. Brands include Nardil, Parnate, Marplan, Aurorix, and Emsam. MAOI’s are not used much any more because of interactions with some foods, beverages, and other medications. 

Wellbutrin is not used for Anxiety Disorder because it is the only antidepressant that does not affect the serotonin system. It can even cause Anxiety and agitation in some patients. It is sometimes used in combination with SSRI’s for Anxiety Disorder to diminish the side effects of SSRI’s.

How does my doctor choose which antidepressant to give me?

All the SSRI’s and SNRI’s, Tricyclic and MAOI’s work the same way. The choice among them is made mostly on the basis of side effects and a person’s ability to tolerate a specific medication.

Most of the antidepressants are started at a low dose and gradually increased until they reach a therapeutic level. Some antidepressants also need to be gradually decreased in dosage when discontinuing them, particularly the SNRI’s, Effexor and Cymbalta.

How long does it take an antidepressant to start working?

It takes from two to six weeks for an antidepressant to begin to work. You may feel worse before you feel better because side effects can occur almost immediately, whereas therapeutic benefits appear later.

What are some of the side effects of antidepressants?

Side effects differ from person to person, and from medication to medication. The graduated dosages when you start taking antidepressants gives your body a chance to get used to them. Most side effects dissipate within days or weeks. Some of the side effects common to most antidepressants are nausea, nervousness, insomnia, weight gain and sexual dysfunction.

An adjustment in dosage or a switch to another antidepressant will usually correct bothersome problems. It is important to discuss side effects with your doctor so that he or she will know when there is a need for a change in medication.

Are antidepressants habit-forming?

Anti-depressants are not physically habit-forming and are not drugs of abuse. However, people sometimes become psychologically dependent upon them to relieve their symptoms, particularly if they have not participated in therapy, which teaches coping and management skills.

My first antidepressant didn’t work. What should I do?

It is not unusual for the first antidepressant tried either not to work or to have intolerable side effects. Finding the appropriate medication and dosage may take time. There are many antidepressants to choose from, and one of them is right for you.

The most frequent reasons for an antidepressant failure are that the dose was too low or the duration of treatment too short.

I feel so much better. Can I stop taking the antidepressant?

Feeling better is not a good reason for discontinuing or reducing your medications. People often are tempted to stop medication too soon, risking relapse or recurrence. For some Anxiety Disorders, medication may have to become part of everyday life to avoid return of disabling symptoms.

I want to take some herbs and diet supplements. Are they safe with antidepressants?

You should never mix medications of any kind — prescribed, over-the counter, herbs, or borrowed — without consulting your doctor. Some substances, like alcohol, reduce the effectiveness of antidepressants and should be avoided. This includes wine, beer and hard liquor. Grapefruit juice also has a negative effect on some antidepressants. Always follow the instructions of your doctor and on the prescription label to the letter.

Some medications, which are usually safe when taken alone, can cause severe and dangerous side effects if taken with other drugs. Always tell dentists, pharmacists and other medical specialists that you are taking antidepressants.

How long will I have to take antidepressants?

The length of time you will need to take antidepressants varies from person to person, and depends on the severity of the Anxiety Disorder. It also depends strongly on whether the drug is taken alone or is combined with therapy. 

Are antidepressants enough to control my Anxiety Disorder?

Antidepressants work best in most people when prescribed alongside a course of psychotherapy. People taking both medication and engaging in psychotherapy generally take less time to feel better. They also maintain their gains longer than those taking antidepressant medications alone.

Where do I find information about the medications I am taking?

It is sometimes hard to tell if what you are feeling is a drug side effect or a symptom of a physical condition. It is a good practice to look up the drugs you are taking and make a list of the “normal” side effects and the serious side effects. That way you will know when to call the doctor about an uncomfortable feeling or illness. And you will also be better informed about your side effects when you visit your doctor.

These online resources are particularly good for researching prescription medications, over-the-counter drugs, and diet supplements, such as herbs:

When taking any medication for Anxiety Disorders, you should…

  • Ask your doctor to tell you about the effects and side effects of the drug being prescribed.
  • Tell your doctor about any alternative therapies or over-the-counter medications you are using.
  • Ask your doctor when and how the medication will be stopped. Some drugs can’t safely be stopped abruptly. They have to be tapered off slowly under a doctor’s supervision.
  • Be aware that some medications are effective in Anxiety Disorders only as long as they are taken regularly, and symptoms may occur again when the medications are discontinued.
  • Work together with your doctor to determine the right dosage of the right medication to treat your anxiety disorder.

