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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 11 of 11. This is the beginning of the thread.
Posted by mamalaw on March 25, 2008, at 14:09:36
I'm feeling like my medications are not really effectively controlling my panic attacks and general anxiety. I'm not sure what options there might be for me to get relief, and was hoping some of you could give me some suggestions. I'll describe the situation below. Thanks.
I've always had GAD, I think, but after the birth of my child it became intolerable and I also developed panic disorder (about 3-4 major, and several minor, attacks weekly). Initially my primary care doc was just addressing the GAD and muscle tension, so I started on 20mg lexapro with 5mg Valium at night and it was great. Then I stopped the Valium (was in physical therapy for my back) and the Lexapro was OK, but I was still anxious, still had panic attacks, and was very sleepy. We tried to switch to Effexor, but within a week I thought I was going to lose my mind I was so anxious, angry, irritable - it was dreadful. I felt better when I stopped taking it. Then we tried Cymbalta, but that didn't seem to do anything. I was still anxious, still having panic attacks. She referred me to a psychiatrist.
The psychiatrist raised me to 30mg Lexapro daily. I was on that for about a month, and then he added .5mg Klonopin in the AM and PM.
So now I am on 30mg Lexapro in the AM and .5 Klonopin 2x/day. While the severity of the panic attacks seems to have diminished some (the physical symptoms are not as severe, and I can function through them, although it is very hard and I feel disconnected), I am almost as anxious now as I was on nothing. The GAD has definitely worsened in the past week or so, and the panic attacks have also gotten some of the edge back.
I am wondering what has helped others with anxiety and/or panic disorder. Do the meds I am on now sound like they should be helping? Are there alternatives I should ask about? Thanks for any help.
Posted by torachan on March 25, 2008, at 14:50:05
In reply to GAD and Panic Disorder - new meds?, posted by mamalaw on March 25, 2008, at 14:09:36
First off, welcome to the club, unfortunately as you surely know. I'll give you my take on the state of current medicinal treatment for GAD/panic as I have about 15 years or so of experience with the disorder.
My strong belief is that the so called first line treatment option of SSRI/NRI's for GAD/panic is based upon some very suspect clinical trial results, and even with them being actually meant for depression there is also some weak clinical efficacy results, IMO. I mean, in these clinical trials, when they identify a patient as having an anxiety disorder it's likely based on subjective reports which are very unreliable. I don't believe there is any actual physiological measurement available to indicate anxiety, although for panic , heart rate and baseline muscle tension would be high.
It's been my experience that SSRI's are very stimulating, hence their effectiveness with depression, so I've always been hesitant to consider them effective for anxiety. Anxiety requires a reduction in overall brain reactivity especially in the emotional center of the brain. A general reduction in synapse firing.
Therefore, to be quite honest, the only medications that for me have proved extremely effective in accomplishing this are benzodiazepines. But of course, doctors are wary of prescribing them because of supposed addiction, but I feel you can become just as "addicted" to SSRI's. It's actually dependency, not addiction.
So, I would suggest increasing the dosage of your benzo. Of course consult with your doctor, but I'm certain he'll want to exhaust other avenues before agreeing to an increase with your benzo.
Hopefully one day something will come along to properly replace benzos for long term anxiety with less ill effects, but that day has yet to arrive, IMO.
Posted by Phillipa on March 25, 2008, at 15:40:32
In reply to Re: GAD and Panic Disorder - new meds?, posted by torachan on March 25, 2008, at 14:50:05
Oh how I empathize with you both as in the same state with benzos my mainstay. And no other anxiety meds in the works. Also for me no SSRI"s or SNRI's have relieved anxiety. Antipsychics not for me. And benzos so many years. I wish us all luck . Sorry benzos from me too. Love Phillipa
Posted by johnj on March 25, 2008, at 15:55:41
In reply to Re: GAD and Panic Disorder - new meds?, posted by Phillipa on March 25, 2008, at 15:40:32
Phillipa:
I don't find this statement true.
