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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 24 of 24. This is the beginning of the thread.
Posted by cactus on July 6, 2008, at 15:27:46
I'm wondering if anyone has tried anything or found relief from a drug for anxiety/panic/stress. I'd like to try something totally different. Please, NO SSRI/SNRI's, TCA's, AP's, MAOI's, DA's, Mood stablizers or benzo's. Opiates are out too.
Does anyone out there have any other options, suggestions or ideas. I'm rather desperate as I've had a major relapse and my doc has put my clonazepam back up to 6mg daily. No depression has presented as yet but I know if I don't stop this now it will spiral out of control very quickly.
Please help, I'm open to anything except the above which I have tried most of over the last 15 or so years. Tianeptine?(spelling) is not available here and my doctor has asked me to stop my modafinil for now until things calm down.
She also asked me if I had any ideas, she is very open minded and willing to let me try different things.
Posted by SLS on July 6, 2008, at 16:28:50
In reply to looking for a novel or off label drug for anxiety, posted by cactus on July 6, 2008, at 15:27:46
It's not really a drug, but I have seen L-theonine mitigate anxiety significantly with a person with Major Depressive Disorder.
- Scott
Posted by cactus on July 6, 2008, at 16:46:27
In reply to Re: looking for a novel or off label drug for anxiety, posted by SLS on July 6, 2008, at 16:28:50
Thanks SLS, that's number 1 for the list, I'll look into it now.
Posted by cactus on July 6, 2008, at 16:49:07
In reply to Re: looking for a novel or off label drug for anxiety, posted by SLS on July 6, 2008, at 16:28:50
I drink heaps of green tea so thanks for the suggestion
Posted by llurpsienoodle on July 6, 2008, at 17:09:21
In reply to looking for a novel or off label drug for anxiety, posted by cactus on July 6, 2008, at 15:27:46
Hi cactii,
I get relief from my anxiety and anxious rumination from wellbutrin SR. It works better than klonopin for me. I think it's because it makes me more decisive and less ambivalent.-Ll
Posted by Sigismund on July 6, 2008, at 18:01:18
In reply to looking for a novel or off label drug for anxiety, posted by cactus on July 6, 2008, at 15:27:46
In your city you have lots of Traditional Chinese Medicine shops.
They have proprietatry preparations which can help (zizyphus is the relevant herb), or you can have one tailor made for you.
They are not strong (of course) but I have used TCM to good effect.
Posted by bleauberry on July 6, 2008, at 18:38:07
In reply to looking for a novel or off label drug for anxiety, posted by cactus on July 6, 2008, at 15:27:46
Since your doc is open to try things, then get a saliva cortisol test. 4 spit samples in a test tube throughout a 24 hour period. In integrative medicine it is a common thing, in mainstream not. Low cortisol = massive anxiety; high cortisol = massive anxiety. Detailed thyroid with freeT3, freeT4, and total T4 would be good too. If these things are out of whack, or not optimal, symptoms that don't do well with psych drugs can be expected. It's a pretty clear clue. Most people who need physiological replacement doses of hydrocortisone (5mg-20mg per day) find it very calming, as I did. With a history of anxiety and meds, I would expect your adrenal glands are spent and cortisol is either way low, way high, or both...but at wrong times of the day.
Amalgam illness...do you have or ever had silver fillings in your teeth? If yes, you probably need not look any further for the root cause.
Tianeptine...easy to get mailorder just about any country, especially with a cooperative doctor.
Herbs...lots to choose from. Focus on ones that dampen the cortisol response.
Magnolia extract
phellodendron extract
passionflower
skullcap
lemon balm
st johns wort
l-theanineDon't underestimate the power of herbs, especially when in combinations. As one of many examples, I know a couple people who were not helped with many psych drugs who were shocked with surprise when a stupid herb like sjw worked great.
L-theanine was mentioned. Good idea. Creates calm peaceful brain waves and boosts gaba function.
Diet: No refined sugars, lots of fruit but only ones with low sugar (mostly berries), lots of veggies but only ones with low sugar, heavy on proteins, low on carbs. Takes 3 to 6 months to see benefits.
Above average doses of vitamin C are a good backdrop for calming things down. Niacinamide (not niacin) in high doses boosts the gaba circuitry and calms things down, sometimes enough all by itself drugs aren't needed. Takes a couple months.
No meds? Plenty of options. I would start first with some cortisol and thyroid tests which a paint a clear picture of what is or isn't going on.
Another useful test would the urine neurotransmitter metabolites. It is probably not completely accurate in figuring out what is going on, but say for example your serotonin and dopamine look normal, but epinephrine and gaba are very high, well, that tells you a lot. Adrenaline is out of control for some reason and gaba is trying its best to counter it. Out of control adrenaline resides in the adrenal glands, and then we are back to the cortisolthyroid connection.
