Best antidepressant for ruminative thinking

[star97]

I am curious as to your opinion about what antidepressants are best for ruminative/obsessive thinking patterns. I have taken Effexor XR in the past (75mg) for depression, but even when not I am not depressed I tend to get anxious and ruminate about mistakes, etc. 75mg was sufficient at managing my depression i.e., I felt like "myself."  Would a higher dose perhaps target more of the worry? I recently got back on Effexor XR (same dose) for depression, but am a little bit worried because I had a hard time getting off of it in the past (was in remission for over a year and a half off of it). Any advice would be appreciated.

[Roger Gould, M.D.]

That is a good medication for what you want, and as long as you can take it without side effects, you should stick with that and not add new ones.  YOu should ask your doctor about experimenting with slightly higher doses, and then you will have your answer...that is the only way to make sure.  Getting off it at slightly higher doses will not be any more difficult than your current dose.   r.g.

[Aruba417]

I've been taking Effexor XR 150mg for about 6 months now for Anxiety and obsessive thoughts, and it has helped a lot. Maybe you DO just need to up it. In fact, my doctor feels it could help more if I'm upped to 300mg. So I'm going to try it, and if it doesn't make a difference, then I'll just come back down to 150mg. I also take Xanax for the anxiety. Just ask your doctor. Good luck.

[oceans3]

i am just curious what you 2 mean by "obsessive" thoughts? i take xanax when needed for nervousness/anxiety. im just curious as to what specifically because im wondering if i fit more into that catagory (obsessive thoughts). i am a perfectionist and worry constantly about how others view me, being critiqued/judged and so on. i constantly care so much about what others think,would rather do something i dont want to do to please others, avoid conflict, if i make a mistake, i cannot let it go.
i have a 4 yr. old and i feel like every move she makes is a reflection on me. things get worse in the fall/winter months due to weather and holiday obligations (which i like to avoid at all costs).
thanks for the help in advance!

[usetobe]

I know exactly how you feel.  I worry about everything and can't stop thinking about every little thing and how to fix it.  I was having panic attacks and a lot of anxiety.  I was on 150mg of Effexor for about a year and it was helping, but not quite enough.  So, I tried 300mg (150 twice a day) and I turned into a zombie.  I had no sex drive and became severely depressed. I also gained 20lbs in one year after starting the medication, which seems to be one of the biggest reasons I'm depressed.  I recently switched to Zoloft and it seemed to help with the depression at first, but now the anxiety and overthinking is back.  so, I'm not sure what is next, but neither Effexor or Zoloft have been able to stop the panic without side effects I consider worse.  I don't want to stop taking medication and be the way I use to be, but these medications are just causing different issues.

[Aruba417]

Obsessive thoughts differ from person to person. It could mean that you can't stop thinking that something is seriously physically wrong with you, despite a clean bill of health from doctors. Or it can be that you keep playing something that happened to you over and over again in your mind. It just means exactly that - an obsessive thought that you can't control. You get consumed by them, and it interferes with your life.

[oceans3]

thanks for checking back in.
no, i dont worry about my health or anything like that, i worry all the time about events and how others feel. i am constantly trying to please everyone (and this happens especially around the holidays).if we dont see this family member they'll be upset. or, if we dont make an appearance here they'll think that. i mean, i try to do it all and its exhausting. i get stressed and always (daily) play a movie in my head of how it will go or what people will say. i know i am a perfectionist and worry about people judging me whether it be something i say or do. as i stated before, i would rather do something that i dont want to do in order to please others or because its the right thing to do. i miss out on many things that i would rather be doing. i dont know, its hard to explain but i just dont know how to stop all this going through my head and just relax. right now im obsessing about thanksgiving. im already worrying about that. planning is a nightmare because we have the inlaws, and my parents. trying to work out times so it meets everyones expectations (w. a 4yr old) stresses me out.
my daughters birthday is in dec. and because im planning it, im nervous about the turn-out as well. will people have fun? will it go well?
i dont know if this is social anxiety disorder or what? i dont like crowds, i feel as if i walk into a room im being stared at, i dont like critisism, i feel like im being judged, at events/gatherings, my heart races and i get clammy. im a mess!

