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This is a summary of the problems that need to be considered prior to initiating treatment with the SRI's.
The SRI category of drugs are now considered the overwhelming first choice for panic disorders. Physicians do not distinguish between panic attacks as a symptom of stress or illness and panic disorder as a disease. If a person has an isolated panic attack or two when under a situation of significant stress, (or sometimes without significant stress), then psychotherapy is more advisable than medication treatments. Although a great many people have lifelong, inherited PNE with symptoms so unpleasant and unremitting that drug treatments are needed. There are a greater number of people who will have panic attacks as a stress response that will go away after one or two episodes. The drug company, education of physicians, instead of simple reassurance, the patients are now given SRI's (Paxil, Zoloft, Celexa, Prozac, Luvox), drugs. The medical professional's patients are given samples of these drugs with no warnings about potential problems. Listed here are the warnings, that every patient should have before starting a SRI.
1) Within the first few doses and persisting, you may experience a preoccupation with suicide. This occurs in people who were never remotely suicidal. The preoccupation is intense and unremitting. Suicide seems natural and important and thoughts dwell on the many ways in which it can be accomplished, ( I could jump into traffic? I could jump out the window? I could drown myself? I could shoot myself.?) These thoughts seem to occur as often as one in every hundred people prescribed these drugs.
2) The SSRI drugs are addicting. If it is helpful, most likely you will need to increase the dosage to maintain the effect. The higher the dosage and the longer you take the drug, the more intense the withdrawal syndrome will be. Some people find withdrawal intolerable and are unable to stop or reduce the medication. Withdrawal may occur at a stable dosage without reducing the
dosage. (see FAQ on SRI withdrawal syndrome). The SRI's are almost always used long term in patients, (years). The longest long term studies that I am aware of at this point only look at a six month treatment period. The withdrawal symptoms may result in anxiety and depression worse than symptoms for which it was initially prescribed.
3) The SRI's commonly make anxiety and panic attacks worse when first taken. Be prepared to have more frequent and more intense panic attacks when you start the SRI drug. The addiction potential of SRIs is equal to or greater than the benzodiazepines, (Xanax [alprazolam], Klonopin [clonazepam], Ativan [lorazepam]). If you are considering using one of these drugs to counter the increased panic attacks precipitated by the SRI's, you might consider just using one of the benzodiazepines alone.
4) Weight gain is common. Initially the SSRI's drug may cause weight loss due to nausea and other GI complaints. Rapid weight gain is common later on. This is due to metabolic slowing rather than appetite increase, so the weight is usually put on despite your maintaining a usual diet.
5) Sexual dysfunction is common. Interest in sex, is reduced or eliminated. The most common difficulty is inability to reach orgasm. Some people will find, this goes away with time. However in other people the problem is progressive with time and will not return to the baseline even when the drug is discontinued.
6) SRI's may cause akathisia. This is a powerful restlessness where one feels the urge to move yet actually moving does not satisfy this urge. Sometimes people describe this as a sensation of their bodies are moving on the inside?. This is extremely uncomfortable and has been associated with suicide and aggression. This symptom can persist after stopping SRI's.
7) SRI's can cause dystonia, a painful stiffness of the muscles that worsens with activity. This will/can persists after SRIs are stopped. There are no known treatment for this. Dystonia will gradually will improves over a period of years.
8) SRIs can cause Parkinson's syndrome. This will persists after the drugs are stopped. As opposed to idiopathic Parkinsonism, which seems to improve with time. Tremor is a common side effect and usually goes away when the drugs are stopped.
9) Read the manufacturers information on side effects: hundreds of side effects are reported. Common side effects include headache, nausea, drowsiness, anxiety, depression, agitation, insomnia, bizarre dreams, appetite loss, diarrhea, dry mouth, sweating, dizziness, seizures, memory loss, and a rash among others. The general rule is that if you did not have a certain symptom prior to starting the drug and it occurs after starting the drug it is a side effect until proven otherwise. Physicians often will ignore side effects or deny them. The best way to know if a symptom is a
side effect is to stop the drug and see if the symptom goes away. The drug can then be restarted to see if the presumed side effect returns. This test, retest strategy is the only way to properly assess for side effects.
