Brief Answer:
change of drug should be considered.

Detailed Answer:
Hello
Welcome to HCM.
I have read your query and understand your concerns.

The consensus guidelines for prescribing antidepressants are:
Start with a low dose and increase slowly.
If the person does not respond to a drug at all in 2 weeks, change of drug is recommended.
The change may be within a class of drugs or to a different class of antidepressants (if intolerablility is the issue).

You have mentioned that, despite taking drug for 3-4 weeks, your anxiety is not controlled and you are having bad nausea also. The possibility can be either you are not tolerating the drug or there is no therapeutic response.

In such case, my opinion would be to change the drug. Starting an antidepressant from a different category would be the choice.
You have already tried pristiq (SNRI) and taking lexapro (SSRI) now. I think wellbutrin would be a good choice for you now.

Nausea can be controlled by some anti-emetics like ondansertron.
An short-term increment of dose of clonazepam can help to control anxiety.

I would also advice you to practice relaxation exercises like deep breathing and meditation to help in anxiety. Biofeedback under a psychotherapist's guidence can also prove beneficial.

Please discuss these issues with your treating doctor. Donot make any changes on your own. All these drugs are prescription drugs and to be taken under psychiatrist's supervision.

Hope this helps.
Any further queries are welcome.
Thanks.

Dr. Shubham Mehta,
M. D. (Psychiatry).

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