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Dr. Bob is Robert Hsiung, MD,
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Posted by linkadge on May 30, 2008, at 16:42:59
In reply to Re: The best Tricyclic for anxiety.... » linkadge, posted by johnj on May 30, 2008, at 9:05:31
Clomipramine might be worth a shot. I personally found it much more tollerable than the SSRI's.
Clomipramine + cyproheptadine worked better.
It can be good for anxiety, panic and OCD.
Anyhow its hard to say.
You may try something like taurine or magnesium in conjunction with an AD. Sometimes I think the drugs and/or anxiety can cause imbalences in inhibitory/excitory neurotransmitters. Omega-3 in the form of fish oil may help too.
Linkadge
Posted by torachan on May 30, 2008, at 18:33:02
In reply to Re: The best Tricyclic for anxiety.... » torachan, posted by johnj on May 30, 2008, at 16:33:17
> One more thing. Is your name Tora-chan as in Japanese?
Very perceptive of you. I'm an English speaking Canadian, but my wife is Japanese, so we call our cat torachan. Tora, I believe means Tiger and chan as you probably know as an affix attached to names of people/animals dear to you.
Anyways, as Linkadge mentioned try Omega 3's as research suggests they help with issues like depression and anxiety, and I take then even though I'm not sure they even work. I'll tell you what works, and it will include some of the minerals and vitamins Link pointed to, it's called Greens Plus. I don't know if your in the States but you can find it in a health food store like GNC. It's a green powder with all the vitamins and minerals included plus all sorts of other stuff if you get the 'one' that includes EVERYTHING, like Siberian Ginseng, green tea extract, etc, etc, etc. I have no affiliation with the company that produces the stuff. I believe there is a generic form of the stuff at a slightly reduced price available at drug stores.
Also, as you also likely know, try exercise and meditation. Meditation is particularly effective, but you need some instruction on how to do it properly. I find it helps at night to meditate as it calms the mind and your breathing.
Good luck.
Posted by torachan on May 30, 2008, at 18:40:36
In reply to Re: The best Tricyclic for anxiety.... » torachan, posted by johnj on May 30, 2008, at 16:33:17
....also, it occurred to me that since you've been off medication for lengthy periods of time on, I think, two different occasions, it suggests to me that medication may not be necessary. You've proven, despite the fact you did state you had issues with anxiety and sleeping, that you could go drug free without any "serious" problems. For me, deep down I believe would be impossible, because I'm quite certain there is an underlying disorder that isn't going to go away, at least any time soon. I hold hope for the future.
Try the suggestions I gave above to manage your anxiety drug free, or try as Link suggested a low dose TCA for sleep or perhaps Imovane/Zoplicone. It has a similar chemistry to that of benzodiaxepines and dependance would become a problem is used on a consistent basis over a lengthy period of time, but it's just a suggestion.
Posted by torachan on May 30, 2008, at 18:49:50
In reply to Re: The best Tricyclic for anxiety.... » torachan, posted by johnj on May 30, 2008, at 16:33:17
..also, I don't know if this aligns with your lifestyle and it may be inappropriate to suggest on these boards, but the substance is becoming legal slowly but surely in many areas around North America. I had an extensive history with it but it tended to cause me anxiety--and may have contributed to my underlying disorder or exacerbated a preexisting disorder, but many studies suggest that for many people "cannabis" can act as a calming agent, and it has been proven time and time again to be extremely safe in the quantities typically used. Nicotine and alcohol are FAR more hazardous to your health than cannabis.
Again, just a suggestion.
Posted by torachan on May 30, 2008, at 19:05:02
In reply to Re: The best Tricyclic for anxiety...., posted by torachan on May 30, 2008, at 18:49:50
http://www.ncbi.nlm.nih.gov/pubmed/16224541
Here's a study suggesting the anxiolytic, antidepressant, and neurogenisis effects of a certain potent type of cannabinoid. The problem is it's next to impossible to acquire this substance in regular cannabis.
There are cannabinoid receptors in the brain so ingesting this type of substance could never be considered toxic.
Posted by johnj on May 30, 2008, at 19:17:38
In reply to Re: The best Tricyclic for anxiety...., posted by torachan on May 30, 2008, at 18:49:50
Well, that is another thing we have in common, my wife is Japanese too and I lived there for quite a few years. That is when I had my first panic attack. Basically, stress. However, I too have had problems dating way back. I have always been emotional if not a nervous person. After the pneumonia it just got worse.
Funny you mention cannabis. I have thought of it but my past dealings didn't make it work so well. Alcoholic abuse runs in the family so I don't want to do that either but I think they were self medicating.
