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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 aussie_jon on August 22, 2008, at 22:29:18
Hi there
panic disorder/generalised anxiety/melancholic depression sufferer, depression and panic controled with paroxetine and reboxetine, I have diazepam 5mg to be taken "as needed" for anxiety, but feel anxious enough to want to use it almost every day.
Hydroxyzine and buspirone havent helped, and I am wondering wether a small dose of atypical antipsychotic might help, as my psych doesnt want me to take daily benzos
Posted by Phillipa on August 23, 2008, at 0:11:35
In reply to Atypical antipsychotics for anxiety, posted by aussie_jon on August 22, 2008, at 22:29:18
Why? I've taken them for over 37 years and am on a lower dose than in the beginning and at times was on none at all? Love Phillipa
Posted by X-ray on August 23, 2008, at 9:01:33
In reply to Atypical antipsychotics for anxiety, posted by aussie_jon on August 22, 2008, at 22:29:18
Hi,
You might try a low dosage of Fluanxol (flupentixol).
I take 0,5 mg in the morning and 0,5 mg in the afternoon.
I have been on Buspar for many years, but Fluanxol is a more potent drug.Best regards,
X-rayP.S. I take Remeron for sleep in the evening.
Posted by med_empowered on August 23, 2008, at 10:09:56
In reply to Re: Atypical antipsychotics for anxiety, posted by X-ray on August 23, 2008, at 9:01:33
I mean..here are a couple things to consider...1)5mgs of Valium is a pretty tiny dose...that'd be like taking .25mgs/Klonopin or Xanax. 2) Yes, benzo dependence is a pain, but atypical antipsychotics are waaaaaaay more problematic. Zyprexa, Seroquel, and Risperdal can cause weight gain; Abilify tends to cause akathisia; Geodon can cause drowsiness and is a 2x daily med. ALL of them can cause tardive dyskinesia, neuroleptic malignancy syndrome, dysphoria, agitation, impaired cognition, and flattened affect.
Plus, they're really expen$ive.
Anyway, I'd personally recommend that you find some way of dealing with your anxiety that doesn't involve the use of antipsychotics at any dose...don't let the glossy ads fool you: these are serious drugs with serious side effects. I think its worth noting that even though they're supposedly more tolerable, lots of schizophrenics (at least here in the US) have to either be coerced or forced to take them...and there are lots of lawsuits already in place over deaths, movement disorders, etc.
Could therapy or self-help or nutritional adjustments help you? I get that you're trying to avoid benzo dependence, and that's great,but...antipsychotics are **HARDCORE** and the main reason they're "not addictive" is b/c they also tend to be unpleasant.
Posted by rskontos on August 23, 2008, at 17:22:01
In reply to could you get a new doc?, posted by med_empowered on August 23, 2008, at 10:09:56
I am with Phillipa, I am on xanax for anxiety and panic attacks and it works. I don't abuse it. I don't take it everyday now that I have it somewhat under control. At least now I know my anxiety for what it truly looks like and sometimes I can control with things other than meds. Not always but sometimes I can stop a panic attack from getting too bad.
My pdoc, I was the one more worried about dependency than he was, assured me I would be fine on it, that he would monitor it. He has not had too. I rarely get it the bottled refilled within a month's time and I can as I am prescribed the xanax every 4 hours. I have never taken that way.
But I understand it you can't get a doctor to prescribe it for you. I have taken daily though and then gone days without it without any ill effects.
Anyway, hope you can something to help. Maybe you could get him to give one script of a benzo with no refills. Which is what mine did initially. They do work well and are cheap.
rsk
Posted by Phillipa on August 23, 2008, at 18:49:36
In reply to Re: could you get a new doc?, posted by rskontos on August 23, 2008, at 17:22:01
What methods do you use when becoming very anxious and don't want to take a med? And do you take any others? Thanks Phillips
Posted by Emily Elizabeth on August 23, 2008, at 22:40:28
In reply to Atypical antipsychotics for anxiety, posted by aussie_jon on August 22, 2008, at 22:29:18
Just wanted to put in my 2 cents. I take Abilify for anxiety and depression and I have never felt better. It has worked really well for me w/ no real side effects. If this is something that your pdoc is suggesting, I would consider it.
Best,
EE
Posted by yxibow on August 24, 2008, at 3:10:02
In reply to could you get a new doc?, posted by med_empowered on August 23, 2008, at 10:09:56
> I mean..here are a couple things to consider...1)5mgs of Valium is a pretty tiny dose...that'd be like taking .25mgs/Klonopin or Xanax. 2) Yes, benzo dependence is a pain, but atypical antipsychotics are waaaaaaay more problematic. Zyprexa, Seroquel, and Risperdal can cause weight gain; Abilify tends to cause akathisia; Geodon can cause drowsiness and is a 2x daily med. ALL of them can cause tardive dyskinesia, neuroleptic malignancy syndrome, dysphoria, agitation, impaired cognition, and flattened affect.