In Summary

Despite the long list of facts, taking antidepressants is not a complicated affair. However, it is very important that you:

  • Follow your doctor’s orders explicitly.
  • Follow the diet and other instructions on the prescription bottle faithfully.
  • Be informed about the side effects of your medications.
  • Be patient: It sometimes takes a while for you and your doctor to find the right medications for you.

What do you think?

  • Do you have any questions that are not on the list?
  • Have you found any other good online sources of drug information?
  • What are your experiences taking antidepressants?

What can you do now?

Your comments are always welcome, and are important to this blog’s community! Leave a comment now.

You can find several related articles in the “Related Posts” list below. Click on the Categories tab at the top of the page for a complete list of all articles. And don’t forget the Google Custom Search field in the right sidebar, too!

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©2008 Anxiety, Panic & Health. All rights reserved.
Resources used in this post:

Chong, Josepha. (2006, August 30). Key Points about Antidepressant Therapy. Retrieved June 27, 2008 from Psych Central Web site: http://psychcentral.com/lib/2006/key-points-about-antidepressant-therapy/

Hartman, Daniel G. (2007, June 12). Treating Anxiety with Antidepressants. Retrieved September 26, 2008 from The Sidewalk Psychiatrist Web site: http://thesidewalkpsychiatrist.wordpress.com/2007/06/12/treating-anxiety-with-antidepressants/

HealthyPlace. (2008). Medications for Treating Anxiety. Retrieved September 26, 2008 from HealthyPlace Anxiety Community Web site: http://www.healthyplace.com/Communities/anxiety/treatment/medications_2.asp

{ 42 comments… read them below or add one }

Ajlouny November 9, 2008 at 9:21 pm

Why prescribe something like Welbutrin if it doesn’t help regulate your serotonin’s and also causes anxiety. I think that it’s important to ask your doctor all the questions and get the answers about everything before taking any medication because everyone’s tolerance is different and effect maybe different for everyone.

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Mike November 10, 2008 at 2:22 pm

Medications for physical conditions are often one-size-fits-all; what works for you will work for me. Unfortunately, psychiatric medications are not that way. There is a range of medications that seem to do the same thing, yet work differently with different people. For example, Lexapro is effective and well-tolerated in some people, yet others find the side-effects too much to handle. It might take trying a few medications to get the right one for you — one that is both effective and produces the most tolerable side effects.

I agree that being a well-informed patient is essential. Ask your doctor about benefits and side-effects before taking a medication. In addition, find the drug information on the internet and keep the side effects, especially the unusual ones, in mind so you can monitor your specific reactions to it.

As for Wellbutrin, I was prescribed it for a short time, but it wasn’t effective for me, and it produced undesirable side effects. It’s very helpful to some people, and seems to have several off-label uses such as smoking cessation. Like you say, it works differently for each person.

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anonymous May 27, 2009 at 9:53 am

deleted by request

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Mike May 27, 2009 at 10:18 pm

Thank you for your comment.

I really empathize with your situation and the loneliness that you feel. Anxiety Disorders are so disruptive, and as you say, have made everyday functioning for you very difficult.

You write of a “cure.” We want a “cure” for Anxiety Disorders like we want a “cure” for headache: a simple pill or procedure to make it go away entirely forever. Unfortunately, among the many reasons for Anxiety Disorders to take root in our lives are genetics and the environment of our upbringing, which we will bear with us to the day of our death. Through proper treatment we can learn to control and manage our Anxiety Disorder so that we can live happy, functional and productive lives, but we can never “cure” our lives of the basic causes of our illness. I wrote an article entitled “Can Anxiety Disorder and Panic Attacks Be Cured?” that discusses my attitude toward “cures” in full.

Every person who takes a particular medication for Anxiety experiences different side effects. The drug that works for me might not work for you. And every medication has side effects for some people. Therefore, it is impossible for me to recommend a drug that would be without side effects for you (besides, I’m not medically qualified to recommend any medication).

It’s an unfortunate but common experience that people just have to keep trying out different drugs until they find one with the fewest side effects. Personally, it took me 4 years to find that combination of medications that works well and has tolerable side effects. It includes a drug that has no side effects at all for me, but has objectionable side effects for many others!

