![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 20 of 20. This is the beginning of the thread.
Posted by Thrud on April 14, 2002, at 7:23:12
Hi all.
Are there any drug groups beside benzos that are effective for anxiety BUT:
1) Do not kill your sexual function.
2) Do not kill your intellect.
Unfortunately a broad range of benzos do this to me.
Please do not suggest the SSRIs, Wellbutrin etc.: been there, hated that.
I think my quest for the Holy Grail will never end....
Thrud
Posted by IsoM on April 14, 2002, at 12:00:25
In reply to Magic anxiolytics, anyone? , posted by Thrud on April 14, 2002, at 7:23:12
Thrud, it's been mentioned before - modafinil (Provigil) or adrafinil (Olmifon). Doesn't kill sexual function or intellect either, but instead enhances them. Not everyone feels the same benefits though.
You need to check back for an earlier posting from another forum member who mentioned that originally Provigil was horrible for her till she found the small therapeutical window of effectiveness.
You've never responded to any of my other comments about adrafinil, so perhaps you don't agree, but you did ask.
Posted by Ritch on April 14, 2002, at 13:49:41
In reply to Magic anxiolytics, anyone? , posted by Thrud on April 14, 2002, at 7:23:12
> Hi all.
>
> Are there any drug groups beside benzos that are effective for anxiety BUT:
>
> 1) Do not kill your sexual function.
>
> 2) Do not kill your intellect.
>
> Unfortunately a broad range of benzos do this to me.
>
> Please do not suggest the SSRIs, Wellbutrin etc.: been there, hated that.
>
> I think my quest for the Holy Grail will never end....
>
> Thrud
The only thing that might work would be a relatively non-sedating TCA, nortriptyline (at lower doses). But, you probably have already been there done that. It worked for my ADHD probably better than any other AD, without making me more anxious (I added some for WB induced anxiety a couple of times and it helped a lot). Of course you might have to deal with constipation, orthostatic hypotension, or heart arrthymias...
BTW, the primary metabolite of nortrip. (can't remember the name) has even fewer side-effects than the parent and is more anxiolytic. Don't look for that one to be developed by a pharm. co. anytime soon. You probably have already tried Buspar. KavaKava is bad for your liver. SJW? Does hydroxyzine fog up your head?-there's another possibility.
Posted by fachad on April 14, 2002, at 15:30:07
In reply to Magic anxiolytics, anyone? , posted by Thrud on April 14, 2002, at 7:23:12
I think there is always some cognitive impairment that goes along with relieving anxiety.
Here are a few suggestions.
First, with any med, regardless of what class (benzo, TCA, SSRI, etc.) always consider trying a "sub-therapeutic" dose. The drug makers set the “standard effective doses”, and they are often too high.
Maybe a drug that you tried would have relieved your anxiety at a lower dose and not caused the sexual or cognitive side effects.
I think your choices are benzos, SSRIs, TCAs, and H1 blockers.
Of benzos, I think Xanax is supposed to have the least side effects, and Klonopin is supposed to be the smoothest.
Of SSRIs, I personally don't like them, but you might be able to get some benefit without the sexual side effects if you went really low on the dose, like 5mg/day of Paxil, or 25mg/day of Zoloft.
Of TCAs, I know that doxepin at 10mg or 25mg was shown to be as effective as Valium by one study. Nortriptiline is probably the "cleanest" anxiolitic TCA, again in the 10mg or 25 mg dose range.
Finally, hydroxyzine pamoate used to be marketed as an anxiety med. It comes in 25mg capsules. They make 10mg hydroxyzine HCL tablets, but I don't think the HCL form is as good as the pamoate form.
No Holy Grail here, but maybe a low dose would allow some benefit without too much side effects.
> Hi all.
>
> Are there any drug groups beside benzos that are effective for anxiety BUT:
>
> 1) Do not kill your sexual function.
>
> 2) Do not kill your intellect.
>
> Unfortunately a broad range of benzos do this to me.
>
> Please do not suggest the SSRIs, Wellbutrin etc.: been there, hated that.
>
> I think my quest for the Holy Grail will never end....