I used to do martial arts, hence the Japan thing, but I hav become exercise intolerant after the pneumonia. It really hoses up my sleep. So frustrating. I have tried a lot of stuff like fish oil (increased anxiety), vitamins, etc. I mostly just go with whole foods as I cannot tolerate wheat or dairy anymore either. Meditation I have done and right now I am doing Qi Qong, which is like meditation but using standing poses to increase the "chi" or as the Japanese say "ki". Familiar with these? The wife can explain.
I have been med free but it has been difficult. Last week was the fist time I really had a good two day bout of depression. It scared me as I was really down. It was after a 3 hour outside job cutting the grass so I wondered if I over did it. I am really working on ridding myself of negative thought patterns but it is SO hard not being negative at 2 AM when all I want to do is sleep! I am thinking a low dose TCA for sleep may take the edge off too. Now, if I can just get my pdoc to go for it.
Regards Tora-chan.
johnj
Posted by johnj on May 30, 2008, at 19:19:29
In reply to Re: The best Tricyclic for anxiety...., posted by torachan on May 30, 2008, at 18:49:50
Can you tell me what side effects you have or have had with effexor? I wonder if pristiq may be better? Did you have start up anxiety? thanks
johnj
Posted by torachan on May 30, 2008, at 19:48:22
In reply to Re: The best Tricyclic for anxiety.... » torachan, posted by johnj on May 30, 2008, at 19:19:29
> Can you tell me what side effects you have or have had with effexor? I wonder if pristiq may be better? Did you have start up anxiety? thanks
>
> johnjDefinitely you have start up anxiety for about 5-7 days. Side effects would include basically disrupted sleep. It takes a while for Effexor's anti-anxiety effect to take hold, and it works in a subtle way. It also seems to increase mood, sociability, and motivation. Weight gain does seem to occur, but not drastically. The Pristiq would likely reduce some of the side effects, but not the disrupted sleep one since that's function of its central mechanism. I'm not sure when or if Pristiq will be available in Canada, or JAPAN...
..because in about two years me and my wife will be moving to Japan for a very likely permanent stay. I'm nearing my late thirties, and am currently trying to obtain my BA, cause as you know you need one to gain employment as an English teacher. How did you find the health care coverage in Japan and did you work as an English teacher? I'm a little concerned about seeing a doctor, but I know there are English speaking ones available in the large cities. We'll be in the Kansai area, specifically Osaka, perhaps Kyoto or Kobe, or somewhere in the middle like Takurazuka.
Anyways, is the "ki" you mention part of "genki" and "kibun"? I think it means spirit and the kanji is　気?　You might not be able to decipher the kanji I just wrote.
John
Posted by torachan on May 30, 2008, at 19:52:40
In reply to Re: The best Tricyclic for anxiety.... » johnj, posted by torachan on May 30, 2008, at 19:48:22
LOL. No the kanji is not 　気?　. This site will not encode kanji characters as I thought it would.
Posted by linkadge on May 30, 2008, at 20:10:05
In reply to Re: The best Tricyclic for anxiety...., posted by torachan on May 30, 2008, at 18:49:50
>Nicotine and alcohol are FAR more hazardous to
>your health than cannabis.Eh? I don't know of many studies comparing nicotine to cannabis. Cannabis has been compared to tobacco but thats different.
Linkadge
Posted by linkadge on May 30, 2008, at 20:13:52
In reply to Re: The best Tricyclic for anxiety...., posted by torachan on May 30, 2008, at 19:05:02
>There are cannabinoid receptors in the brain so >ingesting this type of substance could never be >considered toxic.
Whoa? I am a fan of cannabis to but every drug has its toxicities. The brain has natural opiates, but that doesn't mean that opiates do not have their toxicities.
The neurotrophic effects of certain cannabanoids have unfortunatly not been replicated with THC. Toxicity also depends on the type of cannabanoid receptor being activated and how strongly. Too much activation of certain cannabanoid receptors can cause anxiety, paranoid, seizures etc.
Linkadge
Posted by torachan on May 30, 2008, at 20:30:42
In reply to Re: The best Tricyclic for anxiety...., posted by linkadge on May 30, 2008, at 20:13:52
> >There are cannabinoid receptors in the brain so >ingesting this type of substance could never be >considered toxic.
>
> Whoa? I am a fan of cannabis to but every drug has its toxicities. The brain has natural opiates, but that doesn't mean that opiates do not have their toxicities.
