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Dr. Bob is Robert Hsiung, MD,
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Posted by greywolf on February 18, 2006, at 15:02:53
In reply to Confused regarding choice of med presecribed, posted by Op27Nr2 on February 18, 2006, at 12:20:09
Before you go with anti-psychotics, I would talk to your doc about trying a different benzo or some anti-convulsant, like Neurontin. I wouldn't be in a hurry to go the AP route.
Posted by ed_uk on February 18, 2006, at 15:06:39
In reply to Confused regarding choice of med presecribed, posted by Op27Nr2 on February 18, 2006, at 12:20:09
If you do decide to try Abilify for GAD, it might be a good idea to start treatment with the new 2mg tablet.
Ed
Posted by blueberry on February 18, 2006, at 15:10:59
In reply to Confused regarding choice of med presecribed, posted by Op27Nr2 on February 18, 2006, at 12:20:09
Sounds overly aggressive to me. The likelihood of abilify actually increasing your anxiety for a couple weeks is pretty high. It's just my opinion, but if you have a second opinion coming and you just want to survive until then, there are a couple options.
Health food store. Get an amino relaxing supplement that has gaba, taurine, glycine, and inositol. All natural and good for you. Another one that is sublingual has gaba, taurine, glycine, and tyrosine. And try some magnesium glycinate. Magnesium is calming and so is the glycine in it. Though these work wonders for some people, for most people they will just help take the edge off.
Another option is to call the doctor who prescribed the xanax and ask for two things: 1) A trial of .5mg xanax 3 to 4 times a day for 3 days. 2)A trial of .5mg to 1mg klonopin once or twice a day for 3 days. Go from there. The benzos are like antidepressants, you just have to try a few to find the right one.
While you are waiting, go online and do a search on cortisol saliva test. You can get it done mailorder and it's not very expensive. The doctors won't check this. But if your anxiety is high, cortisol will also be high, and that will eventually wear out the adrenal glands to where cortisol will be way low and you'll really be in a bad place then. If cortisol tests high, it can easily be lowered along with the anxiety with a natural supplement of common minerals called Seraphos.
It's true that anxiety and depression go hand in hand. I just get the sense from your post that the anxiety may be causing some depression, not the other way around.
Just some thoughts and ideas.
Posted by Op27Nr2 on February 18, 2006, at 16:40:50
In reply to Confused regarding choice of med presecribed, posted by Op27Nr2 on February 18, 2006, at 12:20:09
This was my first post, and I was half-expecting flamers to disparage me and my post. I've been feeling really ashamed that I, someone with just an undergraduate degree, am even questioning/doubting a doctor, but I just felt nervous about the whole thing. Thanks for answering my questions with such compassion. You guys are the best!
I just have to ask a few more questions. Why do you (med_empowered) say that doctors hate writing prescriptions for Xanax? Is it some type of a controlled substance? Does Klonopin fall under the same category? I would like to try Klonopin, but if it's too much trouble for the doctor, or otherwise makes me appear to be "fishing" for narcotics, then I won't do it. Are these medications ever prescribed for long-term treatment?
What is NMS and TD?
In the meantime, I will try the suggestions that blueberry has posted. Sounds very helpful.
Thanks again everyone for taking the time to respond.
Posted by linkadge on February 18, 2006, at 17:01:40
In reply to Abilify for Anxiety?, posted by Op27Nr2 on February 18, 2006, at 16:40:50
Hey, don't feel ashamed. It is good that you are questioning your treatment.
There has been a shift in psychiatry away from the use of benzodazapines and other tranquilizers for long term use anxiety disorders.
Basically doctors think they are addictive and so they won't prescribe them long term. While there is some truth to the idea that they can be habit forming, it is also true that the drugs they are using in their place may not be all that great for other reasons.
Using AP's for anxiety disorders carry many risks including movement disorders.
Linkadge
Posted by greywolf on February 18, 2006, at 17:13:58
In reply to Re: Abilify for Anxiety?, posted by linkadge on February 18, 2006, at 17:01:40
The willingness to rx benzos varies by doctor. Some are real concerned about the patient's ability to take those meds responsibly, others don't worry unless a patient has had abuse or significant non-compliance problems in the past.For instance, my gp is fine rxing Xanax, but would not screw around with an AP without a pdoc's supervision.
