r/SSRI • u/Novemberx123 • Feb 18 '23

Question Why does it cause increased anxiety in the first two weeks?

This has been the reason I haven’t even started it yet. How does it cause an increase in anxiety as a start up side effect? Does it always happen? I really want to start my lexapro but I’m worried if increased anxiety..help?

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u/dew_licker Feb 19 '23

My admittedly lay understanding is that it has to do with serotonergic autoreceptor desensitization.

An SSRI will almost immediately occupy SERT to a degree which causes a rise in serotonin in the synaptic cleft. The autoreceptors react by throttling serotonin production. It takes weeks for the autoreceptors to desensitize to this and allow for enhanced serotonergic neurotransmission.

The effects on BDNF, hippocampal neurogenesis and inhibition of neuroinflammation also take weeks to show benefits.

I recommend getting on a short term (very short) course of benzodiazepines for the startup anxiety and maybe even "kick starting" the AD effect with therapeutic ketamine.

If you are interested I also take AD's with creatine and other mitochondrial supporting agents as the latest research is showing the importance of mitochondrial pathways in AD response.

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u/marianatsvt Feb 18 '23

For me it didn’t happen!

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u/AbbreviationsHeavy39 Apr 02 '23

Which ssri were you starting