Posted by bleauberry on July 6, 2008, at 18:43:43
In reply to looking for a novel or off label drug for anxiety, posted by cactus on July 6, 2008, at 15:27:46
Ahh, forgot to mention magnesium.
Magnesium taurate
magnesium glycinate
magnesium citrateOf the 3 I found the glycinate form much more calming. Probably because of the glycine, which works with gaba. Anyway, you would not be the first with a long history of psych meds who found simple stupid magnesium to be a miracle.
And, not really a drug but instead a salt of the earth, lithium.
Posted by bleep on July 6, 2008, at 20:40:39
In reply to Re: looking for a novel or off label drug for anxiety, posted by bleauberry on July 6, 2008, at 18:38:07
What is wrong with silver fillings in your teeth? Can you take SJW w/Topamax? I was told that herbs are completely unstandardized and there is no way to know how much you are really getting...if that is not the case, how much do you take a day of the SJW and what kind do you buy in the U.S.?
Posted by Phillipa on July 6, 2008, at 22:43:08
In reply to Re: looking for a novel or off label drug for anxiety » bleauberry, posted by bleep on July 6, 2008, at 20:40:39
Didn't work for me but maybe buspar? Phillipa
Posted by Tomatheus on July 7, 2008, at 1:20:56
In reply to looking for a novel or off label drug for anxiety, posted by cactus on July 6, 2008, at 15:27:46
Cactus,
Have you considered propranolol (Inderal)? It's a beta blocker that's used for a variety of conditions, including performance anxiety.
The use of propranolol for anxiety has been discussed on Psycho-Babble, as the results of a Google search indicate:
http://www.google.com/search?hl=en&q=propranolol+anxiety+site%3Adr-bob.org&btnG=Search
Tomatheus
Posted by cactus on July 7, 2008, at 3:03:42
In reply to Re: looking for a novel or off label drug for anxi, posted by Tomatheus on July 7, 2008, at 1:20:56
......for all your wonderful suggestion. I will take them all into consideration, except for SJW which didn't work and gave me a bad rash. Peace to you all. C
Posted by bleauberry on July 7, 2008, at 20:23:10
In reply to Re: looking for a novel or off label drug for anxiety » bleauberry, posted by bleep on July 6, 2008, at 20:40:39
What's wrong with silver fillings? Well, a constant trickle of mercury vapor absorbing into your mouth and lungs. The fillings are 40%ish mercury. Mercury is the second most toxic substance on the planet. Sure it has been considered safe for a long time, and 50% of dentists still deny it causes any harm. The body of scientific evidence against fillings is growing rapidly, especially evidenced by remarkable recoveries of people who have had their silver fillings removed.
SJW+Topamax? I don't know. SJW affects the speed of metabolism of many drugs, usually decreasing blood levels of them or increasing them sometimes. You would have to do research to find out exactly which liver enzymes metabolize topamax, because I'm not familiar with that drug. SJW primary speeds up liver enzyme CYP3A4.
Many herbs are unstandardized...mostly the liquid tincture ones. Many tabs and capsules are standardized, though private lab studies have shown their active ingredients vary a fair amount from what the bottle says. Reliable standardized SJW, the ones actually used in clinical trials, are Kira (LI160 formula) available at RiteAid Pharmacies, some health food stores, and internet; and Nature's Way Perika, health food stores and internet. If interested in SJW, the forum sjwinfo.org is a good place to visit. Nothing but sjw users there. Doses on the bottle are 300mg 3 times per day, but real life doses vary from 150mg once a day to 300mg once a day to 600mg to 900mg, multiple doses, single doses, night doses, day doses...basically people find a particular dose and way of dosing that feels best to them. Some of the cheaper brands are preferred by some people. When I tried the cheap Rite Aid house brand, and a grocery store house brand, and Whole Foods house brand, I found all of them quite potent but each had a slight distinct different feel to them. The ones you want to avoid are the ones that are whole herbs unstandardized. They can work fine, and some people swear by them, but you really don't know what you are getting from dose to dose or bottle to bottle.
> What is wrong with silver fillings in your teeth? Can you take SJW w/Topamax? I was told that herbs are completely unstandardized and there is no way to know how much you are really getting...if that is not the case, how much do you take a day of the SJW and what kind do you buy in the U.S.?
Posted by yxibow on July 7, 2008, at 23:14:11
In reply to Re: looking for a novel or off label drug for anxiety » bleauberry, posted by bleep on July 6, 2008, at 20:40:39
> What is wrong with silver fillings in your teeth? Can you take SJW w/Topamax? I was told that herbs are completely unstandardized and there is no way to know how much you are really getting...if that is not the case, how much do you take a day of the SJW and what kind do you buy in the U.S.?
