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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 10 of 10. This is the beginning of the thread.
Posted by HelenInCalif on April 15, 2003, at 1:46:23
After a month of stress at work I have good reason to believe I'll be laid off tomorrow or Wednesday. I know my stress will skyrocket, even though I'm trying to use cognitive techniques (ABCDE for example) to fight this.
The work stress had already caused a light depression and made my ADD worse (for the former I've added fish oil, B vitamins, antioxidants, and a few other supplements; for the latter I've upped my dexedrine dose). Even though I've wanted out of the job, the lack of control of a layoff is already causing me to feel panicked, in a "fight or flight" mode, tonight. Two questions:
1. Is there anything doctors could prescribe to help with an extreme stress reaction? What I'd like to remain functional at work, rather than frozen in fear. Can any medicine help? Because I just changed insurance I'd only like to see a doctor if there's a good chance they'll prescribe something useful. (Currently the Dex and ambien for insomnia are my only prescriptions.)
2. Any suggestions on other diet or supplements changes to make in the face of a sudden stress spike (other than less caffeine)? More or less carbohydrates? Tryptophan from turkey?
Posted by Snoozy on April 15, 2003, at 2:10:33
In reply to Help: next two days will be extremely stressful, posted by HelenInCalif on April 15, 2003, at 1:46:23
> After a month of stress at work I have good reason to believe I'll be laid off tomorrow or Wednesday. I know my stress will skyrocket, even though I'm trying to use cognitive techniques (ABCDE for example) to fight this.
>
> The work stress had already caused a light depression and made my ADD worse (for the former I've added fish oil, B vitamins, antioxidants, and a few other supplements; for the latter I've upped my dexedrine dose). Even though I've wanted out of the job, the lack of control of a layoff is already causing me to feel panicked, in a "fight or flight" mode, tonight. Two questions:
>
> 1. Is there anything doctors could prescribe to help with an extreme stress reaction? What I'd like to remain functional at work, rather than frozen in fear. Can any medicine help? Because I just changed insurance I'd only like to see a doctor if there's a good chance they'll prescribe something useful. (Currently the Dex and ambien for insomnia are my only prescriptions.)
>
> 2. Any suggestions on other diet or supplements changes to make in the face of a sudden stress spike (other than less caffeine)? More or less carbohydrates? Tryptophan from turkey?I'd go for turkey, a big ol' plate of potatoes and a bowl of pasta. Carbs usually slow one down, but you do still want to have adequate protein to keep the blood sugar from crashing. Perhaps avoiding sugary foods too (it's so tempting to scarf down a bag of candy or a bunch of donuts when you're really stressed.) Cutting back on caffeine if you can without getting withdrawl symptoms, should help.
As for medications, I'm assuming you want to stay away from the benzos? I have heard of using a beta-blocker such as propranolol (it's a generic) for stage fright/speaking anxiety-type situations. Maybe that would help for a short-term extreme anxiety bout? Just a thought.
Deep breaths and good luck to you!
Posted by Viridis on April 15, 2003, at 2:20:06
In reply to Help: next two days will be extremely stressful, posted by HelenInCalif on April 15, 2003, at 1:46:23
Xanax could be very helpful, unless you really want to avoid benzos. For the short term, that would be my first-line choice.
Posted by HelenInCalif on April 15, 2003, at 3:38:32
In reply to Re: Help: next two days will be extremely stressfu » HelenInCalif, posted by Viridis on April 15, 2003, at 2:20:06
I know with antidepressants it takes weeks for the medications to work. Are either of these relatively fast in their impact?
Also, are any of the benzos less likely to cause sleepiness as a side effect. Or by definition do all of them do this? Thanks again for any advice.
Posted by HelenInCalif on April 15, 2003, at 11:26:45
In reply to Help: next two days will be extremely stressful, posted by HelenInCalif on April 15, 2003, at 1:46:23
Couldn't sleep last night (I'd wanted to get up early, so I skipped the ambien). Well, at least lack of sleep can be an antidepressant. I imagine that benzo's and lack of sleep don't mix well, though.
Posted by Snoozy on April 15, 2003, at 12:49:38
In reply to Would Xanax or beta blockers act fast?, posted by HelenInCalif on April 15, 2003, at 3:38:32
I looked up some information in a psychiatric drug book. Beta blockers are used for many things, from heart problems to headaches to social phobia. For a stage fright situation, 20-40 mg is taken about one hour before they have to perform. The drug usually controls rapid heartbeat, trembling and sweating.
Beta blockers reduce the amount of nervous system stimultation to the heart and blood vessels, and cut down on the ability of adrenaline to make the heart beat faster. They're very safe for healthy people, and non-addictive. Atenolol is used as well as propranolol (both generic).
