Shown: posts 1 to 15 of 15. This is the beginning of the thread.
Posted by DiscoPuppy on August 26, 2007, at 2:15:12
I've searched through hundreds of posts, hoping to find an answer or someone going through the same experience as me, but. . .
I have serious anxiety issues. GAD, anticipatory anxiety, situational specific anxiety -- you name it.
I've been prescribed Xanax 0.5mg as needed, Klonopin 1.0mg as needed and then Xanax XR 2.0mg once a day in the morning. . . all of which had absolutely NO effect on debilitating anxieties.
I'm not really sure where to go from here. I'd like to go to my doctor and tell him, "here, I'd like to try XXX medication". I'm not even sure where I can start.
Can anyone help? Where do I even start with this? What other non-benzo medication might I be able to suggest I try?
Sorry if this question has been answered a million times. I couldn't find any useful answers in the search function.
Posted by Quintal on August 26, 2007, at 4:21:24
In reply to Benzos do not have any effect on me. . ., posted by DiscoPuppy on August 26, 2007, at 2:15:12
Do you have any Klonopin 1mg tablets left over from your last prescription? If you do, could you try a higher dose, say 2-4mg just once, to see if it had any effect? How long did you take them for? Benzos can induce anesthesia, so there will be some dose has some effect on your anxiety. Have you tried Ativan?
BuSpar is the main non-benzo anxiolytic aside from the SSRIs of course. Atypical antipsychotics are sometimes used as anxiolytics, but they should really be a last-ditch effort because of the bad-*ss side effects like diabetes, obesity and movement disorders. I'd encourage you to thoroughly exhaust the benzo/antidepressant options before settling for that type of medication. Nardil is widely regarded as the most effective of the anxiolytic antidepressants. It can be very hard to get a pdoc to prescribe it.
Q
Posted by Phillipa on August 26, 2007, at 11:55:54
In reply to Re: Benzos do not have any effect on me. . . » DiscoPuppy, posted by Quintal on August 26, 2007, at 4:21:24
You did say non-benzo but I agree with Q as to atypical antipsychotics. I'd say the same either klonopin or valium? What does you doc say about your anxiety. Have life circumstances changed? Did this happen the anxiety all of a sudden like a panic attack or sneek up on you. So sorry. Phillipa
Posted by King of Nothing on August 26, 2007, at 12:23:23
In reply to Re: Benzos do not have any effect on me. . . » DiscoPuppy, posted by Quintal on August 26, 2007, at 4:21:24
You could try Lyrica..very effective for depression and anxiety disorders.
Posted by DiscoPuppy on August 26, 2007, at 12:45:39
In reply to Re: Benzos do not have any effect on me. . . » DiscoPuppy, posted by Quintal on August 26, 2007, at 4:21:24
> Nardil is widely regarded as the most effective of the anxiolytic antidepressants. It can be very hard to get a pdoc to prescribe it.
>
Why?
Posted by DiscoPuppy on August 26, 2007, at 12:48:33
In reply to Re: Benzos do not have any effect on me. . ., posted by Phillipa on August 26, 2007, at 11:55:54
Years ago, I had panic attacks all the time. For whatever reason, they have disappeared - although there are times now where I feel myself ALMOST having them.
There are specific events in my life that trigger a horribly anxious feeling in my mind. But also I feel anxious all day for no apparent reason when there isn't anything to worry about.
Does this make sense? It's a bit hard to articulate what I'm feeling.
Posted by Quintal on August 26, 2007, at 13:05:41
In reply to Re: Benzos do not have any effect on me. . . » Quintal, posted by DiscoPuppy on August 26, 2007, at 12:45:39
Most pdocs are taught that the MAOIs are dangerous and obsolete, and even less effective than SSRIs and newer drugs. It means taking a risk of being sued for inappropriate prescribing, or even negligence, should anything untoward happen during treatment. So most flat out refuse to have anything to do with MAOIs and prescribe the newer drugs, as they're 'encouraged' to do by the pharmaceutical industry.
Q
Posted by DiscoPuppy on August 26, 2007, at 13:07:52
In reply to Re: Benzos do not have any effect on me. . . » DiscoPuppy, posted by Quintal on August 26, 2007, at 13:05:41
Oh, thank you for explaining that to me.