Posted by Phillipa on February 18, 2006, at 23:51:38
In reply to Confused regarding choice of med presecribed, posted by Op27Nr2 on February 18, 2006, at 12:20:09
Get a second opinion these meds are very strong and can sometimes cause TD. Fondly, Phillipa
Posted by Phillipa on February 18, 2006, at 23:54:53
In reply to Abilify for Anxiety?, posted by Op27Nr2 on February 18, 2006, at 16:40:50
TD is tardive diskenesia a movement disorder google it and NHS is the UK medical system sorry the boards were turned off. Very unusual. Fondly, Phillipa
Posted by Racer on February 19, 2006, at 1:22:28
In reply to Confused regarding choice of med presecribed, posted by Op27Nr2 on February 18, 2006, at 12:20:09
>
> I was given a sample of something called Abilify (aripiprazole) 5mg. While he DID mention it was an anti-psychotic, I knew from doing some reading in the past, that anti-psychotics are meds used to treat schizophrenia. I don't have this disorder, nor do I have any family history of schizophrenia.
>
> I'm sure there is a very good explanation for his decision to start me on an anti-psychotic, but I'm very nervous about taking them. I am going to a different doctor to get a second opinion, but that won't be until next month.
>I think the explanation is related to the fact that the drugs we call "anti-psychotics" are often heavy tranquilizers. Chlorpromazine, for instance, is a cousin to acepromazine, which is used as a tranquilizer in animals like horses, and I think dogs. (Chlorpromazine = Thorazine) Risperdal, one of the popular APs, is also described as a heavy tranquilizer, rather than an anti-psychotic, in a lot of the literature.
Yes, these drugs do more and other than just sedate or tranquilize. They can address the psychotic symptoms more directly, through their action on the dopamine system, but they are also used as anxiolytics. And they're used that way because they work.
There are risks, and TD is one of them, but at a low dose the risk is also low. And, since you're taking this for anxiety, and not psychosis, you'll be on a low dose.
Another option for anxiety is Buspar, which is marketed as an anxiolytic -- but was developed as an anti-psychotic.
I hope that helps somewhat, either to set your mind a bit at ease, or at least to help explain what your doctor might have been thinking. Good luck to you.
Posted by blueberry on February 19, 2006, at 12:58:22
In reply to Confused regarding choice of med presecribed, posted by Op27Nr2 on February 18, 2006, at 12:20:09
Yeah, xanax and klonopin are in the same family. They are controlled substances. Some doctors shy away from them because over time they cause physical dependence, which, in my opinion, they incorrectly label as addiction. All the psych meds cause phsycial dependence. Benzos are notoriously difficult to get off of, but then so are effexor and antipsychotics.
Posted by Emily Elizabeth on February 20, 2006, at 0:02:05
In reply to Confused regarding choice of med presecribed, posted by Op27Nr2 on February 18, 2006, at 12:20:09
It sounds like your doc is being aggressive, but not irresponsible. AP's are frequently used when a patient has severe anxiety and has not responded adequately to previous treatments. (Of course, what constitutes an adequate response to previous treatment? It's a pretty gray area.)
I think it is great that you are getting a 2nd opinon. AP's can be extremely useful for some people, including many non-schizophrenic individuals. However, if you can get away with something "milder," that's what you want to do.
On the other hand, don't shy away from Abilify just because it is an AP. It is a slippery slope from anxiety to psychotic symptoms. Treating difficulties early on is often easier than waiting until they become severe.
Could you call the 2nd pdoc and see if there is a cancellation so that you can get in sooner? It would be nice to see him now rather than later. Also, talk to pdoc 2 abt what pdoc 1 suggested. Tell him that you are concerned and ask about other options. If pdoc 2 is a good one, he will respond to your concerns and help you arrive at a safe, responsible and personally acceptable plan. Of course, that is assuming that he is a good pdoc. My fingers are crossed for you that he is. Please keep posting. (And BTW, WELCOME to Babble!!)
Best,
EE
Posted by linkadge on February 20, 2006, at 8:38:06
In reply to Re: Confused regarding choice of med presecribed, posted by Emily Elizabeth on February 20, 2006, at 0:02:05
While certain anxiety may respond to antipsychotics, other anxiety may actually get worse.
For instance some doctors prescribed AP's for social phobia, but that can make a lot of people's condition worse. I remember I became more withdrawn on certain AP's because not only was I still anxious, but they also made me much less confident in speaking to people.
I also had test taking anxiety, and performance anxiety (piano) that *skyrocketed* on AP's as my ability to perform deteriorated.
Linkadge
Posted by sdb on February 20, 2006, at 15:44:36
In reply to Confused regarding choice of med presecribed, posted by Op27Nr2 on February 18, 2006, at 12:20:09
Hi Op27Nr2,
ssris are a treatment for GAD but even these drugs don't work for everybody or the sideeffects are not tolerable. I personally know a case of severe mania (closed department of psy-hospital, hereditary illness in family) completely cured with abilify. She's travelling around with her son now. Abilify against anxiety I dont know examples.