>
> The neurotrophic effects of certain cannabanoids have unfortunatly not been replicated with THC. Toxicity also depends on the type of cannabanoid receptor being activated and how strongly. Too much activation of certain cannabanoid receptors can cause anxiety, paranoid, seizures etc.
>
> Linkadge
>Yes, I agree. The drug can certainly reach toxic levels if your smoking huge joints but I'm talking about smoking a tiny quantity like a very thin joint. I think the problem I and many others have with cannnabis and anxiety, paranoia, etc, is they typically ingest much too large a quantity for various reasons, like social peer pressure. Of course tolerance does develop which requires larger ingested amounts, but it seems in the sub-culture a trend developed where ingested unneeded excess quantities in the form of huge "blunts" and massive bong hits became the preferred method.
I once grew an Indica variety of the plant, which tends to sedate more than a sativa, and would only smoke very tiny amounts, and once I got accustomed to the initial uneasiness of smoking a so-called "bad" drug which is socially conditioned into you since a young age, I found it rather soothing and comforting and it did make me prone to enjoying a good night's rest.
Posted by linkadge on May 30, 2008, at 20:39:06
In reply to Re: The best Tricyclic for anxiety...., posted by torachan on May 30, 2008, at 20:30:42
Yes, for many people even a few puffs can provide anxiolysis and relief of insomnia.
Linkadge
Posted by Sigismund on May 30, 2008, at 21:44:54
In reply to Re: The best Tricyclic for anxiety...., posted by linkadge on May 30, 2008, at 20:39:06
It tends to deepen sleep for me.
Posted by johnj on May 31, 2008, at 10:37:12
In reply to Re: The best Tricyclic for anxiety.... » johnj, posted by torachan on May 30, 2008, at 19:48:22
Effexor is interesting that is for sure. My buddy had the same thoughts as you did. Sleep disturbance is a worry for me though. I wonder if that gets better over time? Weight gain is not an issue as I am too skinny as it is. I did wake up after about 4 hours last night and was nervous for a time but then slept for about 3 more hours and then ate something at 5:30 and laid back down until 7 or so. Up and down for me that is for sure.
I worked as an English teacher part time and then in a City Hall's international department.
The healthcare system is ok, but if I was you I would check out a university hospital or related and find a pdoc that has been trained abroad. I would even correspond now if you can locate someone. Get a relationship developed now. You can always import your meds as that is what I did in 2001. I got 3 months at a time. If you are in a big city you will be much better off as healthcare is concerned. My favorite part of Japan is probably Osaka area, Kansai. I lived in Koyoto and the people there are more difficult to understand. I speak good Japanese but the people in Kyoto are hard to understand even for the people of Kyoto from what I was told. I didn't care for Kyoto to be honest. The people are much more outgoing and friendlier in Osaka than Tokyo. Osaka-ben is fun too. Excellent food in Osaka! Korean barbecue is the best.
Yes, it is the same character as the "ki" in kibun and genki, but takes on a slight different meaning. Can you workout? If yes, definately find a good quality martial arts school and train if you are up to it. Aikido is a good option too.
Please keep me informed as to what you decide to try for sleep.
Best Regards
johnj
PS If you would like to babble mail me and keep in touch that would be fine. I am a little leary of babble mail because of privacy issues but for you that would be just fine since we are similiar in the Japan thing.
Posted by torachan on May 31, 2008, at 17:31:29
In reply to Re: The best Tricyclic for anxiety.... » torachan, posted by johnj on May 31, 2008, at 10:37:12
Yeah, sleep, what's that? Had a horrible night last night and I'm suspecting the culprit is the combination of Effexor and Seroquel. I also have Remeron, along with my mainstay Klonopin, which did seem to definitely help me sleep. To be honest, I've tried several medications including several sleeping pills--somewhat useless for me--and Remeron I found to be the only drug so far that was able to induce sleep rather forcefully, especially the first few nights. Its effects do seem to wane over time though.
I'm thinking I may be using a bad combo of Effexor at 75mgs, Seroquel at 25mgs, and Remeron at 15mgs. When I tried just Effexor and Remeron there were no problems, but I heeded the advice of Linkadge in which he suggested Effexor/Remeron is not a good combo for anxiety, and introduced the Seroquel but didn't drop the Remeron. Possible a bad mix I guess. But this goes back to my first lengthy experience with Effexor. The stuff just lightly covers up and maintains the existing underlying tension while glossing over the surface anxiety if that makes sense. I don't hold it in high regard, to be honest. There are days where I'm fine with it and many when I'm not.
I think I'll just try Effexor at 37.5mg and Remeron at 15mgs and drop the AP. Continue with the benzo of course, and discuss with the doctor what other options are available. But I don't think there are many left. Perhaps wait for the newer meds to come along. Valdoxan perhaps.
