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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 18 of 18. This is the beginning of the thread.
Posted by Lindenblüte on September 25, 2006, at 22:47:46
short version:
Is there a short term med for anxiety that is non-sedating, and can be taken as needed- that won't be depressive or emotion-blunting?
Long version:
I've been having a lot of anxiety lately because I've been having flashbacks of childhood trauma and associated terror. Well, these are sporadic. Many days I have a lot of these episodes, sometimes for hours at a time. Today, only a few twinges here and there.I'm going through some pretty stressfull changes in my life right now (school just started) and I just terminated with T1 and am starting with T2. I also am experiencing and admitting to myself and others just how traumatic my childhood was for the first time.
My pdoc is up to date with my therapy situation. he is in contact with both therapists. I have asked him several months ago for something for anxiety. He told me that cymbalta should help with that. I asked him again recently, and told him that I had a near panic attack (he said, if not for cymbalta, it probably would have been much worse)
I asked him directly if there was something he would recommend for my anxiety. He is very reluctant, though. I am recovering from major depression and have been responding well to 90mg cymbalta, 25-50 mg seroquel and 200mg provigil. He is concerned that if I take something for anxiety, I will only numb my emotions again, when what I need is to be feeling them. I explained to him that I was having uncontrollable outbursts of really strong emotions, like rage, and tears, and inappropriate laughter, etc, and that I was spending hours at home, shaking, and having suicidal thoughts for the first time in a long time.
But, some days I feel peachy keen.
why is he so reluctant? do I need more poly pharmacy? do I need an anxiolytic? I've been self-medicating with (2 drinks) alcohol, but that doesn't seem so appropriate either...
-Li
Posted by alexandra_k on September 26, 2006, at 7:10:12
In reply to do I need something for anxiety?, posted by Lindenblüte on September 25, 2006, at 22:47:46
> short version:
> Is there a short term med for anxiety that is non-sedating, and can be taken as needed- that won't be depressive or emotion-blunting?> why is he so reluctant?
Because there isn't anything that isn't potentially addictive.
I mean... Feel anxious... Take pill... Feel better...
Repeat as needed.
Feel anxious... No pill... Where are my darned pills??? My darned pills aren't working!!!!! Need more pills or need those pills...Withdrawal can be 10X worse than what you are experiencing now.
I know it can be hard...
But there are relaxation techniques etc that are good for episodes of anxiety and you should profit *heaps* more from those in the long term...
Posted by SLS on September 26, 2006, at 8:18:56
In reply to do I need something for anxiety?, posted by Lindenblüte on September 25, 2006, at 22:47:46
> short version:
> Is there a short term med for anxiety that is non-sedating, and can be taken as needed- that won't be depressive or emotion-blunting?For the intermittent use you are indicating, Xanax or Ativan probably make the most sense. Benzodiazepines can be enormously effective and safe tools if you look at them as such. If you respect them, they can be very helpful. Personally, I have not found either of these drugs to be depressive, sedating, or emotionally blunting. They are calming. I think, in a way, this is emotionally diffusing. Xanax is probably more so than Ativan. I used Ativan at night for sleep. However, during the day, it was anxiolytic. Xanax is probably better for panic disorder or social phobia. I prefer Ativan because I felt less intoxicated and more clear-headed. Everyone is different, though.
> I explained to him that I was having uncontrollable outbursts of really strong emotions, like rage, and tears, and inappropriate laughter, etc, and that I was spending hours at home, shaking, and having suicidal thoughts for the first time in a long time
For stuff like this, I think Xanax would be better. It is more potent as an anxiolytic and has antidepressant properties.
By the way, is there any history of mental illness in your family? Bipolar disorder?
I agree with Alexandra that you should do as much as you can to reduce your levels of anxiety through techniques of the mind since it is activity of the mind that is triggering the anxiety episodes in the first place. If you reduce the "anxious pressure" that you are placing on the brain, you might be able to reduce the biological force that drives these episodes. Perhaps you can ask some questions over on the Psychology board for suggestions on how to deal with the anxiety as memories, thoughts, and emotions emerge as a result of your psychotherapy.