The down side is they're just going to work on some of the physical symptoms of anxiety - the rapid heartbeat, etc. They don't have an overall calming effect like the benzos. All the benzos do cause sleepiness.
There are long (Valium, Klonopin) and short (Ativan, Xanax) acting benzos. The short ones are eliminated from the body a few hours after they are taken. The upside to taking a short one is that if it's too sedating, it's out of your system fairly quickly.
If you want to try a benzo, I would suggest calling your doctor and explaining that you are in a short-term situation of extreme anxiety inducement. Ask for 5 or 10 pills (if you think this will be adequate) of the lowest dose available. Doctors seem to be more willing to prescribe them in a limited quantity for a short (1-2 weeks) time period. You can even try cutting the pills in half at first, to see how it affects you.
I'm familiar with Ativan and Xanax. I never noticed much difference in how they worked. I would note that both are available generically, however I know that Ativan (lorazepam) has been in the news for huge price increases - I think there's only one generic manufacturer. I know someone whose Ativan rx doubled in price. This may have changed by now - a pharmacy should be able to tell you.
I hope this helps in some way. Please let me know how you're doing.
> I know with antidepressants it takes weeks for the medications to work. Are either of these relatively fast in their impact?
>
> Also, are any of the benzos less likely to cause sleepiness as a side effect. Or by definition do all of them do this? Thanks again for any advice.
Posted by HelenInCalif on April 15, 2003, at 13:17:45
In reply to Re: Would Xanax or beta blockers act fast?, posted by Snoozy on April 15, 2003, at 12:49:38
thank you. Given my lack of sleep last night, I'm actually feeling calmer than I might otherwise. Still, I probably should call my doctor. From what you write the Benzos would be a bad idea as I couldn't compensate for sleepiness.
Do you know if they must test for anything (other than blood pressure) for Beta blockers? Keeping my heart rate down while talking with the firing manager or coworkers would be enough to help me, I think.
> I looked up some information in a psychiatric drug book. Beta blockers are used for many things, from heart problems to headaches to social phobia. For a stage fright situation, 20-40 mg is taken about one hour before they have to perform. The drug usually controls rapid heartbeat, trembling and sweating.
>
> Beta blockers reduce the amount of nervous system stimultation to the heart and blood vessels, and cut down on the ability of adrenaline to make the heart beat faster. They're very safe for healthy people, and non-addictive. Atenolol is used as well as propranolol (both generic).
>
> The down side is they're just going to work on some of the physical symptoms of anxiety - the rapid heartbeat, etc. They don't have an overall calming effect like the benzos. All the benzos do cause sleepiness.
>
> There are long (Valium, Klonopin) and short (Ativan, Xanax) acting benzos. The short ones are eliminated from the body a few hours after they are taken. The upside to taking a short one is that if it's too sedating, it's out of your system fairly quickly.
>
> If you want to try a benzo, I would suggest calling your doctor and explaining that you are in a short-term situation of extreme anxiety inducement. Ask for 5 or 10 pills (if you think this will be adequate) of the lowest dose available. Doctors seem to be more willing to prescribe them in a limited quantity for a short (1-2 weeks) time period. You can even try cutting the pills in half at first, to see how it affects you.
>
> I'm familiar with Ativan and Xanax. I never noticed much difference in how they worked. I would note that both are available generically, however I know that Ativan (lorazepam) has been in the news for huge price increases - I think there's only one generic manufacturer. I know someone whose Ativan rx doubled in price. This may have changed by now - a pharmacy should be able to tell you.
>
> I hope this helps in some way. Please let me know how you're doing.
>
>
> > I know with antidepressants it takes weeks for the medications to work. Are either of these relatively fast in their impact?
> >
> > Also, are any of the benzos less likely to cause sleepiness as a side effect. Or by definition do all of them do this? Thanks again for any advice.
>
>
Posted by Viridis on April 15, 2003, at 13:31:43
In reply to Would Xanax or beta blockers act fast?, posted by HelenInCalif on April 15, 2003, at 3:38:32
Most benzos act almost immediately -- with Xanax, I can feel the calming effect within about half an hour, or in a few minutes if dissolved under the tongue. The effects of Xanax typically last about 3-4 hours.
Benzos can cause sleepiness and/or lack of coordination if you're not used to them. I take Klonopin (a long-acting benzo) daily, and it took a week or two to get over these minor side effects, so at first I just took very small doses throughout the day. Now I have no side effects at all. I also take Xanax occasionally. For me, 0.25-0.50 mg just makes me feel calm, but more than this makes me drowsy (for me, 1.0 mg is great for occasional insomnia, although I wouldn't use it regularly for this purpose).