Buspirone, mirtazapine or even a benzo (prazepam, ketazolam) are other options. If the anxiety is more "social" related clonazepam is one of the most effective substance.
Choosing a substance needs good anamnesis and exact diagnosis when possible e.g. which subtype of anxiety you have, maybe underlying depression or bad life experiences.~sdb
p.s. Op27Nr2 from which composer possibly from yourself (?) :-)
Posted by Op27Nr2 on February 21, 2006, at 0:06:28
In reply to Re: Confused regarding choice of med presecribed, posted by sdb on February 20, 2006, at 15:44:36
sdb,
Us musicians - we're a weird, errrrr ummmm eccentric bunch. I played the third movement to Beethoven's Op27, #2 Sonata (among other pieces) for my senior recital in high school. It was a very special performance for me, as it was the last time my mother attended my performances while she was still alive.
The anxiety I experience is not socially-related. It's really hard to explain what I feel. Sometimes I wish I could meet someone that can understand this anxiety I feel. Basically I have relatively benign everyday life occurrances or thoughts that, for whatever reason, trigger an anxious response. Going to traffic court? I'm going to end up with a felony on my record for the rest of my life. Stopping for gas on my way to work? I'm going to get fired for being late. Eating that last morsel of food on my plate? I'm going to end up morbidly obese for the rest of my life.
Do you see how irrational my thought process is? And that was just a VERY small sample of what goes on in my head during the course of my everyday life. There's so much more to this than I can articulate in words on here.
My worrying about everything totally consumes me to the point where I avoid doing the things I need to do on a daily basis. Perhaps this, in fact, *IS* a form of social phobia. I don't know. Whatever it is, I wish I could just get over it.
Posted by Greif on February 21, 2006, at 13:10:07
In reply to Re: Confused regarding choice of med presecribed, posted by Op27Nr2 on February 21, 2006, at 0:06:28
Have you tried beta blocker proprananol...good for performance anxiety. I ahve GAD and the AP I have tried either turn me into zombie (zyprexa) or send me into orbit. I would see a pshchologist and get evaluation (MMPI etc) and get advice. Psychologists have abandonded the behavioral model and most agree with medical model along with psychotherapy. Otherwise prepare yourself for testing many meds until you find the right one.
Posted by sdb on February 22, 2006, at 17:59:29
In reply to Re: Confused regarding choice of med presecribed, posted by Op27Nr2 on February 21, 2006, at 0:06:28
Hi op27Nr2,
I think it's pretty nice you're playing the op27Nr2 Sonata. Not everybody is able to do that :-)
I can understand your problems. I personally think that it can be difficult to recommend a drug or something else through the forum. If you read other posts you will find probably an option which could be appropriate and you can discuss about with a therapist.
What I can recommend is finding an understandable psychiatrist you can talk with about everything eg. your problem now but also about your past, childhood, youth and so on.
Your therapist need to have a "wave frequency" you can understand, interpret.
For me, such a short talking therapy was pretty good. Maybe I will resume this therapy soon. I stopped because of lack of time. I've found out that there were some things in my life which probably have some influence just until now but I was not aware first (I could not walk 3 years during my childhood). It can be very difficult to analyze yourself without a help from somebody else. This is only my opinion maybe there will be others sharing their experiences with you.Good luck
sdb
Posted by Op27Nr2 on February 24, 2006, at 12:58:06
In reply to Abilify for Anxiety?, posted by Op27Nr2 on February 18, 2006, at 16:40:50
Thanks so much for all of those who took the time to respond to my post. I wish the people I encounter on a daily basis were as compassionate as you all are.
I went to the health food store and got myself an amino supplement.
I called my very first doctor back (the temporary one), and he was more than willing to draw up a script for Clonazepam 1MG. I'll try this out until I see my second opinion specialist next month.
Has Welbutrin (sp?) ever been prescribed to treat anxiety? I am interested in it because of the desirable side effects people report experiencing on it.
Posted by Phillipa on February 24, 2006, at 19:06:29
In reply to Re: Confused regarding choice - op27Nr2, posted by sdb on February 22, 2006, at 17:59:29
Wellbutrin is stimulating. Fondly, Phillipa
Posted by Op27Nr2 on February 24, 2006, at 19:46:32
In reply to Re: Confused regarding choice - op27Nr2 » sdb, posted by Phillipa on February 24, 2006, at 19:06:29
Posted by linkadge on February 26, 2006, at 9:53:28
In reply to stimulating = bad for anxiety? (nm), posted by Op27Nr2 on February 24, 2006, at 19:46:32
Wellbutrin is generally NOT good for anxiety. Of all the antidepressants sometimes prescribed in mood disorders, Wellbutrin is not among them. Its profile is similar to that of a stimulant. So if coffee affects your anxiety negatively then, wellbutrin would prob be a bad choice.