[Aruba417]

I know how you feel about family members being upset about this and that. We go through the same thing and we don't even have kids yet! And it will only get worse. Last year, I got into it bad with a family member that I used to be really close to, and now I think about it all the time. She's still causing problems, so it's not like I can talk to her and reslove it. But I constantly dream about it and stuff, so I know how you feel. Have you talked to your doctor? Maybe you need something more along the lines of therapy, rather then medication. Also, I know this sounds easier said than done, but sometimes, you gotta say to yourself, "why am I going to sacrifice MY fun and MY mental health to please everyone else?" Because you know what? No matter how hard we try to please everyone, someone will end up getting hurt anyway no matter how hard we try. My therapist told me something once that really stuck with me: You can't control what everyone else thinks. They're gonna think something no matter how hard you try. You have to start thinking about yourself in order to enjoy life. If you don't, you're never going to be happy, and you're never going to feel better. Good luck, I hope you feel better soon.

[oceans3]

thank you for responding. your words helped and i will keep trying to say them over and over until it decides to sink in. i did go see a therapist once for a while and it did help but you  know, those thoughts come back after a while. also, its hard for me to seek help because i have a bachelors degree in psychology so i feel that i should be able to help myself. i told that to the therapist and he said if he were a medical dr. with a broken arm, he wouldnt treat it himself. anyway, there is a book (lot of books actually) by louise hey. she says the type of things that you said in your post and more. she's really good and she makes so much sense. i know where all my feelings stem from (father was critical, yet never said good job, but sure said things like what are you stupid? or thats not too smart). he used to be a heavy drinker but not anymore and he doesnt say those things. he is very different now. however, there is another family member who has potential to be critical that i try very hard to please and want to look sucessful and have fear of screwing up. she talks about others in a negative way so i feel like well then.. am i next? does she talk about me? it has gotten worse after my girl was born because now i feel like what ever my daughter says or does (if its not appropriate) then its a reflection on me. its just a lot of pressure.
i talked it over with my obgyn when i went for my appt. (she delivered my baby) and prescribed xanax. i HATE taking even asprin but i just want to be calm and not worry so much about others. thanks again for your input.i better get out the louise hey books again. do you live in aruba? its the happy island!

[Aruba417]

I will have to look up Louise Hey. Trying to please family members is hard when they don't act like they appreciate it. That's why I'm getting over it. I've had it with them and their gossip and story-telling, and it just makes me so angry. I've decided that they're just upset with THEIR pathetic lives and they try and make trouble for those of us that are happy (or at least TRYING to be happy). I'm not saying it never bothers me anymore, because it does. It bothers me a lot that I have family members lying to other family members about me. It's just rediculous how people can act sometimes. I know it would be hard for you to see a therapist, but, give it a try. It could help a lot. And no, unfortunately, I don't live in Aruba, I live in Arizona! LOL! I visited Aruba on my honeymoon and fell in love with it! It is definitely the happy island.

[oceans3]

well both begin with an "a" and both places are WARM! i live in mass. cool here. anyway, i need to make a correction, the author is louise "hay" not "hey". i really like her book titled, "you can heal your life." she has so many books out but that one seems to fit me best. its an easy read and makes so much sense. i hope you check it out.
you are exactly right in saying people who bad mouth or critisize are unhappy with their own lives. also when people say negative things its usually how they are feeling about themselves. ya know, i can rationalize things, know where it all stems from, read self help books and so on but it still doesnt stop that excessive thinking. i called my dr.yesterday to switch from xanax to lorezipams. how do you like the xanax?

[Aruba417]

The Xanax seems to work for me when I get real "shaky" or start to feel like I'm on the verge of a panic attack. However, I don't take it everyday for the Anxiety Disorder. I take Effexor XR, which seems to be helping pretty good. I only take the Xanax maybe 3 times a week, or if I'm going through a bad relapse of panic attacks.

[underdosed and ready to fall]

I tried Effexor XR for ruminative thinking but that stuff was way too strong for me.  Turned me into a zombie.  My Dr put me on 10mg Lexapro this past spring.  After about a month on it all the ruminative thinking, worrying, sitting up all night in bed thinking something bad was going happen, etc. was gone.  It was like magic.  I was able to get back to my life and sleep normally again.  Now I don't care what happens, just do what I can and see what happens next.  I feel for anyone dealing with GAD. Its like a living nightmare.