I think this is meant for an alternative discussion. I mean, we can all disagree with each other, that's the whole point of discussion, but the jury is still out on silver fillings, and properly used, they are an amalgam. That means they stay in their place. For years. Decades.
I've heard of stories of people who are scared of their silver fillings and of course insurance doesn't pay for it and they spend over $10,000 to rip out all their fillings and replace it with plastic.
Well epoxy fillings are not as resilient in the back of your mouth, that stands out as a ADA fact. And teeth rot as a result of all of this can occur -- as well as the irony that you can end up swallowing the mercury which is then released as these fillings are ripped out.If one wants to discuss mercury, millions of pounds of mercury are accumulating in landfills because of the new compact fluorescent bulbs as well as 60 years of history of regular light tubing which has been trashed. Thankfully highly toxic beryllium was removed as a fluorescent dye in the tubes and replaced with zinc and calcium compounds.
Yes -- there is debate in the government(s) community at large -- from autism to any other disorder that can't be explained so mercury is a magnet for blame.
There's only some vague partial truth beginning to come out on that in the sense that as numbers of us are susceptible to mental/biochemical imbalance illnesses because of genetics, it is conceivable that those who are predestined to develop autism have genes that intercept heavy metals in some ways.
-- tidingsJay
Posted by yxibow on July 7, 2008, at 23:41:11
In reply to looking for a novel or off label drug for anxiety, posted by cactus on July 6, 2008, at 15:27:46
> I'm wondering if anyone has tried anything or found relief from a drug for anxiety/panic/stress. I'd like to try something totally different. Please, NO SSRI/SNRI's, TCA's, AP's, MAOI's, DA's, Mood stablizers or benzo's. Opiates are out too.
These are all novel things unless you've been through all of them. Is it the fear of the medicine, or the tiredness of multiple trials that you've already been through?Because at some point one has to accept side effects or accept living with the anxiety and using coping strategies.
I know that sounds harsh, but in some ways we are in the middle ages of medication -- its not the only thing to use, but its part of a system that should incorporate therapy of any kind, behavioural or talk or whatever is appropriate.
> Does anyone out there have any other options, suggestions or ideas. I'm rather desperate as I've had a major relapse and my doc has put my clonazepam back up to 6mg daily. No depression has presented as yet but I know if I don't stop this now it will spiral out of control very quickly.It won't spiral out of control very quickly as noted below -- it takes time. But yes, there are other novel things, all the things I mentioned above, which either you have taken or aren't willing to take.
6mg is a heavy dose -- I've been there and while there are really case study reasons for high benzodiazepine use, over time there can be risks of short term memory issues and a lot of other things. But that is an individual thing, and may take years to occur.I converted what... 8mg of Klonopin into 160mg of Valium (roughly 1mg of Klonopin is 20mg of Valium) and now am taking about half of that some years later.
> Please help, I'm open to anything except the above which I have tried most of over the last 15 or so years. Tianeptine?(spelling) is not available here and my doctor has asked me to stop my modafinil for now until things calm down.
Provigil doesn't sound like a terribly good idea for anxiety, but maybe your system responds differently.
> She also asked me if I had any ideas, she is very open minded and willing to let me try different things.
Buspar was mentioned -- it is a very distant cousin to an antipsychotic although it has no AP value at rational doses -- only about 1/3 of people get some benefit out of it. Also dizziness can develop, in some. Something to watch out for.
The only other one mentioned, propranolol would be a rational use for anxiety, but if you're woried about depression, its about 50/50 I'd say for using benzodiazepines or propranolol --- if you're susceptible to depression caused by CNS depression at all.
Propranolol stops some fight or flight issues and mainly peripheral muscle shakiness, it has many off label uses from stage fright to augmenting shakiness from medication and parkinsonism.
But, just like all beta blockers, you have to be aware of your pulse and blood pressure. If you already are below normal on those, one should be really careful about how much propranolol is used, because although it is noncardioselective........ (which is why its used, its old, known, noncardioselective and therefore is more useful for muscle relaxation.) But remember, the heart is a muscle too.
So venturing out on propranolol as a sole agent should be a gradual climb until you're accustomed to it. You don't want to faint on the road or fall down steps.If you use it as a main medication, you should have a cuff monitor, they're not expensive these days and you can get one from a drugstore and see what your pulse and blood pressure is from time to time. No need to be obsessive about it though.
I'm not trying to scare off the use of it -- it has its places, but like I noted it can cause fainting (and sometimes headaches). Just due caution.