>
> Thrud
Posted by Bekka H. on April 14, 2002, at 16:07:51
In reply to Magic anxiolytics, anyone? , posted by Thrud on April 14, 2002, at 7:23:12
The best anxiolytic that does not impair cognition, but actually improves cognition, is physical exercise --brisk walking, jogging, swimming, bicycling, or whatever you enjoy, for at least 30 minutes, at least 3-4 times per week.
Exercise is magic.Bekka
Posted by Thrud on April 14, 2002, at 19:18:01
In reply to Re: Magic anxiolytics, anyone? » Thrud, posted by IsoM on April 14, 2002, at 12:00:25
> You've never responded to any of my other comments about adrafinil, so perhaps you don't agree, but you did ask.Hi IsoM.
No offence meant by my not replying to your posts. You weren't wasting your time: I went and investigated Modafinil and Adrafinil.
After reading the literature on them I have decided they are worth a try. I would much prefer to try Modafanil but I think the cost is prohibitive. If memory serves me (which it probably doesn't) Adrafinil is an amphetamine type of stimulant where Modafinil is some new unique material: this makes me a bit hesitant about Adrafinil. Maybe I am wrong here...another memory is floating back that Modafanil is actually a metabolite of Adrafinil...
Still, if you confirm that Adrafanil relieves (at least some) anxiety without cognitive and sexual problems I will ask my pdoc for it. I need to do a little more of my own research on it too.
I appreciate your input IsoM, and if I don't reply that doesn't mean I've ignored you!
Thrud
Posted by Thrud on April 14, 2002, at 19:22:26
In reply to Re: Magic anxiolytics, anyone? » Thrud, posted by Ritch on April 14, 2002, at 13:49:41
> The only thing that might work would be a relatively non-sedating TCA, nortriptyline (at lower doses). But, you probably have already been there done that.
Yes, unfortunately TCAs were bad news for me.
>SJW?
Tried it, doesn't help.
>Does hydroxyzine fog up your head?-there's another possibility.
What is hydroxyzine? I haven't heard of it, much less tried it..
Thanks.
Thrud
Posted by Thrud on April 14, 2002, at 19:25:31
In reply to Re: Magic anxiolytics, anyone? » Thrud, posted by fachad on April 14, 2002, at 15:30:07
> I think your choices are benzos, SSRIs, TCAs, and H1 blockers.
What are some examples of H1 blockers? Doesn't increasing serotonin = sexual dysfunction?
> Of benzos, I think Xanax is supposed to have the least side effects, and Klonopin is supposed to be the smoothest.
This was basically my experience also.
Posted by Thrud on April 14, 2002, at 19:28:27
In reply to Magic anxiolytics, anyone? - Thrud, posted by Bekka H. on April 14, 2002, at 16:07:51
> The best anxiolytic that does not impair cognition, but actually improves cognition, is physical exercise --brisk walking, jogging, swimming, bicycling, or whatever you enjoy, for at least 30 minutes, at least 3-4 times per week.
> Exercise is magic.
>
> BekkaI agree...to a point. I exercise aerobically a LOT but by itself it is still not enough. Damn hard-core anxiety!
Thrud
Posted by IsoM on April 14, 2002, at 19:40:46
In reply to Re: Magic anxiolytics, anyone?, posted by Thrud on April 14, 2002, at 19:18:01
Thanks Thrud. I didn't mean to say you were ignoring me on purpose, but wasn't sure if anything I'd written before was helpful to you, & whether I should mention the adrafinil again.
Nope, adrafinil isn't an amphetamine-type. It & modafinil are the only two in their class of stims. And yes, modafinil is a metabolite of adrafinil. You won't get adrafinil here in North America though. I order mine on-line. I'd rather give modafinil (Provigil) a try but not at the price it is now.
I can vouch for cognitive improvement with me while relieving anxiety. But it took a short while to kick in - it didn't have an immediate effect. Don't know about the sexual part as I'm not in a relationship now, but I've read that others have said (research papers agreed) that it improved sexual enjoyment, rather than hindering it.
I ran out of adrafinil again (after vowing never to let it happen) & definitely feel the anxious & irritable edge back again. Can't wait for it to come in the mail. Instead of being calm & content, I'm irritable & ready to jump on people. My shoulders are tight & sore again, & I find I'm clenching my jaws too, & have frequent headaches from furrowed brows. Adrafinil relieves it all for me. It's amazing how different I feel on it.