Dizziness is a frequent symptom to Anxiety Disorder sufferers. I wrote an article about it entitled “Dizzy? It May Be an Anxiety Disorder! I personally suffer from dizziness as well, though mine may be partially due to medications (for physical ailments) and inner ear problems. I have benefitted from balance exercises I learned for the inner ear problems. They are readily found by searching for “balance exercises” on Google. As the article notes, physical balance exercises may be as effective as psychotherapy in combatting the problem.

There are many books available that can help you with your Anxiety Disorder. One of the best I’ve found is Edmund Bourne’s “The Anxiety and Phobia Workbook.” It gives you positive things that will help you every day with your Anxiety Disorder. Its help with panic attacks is particularly good. It’s the single book that I find myself returning to again and again.

I believe that effective treatment of Anxiety Disorders is like a 3-legged stool: 1) medication, 2) effective talk therapy, and 3) work you do yourself to alleviate your problems. Each one of these “legs” is necessary for you to learn to control the symptoms of your Anxiety Disorder. In your search, please bear in mind the balance between these three factors — don’t rely on medications alone, or therapy alone, or your personal efforts alone!

You sound like you are at your wit’s end, and I can certainly empathize with that. Be assured that it is possible to learn how to manage your Anxiety Disorder so that its effect on your life is minimal. There are millions that have learned to do so. Keep up your courageous search, even though the time it is taking may seem intolerable to you now.

Please keep me informed of your progress. You may leave further comments on this post, or email me directly using the “Contact” tab at the top of each page.

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La Juan July 22, 2009 at 1:58 pm

My husband died July 4th 2008. He had a heart attack,
while I was doing CPR on him. I had a heart attack, but
did not know I had one until the next day. I had no
health problems that I had to take medicine for.
Now I have stress, high blood pressure. My fears
of having another heart attack is very stressful, I
watch my husband of 47 years . He pass away at the
hospital . I started taking cymbalta 3 days ago. I thought
I could handle the stress on my own. I had a blockage
and 1 stent put in with no damage to my heart . The
death and the heart attack causes my stress level.

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Michelle Lucia September 23, 2009 at 12:37 pm

I was doing well on Effexor-300mg but decided to try Pristiq because it is not supposed to have the weight gain side effect? Well I tryed it but it changed my sleeping pattern to where I was only getting 4-6 hrs of sleep and it made me jittery. I have now started back on the Effexor-300mg. The Dr. didn’t feel that going right back to my dosage would be an issue. It has been a week but I still have not felt better. I feel anxious in the morning and just not myself yet. How long do you think it will take to feel myself again?

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MARIA January 7, 2010 at 3:55 pm

BEFORE taking medication , TRY NATURAL ways, like exercising everyday for 1 hour (making sure you sweat), eat healthy-nutrition is very important- B-vitamins, C vitamin, calcium and magnesium, most of ALL understanding your condition 100% by reading about it from books and websites, THERAPY (CBT) itself is VERY HELPFUL! always do whats natural first

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asncuvophjg April 23, 2010 at 12:28 am
claudia h June 23, 2010 at 1:55 pm

was on celexa for 3 yrs and suddenly it didn’t work as well. I was only taking 20 mg. tried uping dose to 40mg for about a week but didn’t notice any change. I quit taking the 40 and am now wondering if I should have stayed on the 40mg longer so get the entire benefit. Would appreciate it if anyone can give me help with this as I really liked how I felt on the celexa.

Reply

Hero June 30, 2010 at 10:11 am
drcjr1964 July 8, 2010 at 8:15 am

Can anti-depressants cause a person to become withdrawn from being able to be around a crowd of people or make them want to be by themselves, but still can communicate by phone other other means?

Reply

Marjo July 29, 2010 at 8:23 pm

Hi
My husband is taking cymbalta and has trouble eating and swallowing. I would like to know for how long will he be taking this medication. He has a severe depression and has tried to commit suicide 3 times and was hospitalized. He hates this side effect and would like more info on maybe a new medication with less side effect.

