SELECTIVESEROTONINREUPTAKEINHIBITORS(SSRIS). The SSRIs are
the newer, safer, less sedating antidepressants that seem to do just about
everything else as well. They increase serotonin by slowing its reuptake by
dendrites after cell firing, thus leaving more available in the synaptic area.
Prozac was the first drug in this class in the United States, followed swiftly
by Zoloft and Paxil.. Though these drugs generally have fewer long-term side
effects than tricyclics, the first few days can be very difficult, especially for
people with fear disorders. A common side effect as the body adapts to SSRIs
is agitation. Clients typically describe the feeling in multiples of cups of cof-
fee. Usually these medications are started at a lower than therapeutic dosage
to diminish this effect, and usually the agitation subsides in a few days. But
by then people with fear disorders often decide that it makes them worse and
discontinue the medication. This is another reason that benzodiazepines are
used in the first couple of weeks of treatment.
The effects of SSRIs vary tremendously across individuals. One can
make people worse, while another with almost identical chemical prop-
erties can work miracles. Nobody knows why. Every doctor has his or her
own preferences, but the word on the street is that among the three big
ones, Prozac and Zoloft are more activating, and Paxil is slightly more
sedating, and thus better for fear disorders. It’s as good a guess as any, but
the variability of effect across patients is so great that few generalizations
hold up.There is absolutely no substitute for close, regular contact with the
prescribing physician.The usual procedure is to start people on a low dose,
have them adapt to it, then raise it in a couple of weeks.
Though studies show that SSRIs increase available serotonin imme-
diately, they generally take at least two weeks to work on depression, and
even more before they have an effect on fear disorders. Nobody knows
why these drugs take so long to work if their main effect is supposedly
achieved by increasing available serotonin. Clearly there are other unknown
effects involved. In addition to the big three, there are other SSRIs, like
Luvox and Celexa, as well as NDRIs like Wellbutrin, and NASAs like
Remeron.
When SSRIs are working well, people taking them don’t feel medi-
cated, they just feel better. This can lead them to stop taking the drug
because they don’t think they need it. Illogical as this may sound, it happens
all the time. Common side effects like weight gain and loss of sexual
Explosions into Fear ❧ 89