Hey, I play the piano too. If you're really intensly into piano, you may want to avoid the antipsychotics alltogether. Both risperdal and zyrpexa made it difficult for me to move my fingers. The whole class can cause muscle stiffness and rigidity. (Thats sure going to be problematic when you get to the Third movement bar 76.)
You may want to try SJW if you have not already. It helped my anxiety and actually had a positive impact on my playing.
There are so many different supplements available to help anxiety, literally dozens, some better than others. The pharmacudicals may be worth a try, (I've certainly been on them all), but their side effects can be burdonsome.
Linkadge
Posted by sdb on February 26, 2006, at 19:57:27
In reply to Re: stimulating = bad for anxiety?, posted by linkadge on February 26, 2006, at 9:53:28
Hi altogether,
Wellbutrin is more against depression. It activates, perhaps agitates you thus having unpleasant effects similar to coffein being more nervous. Trazodone, Wellbutrin (bupropion), Remeron (mirtazapine) and Buspar (buspirone) are the meds without or even with pro influence relating to sexual performance (libido, arousal);
common SSRIS will cause problems.Klonopin (clonazepam) actually a antiseizure med is one of the strongest antipanic med often used for social phobia and sometimes in bipolar disorder. Sometimes clonazepam can cause sx sideffects too. Xanax XR is an antipanic med, some people have only sedating effects other people even antidepressant effects.
link: >>SJW-It helped my anxiety and actually had a positive impact on my playingThats interesting (!). How do you mean positive impact? SJW good for piano skills but weak antidepressant?
I like Richter and Gould interpretations. Bye the way, Gould had a unbelievable drug record from allopurinol and so on to propranolol, diazepam. He took many meds available that time starting very young. Richter was said to drink too much alcohol sometimes but understandable what things happened during his life. Some docs attributed to Gould hypochondria, avoidance personality, obsessive disorder and to Richter bipolar disorder.
Posted by ed_uk on February 27, 2006, at 13:27:37
In reply to Re: stimulating = bad for anxiety? to-Op27Nr2-link, posted by sdb on February 26, 2006, at 19:57:27
Hi S
When I used to play in school concerts, I always needed 10mg diazepam (Valium) an hour before. It wasn't enough though, 20mg might have been better. I did try 15mg for one concert but that wasn't enough either. Propranolol (Inderal) was useless on its own but it did relieve tremor when I took it in combination with diazepam.
Ed
Posted by linkadge on February 27, 2006, at 15:25:38
In reply to Re: stimulating = bad for anxiety? to-Op27Nr2-link, posted by sdb on February 26, 2006, at 19:57:27
I read somewhere that hypercin (or maybe it was hyperforin) was a better antidementia agent than antidepressant.
But for me, SJW had a slight motor activating effect. I felt like my movement was a little more limber, as I tend to get stiff very easily.
Linkadge
Posted by platinumbride on February 27, 2006, at 15:46:59
In reply to stimulating = bad for anxiety? (nm), posted by Op27Nr2 on February 24, 2006, at 19:46:32
fwiw:
My sister's doc upped her abilify when she found that she was very anxious recently.
It helped her immensely to have those extra 5 mgs. She is Bipolar I.
I take abilify for bipolarII. It has been great for depression.
I have anxiety as it is. Today my doc gave me cogentin for agitation that the abilify is causing - well, really akithisia.I bet that, inn general, abilify can be helpful as long as there is a willingness to try other agents for agitation/akithisia.
Diane
Posted by sdb on February 27, 2006, at 16:26:27
In reply to Re: stimulating = bad for anxiety? to-Op27Nr2-link, posted by linkadge on February 27, 2006, at 15:25:38
Link, did the SJW help for you a little and for what?-The effectiveness of SJW is still in question. There are some controversial german studies with superior results for SJW compared to SSRIS especially in the aspect of anxiety.
ed, I did not know that you play the piano. You should send me a studio record :-) I dont know if Gould took drugs for a performance. Actually unbelievable after hearing his many studio- or rare life records. But its well known that he always had a glass of pills in his handbag or many glasses in the washing room in the hotel chamber. Somebody asked him: "Do you really take this?"-answer: Not all at once. Gould was a single child isolated from school and society from his mum and he was of course genius in a way; "genius" an attribute which is controversial, relative.
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