Thanks for any help

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lesley October 10, 2010 at 10:00 pm

hi im on lexapro 10mg i suffer anxiety and depression due to my fears of leaving my partner and kids …. i really wanna fight this ive seen a phsycologist 5 times and it isnt helping …. Please Help as im loosing my family

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paige reynolds October 24, 2010 at 11:16 am

neurologist perscribed 10mg 1st week nortriptyline then 2nd week 20mg…for anxiety and tension headaches..is this an appropriate choice..is an old drug..are the newer ones better, have taken it 3 nights now do not feel any better, also a little more tired, but sleeping has improved.

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Carl January 19, 2011 at 7:05 am

Was put on Citalopram for depression and anxiety.
24 hours of hell, phsycosis, panic attacks, paranoia, accute anxiety etc etc
Came off it the next day and flushed it down the toilet. This medicatrion should be banned by the FDA. It causes acute anxiety and panic attacks, it does the exact opposite to what it is supposed to treat. Im sick of people saying ride with it, it will kick in in a month or so/
THATS UNACCEPTABLE, RIDING WITH THIS FOR EVEN MORE THAN 24 HOURS DESTROYS YOUR MENTAL ABILITY AND DESTROYS YOUR BRAIN
THIS POISON CELEXA /CITALOPRAM SHOULD BE BANNED

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Sandi June 5, 2011 at 9:46 am

It’s absolutely not true that antidepressants are not physically addicting. Ask anyone who has tried to go off them. Some people believe it’s worse than going off of heroin because it takes longer.
Extreme nausea, dizziness, headache and “brain zaps” are just a few of the many withdrawal side effects to expect. Antidepressants are life savers but it’s unfair to tell people they will not become physically addicted to them.

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Tracey August 6, 2011 at 10:38 am

I am currently taking sertaline (Zoloft) and have done on and off for 16 years. When I initially started to take this medication I was prescribed 100mg however, as time has gone by (16 years) I find myself having to take 150 mg daily. My concern here is that I become immune to it and it no longer does the job that it is supposed to do. The medication is taking in combination with pyscotherapy and this seems to work for me. However, psychotherapy on its own does work without the combination of the meds. I guess I am worried that I become immune to the meds… is this possible??

Also I was wondering why 50 mg works for one person yet I have to take 150 mg to get the same effect…????

Thanks for reading my concerns and I look forward to your reply.

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David cheesman September 1, 2011 at 10:24 am

My mother died 8 months ago, and the last 2 months hav been hell, my docter has told me it’s developed into depression, and has presribed celex, which I tried, but they made me feel worse. I get these intrusive memory flashes, but I can’t really describe them, they come infrequently, about every 15 mins, and I eel a wave of dread, and I tense up, and feel like crying, am I losing my mind?, because it feels that way. . . . Any advice would be appreciated, thanks for listening. God bless

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Kylie September 5, 2011 at 6:37 pm

Im 17 and i suffer from anxiety according to my doctor. My dad has the same thing but he started at the age of 40 and according to my doctor my case is worse. I get panic attacks over stupid things and it makes my parents argue so i end up getting anxiety cause its my fault. According to my current doctor and other doctors this anxiety is apparently affecting my heart causing heart pains and shortness of breath so im not allowed to do excessive sports. Last month my doctor decided to prescribe 1 of my dads medication called deanxit for everyday use and my mum thought im an old mental person who needs medication. So i stopped taking them. Is it bad that i stopped? Will there be and consequences and does needing pills really mean im a mental person? i dont mean to insult anyone btw

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shiva July 19, 2013 at 12:45 am

there is no shame in taking these medicines.anxiety can stop you from living life.i had it for 20 years.i used to struggle in life.now iam very fine.you can email me for more details shiva321 @ yahoo .com

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Joshua November 2, 2011 at 11:40 am

ok, so i have been taking benzos for about 15 years to deal with my anxiety and severe depression. I have tried several anti-depressents including Lexapro, Effexor, and Paxil. I have always been very bothered by the sexual dysfunction and weigh gain side effects. Since i am trying to combat my depression and self-esteem issues, I have found that because of these side effects, these medicines are sort of counter active because even if they make me feel more confident, once i meet someone i won’t be able to be intimate with them. I have successfully tapered myself off of klonopin and i am very anxious and depressed. I know that i need to start taking something again? any advice?