Regards, john
Posted by torachan on May 31, 2008, at 17:49:50
In reply to Re: The best Tricyclic for anxiety.... » torachan, posted by johnj on May 31, 2008, at 10:37:12
Oh I forgot. What do you mean by you imported your meds? Do you mean got a prescription from a local doctor in Japan and then used it to order from an online pharmaceutical company? Or was it the other way which I guess I shouldn't mention? Japan as I understand can be fairly strict regarding these issues about medication. I'm curious that you were able to get three month supplies as my wife suggested to me that its common in Japan for doctors to prescribe only a months worth, and each time you visit the doctor you have to pay.
Oh, and about health care; when I get employed and am provided with the basic National health care, how much of the costs are covered for a regular doctor visit? My wife indicated it would be fairly costly for a patient like me who requires continuous prescriptions, and thus regular doctor visits.
Thanks.
Posted by johnj on May 31, 2008, at 19:03:30
In reply to Re: The best Tricyclic for anxiety.... » johnj, posted by torachan on May 31, 2008, at 17:31:29
Sorry to hear you had a bad night. Sleep is hard to come by.
I took remeron for some time and couldn't shake the tension it gave me. It also gave me what I call "sponge brain". I tried seroquel and ditched it as it fragmented my sleep. 50-mg gave me akathisia, which was not fun at all. I seem to think a better combo would be the effexor and a tca for sleep. I just don't understand why pdoc's don't prescribe them more often as they have a good track record, even for depression. I know they say they have side effects but I would rather have dry mouth and constipation than insomnia from my meds, but that is me.
Have you ever tried a tca? Even for depression nortryptiline is very good. I took it with success for quite a few years, almost 10. It can help with sleep issues and anxiety.
I had an ok night but lots of chest anxiety today. I may look into buspar.
good luck.
johnj
Posted by johnj on May 31, 2008, at 19:14:56
In reply to Re: The best Tricyclic for anxiety.... » johnj, posted by torachan on May 31, 2008, at 17:49:50
I had a pdoc here in the US who wrote prescriptions for me and a family member sent them to me. Here in the US you can get a 3 or 6 months supply if you have been on a med and are stable on it. That is what I did. All legal. You may want to talk with your doc and maybe he will work with a pdoc over there that speaks English. I would lay a lot of groundwork now.
What is best is to get on something that you can get in Japan. Nortryptiline is one of those. I think you can get remeron now, but I don't like that med. Seriously, I would try a tca with effexor and if it works try maybe weaning off effexor. I believe you can get any benzo over there as I got tranzene when living there. Newer meds. I think a tca for sleep is better than remeron and seroquel. Again, I didn't have luck with those in the long run when comparing them to a tca. TCA side effects improve over time too. Nortyp has a low side effect profile too. If/When I try another med it will be some type of tca. I can't see low doses for sleep having many side effects.
You can import your meds no problem. I even did it when I was working in the US and Japan. I would spend 6 weeks or more and one time I had my doc office ship it over. They were cool about it. I don't think the healthcare in Japan would cost you that much but I compare it to the US which is way more expensive than Japan or Canada due to national programs.
I can't remember what a visit in Japan costs but it is cheaper than the 20 US I pay over here for a visit. I am used to relatively high costs so it doesn't seem high to me.
johnj
Posted by linkadge on May 31, 2008, at 19:40:14
In reply to Re: The best Tricyclic for anxiety.... » johnj, posted by torachan on May 31, 2008, at 17:31:29
>When I tried just Effexor and Remeron there were >no problems, but I heeded the advice of Linkadge >in which he suggested Effexor/Remeron is not a >good combo for anxiety, and introduced the >Seroquel but didn't drop the Remeron. Possible a >bad mix I guess. But this goes back to my first >lengthy experience with Effexor.
If effexor/remeorn was working then certainly don't change it. I didn't realize you were already taking this combination. If its not causing anxiety then all the better. I just know of a few people who had bad experiences on the combination. Just watch your blood pressure on this combination.
>I think I'll just try Effexor at 37.5mg and >Remeron at 15mgs and drop the AP. Continue with >the benzo of course, and discuss with the doctor >what other options are available. But I don't >think there are many left. Perhaps wait for the >newer meds to come along. Valdoxan perhaps.
I'd personally like to see something like ritanserin (a potent/selective 5-ht2a/c antagonist) as an available augmenting agent. Cyproheptadine comes close to a selective 5-ht2a/c antagonist.
