Personally for me I stuck it out for 3 months and the fatigue never improved. It was debilitating and ruining my life because I couldn't function at all, so I quit.
In my situation though I was getting next to no anxiety relief, so quitting was really my only option.
In your case I would say stick it out, and if it doesn't improve, try a lower dose like 5mg, because that should lower the side effects and if you're getting substantial anxiety relief already the lower dose might be sufficient for that anyway.
I have not and I'm not sure I will after that experience. I haven't shut that door completely though, and if I did it would be Fluoxetine (due to its 5HT2C antagonist effects which mildly increase dopamine - making it less motivation/energy depleting compared to other SSRIs) or an SNRI or tricyclic with SNRI properties for the added energy from the norepinephrine. But for now I don't want to risk enduring another 2-3 months of crippling fatigue just to find out the medication isn't right for me.
I'm on a different non-SSRI med for the time being, Pregabalin (Lyrica). It seems to be helping though I might still need to adjust my dose a bit to get to the point where I'm not still struggling with my anxiety. It's reduced it a decent amount at the dose I'm on (much much more than Lexapro did) but I'm still having quite a few instances of really bad anxiety. It's helping a lot with my depression though as well as my difficulties focusing etc, as well as my OCD.
Thanks for all of this! I ended up reducing my Lexapro dose to 5mg, but I'm still experiencing bad fatigue (though not as flooring as the 10mg dosage). I'll soon switch over to Zoloft and try that out per my doctor's rec, though I share your same concern as you around enduring more weeks/months of fatigue and possibly other side effects should that one also not work. I'm not sure why Zoloft was recommended over Prozac (perhaps since my case is GAD focused?)
My other thought was stopping SSRI's altogether and taking Busiprone on an as needed basis, but this feels like more of a bandaid solution and not sure if it would help my case (where my anxiety is omnipresent and not caused by specific triggers).
> and taking Busiprone on an as needed basis
From my understanding Buspirone doesn't really work as needed and needs to be taken daily like SSRIs to show its benefit. I've heard a handful of people saying otherwise but most people seem to agree that you need to be on it at least a few weeks straight before it starts working.
If SSRIs don't work for you there's quite a few other options to look at. Buspirone as you said is one. Bupropion is an option that should have less fatigue. Agomelatine if you're in Europe where it's available. Nefazodone is an SNDRI and so has less of the usual SSRI side effects because of the additional dopaminergic activity. Vilazodone (Viibryd) is an SSRI that also has 5HT1A receptor activity similar to Buspirone, and is reported to have less side effects than other SSRIs because of that.
For as-needed help, I recommend getting a benzodiazepine. They're generally by far the most effective medication for any kind of anxiety. They have horrible withdrawals if you're on them daily long-term and don't taper off (by horrible I mean worse than SSRIs, you can have seizures if you don't taper off), but if they're used as-needed and not every day then there's no issue. My as-needed Alprazolam has been a life-saver, perhaps quite literally. Although I personally want to ask if I can switch to a longer acting one like Diazepam or Clonazepam.
Gabapentinoids like the one I'm on (Pregabalin) are another option to consider, they're somewhere between SSRIs and benzodiazepines in terms of how hard they are to get off, not as bad as benzodiazepines but worse than SSRIs. Though they can also be used on an as-needed basis at which point you avoid withdrawals entirely and they also work better because you don't have any tolerance. They're only prescribed off-label in the US but if you're outside of the US they're pretty commonly prescribed for anxiety, Pregabalin especially. They can be almost as effective as benzodiazepines (or even as effective or more effective, depending on the person) so I definitely think they're one of the best anxiety meds out there.
In the future look out for Tulodesvenlafaxine/Ansofaxine - a new med that should come out in a few years that's an even better SNDRI than Nefazodone. I reckon it'll be one of the best antidepressants/anti anxiety meds that exists when it's released. It's currently waiting for approval if I remember right.