What's going on with the Seroquel and the Provigil?
- Scott
Posted by Phillipa on September 26, 2006, at 22:30:18
In reply to Re: do I need something for anxiety? » Lindenblüte, posted by SLS on September 26, 2006, at 8:18:56
I agree with Scott xanax as needed. And drinking is addictive too. The docs said do not drink on meds. Love Phillipa
Posted by Lindenblüte on September 27, 2006, at 7:47:24
In reply to Re: do I need something for anxiety?, posted by Phillipa on September 26, 2006, at 22:30:18
Okay,
thanks phillipa
I guess I'm doing okay lately by distracting myself.We'll see... I go to visit new T today. Hopefully I won't get too freaked out!
:)
drinking is pretty much limited to one or two on Friday or Sat nights. My pdoc said that that amount is safe with my meds.
-Li
Posted by Jost on September 27, 2006, at 10:35:34
In reply to Re: do I need something for anxiety?, posted by alexandra_k on September 26, 2006, at 7:10:12
Xanax works for me. I take it when I have occasional highanxiety or near-panic. I take half a .5 mg tablet. If you're extremely anxious you can dissolve it under your tongue for quicker absorption.
It improves my mood a lot, and makes me much less anxious. No blunting of emotion, or anything of that sort in my experience. In fact, I find the opposite, I can concentrate, which usually leads to more emotional focus.
The dangers of addiction are overstated for most users. They;re real-- but you have to be using a lot. (It is a drug that MDs are known to have abused, and can lead to very bad addiction, if you do get deeply into it.) My pdoc say you don't get into the addiction-threat level until you're at about 4 mg a day. I've never gotten close to that.
If I'm having a really bad seige, I might take a whole pill a one time-- not too often, but it's happened. I also might take as much as four .5 mg doses at varying times in a day.
Yes, I make sure I keep it to a minimum, but I've never had to "control" it-- it helps, and I use it, then I may not need it for a while, and I don't. No effects of not-taking it, that I've noticed. At worst, if you take a lot, you can be slightly sedated for part of the day. It's not that bad, and wears off. (Of course this depends on metabolism, but I mat be a fairly slow metabolizer---on many drugs.)
I'm not sure why your pdoc is concerned. Maybe you should try to figure this out (ie by asking directly, until you feel you do understand)-- since it could be that there is some issue you could address with him. In the absence of any specific reason not, xanax could be a good drug for you.
Jost
Posted by Lindenblüte on September 27, 2006, at 11:37:55
In reply to Re: do I need something for anxiety?, posted by Jost on September 27, 2006, at 10:35:34
I think one reason why he might be concerned is because I tend to be really sensitive to side effects. He may feel that the anxiety from life is currently more manageable than the anxiety from experiencing side effects. Also, he has concerns about too much polypharmacy. I'm already on 3 drugs. hmm
-Li
Posted by Phillipa on September 27, 2006, at 21:01:26
In reply to Re: do I need something for anxiety? » Jost, posted by Lindenblüte on September 27, 2006, at 11:37:55
Li sounds like you've already made up your mind that you're handling things fine or that another med would conplicate things. Love Phillipa
Posted by alexandra_k on September 27, 2006, at 21:20:14
In reply to Re: do I need something for anxiety? » Jost, posted by Lindenblüte on September 27, 2006, at 11:37:55
There are some meds that are used to treat depression AND anxiety. Effexor, for example. But my guess would be that you seem to be coming out of your depression... It is starting to lift... And hence your doc is (understandably) reluctant to do anything (like switch your meds) that might set you back in your functioning.
It can be hard...
Because typically the meds don't make things all better. It is just about finding the med that works the best for us. Trouble is trading off how much your med is helping you now (and I guess you won't know that unless you stop taking it) vs the potential benefit you may recieve from another. Because the other might not help you and the side effects might be worse :-( Also some people find that if a med is working and they stop taking it... Then when they take it up again it doesn't seem to help them like they did.