Linkadge
Posted by linkadge on May 31, 2008, at 19:45:23
In reply to Re: The best Tricyclic for anxiety.... » torachan, posted by johnj on May 31, 2008, at 19:14:56
The TCA can be more tollerable than the SSRI's for some. Amitrpytaline is still considered a gold standard against which AD efficacy is measured.
The TCA's also have a record of actually getting people *well*.
This whole "you'll need to take your meds for the rest of your life" nonsense, is because SSRI's usually don't get people to remission and doctors don't want to put their patients through withdrawl.
I have a few uncles that went on TCA's for major depressive episodes. They got better and then came off and that was it. That just doesn't happen these days.
Linkadge
Posted by johnj on May 31, 2008, at 20:29:03
In reply to Re: The best Tricyclic for anxiety...., posted by linkadge on May 31, 2008, at 19:45:23
Wow, I think you are on to something with this observation. I tend to agree that ssri's just don't do a long term job as tca's have done. Remeron long term just doesn't seem practical either. It seems with ssri's people have to take a combo to feel well. I know tca's have side effects but like I said before I would rather have constipation or dry mouth instead of insomnia. I can't take a long term med induced insomnia.
Posted by torachan on May 31, 2008, at 22:24:27
In reply to Re: The best Tricyclic for anxiety...., posted by linkadge on May 31, 2008, at 19:45:23
Thank you Linkadge and johnj. Excellent advice. I think I'm on a mission now to "strongly" suggest to my doc to give me a shot with a TCA. In the short time I've known him, he's been very accommodating, more than most docs I've met. It's just when I make suggestions like a TCA--I seem to remember mentioning this, but you know how it is, spit out as many words as you can in 5-10min then it's out the door--and a MAOI or Lithium, stuff like that, but he leans toward the newer drugs, as most do. I think it's primarily because of money and the believe that science is always advancing. But that's not always the case; case in point, BENZOS. They still can't beat the efficacy of those drugs developed in the '60's.
Anyways, I think with enough prodding he'll go for it.
Link, johnj suggested Nortryptyline. How does it fare against Amitryptyline and Doxepin? Also, is Cyproheptadine similar in chemistry and effects to Zoplicone?
Posted by yxibow on June 1, 2008, at 3:37:21
In reply to The best Tricyclic for anxiety...., posted by jms600 on May 27, 2008, at 16:53:33
> Hi everyone
>
> My Generalized Anxiety Disorder is going from bad to worse and I'm desperate to try and find some relief. I'm considering trying a Tricyclic antidepressant as I haven't tried one yet.
>
> Does anyone know which is the best Tricyclic for anxiety?? I also suffer from depression and panic disorder.
>
> I've already tried:
>
> Valium
> Leaxapro
> Seroxat (Paxil)
> Prozac
> Zoloft
> Effexor
> Remeron
> Zyprexa
> Seroquel
> Amisulpride
> Promazine
> Haloperidol
> Stelazine
>
> Any suggestions for a good Tricyclic anti-depressant for anxiety would be grately appreciated.
>
> Thanks!This thread has quite a few posts, so I don't know if it was already mentioned, but as far as tricyclics, I would say Anafranil (Clomipramine). It was the first or one of the first early agents used for OCD when brain mapping was being discovered and can be considered an "SRI", before SSRIs.
It does carry some side effect burdens such as sweating and other things, although not everybody gets the anticholinergic effects of each tricyclic. Most are fairly sedating, although I think Elavil (amitriptyline) is probably the most, although Sinequan (doxepin) can zonk out some initially.
-- tidings
Posted by SLS on June 1, 2008, at 5:28:04
In reply to Re: The best Tricyclic for anxiety...., posted by linkadge on May 31, 2008, at 19:45:23
> The TCA can be more tollerable than the SSRI's for some. Amitrpytaline is still considered a gold standard against which AD efficacy is measured.
>
> The TCA's also have a record of actually getting people *well*.At this point, it seems that Effexor is closest to the TCAs with respect to percentage of responders and quality of response.
Imipramine was considered to be the gold standard and was used as the standard comparator drug in clinical trials. However, amitriptyline is indeed somewhat better with regard to percentage of responders, and clomipramine better yet.
Regarding anxiety, some people experience an improvement with desipramine, especially once they begin to see the depression abate. Perhaps Linkadge knows of a receptor to which it binds other than NE alpha-1. Or perhaps there are NE pathways that are inhibitory upon the anxiogenic serotonergic tracts.
It is hard to say whether the anxiety is constantly in the background like GAD or a psychosocial consequence of being to asked to perform while in the depressed state.
- Scott
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