Posted by IsoM on April 14, 2002, at 19:45:20
In reply to Re: Magic anxiolytics, anyone? - Thrud » Bekka H., posted by Thrud on April 14, 2002, at 19:28:27
Just wanted to make a comparison for you. Adrafinil feels similar to when I used to take together a stim (Dexedrine) for focus & to combat EDS, and a BZD (alprazolam) for the inner tension & muscle tightness. I feel both calm & alert on adrafinil. Wish it worked as well for everyone as it does for me. Don't forget the therapeutical window bit.
Posted by Ritch on April 15, 2002, at 10:40:11
In reply to Re: Magic anxiolytics, anyone?, posted by Thrud on April 14, 2002, at 19:22:26
> >Does hydroxyzine fog up your head?-there's another possibility.
>
> What is hydroxyzine? I haven't heard of it, much less tried it..
>
> Thanks.
>
> Thrud
Hydroxyzine is an antihistamine that is used to treat hives and to reduce pre-operative anxiety (in combination with analgesics). It also has been used IM or IV(I think) to treat acute agitative states. It has been around forever. I gave it a shot as a switch from chlordiazepoxide back in the 80's. It worked OK, but I liked the librium better. The brand name for it is Atarax. Since it doesn't effect GABA (like BZD's) it is useless for alcohol withdrawal, etc. You might consider a "lighter" lower-potency benzodiazepine like oxazepam or chlordiazepoxide, or even clorazepate.Mitch
Posted by Jaynee on April 15, 2002, at 16:41:30
In reply to Magic anxiolytics, anyone? , posted by Thrud on April 14, 2002, at 7:23:12
I am on Celexa, but it wasn't helping enough with the anxiety. It helped somewhat, but I have added Passion Flower tincture to it and it really helps. I buy Vogel tincture drops. Give it a try, it can't hurt.
From PUBMED:
Abstract
Journal of Clinical Pharmacy & Therapeutics
Volume 26 Issue 5 Page 363 - October 2001
Passionflower in the treatment of generalized anxiety: a
pilot double-blind randomized controlled trial with
oxazepam
S. Akhondzadeh PhD12, H. R. Naghavi MD1, M. Vazirian MD1, A. Shayeganpour
PharmD2, H. Rashidi PharmD2&M. Khani MSc2
Objective: Passionflower (Passiflora incarnata) is a folk remedy for anxiety. A
double-blind randomized trial compared the efficacy of Passiflora incarnata extract
with oxazepam in the treatment of generalized anxiety disorder.Methods: The study was performed on 36 out-patients diagnosed with GAD using
DSM IV criteria. Patients were allocated in a random fashion: 18 to the Passiflora
extract 45 drops/day plus placebo tablet group, and 18 to oxazepam 30 mg/day
plus placebo drops for a 4-week trial.Results: Passiflora extract and oxazepam were effective in the treatment of
generalized anxiety disorder. No significant difference was observed between the
two protocols at the end of trial. Oxazepam showed a rapid onset of action. On the
other hand, significantly more problems relating to impairment of job performance
were encountered with subjects on oxazepam.Conclusion: The results suggest that Passiflora extract is an effective drug for the
management of generalized anxiety disorder, and the low incidence of impairment
of job performance with Passiflora extract compared to oxazepam is an advantage.
A large-scale trial is justified.
another study:J Clin Pharm Ther 2001 Oct;26(5):369-73
Related Articles, Books, LinkOut
Passionflower in the treatment of opiates withdrawal: a double-blind
randomized controlled trial.Akhondzadeh S, Kashani L, Mobaseri M, Hosseini SH, Nikzad S, Khani M.
