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

Question

Hi doctor,

I am a 30-year-old male.

Medications: Started Lyrica (Pregabalin) yesterday 25 mg (moving to 50 mg tomorrow).

Issues: Generalized anxiety (Social and Performance anxiety).

Query: Did my general physician prescribe the right medicines? I mainly suffer from social and performance anxiety (talking to people, talking in groups, meetings at work, etc.) for the past ten years. My voice breaks when I talk, and I have a chronic dry mouth from stress or anxiety every day (even when off medicines). I worry and overthink a lot about what others think of me. I tried Amitriptyline (tricyclic antidepressant) when I was in my early 20's (I am 30 now) and tried Lexapro and Zoloft in more recent years, but they did not do much for me and gave me a lot of annoying side effects. I have tried beta blockers too. For the past two years, I have been on medication-free but every day becomes tougher and tougher to get through due to anxiety symptoms. I would not say I have a low mood or depression. I have tried Benzodiazepine, and I abused them for a few months and had to go through a horrible withdrawal. I have not touched them in over two years. My new general physician recommended trying Lyrica (Pregabalin) and wants to see how it goes for a couple of weeks in battling my anxiety. I am starting on 25 mg once daily and moving to 50 mg 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 doctor also mentioned possibly trying Amitriptyline again, too, if Lyrica does not work. Of course, I am very anxious about the side effects. Any advice would be appreciated.

Answer 1

Hello,

Welcome to icliniq.com.

Yes, Pregabalin is a SNRIs (serotonin and norepinephrine reuptake inhibitors) class of medicine. You have tried SSRI and TCAs (tricyclic antidepressants). SNRIs do help with anxiety disorders. Pregabalin is not the best SSRIs (selective serotonin reuptake inhibitors) for anxiety as such. It is more useful for neuropathic pain at doses of 75 mg or so. For anxiety, it should be around 100 or 150 mg. If this does not work, you can try other SNRI like Venlafaxine, Desvenlafaxine, or Duloxetine. Also, if it does not work, you can try or add Mirtazapine (NaSSAs (noradrenergic and specific serotonergic antidepressants) class). Along with that, for daytime anxiolysis, you can try Tofisopam, Clobazam, Buspirone. Many resistant cases will also respond if 2 mg of Aripiprazole is added to the primary drug as an augmenting agent.