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claudia hopkins November 2, 2011 at 11:53 am

I have been on different anti-dep. drugs for many yrs. and with time they lose their help with my anxiety..lately was put on zoloft and it seems to be working well at present but they also put me on one tablet of clonazapam a day also…I worry that taking the clona. will become addicting…the zoloft and clon. seem to be working well but wonder if taking the combination can be done indefinetly…your help would be appreciated..

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Joshua November 2, 2011 at 1:26 pm

honestly, i would advise against taking clonazapam for longer than two weeks..you WILL become addicted and before too long you will not get the same effect from taking it once your body becomes tolerant(and addicted) to the 1mg. You will have to take more and more often to get the same effect. Believe me, I started taking it over 10 years ago and it took complete control over my life. I could not do even the simplest task with taking it and i would always have to have a few pills on me at all times..it was a nightmare…The WORST part is getting off this drug…It is by far the hardest drug to get off and the worst withdrawal you can ever imagine. I am going thru it now for about the 5th(and LAST!!!) time…I slowly tapered myself down from 3-5 mg a day over the course of 6 months and I am now drug-free for 9 days…I am so strung out..Can’t look people in the eye, can’t sleep, eat, barely leave the house. Look at these withdrawal symptoms>>http://www.psychdrugtruth.com/klonopin.htm<<&lt;….trust me, you don't want to end up being a slave to this drug…I have wasted over ten years of my life to it and i wuld do anything to get those years back!!

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halolo August 8, 2012 at 6:09 am

Hi
I was suffering from only one problem say, pain throughout the body 4 months back.My doctor prescribed Tryptomer for that.After consumed that for 1 month , i discontinued the medicine suddenly. But after that i am facing number of problems insomnia, hear pounding, fear, worry etc from that. My life is nowadays hell

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Al Beback September 7, 2012 at 12:19 pm

I only have major anxiety. Every doctor I’ve been through has demanded that I take anti-depressants with a benzo. With the exception of MAOI’s which I refuse to take, they all make my anxiety worse, like life threatening. I’ll go from a panic attack into actual shock. For me the benzo Klonopin by it’s self works, and that’s it. Unless your anxiety is a symptom of depression then any anti depressant is only going to make it worse. As a matter of fact because I was prescribed antidepressants my anxiety disorder is now permanently more severe.

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Debra Heselton November 26, 2012 at 9:03 pm

I am taking 15 mg of the antidepressant Mirtazapine. The doctor will increase the dosage to 30 mg in 2 weeks. I have never heard of this medication. I also have problems sleeping at night and this med. has a sleep aid as well. I had a traumatic event happen in my marriage. I am also been diagnosed with PTSD And depression. In the past I have been very sensitive to antidepressants such as problems with ringing in the ears, sexual side effects and extreme tiredness. My questions are, does this sound like the right med. for my diagnosis? Also will the side effects eventually subside? Any help with this matter would be much appreciated. Thank You!

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Chris January 3, 2013 at 6:28 am

My mother-in-law is tacking antidepressants and it is a constant rollercoaster of emotions at home. She forgets to take them or she adjusts the dose to her fancy. It’s a disaster. She won’t let us talk to her doctor either.

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virginia tedder January 18, 2013 at 12:42 pm

Have been on Lexapro (10 mg.) for 10 wks. with zero results except maybe more anxiety, depression. Is it time to wean off ?

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June Wiginton January 25, 2013 at 9:32 pm

What symptoms do you experience if you stop taking your anti-depressant medication?

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sita April 26, 2013 at 10:59 am

I take antidepressents before 14weeks but still depreeion.when i think work or anything i am shaking and i can not anything and i can not sleep.in this situation what can i do. Please give me right solution.

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kaitlyn August 17, 2013 at 8:33 am

I’m afriad to take an anti depressant my doc prescribed it month after I told him I am suffering from anxiety but I am not depressed at all I’m just scared that when I get off them I will feel depressed I would rather take something natural

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lisa August 18, 2013 at 6:54 pm

I take wellbutrin for depression and xanex for anxiety but I still suffer from severe anxiety someone told me there are better anti depressants than wellbutrin that would not add to my anxiety is this true?

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Ross Vaughn September 22, 2013 at 8:17 pm

It is scary for a teen dealing with teen depression, it can be a simple episode that they’re upset over a breakup. Or, it can be a constant depression that can destroy lives. As a parent of two preteen boys I keep an eye for warning signs that mine may have teen depression … The scary truth about teen depression
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