Posted by Lindenblüte on September 27, 2006, at 21:48:40
In reply to Re: do I need something for anxiety? » Lindenblüte, posted by Phillipa on September 27, 2006, at 21:01:26
> Li sounds like you've already made up your mind that you're handling things fine or that another med would conplicate things. Love Phillipa
HAHA! I have made up my mind that I am not handling things fine. That's why I asked my old T "need help!"
That's why I told my pdoc that I need help!
That's why they both referred me to a new T!
My pdoc seems to think that therapy will help me more than another drug/side effect will. We (both of us!) definitely don't want to take me off of the anti-depressant (cymbalta).
So, instead of suffering withdrawal and start-up side-effects from a med change, I get to suffer withdrawal and start-up side effects from a therapist change. yay. Popping a pill is somehow more attractive than revisiting my abusive childhood.
I'm such a little materialist. Give me a bottle of shiny colorful pills and I'll fall in love with the idea of "getting well". But the nausea in the middle of the night and the fatigue all day long...
no such thing as a panacea
-Li
Posted by Phillipa on September 27, 2006, at 22:24:00
In reply to Re: do I need something for anxiety?, posted by alexandra_k on September 27, 2006, at 21:20:14
Li well my pdoc said to me set up your own heirchy of doing a little more each day. Scarey stuff. I wish there was a magic pill too. Love Phillipa
Posted by tizza on September 28, 2006, at 2:48:58
In reply to Re: do I need something for anxiety? » Phillipa, posted by Lindenblüte on September 27, 2006, at 21:48:40
sounds like you're on top of it, great news!! I have to admit though that when I took seroquel it totally obliterated my anxiety and that was at 25mg. Unfortunatly I couldn't tolerate it, it made me sleep for 14 hours a night, so back to my beloved Valium, that was about a year ago, maybe longer. If I was going to change anything I'd up the seroquel again before trying a benzo because it has very powerful anxiolytic effects, but that just might be what you need, a very small dose of some benzo. If you do decide to go down that path be wary of xanax, it's a great drug but ativan could be of some use too. Good luck hon, it sounds like you have it covered already, love Paul
Posted by Lindenblüte on September 28, 2006, at 15:55:54
In reply to Re: do I need something for anxiety? » Lindenblüte, posted by SLS on September 26, 2006, at 8:18:56
I typed a lovely response to your post yesterday. I guess it didn't stick. I HATE it when that happens. sorry.
> For the intermittent use you are indicating, Xanax or Ativan probably make the most sense. Benzodiazepines can be enormously effective and safe tools if you look at them as such. If you respect them, they can be very helpful. Personally, I have not found either of these drugs to be depressive, sedating, or emotionally blunting. They are calming. I think, in a way, this is emotionally diffusing. Xanax is probably more so than Ativan. I used Ativan at night for sleep. However, during the day, it was anxiolytic. Xanax is probably better for panic disorder or social phobia. I prefer Ativan because I felt less intoxicated and more clear-headed. Everyone is different, though.
>
> > I explained to him that I was having uncontrollable outbursts of really strong emotions, like rage, and tears, and inappropriate laughter, etc, and that I was spending hours at home, shaking, and having suicidal thoughts for the first time in a long time
>
> For stuff like this, I think Xanax would be better. It is more potent as an anxiolytic and has antidepressant properties.Okay, thanks for this info. I will look into it online. I'm not so worried about the abuse potential. currently I'm abusing myself (SI) so, I guess I should tell pdoc more about this stuff. He might change his mind.
> By the way, is there any history of mental illness in your family? Bipolar disorder?
Oh YES! Uncle: schizophrenic. institutionalized for several years, committed suicide in his late 20's. Brother 1) Dx with either bipolar or unipolar depression. hospitalized for a year as inpatient. Multiple suicide attempts. Violent temper, etc... "recovered" for the last few years. Brother 2) Dx with depression as a child. (therapy, no meds, currently doing well) 3) Mom: Dx with depression at several points, but also has a sh*tty marriage and chronic hypothyroidism and sleep disorders narcolepsy and apnea, which complicate matters 4)Dad, who my psychologist believes is bipolar, and also has severe childhood neurological disorders and learning disability.