-- best wishesJay
Posted by cactus on July 8, 2008, at 3:56:33
In reply to Re: looking for a novel or off label drug for anxi » cactus, posted by yxibow on July 7, 2008, at 23:41:11
thanks yxibow, beta blocker are out due to asthma concerns and I did get my clonazepam down to 3mg over quite a few months during this year with no problems at all. My doc just popped it back up to calm me down for a few days. I'm already back to 4mg and doing better. I haven't had a chance to scratch myself lately so I have 4 days off soon and I'm going to get stuck into some serious research. (Meds, supplements and herbal.) It's just a really sh*t*y bout of situational stress that is most annoying. I know there are times in my life when I need meds. Modafinil has been amazing for me over the last 6 months but since I'm stressed out, I'm taking a break from it. It's been THE best psych med combinations I have ever taken in conjunction with clonazepam for mood stabilization/anxiety and RLS properties. Clonazepam is a 3 in 1 drug for me and modafinil is for sleep apnea and shift work but blew my depression away which I wasn't expecting.
Blue, thanks too for all your suggestions, I have a mouth full of fillings, lol, but I'm really interested in the properties of magnesium.
Posted by bulldog2 on July 11, 2008, at 15:41:45
In reply to looking for a novel or off label drug for anxiety, posted by cactus on July 6, 2008, at 15:27:46
> I'm wondering if anyone has tried anything or found relief from a drug for anxiety/panic/stress. I'd like to try something totally different. Please, NO SSRI/SNRI's, TCA's, AP's, MAOI's, DA's, Mood stablizers or benzo's. Opiates are out too.
>
> Does anyone out there have any other options, suggestions or ideas. I'm rather desperate as I've had a major relapse and my doc has put my clonazepam back up to 6mg daily. No depression has presented as yet but I know if I don't stop this now it will spiral out of control very quickly.
>
> Please help, I'm open to anything except the above which I have tried most of over the last 15 or so years. Tianeptine?(spelling) is not available here and my doctor has asked me to stop my modafinil for now until things calm down.
>
> She also asked me if I had any ideas, she is very open minded and willing to let me try different things.How about atarax or hydroxyzine. Old but used for detox from benzos and still used for anxiety.
Posted by cactus on July 11, 2008, at 23:16:03
In reply to Re: looking for a novel or off label drug for anxiety, posted by bulldog2 on July 11, 2008, at 15:41:45
thanks, I haven't of hydroxyzine, and I'll look into atarax. C
Posted by cactus on July 13, 2008, at 15:11:15
In reply to Re: looking for a novel or off label drug for anxiety, posted by bulldog2 on July 11, 2008, at 15:41:45
damn, they're antihistamines, I can't take them because of RLS. Thanks for the suggestion though, much appreciated. C
Posted by Astounder on July 16, 2008, at 3:38:24
In reply to looking for a novel or off label drug for anxiety, posted by cactus on July 6, 2008, at 15:27:46
It sounds paradoxical, but they can alleviate anxiety for some.
What about an upper/downer combo?
Posted by cactus on July 16, 2008, at 15:12:40
In reply to Have you tried stimulants?, posted by Astounder on July 16, 2008, at 3:38:24
yes, I'm on provigil 200mg(modafinil) and clonazepam 4mg
Posted by elanor roosevelt on July 17, 2008, at 22:16:59
In reply to Re: Have you tried stimulants? » Astounder, posted by cactus on July 16, 2008, at 15:12:40
I found provigil enhanced my anxiety
Also, provigil is not a stimulant
Posted by cactus on July 18, 2008, at 3:51:53
In reply to Re: Have you tried stimulants?, posted by elanor roosevelt on July 17, 2008, at 22:16:59
> I found provigil enhanced my anxiety
>
> Also, provigil is not a stimulantYes you're right Elanor, but for some crappy reason it's sort of made it's way into that class here in my country. Not officially mind you, but that's how it's perceived by most people in the medical field in Australia, so they are very wary to prescribe it.
It didn't effect my anxiety for 4 months. I'm just going through a rough patch. Thanks for your input
Posted by zeugma on July 21, 2008, at 7:49:56
In reply to Re: Have you tried stimulants? » elanor roosevelt, posted by cactus on July 18, 2008, at 3:51:53
It depends on the type of anxiety you are suffering from.
There is a lot of evidence to suggest that social anxiety and 'generalized' anxiety (including panic disorder and most of what is subsumed under the name of 'anxiety') have different substrates.
Ritalin helped enormously with social anxiety, while worsening my general anxiety level, and seemed to counteract the effect of clonazepam (whose dosage I had increased merely to deal with the amplified anxiety from Ritalin).
I take Provigil, which IS a stimulant (I will post elsewhere my reason for saying so) but which causes less general anxiety, while having very limited, if any, effects on social anxiety.
This is the end of the thread.
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