I thought maybe you implied that it was a scheduled medication so I tried researching that aspect after you mentioned it. I guess I was on the wrong track.
Again, thank you for your candid response.
Posted by DiscoPuppy on August 26, 2007, at 13:10:53
In reply to Re: Benzos do not have any effect on me. . . » DiscoPuppy, posted by Quintal on August 26, 2007, at 13:05:41
I find this very sad and disappointing. If a drug is known to work for a specific indication, doctors should not feel encumbered to prescribe something appropriate to treat their patient.
Posted by Racer on August 26, 2007, at 13:41:23
In reply to Re: Benzos do not have any effect on me. . ., posted by DiscoPuppy on August 26, 2007, at 13:10:53
> I find this very sad and disappointing. If a drug is known to work for a specific indication, doctors should not feel encumbered to prescribe something appropriate to treat their patient.
I assume this is in response to Quintal's comments about Nardil.
Here's the thing about anti-depressants in general: mostly, they all work for roughly the same percentage of people who take them. Doctors do tend to exhaust the SSRIs and other newer drugs before going for MAOIs, and even before going for TCAs. That's because the newer drugs tend to have fewer, milder side effects and be much safer in overdose.
Additionally, MAOIs require that one follow a diet which restricts certain types of food -- basically, anything aged or fermented. If the diet is not followed, the result can be life threatening. While those here who take the drugs have learned to accommodate the diet, most of the world would not find that so easy.
Always remember that those of us who come here tend to be outliers -- many of us have tried and failed many drug trials, we tend to be treatment resistant, and we've found this place to learn more so that we can be more involved in our own treatment. That's great, of course, but it's also not necessarily true of the average consumer of mental health care. The average person who goes to a doctor for an anti-depressant probably wants a simple, easy fix -- take a pill every day, no more depression. Since that's the average patient, a lot of psychiatrists don't have a lot of experience with MAOIs. That being the case, I don't think we can fault them for being resistant to prescribing them.
What's more, while MAOIs do work well for a lot of people, they won't necessarily be the answer for everyone. And they're not the first drugs I'd recommend for anyone to try -- it makes sense to try the "easier" drugs before going to the big guns. MAOIs will always be there if the other drugs don't work out. Why not try those drugs which won't require giving up Japanese food, pepperoni pizza, etc, before going on to MAOIs? The more benign alternatives may just work for you -- they do work for hundreds of thousands of people, after all.
In terms of anxiety such as you describe, I'd say start with an SSRI -- they do tend to reduce anxiety, although some people find them to cause apathy. In fact, that apathy is a benefit for some people. Otherwise, I loved BuSpar, although it increased my depression too much to continue it. Seroquel might be a good option, as well.
Personally, I'd recommend psychotherapy to learn some self-soothing techniques, and explore what causes your reactions to these situations. I suspect you'd get more long lasting benefit than the meds can provide. That's my bias, though.
Good luck.
Posted by Quintal on August 26, 2007, at 14:02:42
In reply to Re: Benzos do not have any effect on me. . ., posted by DiscoPuppy on August 26, 2007, at 13:10:53
I've heard of people stabilized on an MAOI moving location and meeting doctor after doctor that refuses to continue scripts for MAOIs, even when they're already doing well on them, because of the reasons I stated above. They're not first-line treatments for anxiety by any means, but people with mild conditions using first-line treatments tend not to hang around here. I mean, the atypical antipsychotics have serious side effects too, but pdocs seem to trust them, an consider them acceptable even for relatively minor conditions. I think atypicals could be classified as dangerous drugs, because they can seriously damage health when taken exactly as prescribed. On the contrary MAOIs are quite safe as long patients follow the diet properly and don't take any contraindicated drugs. Personally, I had fewer side effects on Parnate than I did with first-line drugs like the SSRIs. Nardil is fairly heavy-duty in the side-effect department though.