[oceans3]

really? my sister takes lexapro. thanks for sharing your experience. glad you found something that helps!!

[ginger11]

i have been on zoloft for 10 years. i was on 200 mg and then after a few years i reduced the dosage to 100 mg.i used to suffer from obsessive disorder and GAD with panic attacks. i still find that at times of external stress (ie. anything medical, even having to go see a doctor) i start my obsessive thinking about disease. sadly,i feel that this pattern will be with me always. i also have gained a lot of weight 50 pounds during this period.(so how "happy" can i be?) i have contemplated changing meds, but would not know what to try.any feedback would be appreciated. thanks.

[Anything4Money]

The FDA  does not carry out any independent studies of drugs before approving them. These drug studies are constructed,supervised and funded by drug companies who use doctors and research teams of their own choosing,often people who have long established relationships with the company.

The FDA allowed Eli Lilly to use “placebo washout” to test for the efficacy of prozac.After an initial 1-2 weeks ,people responding positively to a placebo were withdrawn from the trail.This purposely  creates an unnatural pool of patients and makes the drug perform better statistically.It is unscientific.

A requirement for FDA drug approval is that the drug company produces 2 or more research  protocols  each according to a strict and specific set of rules.Despite this,in the case of prozac,1 protocol included 10 different studies, under different leadership and at different sites.Numbers of individual studies varied from 1-10 for prozac protocols.However Eli Lilly still entered all of this into 1 pool of data for statistical purposes as if it  were 1 trail based on clinical conditions although patients were given the drug under a variety of different conditions.Again this is unscientific.


The candidates for trail were cherry –picked , to give a positive impression of prozacs efficacy,instead of being chosen as required in accordance with the American Psychiatric Associations “diagnostic and statistical manual of mental disorders”.A strict criteria is laid down for trailing of drugs on depressed people. Atleast  5 out of a list of 9 factors have to apply to each patient but this requirement was not met.

People are under the false impression that prozac was trailed on serverely depressed people however prozac studies were deliberately designed to exclude such people and in particular people with tendencies or thoughts towards suicide.No study of any hospitalised psychiatric patient was put forward in those used to approve the drug.

In the 1991 publication “everything you need to know about prozac” a deliberately misleading quote is

   “some of the reassurance comes from the data on over 11,000 patients who took the drug in clinical trails”

This figure was taken from a letter in august 1990 written by Eli Lilly to physicians to counteract concerns that prozac caused suicidal tendencies.The letter states –

“more than 11,000 individuals participated in clinical trails for prozac,including over 6000 treated with  prozac”

However the drug label as reprinted  in the Physicians Desk Reference (PDR) states that there were only “5,600 prozac-exposed”  individuals in the premarketing period of evaluation.
   Elsewhere in the Physicians Desk Reference its stated that  only 4000 people received prozac in “US premarketting clinical trails”The only studies which are considered scientifically valid for the purposes of testing the efficacy of a drug are placebo –controlled studies but this is not how these 4000 patients were trailed.
A table of adverse reactions in the Physicians Desk Reference reviews a yet lesser 1,730 patients who were involved in “ placebo- controlled clinical trails”

Despite all the protocols being manipulated in favour of making prozac appear to work successfully only 3 were considered  favourable and able to  be submitted to allow the drug to be approved.

The FDA `s  “summary of basis approval”,October 1988, states that out of 14 protocols involving controlled trails of prozac that were submitted for approval –
4  compared prozac  to placebo  and  out of the other 10, 8 protocols showed prozac had no positive effect at all.Overall there were more reported negative effects from prozac and this was by Eli Lillys own selected research teams and under biased trail conditions so just what would have a proper scientific clinical trail have concluded?


It doesn’t matter  how many instances a drug is proven to fail in its clinical trails.As long as eventually with as much alterating ,exclusion and misrepresentation as required ,2 or more trails show the drug to do statistically better than placebo, the FDA can approve it.

The details relating to these 3 favourable protocols that has been obtained through the freedom of information act, shows that the number of people who actually completed the 4-6 week long trails that were used by the FDA to approve prozac was only
286 PATIENTS.


