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TherapistMarryAnn, Therapist
Category: Mental Health
Satisfied Customers: 5804
Experience:  Over 20 years experience specializing in anxiety, depression, drug and alcohol, and relationship issues.
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I am a 28yr old female with a history of alcohol addiction.

Customer Question

I am a 28yr old female with a history of alcohol addiction. I have been sober for 2 years. I have been diagnosed with depression and anxiety/panic (anxiety increases in social situations, I avoid social situations). I've had anxiety since a very young child. I have tried Prozac which helped with anxiety, but not depression.
Currently I am on Nortriptyline, Welbutrin and Ritalin (to help with concentration and "brain fog," symptoms). I still feel tired often and that I can't concentrate. I feel here, but not here. Derealization? It's weird. My psychiatrist tried remeron, but I had terrible weight gain, so switched to nortriptyline 75mg/night (1 month), and now up to 100mg/night (1.5 weeks). Lately, I have panic attacks at night and I feel my social anxiety has increased. I feel I'm always telling my psychiatrist that the drug treatment isn't working so I want to make sure to really give nortriptyline a chance to make sure it really doesn't work before calling him (again). I also have klonopin to take as needed. Klonopin helped for particularly anxiety provoking situations (days) previously, but seems to work less effectively now.
Other drugs I've tried: Effexor (felt panicky-brain zaps), Abilify.
Submitted: 6 years ago.
Category: Mental Health
Expert:  TherapistMarryAnn replied 6 years ago.

Hi, I'd like to help you with your question.


Medications are very good for treating your symptoms, but not for reducing or eliminating the panic and anxiety. When treating anxiety and depression, it is very important to treat with therapy and manage the symptoms with medications, at least until you feel you can cope without the medications. Have you tried therapy? If not, ask your doctor for a referral. Or if you attend church, ask your pastor for help. You can also search on line at If you are in treatment to maintain your sobriety, you could also talk with your treatment team about finding a therapist.


When you seek out a therapist, concentrate on finding one that can help you by using Cognative Behavioral therapy (CBT) or Integrated therapy. Both are the latest and most proven techniques for treating anxiety, depression and phobias. CBT uses techniques to help you change your thought process from anxious to calm. Integrated therapy helps you learn what in your past may have caused you to feel anxious then helps you work on changing your thought processes to help you become more calm and less depressed.


There are also several resources you can use at home to help get started. One excellent resource is the book The Anxiety and Phobia Workbook by Edmund Bourne. Another is the books by Lucinda Bassett. Another one is The Cognitive Behavioral Workbook for Anxiety: A Step-by-Step Program by William J. Knaus. For depression, try these resources: Undoing Depression: What Therapy Doesn't Teach You and Medication Can't Give You by Richard O'Connor and The Cognitive Behavioral Workbook for Depression: A Step-by-step Program (Workbook) by William J. Knaus and Albert Ellis. You can find these on or your local library may have them for you.


I hope this has helped you,

Customer: replied 6 years ago.
As described in my "already tried" section I have CBT. I've been in therapy for 2 years, have been in group therapy for 1/2 a year, and regularly attend AA. I understand that medication needs to be used in conjunction with efforts to treat the underlying issues. I was more curious for a suggestion on what medications can help me manage the anxiety and depression. And if it is worth sticking with Nortriptyline for longer? Right now my anxiety is disturbing sleep and work.
Expert:  TherapistMarryAnn replied 6 years ago.

Thank you for the clarification.


It sounds like the Nortriptyline is not working for you yet. Although it does have a gradual on set process, you should have seen greater impact by this time. Most medications take about 6 weeks to be reach maximum effectiveness. Since you recently increased the medication, it should be more effective by 2 weeks. If this is not the case, you do need to talk to your doctor about trying another medication.


Please be encouraged that although the pharmacological industry portrays medications as exact, it is far from reality. Often, people have to go through several medication regimes before a beneficial combination can be discovered.



TherapistMarryAnn and other Mental Health Specialists are ready to help you
Customer: replied 6 years ago.
Are you aware of any medication regimes that typically work for Alcoholics with anxiety and depression? It seems to me that there could be a connection between anxiety/depression and alcoholism. Maybe a trend toward a specific imbalance in biochemicals. If not this specifically, do you know of any regimes that help with social anxiety, panic and depression? I've done some reading online and found that Zoloft and Paxil are approved for helping to treat these symptoms. I'm curious why my psychiatrist has not prescribed these yet. He has said he wanted to try other classes of medication. Although Zoloft and Paxil are SSRIs and I'd tried an SSRI before (Prozac) I thought that if one SSRI doesn't work well, that another SSRI might work better. I've tried several different classes of drugs. Do Zoloft and Paxil just have the stamp of approval for treating these conditions, but are not necessarily the more effective treatments?
I am aware that there are certain "rules" a psychologist needs to abide by in offering advice. Maintaining ambiguity is "safe." I am trying to get some real answers here. Could you offer more specific advice, based on your experience? I've heard all the answers you've offered before, and I understand why these are the first responses you've given.
Expert:  TherapistMarryAnn replied 6 years ago.

There are links in some research between alcoholism and depression as unique conditions. And:


You are correct. The entire known SSRI series of medications are slightly different by chemical trade patent. This means that although they work in the same manner, the chemical mechanism by which they do so varies slightly. That is why some of these drugs work well on some people and not others, and why it is typical that psychiatrists try various medications regimes within the same class of drug. (Prozac may work for you but not someone else and visa-versa) It would be rather short sighted to eliminate a class of medications simply because one failed to work well with you.


You can try Buspar. It tends to be non addictive and is very mild. It may work for you with the anxiety and often helps those who have a history of alcohol use or addictions. You should talk with your doctor as to what would work best with the Buspar to address your depression.


You may very well have a biochemical imbalance. Have you considered seeing an endocrinologist? They can do a complete workup and determine what is causing any imbalance you might have and they can consult with your doctor to determine treatment.


You can try natural alternatives to enhance the effects of the medications. For example, in the UK and US studies with B-6 and B12 (Water soluble vitamins so any extra will be excreted in your urine) along with 1000mg of Omega 3 fatty Acids per day and 10 mg zinc and 100mg of Magnesium Gycinate have shown good mood stabilization characteristics. (A good source of supplements is who sell pharmaceutical grade supplements.) Just be sure to ask your doctor if these supplements are safe for you.