"And no other anxiety meds in the works"
Posted by johnj on March 25, 2008, at 15:56:43
In reply to GAD and Panic Disorder - new meds?, posted by mamalaw on March 25, 2008, at 14:09:36
I believe they can be quite effective and I am looking at them too. What has worked for people?
johnj
Posted by jms600 on March 25, 2008, at 16:27:37
In reply to What about TCA's? » mamalaw, posted by johnj on March 25, 2008, at 15:56:43
Many people on here seem to find antipsychotics useful for anxiety. Don't let the name put you off - they tend to prescribe much lower doses for anxiety, than they do for psychosis.
A lot on here like Seroquel (Quetiapine) for anxiety. I took it for around two months but it didn't seem to do much for me. I'm now taking Zyprexa (Olanzapine) - 5mg at night. It's not really doing a great deal although I think it's better than Seroquel. Zyprexa seems to be the favourite on this site for the relief of anxiety.
So my advice is to consider trying an antipsychotic. It's worth discussing it with your doctor at least. To my knowledge, the newer 'atypical' antipsychotics aren't licensed for treating anxiety states, so if your doctor doesn't want to prescribe a drug that isn't licensed for anxiety then maybe look at some of the older 'typical' antipsychotics such as Stelazine (Trifluoperazine) - I believe this, and a few others are indicated and licensed for anxiety treatment. However these drugs can produce movement disorders so, again, it's best to discuss the pros and cons with your doctor first.
Hope this is of some help to you.
Posted by Phillipa on March 25, 2008, at 19:38:25
In reply to Re: GAD and Panic Disorder - new meds? » Phillipa, posted by johnj on March 25, 2008, at 15:55:41
Johnny J there are seriously? What's the status of them do you know? Phillipa ps maybe so hope for me
Posted by your#1fan on March 25, 2008, at 22:07:29
In reply to GAD and Panic Disorder - new meds?, posted by mamalaw on March 25, 2008, at 14:09:36
My usage of Prozac is 40mg which has completely relieved that sick depression i had.
Xanax has done wonders.......klonopin made me depressed. I was on klonopin for a while, two years ago actaully. Xanax causes ease in both depression, and anxiety. Klonopin is the worst thing for depression if you suffer from it.....Thats my view...i just caused me to be really bad, i couldnt function, i would get out but feel like doing nothing.
I feel Xanax has the best effect because it only lasts 2 hours at max for me. Anything thing else....klonopin, Ativan lasts too short, and Valium, i hate valium, never taken in it, never plan too.
Nuerotin could help some anxiety, with a benzodiapine.
fan
Posted by DuckDuckGoose on March 26, 2008, at 11:53:51
In reply to Re: GAD and Panic Disorder - new meds?, posted by your#1fan on March 25, 2008, at 23:07:29
I use Remeron at a low dose (7.5mg) in addition to my zoloft to help me sleep. As a bonus, it has provided me with a deep sense of calm, ridding me of my frequent anxiety. You might try remeron before an anti-psycotic because of less long term side effect danger.
Posted by cactus on March 26, 2008, at 18:10:48
In reply to GAD and Panic Disorder - new meds?, posted by mamalaw on March 25, 2008, at 15:09:36
As a fellow GAD sufferer, I have tried many different medications over the years and nothing really works for me except benzo's, most are good but nothing touch my GAD like valium and clonazepam (klonipin/rivotril)
I'm talking about me being able to function normally and work. Benzo's are the best for me. I can't function at all on anti psychotics, even on a small dose, they leave me unable to perform my proper work duties because they put me in a stupor and are indicated on the patient information sheets with quite severe side effects, some of which are irreversible. I know people will disagree with me on this but why take anti psychotic medication if you're not psychotic.
Benzo's have been around for years and are safe option but they are addictive for some. This is just my personal opinion. If I wasn't depressed, which I have been in the past on quite a few occasions, I personally wouldn't take anything except benzo's for GAD on it's own. Some people get great results from using anti depressants or anti psychotics for anxiety but I didn't get anything but trouble from them. Just remember this is my personal experience and I hope it was helpful.
Posted by Phillipa on March 26, 2008, at 19:12:27
In reply to Re: GAD and Panic Disorder - new meds?, posted by cactus on March 26, 2008, at 18:10:48
Same with me. Haven't upped dose in many years. Ad's just dont work for me and once seroquel given to me was worse than zombie and taken off the next day as doc saw how bad I was and this just me too. Phillipa
This is the end of the thread.
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