One of the protocols known as protocol 27, stated “fluoxetine was not shown to be consistently different than placebo” but  it was still used to approve prozac.Criticisms of this study were made by Walter Sloboda a scientific investigation psychologist in an in-house FDA memo .The antidepressant Tofranil had been given in addition to prozac in the trail without this being recorded yet it was still put forward as a reliable measure of prozacs efficacy.He also reported that several cases of laboratory findings were ignored,entailing risk to patients.

One such  serious health concern  from protocol 27,that was ignored, was the hospitalisation of a woman immediately after starting the trail.No follow-up information on this was recorded.The trail methods of this protocol were again criticised in a letter from the FDA `s director of the division of scientific investigation in august 1984 stating it “ had several departures from Food and Drug Administration regulations or commonly accepted drug investigational practices”

In another trail by  Jay B. Cohn M.D. psychiatrist from university of California,it came to light that he failed to declare a history of alcoholism in 3 patients ,1 of whom had cirrhosis of the liver . It was also found out that Cohn had failed to obtain written informed consent and then “backdated the consent form.”
Hardly an ethical or reliable source of drug research.Despite being heavily criticised by the FDA for this it was still published in the `journal of clinical psychiatry` as part of an Eli Lilly sponsored symposium as proof of the efficacy of prozac

In other trails yet more flaws exist in that patients were taking a range of psychiatric medications in addition to prozac.For example trails led by James D Bremner MD,a psychiatrist in Olympia Washington, about a third of his patients were taking tranquilizers or sedatives which can only have clouded the real effects caused by prozac.

The FDA`s November 1984 “in-house meeting on fluoxetine” brought together a “flaw in the experimental design and execution of fluoxetine studies.”It was discussed how patients who had not been responding well initially in the drug trail were being switched from what they had been given up until then.This was a total breach of  proper practice.Again hardly a proper basis on which to approve a drug.

[momnurse]

WOW . I have had ruminative thing for years, and didn't know what it was called. My mind just trails with stories and goes on and on and I could probably write books if i had time. Several years ago, I had symptoms of chest pain, left arm pain tingling in fingers. Could not find anything. Neurologist X 2 that I saw keep tellling me I was depressed. I was so mad. I did find out with 2nd MD I have demylinization of nerve due to C3 -C5 being pinched at times. I finally gave in ad started Paxil, boy I felt good, not stressed, but not as worried to the point of gaining 40 lbs, spending too much money, (because I'll make it somehow)Got a freaking tatoo(hidden). I've treid to wean off but wound up restarting twice. I'm starting Wellbutrin XL and off Paxil 10mg for 4 days and starting the vertigo and zaps. I take xanax as nedded, but I never can feel that it is doing anything for me. My GYN visit is tomorrow. I don't want to sound like a baby, but would like to ask for something for prn use along with the WellbutrinXL.

[HELPE UNDERSTAND]

i have chest pains and left arm pain and they tell me it's anxiety, depression and panic attacks but i don't believe that it fels like i'm having a heart attack and then i worry over and over again that i'm going to die from this. i am so scared that i have made an appointment with a heart doctor and i am going thru 7 hours worth of tests to rule out that it;s my heart. maybe i should go have some nerve endings checked to see if i may have a pinched nerve that's causing this if so i know it would make me feel better and i could get off my meds .

[nana26]

Hi.I started having panic attacks  and being depressed about 10 years ago.I got depressed because of the anxiety problems and not knowing what the heck was wrong with me for about 4 years.  I also had  the ruminative thinking. My mind just went on forever with thoughts of everything. It's like it wouldn't shut off and rest for a while unless I took something to put me to sleep. I started out on paxil which "saved my life". But after about 3 years, the paxil didn't seem to be helping anymore. I got depressed again, started thinking all the time, having anxiety attacks...I started taking Effexor XR, 150 mg. a day and I take xanax only when I need it. I've been on the Effexor for about 2 years now and it seems to not be working anymore for the anxiety and thinking. I also can't sleep anymore. I have to take xanax, which i am on the lowest dosage, but one of those used to make me rest, but now i feel like i need more, but i don't want to be addicted to another drug. I hate taking medicine, but i'd rather take pills than be like i used to be. I couldn't function like that. I don't know if i need to try a different antidepressant or take more xanax. I also lost my insurance, so I've having to buy the effexor, which happens to be the most expensive. I don't know if i can afford it much longer anyway. I know Lexapro is about half the price, but i don't know how good it works. Any advice at all would be great.
Thanks, Nana26