Roozbeh Psychiatric Hospital, Tehran University of Medical Sciences, South Kargar Avenue,
Tehran 13334, Iran. s.akhond@neda.netOBJECTIVE: Clonidine-based therapies have been utilized as the main protocol for opiate
detoxification for several years. However, detoxification with clonidine has its limitations,
including lack of efficacy for mental symptoms. Accumulating evidence shows the efficacy of
Passiflora incarnata extract in the management of anxiety. In our continuing study of traditional
medicines, which have neurotropic effects, this plant had an anxiolytic effect, which may be used
as an adjuvant agent in the detoxification of opiates by clonidine. We present the results of a
double-blind randomized controlled trial of clonidine plus passiflora extract vs. clonidine plus
placebo in the outpatient detoxification of 65 opiates addicts. METHODS: A total of 65 opiates
addicts were assigned randomly to treatment with passiflora extract plus clonidine tablet or
clonidine tablet plus placebo drop during a 14-day double-blind clinical trial. All patients met the
DSM IV criteria for opioid dependence. The fixed daily dose was 60 drops of passiflora extract
and a maximum daily dose of 0.8 mg of clonidine administered in three divided doses. The
severity of the opiate withdrawal syndrome was measured on days 0, 1, 2, 3, 4, 7 and 14 using
the Short Opiate Withdrawal Scale (SOWS). CONCLUSION: Both protocols were equally
effective in treating the physical symptoms of withdrawal syndromes. However, the passiflora
plus clonidine group showed a significant superiority over clonidine alone in the management of
mental symptoms. These results suggested that passiflora extract may be an effective adjuvant
agent in the management of opiate withdrawal. However, a larger study to confirm our results is
warranted.Publication Types:
Clinical Trial
Randomized Controlled Trial
Posted by BobS. on April 15, 2002, at 20:22:23
In reply to Magic anxiolytics, anyone? , posted by Thrud on April 14, 2002, at 7:23:12
Thrud,
I, like you, am looking for magic. I started a thread above, which unfortunately, requires access to Nature magazine. 5-HT1a is discussed in the articles as having a role in anxiety. If so, something affecting the 5-HT1a rececptors might be the way to go. Like you I want nothing to do with the SSRIs, etc. Ritch, who posted here, suggested Buspar. Have you tried a coctail of low dose Buspar and low dose Xanax? Could there be magic there??
BobS.
Posted by kid47 on April 16, 2002, at 12:18:13
In reply to Magic anxiolytics, anyone? , posted by Thrud on April 14, 2002, at 7:23:12
I took Neurontin for several months (800mgx4/day) as a mood stabilizer. It had a gentle calming effect but did make me slightly tired. No other noticeable side fx however. Maybe a lower dose would reduce anxiety without the sleepiness. Good luck Take care
kid
Posted by Thrud on April 16, 2002, at 21:32:27
In reply to Re: Magic anxiolytics, anyone? , posted by BobS. on April 15, 2002, at 20:22:23
Hi BobS.
The only problem I have with Buspar is the cost. Otherwise I would have tried it by now!
Thrud
Posted by Thrud on April 16, 2002, at 21:35:25
In reply to Re: Magic anxiolytics, anyone? , posted by kid47 on April 16, 2002, at 12:18:13
Hi kid47.
Neurontin seems to do lots of different things for lots of different people, but it does seem to sedate just about everyone.
I'll keep it in mind, but I doubt I'll be trying it in the near future.Thanks.
Thrud
Posted by IsoM on April 16, 2002, at 22:53:37
In reply to Re: Magic anxiolytics, anyone? » kid47, posted by Thrud on April 16, 2002, at 21:35:25
Shows how different we can be & our reactions to different meds. Buspar was horrible for me - I felt edgey, jittery, wound up tight, & very irritable. Yet for others, it's so calming. I'll get back to you with some more links for adrafinil this weekend. I'll have to do a bit of digging.
Posted by alan on April 17, 2002, at 20:16:00
In reply to Re: Magic anxiolytics, anyone? , posted by BobS. on April 15, 2002, at 20:22:23
. Have you tried a coctail of low dose Buspar and low dose Xanax? Could there be magic there??
> BobS.
_________________________________________
Might want to be careful. I believe benzos are contraindicated while using Buspar and it is recommended that bzd's are to be started up only after about a six week stop of bzd's. Also, taking Buspar AFTER taking bzd's is generally known to make the Buspar less effective.Alan
Posted by Raga on April 18, 2002, at 9:50:31
In reply to Magic anxiolytics, anyone? , posted by Thrud on April 14, 2002, at 7:23:12
I'm surprised no one has mentioned antipsychotics.
A low dose of these will help with anxiety. I'm on 1.5 mg Risperdal, and it eliminates my panic attacks, OCD behaviours and general anxiety with no side effects except for the slightest of sedation.-Raga
This is the end of the thread.
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.