Posted by SLS on January 1, 2013, at 14:00:26
In reply to Re: A nice surprise, Dr. Gillman responds to question, posted by metamorphosis on January 1, 2013, at 12:10:38
Your friend is lucky to have you.
Q: For how long has your friend had anxiety?
Q: How severe is the anxiety?
Q: Will he be using an anxiolytic drug everyday, or as a PRN only when needed?
I realize that he wants to avoid benzodiazepines, but Ativan is a clean drug that I didn't find too difficult to discontinue. It might make an ideal drug, especially if used as a PRN.> So did agomelatine help with sleep with it's melotonergic effects?
It helped at first. It really isn't very good for sleep in the long-term, though. My friend finds that agomelatine has greatly reduced his bipolar ultra-rapid cycle. I guess it's a hypothalamus thing.
> Also, as I mentioned my buddy wants an anoxyilitic to take the edge off. Does agomelatine help at all with this.
I would have to say no.
> What would be your top choices?
"Taking the edge off" doesn't sound like his anxiety is too severe.
I am reluctant to place low-dose Seroquel (quetiapine) at the top of the list, but it really does work. It can be used everyday or as a PRN. Many doctors are vehemently against using an antipsychotic for anything but psychosis. The only real downside I can see with Seroquel is metabolic. Weight gain is common, and diabetes is a possibility. EPS (extrapyramidal side effects) is also a possibility, but it happens infrequently. I have never seen it for myself, and I spent about 8 years interacting with patients who were taking Seroquel. As with other psychotropic drugs, reactions to taking Seroquel can vary between individuals. I found that Seroquel made me irritable.
Buspar (buspirone) might help, but it often takes a few weeks to begin working.
Someone I know had good results with Phenergan (promethazine). He was a difficult case, and had previously needed Zyprexa (olanzapine) to manage his anxiety.
If your friend will consider a TCA, doxepin might be the best choice.
I am having a difficult time creating a list sorted in order of preference. I guess I would try doxepin first and Seroquel second. Either drug can conceivably help Parnate to work better, but might require higher dosages than what might be effective for treating anxiety. Amitriptyline and nortriptyline are also worth mentioning. Antihistaminergic drugs (doxepin and Seroquel included) often help. Hyroxyzine, promethazine, and cyproheptadine are examples of this.
- ScottSome see things as they are and ask why.
I dream of things that never were and ask why not.- George Bernard Shaw
poster:SLS
thread:1034189
URL: http://www.dr-bob.org/babble/20121231/msgs/1034353.html