Me? I'm perfect. No problems here. I'm the healthy one. Well-adjusted and cheerful!
> I agree with Alexandra that you should do as much as you can to reduce your levels of anxiety through techniques of the mind since it is activity of the mind that is triggering the anxiety episodes in the first place. If you reduce the "anxious pressure" that you are placing on the brain, you might be able to reduce the biological force that drives these episodes. Perhaps you can ask some questions over on the Psychology board for suggestions on how to deal with the anxiety as memories, thoughts, and emotions emerge as a result of your psychotherapy.
thanks- I have had to quit doing PT/bodywork, 'cause it was causing me anxiety (required hands-on contact from a man) and meditation scares the crap out of me! Had to quit, 'cause I kept on getting these flashbacks and really nasty feelings... aerobic exercise is something I need to pursue, but at the moment I've got some asthma (they're painting the walls in my office building. I had to leave after an hour today). So, that's out. I know I just need to be patient with the therapy, but I'm kinda struggling... :(> What's going on with the Seroquel and the Provigil?
>seroquel- have been taking 12.5 to 25 mg for months (depression insomnia) and recently increased to 50 mg when pdoc didn't want to give me anything for my anxiety. He had no problem with the seroquel increase.
provigil- 90 mg of cymbalta makes me yawn and nap all day long. ugh. now I'm awake.
Posted by Phillipa on September 28, 2006, at 18:20:41
In reply to Re: do I need something for anxiety? » SLS, posted by Lindenblüte on September 28, 2006, at 15:55:54
Li my daughter just recently started zoloft and 25mg of seroquel. She's upped the zoloft to 50mg and the seroquel at bedtime to 50mg. Says it's helped her anxiety better than anything. She was self-medicating with wine nightly to sleep. Love Phillipa ps my and my kid's Dad all have a hx of depression, bipolar ex-husbands side, alcholism his side to and anxiety my side. And my throid is hypo too that's when the depression started changed from just anxiety.
Posted by Lindenblüte on September 28, 2006, at 18:23:10
In reply to Re: do I need something for anxiety? » Lindenblüte, posted by Phillipa on September 28, 2006, at 18:20:41
> Li my daughter just recently started zoloft and 25mg of seroquel. She's upped the zoloft to 50mg and the seroquel at bedtime to 50mg. Says it's helped her anxiety better than anything. She was self-medicating with wine nightly to sleep. Love Phillipa ps my and my kid's Dad all have a hx of depression, bipolar ex-husbands side, alcholism his side to and anxiety my side. And my throid is hypo too that's when the depression started changed from just anxiety.
Thanks Phillipa,
I've already increased my seroquel dosage. I don't feel relief from that. I'm going to see my T tomorrow afternoon. If I don't feel better over the weekend, I'm off the pdoc's. :(
Posted by Phillipa on September 28, 2006, at 21:24:08
In reply to Re: do I need something for anxiety? » Phillipa, posted by Lindenblüte on September 28, 2006, at 18:23:10
Li seroquel's not helping? It's stronger than a benzo. I'm confused when's the anxiety and what are the feelings you're having. How high seroquel now and how often. Love Phillipa
Posted by Lindenblüte on September 28, 2006, at 23:52:08
In reply to Re: do I need something for anxiety? » Lindenblüte, posted by Phillipa on September 28, 2006, at 21:24:08
Seroquel every pm about 30 mins before lights out 50 mg. makes me pass out and stay asleep for at least 5-6 hours.
I cannot imagine taking it during the day. It's main effect on me seems to be sedation.
If it's helping, it's not enough. I'm not feeling too safe. I wonder if all I need is to cry? Why can't I?
-Li
Posted by Phillipa on September 29, 2006, at 19:22:05
In reply to Re: do I need something for anxiety? » Phillipa, posted by Lindenblüte on September 28, 2006, at 23:52:08
When I was on cymbalta my head felt like it would explode I wanted to cry so bad and couldn't. Love Phillipa
This is the end of the thread.
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