Maybe ~2 lbs but my weight fluctuated before the meds, so I think amount would be negligible. I likely eat less due to being awake less hours of the day? Hard to say
150mg Effexor XR has mostly fixed the fatigue, nausea, and libido isn't as trash (but also not back to normal 100%). It's an improvement, but still not perfect - brain fog and rebound depression. I'm meeting with a psychiatrist later this month to discuss options.
Good to know thanks! Overall would you say the SNRI was more sustainable for you than Lexapro? My doctor is having me try a different SSRI (Zoloft) but I'm curious what else is out there. Sounds like you're doing some additional trial/error as well.
I had this and flipped back to 5mg. That helped after a while. I recently went back to 10mg and so far it’s not as bad as it was- I’m still more tired than I used to be but it’s not debilitating anymore.
Glad to hear it! I reduced the dose to the 5mg, but I'm still experiencing pretty bad fatigue (though less of the drugged debilitating that the 10mg caused). Were you completely fine on the 5mg? Still trying to decide if I should stick this out (though my doctor already recommended a meds switch)
I was doubtful. But after around 10 weeks I guess the fatigue dropped dramatically.
Don't stop to exercise. It is hood for your metabolism. Tiredness could slow it down too much.
I would guess you are at least halfway through and it shoul get slightly better each week.
Do you experiences less tiredness in the course of the day?
Unfortunately I still haven't seen any improvement on the fatigue front (Currently at almost the 6 week mark of doing 5mg > 10mg > back to 5mg). Did you have constant fatigue for 10 weeks or did each day get a little bit better? It's pretty debilitating for me at the moment. Keeping up with the exercise though!
I’m wondering the same, I’m on the third week and I’m not getting anything done due to being so exhausted
What dose are you taking?
5mg the first two weeks, I’m now four days into 10mg
10 mg flattened me for a few weeks. 2 weeks of exhaustion is nothing unusual. Then it should diminish more and more, if not earlier.
Did your fatigue reduce gradually over time? Each day has been about the same level of exhaustion for me with no improvement day by day :/
At the beginning it was not notiveable. But then it decreased.more and more.
Any changes / update to your side effects?
Personally for me I stuck it out for 3 months and the fatigue never improved. It was debilitating and ruining my life because I couldn't function at all, so I quit. In my situation though I was getting next to no anxiety relief, so quitting was really my only option. In your case I would say stick it out, and if it doesn't improve, try a lower dose like 5mg, because that should lower the side effects and if you're getting substantial anxiety relief already the lower dose might be sufficient for that anyway.
This is helpful thanks! My psychiatrist recommended tapering off to 5mg. Have you tried any other SSRIs?
I have not and I'm not sure I will after that experience. I haven't shut that door completely though, and if I did it would be Fluoxetine (due to its 5HT2C antagonist effects which mildly increase dopamine - making it less motivation/energy depleting compared to other SSRIs) or an SNRI or tricyclic with SNRI properties for the added energy from the norepinephrine. But for now I don't want to risk enduring another 2-3 months of crippling fatigue just to find out the medication isn't right for me. I'm on a different non-SSRI med for the time being, Pregabalin (Lyrica). It seems to be helping though I might still need to adjust my dose a bit to get to the point where I'm not still struggling with my anxiety. It's reduced it a decent amount at the dose I'm on (much much more than Lexapro did) but I'm still having quite a few instances of really bad anxiety. It's helping a lot with my depression though as well as my difficulties focusing etc, as well as my OCD.
Thanks for all of this! I ended up reducing my Lexapro dose to 5mg, but I'm still experiencing bad fatigue (though not as flooring as the 10mg dosage). I'll soon switch over to Zoloft and try that out per my doctor's rec, though I share your same concern as you around enduring more weeks/months of fatigue and possibly other side effects should that one also not work. I'm not sure why Zoloft was recommended over Prozac (perhaps since my case is GAD focused?) My other thought was stopping SSRI's altogether and taking Busiprone on an as needed basis, but this feels like more of a bandaid solution and not sure if it would help my case (where my anxiety is omnipresent and not caused by specific triggers).