If you can get your doctor to give you a small prescription of a benzo, I'd recommend Xanax (alprazolam); some respond better to Ativan (lorazepam); Klonopin (clonazepam) is good but longer-acting, and it seems to take a bit longer to adjust to Klonopin for some people. Xanax just seems to provide the best short-term stress relief for the widest range of people.
I would try a small amount (for Xanax, 0.25 mg) and see how it works, preferably at home when you don't have to do anything demanding or drive anywhere. There's a lot of variation in reaction -- some people respond to 0.25 mg, some need at least 1.0 mg, and so on. If 0.25 mg hasn't done anything within an hour, try adding another 0.25 mg, etc.
Of course, you should discuss all of this with your doctor. Many doctors are afraid of benzos because they can cause dependency with long-term use, but even "benzophobic" doctors will sometimes prescribe a few pills to get you through a brief, very stressful time. They're usually very effective, and are very safe.
Good luck!
Posted by Snoozy on April 15, 2003, at 14:36:10
In reply to Re: Would Xanax or beta blockers act fast? » Snoozy, posted by HelenInCalif on April 15, 2003, at 13:17:45
It looks like they just need to check your pulse and blood pressure before prescribing propranolol/atneolol. The only problems would be if you have an abnormally slow heart rate, or asthma/allergies that regulary make you wheeze (I don't know what that's about - just reading what my book says!)
About Xanax - I take 0.5 mg tablets, and they're scored so they're very easy to cut in half. I did see that it's made in 0.25 tablets, so you could cut those in half and only take 0.125 mg. You could probably even cut the pill in quarters.
Do you regularly take Ambien for sleep? I tried it a few times and it was kind of weird for me (not as weird as Sonata though). When I really need help to sleep, I take Benadryl - it's over-the-counter. If you're not used to taking it, it really makes you drowsy. It doesn't clear the system as fast as Ambien though, so it can have a hangover effect. I sometimes take it over the weekend when I want to get some extra catch-up sleep.
> thank you. Given my lack of sleep last night, I'm actually feeling calmer than I might otherwise. Still, I probably should call my doctor. From what you write the Benzos would be a bad idea as I couldn't compensate for sleepiness.
>
> Do you know if they must test for anything (other than blood pressure) for Beta blockers? Keeping my heart rate down while talking with the firing manager or coworkers would be enough to help me, I think.
> > I looked up some information in a psychiatric drug book. Beta blockers are used for many things, from heart problems to headaches to social phobia. For a stage fright situation, 20-40 mg is taken about one hour before they have to perform. The drug usually controls rapid heartbeat, trembling and sweating.
> >
> > Beta blockers reduce the amount of nervous system stimultation to the heart and blood vessels, and cut down on the ability of adrenaline to make the heart beat faster. They're very safe for healthy people, and non-addictive. Atenolol is used as well as propranolol (both generic).
> >
> > The down side is they're just going to work on some of the physical symptoms of anxiety - the rapid heartbeat, etc. They don't have an overall calming effect like the benzos. All the benzos do cause sleepiness.
> >
> > There are long (Valium, Klonopin) and short (Ativan, Xanax) acting benzos. The short ones are eliminated from the body a few hours after they are taken. The upside to taking a short one is that if it's too sedating, it's out of your system fairly quickly.
> >
> > If you want to try a benzo, I would suggest calling your doctor and explaining that you are in a short-term situation of extreme anxiety inducement. Ask for 5 or 10 pills (if you think this will be adequate) of the lowest dose available. Doctors seem to be more willing to prescribe them in a limited quantity for a short (1-2 weeks) time period. You can even try cutting the pills in half at first, to see how it affects you.
> >
> > I'm familiar with Ativan and Xanax. I never noticed much difference in how they worked. I would note that both are available generically, however I know that Ativan (lorazepam) has been in the news for huge price increases - I think there's only one generic manufacturer. I know someone whose Ativan rx doubled in price. This may have changed by now - a pharmacy should be able to tell you.
> >
> > I hope this helps in some way. Please let me know how you're doing.
> >
> >
> > > I know with antidepressants it takes weeks for the medications to work. Are either of these relatively fast in their impact?
> > >
> > > Also, are any of the benzos less likely to cause sleepiness as a side effect. Or by definition do all of them do this? Thanks again for any advice.
> >
> >
>
>
Posted by stjames on April 15, 2003, at 23:06:12
In reply to Would Xanax or beta blockers act fast?, posted by HelenInCalif on April 15, 2003, at 3:38:32
Both are quick acting, at least Inderal is in that class,
and Xanax is found by some to be least likely
to make you sleepy.
This is the end of the thread.
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