Q. Did my GP prescribe the right medicines for my social and performance anxiety?

Answered by
Dr. Parth Nagda
and medically reviewed by Dr. Sneha Kannan
This is a premium question & answer published on Mar 25, 2020

Age: 30 Gender: Male Medications: Started Lyrica (pregabalin) yesterday 25mg (moving to 50mg tomorrow). Issues: Generalized Anxiety (Social and Performance anxiety). Query: Did my GP prescribe the right meds? I mainly suffer with social and performance anxiety (talking to people, talking in groups, meetings at work etc) for the past 10 years. My voice breaks when I talk and I have a chronic dry mouth from stress/anxiety every day (even when off meds). I worry and overthink alot about what others think of me. I've tried amitriptyline (tricyclic antidepressant) when I was in my early 20's (im 30 now) and also tried Lexapro and Zoloft in more recent years but they didn't do much for me and gave me alot of annoying side effects. I have tried beta blockers too. For the past 2 years I've been medication free but every day becomes tougher and tougher to get through due to symptoms of anxiety. I wouldn't say I have low mood or depression. I have tried benzos also and I did abuse them for a few months and had to go through a horrible withdrawal. I haven't touched them in over 2 years. My new GP recommended I try Lyrica (Pregabalin) and wants to see how it goes for a couple of weeks in battling my anxiety. Im starting on 25mg once daily and moving to 50mg tomorrow or next week which is a low dose. Does this make sense to try with my history? I have a chronic dry mouth from chronic stress and anxiety and most drugs make my mouth way worse. The doc also mentioned possibly trying amitriptyline again too if Lyrica doesn't work. Of course i'm very anxious about the side effects. Any advice would be appreciated.

Dr. Parth Nagda

Psychiatry
# Hello, yes pregabalin is an SNRI class of medicine. You have tried ssri and tcas.

Snris do help in anxiety disorders. Per se, pregabalin isn't the best ssri for anxiety as such. It's more useful for neuropathic pain at doses of 75 mg or so. For anxiety it should be around 100 or 150mg. If this doesn't work, you can try other snri like Venlafaxine, desvenlafaxine or duloxetine.
Also if it doesn't work, u can try /add mirtazepine (NaSSA class)
Along-with that, for day time anxiolysis, you can try tofisopam, Clobazam, buspirone

Many resistant cases will also respond is 2 mg of aripiprazole is added to the primary drug as an augmenting agent.

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