All antidepressants worsening psychosis?

Hey

I used to take prozac before for my ocd/panic symptoms without any problems but right now I’m no longer able to tolerate any SSRI, SNRI.

I have tried lexapro(escitalopram), zoloft(sertraline), pristiq(desvenlafaxine), prozac(fluoxetine), viibryd(vilazodone) - all seem to be worsening my psychosis.

I’ve not tried benzodiazepines due to fear of cognitive impairment and confusion. Someone suggested I may try alpha 2 delta ligands such as pregabalin/gabapentin. But I’m not sure.

Right now I’m on clozapine 225mg for my psychosis and valproic acid 400mg(extended release) for myoclonic jerks.

Anybody have any thoughts/suggestions for my ocd/panic symptoms ?

I’ve only been on Zoloft so don’t know about the others but I think all SSRIs are probably similar. But for me sertraline made psychotic symptoms worse both times I was on it, although it could have been SSRI induced mania for me

Buspar is one I’m considering for anxiety. I don’t know if it would help with ocd.

SSRI’s generally should not effect psychosis because they only effect seratonin levels (ideally) and psychosis is supposedly more effected by dopamine. SNRIs or NRIs (Wellbutrin), according to my first psychiatrist, should not be prescribed to someone with a psychotic disorder as it’s possible they could exacerbate symptoms.

But still, everyone’s brain chemistry is different and thus meds effect everyone differently. If you know they worsen your psychosis I’d definitely recommend you stay away. I’m not sure what to say for your OCD and panic symptoms otherwise though, sorry :frowning: I feel that benzos get a much badder reputation then they deserve. Unless you’re abusing them or on a high dose for years I don’t think you get serious issues, at least I haven’t heard of someone taking a low dose as prescribed having troubles. And they can be immensely helpful, trust me.

Is there a way to take an SSRI without feeling paranoid ? Will increasing my antipsychotic dose help ?

I’m on clozapine and valproate at the moment.

Antidepressants work on serotonin not dopamine so they shouldn’t cause psychosis to get worse.

I have had recurring psychotic symptoms coming off an antidepressant so maybe the serotonin does have some effect.

You are on a low dose of clozaril, have you considered that that might be responsible for the positive symptoms?

Some people are sensitive to med changes, @Wave always talks about antidepressants exacerbating psychosis.

Maybe go up to a higher dose on the clozaril?

Its nice to see someone else is concerned about cognitive impairment, how have you found clozapine for cognition, are you able to handle new situations and solve problems reliably?

I think this is particular to people prone to mania-induced psychosis. SSRIs can trigger mania and rapid cycling in people with bipolar and sza-bipolar type (although I think that the percentage that that happens to is significant but low, like 10-20%.)

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Wellbutrin caused my first and second major psychotic episode. It’s the only anti-depressant I’ve ever taken, but when I asked my doctor again like 4 years later about anti-depressants he said “They’re no good for you” I’m schizo-affective bi-polar type btw.

I think it depends very very much on the person, so you can only know what it does for you…

I didn’t have any psychotic symptoms when i was on an antidepressant only (Effexor/Venlafaxine, no antipsychotic added). I had my second psychotic breakdown as a withdrawal response from Effexor. I have used an antidepressant another time (Zoloft, again monotherapy without antipsychotic) and had another psychotic breakdown upon withdrawal. So for me antidepressants seem to decrease psychosis risk and withdrawal seems to increase psychosis risk… which is exactly the opposite response.

I’ve read that people with psychotic depression are sometimes succesfully treated with antidepressant monotherapy only.

Maybe it depends on the type of psychosis like Rhubot says… my psychoses are very much related to fear and depression… not mania.

Memantine+Rasogiline BEST but you need to check correct dosage+food interactions+drug interactions or else you will end up dead.

If you have taken SSRI Flauxitine then there should be 5 week gap between SSRI and MAOI like Selegiline or Rasagiline.

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