Q
Posted by DiscoPuppy on August 26, 2007, at 15:01:50
In reply to Re: Benzos do not have any effect on me. . . » DiscoPuppy, posted by Quintal on August 26, 2007, at 14:02:42
If you do a search for my user name, you can see that I've been a member of this forum since 2001. I don't, by any means, consider myself an expert in psychiatric medication or conditions. I do, however, feel confident enough to know that I don't respond to certain medications. I have tried every SSRI for GAD without success (or the side effects were adverse enough to outweigh the potential benefits), and a few benzos for anxiety triggered by specific events.
I'm at a point where I'm willing to try anything to seek relief - even if it means giving up Japanese food or red wine.
Posted by Racer on August 26, 2007, at 21:28:41
In reply to Re: Benzos do not have any effect on me. . . » DiscoPuppy, posted by Quintal on August 26, 2007, at 14:02:42
> I've heard of people stabilized on an MAOI moving location and meeting doctor after doctor that refuses to continue scripts for MAOIs, even when they're already doing well on them, because of the reasons I stated above.
Quintal, I don't argue that MAOIs are good drugs, and that it doesn't make sense for doctors to refuse to continue a drug which has been working effectively for someone. I question why it happens, and don't think it's fair to the doctors to suggest it's for any sinister reason.
Part of my reason for posting what probably looks to some as anti-MAOI posts is to try to provide some balance in amongst the pro-MAOI posts. Yes, they're great drugs for those they work for and who can tolerate them. But that's true of any drug -- they're all great if they work without intolerable side effects.
The more important reason -- at least to me -- is that there are people out there who cannot take MAOIs, who might feel hurt, upset, fearful, hopeless, etc, if those drugs are presented as the best answer, or the only answer left. They may also feel upset by the implications that the diet is easy to follow, that there's something wrong with them if they aren't willing to make that sacrifice in order to take the wonder drug.
I'm one of those who can't take MAOIs. Could I give up the foods? Probably. For the indefinite future? No. What's more, my therapist started screaming when she heard my pdoc was considering EMSAM, because it was an MAOI. For people with eating disorders, any drug which requires restricting diet is going to be a very last resort from any competent doctor. What's more -- and the reason I'm not willing to give up trying other options -- my already-low blood pressure has proven very sensitive to medications. I'm unwilling -- heck, unABLE -- to give up driving in order to take a medication. Based on prior experiences, I'd have to give up leaving the house unless/until that particular effect passed. Steroids to keep my pressure up? Not from any doctor who'd seen my bone scans.
Anyway, I know how I feel whenever someone suggests to me -- again -- that MAOIs are my best bet. I'm just trying to make sure that other people don't get the same feeling here -- at least as much as I can.
Peace.
Posted by Quintal on August 26, 2007, at 21:58:11
In reply to Re: Benzos do not have any effect on me. . . » Quintal, posted by Racer on August 26, 2007, at 21:28:41
Yes, I know the dietary restrictions can be a serious problem for some people, for no fault of their own. I think I understand what you're saying, and I often feel the same way when people suggest benzos or Nardil are the best answer, or the only answer left after SSRIs etc. for people suffering from severe anxiety - because I don't think I could take them long-term without running into trouble. Yeah, I tend to imagine there's an insinuation of blame from people who say that too - "you could control yourself, you could stick it out if you really wanted to" or something like that. But I know the effect GABAergic drugs have on me and I don't want to turn into even more of a raging monster, so they're just not an option. That's why I've never taken Nardil, but Parnate is another matter. If I had problems with eating I'm sure it would be contraindicated too and I'd feel the same way.
Q
Posted by Phillipa on August 26, 2007, at 22:05:27
In reply to Re: Benzos do not have any effect on me. . . » Racer, posted by Quintal on August 26, 2007, at 21:58:11
I was thinking about this really while showering and was thinking I know a lot of posters on babble doing well on SSRI's SNRI's or remeron with a benzo. I myself find the idea of an MAOI to be very risky. What if out to eat by mistake you eat a wrong food that was mixed into let's say a casserole. I think I'd do ECT before an MAOI but that is just me. My pdoc likes VNS. Doing it in NC. So many factors to consider. And I too have low blood pressure and part of my theraphy is to drive too. So I have to be able to drive. I'm in a pretty big city with lots of traffic. Phillipa
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.