> Plus, they're really expen$ive.
> Anyway, I'd personally recommend that you find some way of dealing with your anxiety that doesn't involve the use of antipsychotics at any dose...don't let the glossy ads fool you: these are serious drugs with serious side effects. I think its worth noting that even though they're supposedly more tolerable, lots of schizophrenics (at least here in the US) have to either be coerced or forced to take them...and there are lots of lawsuits already in place over deaths, movement disorders, etc.
> Could therapy or self-help or nutritional adjustments help you? I get that you're trying to avoid benzo dependence, and that's great,but...antipsychotics are **HARDCORE** and the main reason they're "not addictive" is b/c they also tend to be unpleasant.
>
>You have a inkling of correctness about things that can definitely happen on long term (and unfortunately short term for the rare) APs but I do feel it sort of comes off like a scare statement for those who are already in need of taking them.
The risk of TD on Seroquel is particularly low, NMS is so extremely rarely reported on any of them, the sulpirides have a slightly higher chance I think but they're not exactly atypicals.
As for benzodiazepines -- 5mg a day yes is a very small dose for Valium. But one has to remember that its not necessarily the dose but how long one is on it. I am still reeling from high dose Valium. But people can get used to small dose Valium as well, just as quickly where for them GABAa becomes just as blocked.
Paxil is fairly effective for what is being described and the dose can be adjusted as needed (just make sure you dont forget to take it as it has a short half life) -- I guess you are in a country where reboxetine is released, otherwise you would be using Cymbalta.
Its always better to try not to take diazepam every day -- I mean you can discuss more with your doctor about this, but the reason is that I think he or she as I noted wants it to be effective when you really need to use it. It may be a generalized standard that he or she is comfortable, but I know that as I used more Valium because it was necessary and there was evidence justification for it Xanax became less effective when I needed it, etc.
Just a few points.--- tidings
-- Jay
Posted by SLS on August 24, 2008, at 6:27:01
In reply to could you get a new doc?, posted by med_empowered on August 23, 2008, at 10:09:56
Hi ME.
I am quite ambivalent regarding the use of atypical antipsychotics as a anxiolytic or hypnotic. However, at 25-50mg, I think Seroquel might stand out as a reasonable alternative to benzodiazepines. I am not benzophobic, but many doctors certainly are. My impression is that Seroquel at these low dosages has a very low risk of EPS, and almost none for TD. I don't know if weight gain and diabetes are risks at these dosages either.
- Scott
Posted by X-ray on August 24, 2008, at 7:46:45
In reply to Re: Atypical antipsychotics for anxiety, posted by Emily Elizabeth on August 23, 2008, at 22:40:28
Hello Emily Elizabeth,
Abilify might be an option for me.
So I have a few questions:What is your dosage of Abilify?
What time do you take this drug?
Do you take any other medicine?
Do you sleep well?Best regards,
X-rayP.S. I'm on Remeron and Fluanxol.
Posted by Emily Elizabeth on August 24, 2008, at 11:58:54
In reply to Re: Atypical antipsychotics for anxiety, posted by X-ray on August 24, 2008, at 7:46:45
Hello,
I currently take 15 mg of Abilify (I was up to 30 at one point). I also take 20 mg of Lexapro and 600 mg of Lithium (for treatment resistant depression). I take the meds at bedtime. I sleep very well, perhaps even too much.
Hope this helps! If you have any more ?'s just let me know!
Best,
EE
Posted by PC_Load_Letter on August 24, 2008, at 13:06:45
In reply to Re: Atypical antipsychotics for anxiety » X-ray, posted by Emily Elizabeth on August 24, 2008, at 11:58:54
Hi,
Is your depression more the atypical type (hypersomnia, carb cravings, extreme fatigue) or melancholic type (insomnia, loss of appetite)? From your description it doesn't sound like you have any bipolarity going on. Is this correct?
Also, what specific benefits do the three individual meds add to your current mix/response?
Thanks in advance.
> Hello,
>
> I currently take 15 mg of Abilify (I was up to 30 at one point). I also take 20 mg of Lexapro and 600 mg of Lithium (for treatment resistant depression). I take the meds at bedtime. I sleep very well, perhaps even too much.
>
> Hope this helps! If you have any more ?'s just let me know!