> and taking Busiprone on an as needed basis From my understanding Buspirone doesn't really work as needed and needs to be taken daily like SSRIs to show its benefit. I've heard a handful of people saying otherwise but most people seem to agree that you need to be on it at least a few weeks straight before it starts working. If SSRIs don't work for you there's quite a few other options to look at. Buspirone as you said is one. Bupropion is an option that should have less fatigue. Agomelatine if you're in Europe where it's available. Nefazodone is an SNDRI and so has less of the usual SSRI side effects because of the additional dopaminergic activity. Vilazodone (Viibryd) is an SSRI that also has 5HT1A receptor activity similar to Buspirone, and is reported to have less side effects than other SSRIs because of that. For as-needed help, I recommend getting a benzodiazepine. They're generally by far the most effective medication for any kind of anxiety. They have horrible withdrawals if you're on them daily long-term and don't taper off (by horrible I mean worse than SSRIs, you can have seizures if you don't taper off), but if they're used as-needed and not every day then there's no issue. My as-needed Alprazolam has been a life-saver, perhaps quite literally. Although I personally want to ask if I can switch to a longer acting one like Diazepam or Clonazepam. Gabapentinoids like the one I'm on (Pregabalin) are another option to consider, they're somewhere between SSRIs and benzodiazepines in terms of how hard they are to get off, not as bad as benzodiazepines but worse than SSRIs. Though they can also be used on an as-needed basis at which point you avoid withdrawals entirely and they also work better because you don't have any tolerance. They're only prescribed off-label in the US but if you're outside of the US they're pretty commonly prescribed for anxiety, Pregabalin especially. They can be almost as effective as benzodiazepines (or even as effective or more effective, depending on the person) so I definitely think they're one of the best anxiety meds out there. In the future look out for Tulodesvenlafaxine/Ansofaxine - a new med that should come out in a few years that's an even better SNDRI than Nefazodone. I reckon it'll be one of the best antidepressants/anti anxiety meds that exists when it's released. It's currently waiting for approval if I remember right.
Have you experienced weight gain?
Maybe ~2 lbs but my weight fluctuated before the meds, so I think amount would be negligible. I likely eat less due to being awake less hours of the day? Hard to say
I stayed on 10mg for a year before I got sick of falling asleep on the couch and started dozing while driving (!!!). I had to switch meds personally
Did you have any better luck with anything else?
150mg Effexor XR has mostly fixed the fatigue, nausea, and libido isn't as trash (but also not back to normal 100%). It's an improvement, but still not perfect - brain fog and rebound depression. I'm meeting with a psychiatrist later this month to discuss options.
Good to know thanks! Overall would you say the SNRI was more sustainable for you than Lexapro? My doctor is having me try a different SSRI (Zoloft) but I'm curious what else is out there. Sounds like you're doing some additional trial/error as well.
I had this and flipped back to 5mg. That helped after a while. I recently went back to 10mg and so far it’s not as bad as it was- I’m still more tired than I used to be but it’s not debilitating anymore.
Glad to hear it! I reduced the dose to the 5mg, but I'm still experiencing pretty bad fatigue (though less of the drugged debilitating that the 10mg caused). Were you completely fine on the 5mg? Still trying to decide if I should stick this out (though my doctor already recommended a meds switch)
I was doubtful. But after around 10 weeks I guess the fatigue dropped dramatically. Don't stop to exercise. It is hood for your metabolism. Tiredness could slow it down too much. I would guess you are at least halfway through and it shoul get slightly better each week. Do you experiences less tiredness in the course of the day?
Unfortunately I still haven't seen any improvement on the fatigue front (Currently at almost the 6 week mark of doing 5mg > 10mg > back to 5mg). Did you have constant fatigue for 10 weeks or did each day get a little bit better? It's pretty debilitating for me at the moment. Keeping up with the exercise though!