>
> Best,
> EE
Posted by Emily Elizabeth on August 24, 2008, at 16:42:56
In reply to Re: Atypical antipsychotics for anxiety » Emily Elizabeth, posted by PC_Load_Letter on August 24, 2008, at 13:06:45
I would say my depression is closer to the atypical type. I don't have any bipolarity going on.
As for my combo, the lexapro is there just because i think my pdoc thought that i need to be on an anitdepressant. Whatever. I don't know that it does much. The lithium was added to augment the lexapro and it helped. I'd say that it brought me to 50% remission. It also helped with suicidal feelings. So, we didn't want to dump it b/c it clearly was doing something, although not enough. We added the Abilify because the other meds weren't doing enough. And voila! It all came together and I have a combo that works for me.
Hope this answers your questions. Let me know if you have more!
Best,
EE
Posted by PC_Load_Letter on August 24, 2008, at 22:59:58
In reply to Re: Atypical antipsychotics for anxiety, posted by Emily Elizabeth on August 24, 2008, at 16:42:56
Did you ever try Zyprexa or any of the other anti-psychotics? I tried Zyprexa without any benefit, but it looks like Abilify is quite different and worth trying. How long did it take you to feel the positive effects of the Abilify?
My depression is also unipolar atypical, so I'm heartened to hear that yours is as well (though not glad about the misery you must have also gone through!)
Anyway, congrats on your response to the Abilify and thanks for the info!
> I would say my depression is closer to the atypical type. I don't have any bipolarity going on.
>
> As for my combo, the lexapro is there just because i think my pdoc thought that i need to be on an anitdepressant. Whatever. I don't know that it does much. The lithium was added to augment the lexapro and it helped. I'd say that it brought me to 50% remission. It also helped with suicidal feelings. So, we didn't want to dump it b/c it clearly was doing something, although not enough. We added the Abilify because the other meds weren't doing enough. And voila! It all came together and I have a combo that works for me.
>
> Hope this answers your questions. Let me know if you have more!
>
> Best,
> EE
Posted by Emily Elizabeth on August 25, 2008, at 20:30:08
In reply to Re: Atypical antipsychotics for anxiety » Emily Elizabeth, posted by PC_Load_Letter on August 24, 2008, at 22:59:58
No, Abilify is the only antipsychotic that I tried.
Good luck. I hope that it works for you!!
Best,
EE
Posted by mknight on August 27, 2008, at 15:34:28
In reply to Re: Atypical antipsychotics for anxiety » Emily Elizabeth, posted by PC_Load_Letter on August 24, 2008, at 13:06:45
> Is your depression more the atypical type (hypersomnia, carb cravings, extreme fatigue) or melancholic type (insomnia, loss of appetite)?
Atypical depression is the only diagnosis in the DSM that even comes close to my situation. I sleep a lot, eat a lot, am extremely tired all of the time, have very strange feelings in my legs like running up a hill as hard as you can.
But the worst problem I find very little mention of is feeling stoned and spacey like smoking marijuana or taking mild mescaline. This problem is affected by carbohydrates like bread, rice, potatoes, etc.
One solution would be the Zone Diet or similar meat and vegetable diet, but it is certainly not a cure, only lessens the stoned feeling.
Any comments on feeling stoned? Concentration and memory are good but outside or in public I am really spacey.
Posted by PC_Load_Letter on August 27, 2008, at 20:38:16
In reply to Re: Atypical antipsychotics for anxiety » PC_Load_Letter, posted by mknight on August 27, 2008, at 15:34:28
Hi,
Regarding your "stoned and spacey" symptoms, since they appear to be triggered by being outdoors or in social situations, what comes to mind first is possible panic attacks brought on by either agoraphobia, social anxiety or both. Panic attacks can often leave one with a sense of altered consciousness. The vast majority of people diagnosed with depression also have problems with anxiety.
> Atypical depression is the only diagnosis in the DSM that even comes close to my situation. I sleep a lot, eat a lot, am extremely tired all of the time, have very strange feelings in my legs like running up a hill as hard as you can.
>
> But the worst problem I find very little mention of is feeling stoned and spacey like smoking marijuana or taking mild mescaline. This problem is affected by carbohydrates like bread, rice, potatoes, etc.
>
> One solution would be the Zone Diet or similar meat and vegetable diet, but it is certainly not a cure, only lessens the stoned feeling.
>
> Any comments on feeling stoned? Concentration and memory are good but outside or in public I am really spacey.
Posted by Zyprexa on August 28, 2008, at 20:30:28
In reply to Atypical antipsychotics for anxiety, posted by aussie_jon on August 22, 2008, at 22:29:18
Zyprexa has always worked for my anxiety. Taking it 10 years now.
This is the end of the thread.
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