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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 43. This is the beginning of the thread.
Posted by Cseagraves on April 11, 2009, at 20:50:51
Hi again!
Been reading alot today. Have been trying to find a med that is directly geared toward anxiety and panic disorder. I always have severe reactions to ssri's and I'm thinking its because I'm not depressed. Maybe those particular chemicals in my brain do not need adjusting. This whole anxiety/panic/agoraphobia didn't hit me until about a year and a half ago. This is not something I have been struggling with for years and years.
TCA's don't work either.
The only benzo I can take that really helps for a short period is xanax. (Have tried all the others). I have just as severe side effects to antipsychotics. I don't think I need them either. My body totally rejects these meds.
The only thing I need is help with these awful anxieties and panic. This constant fear that I feel, I am always in flight or fright mode.
My body seems to have a very low tolerance to meds. (I can't even take pain pills)
The two meds I found today that looked like they might be what may help is Buspar or Celexa.
If anyone has had experience with these for extreme and debilitating anxiety, could you please let me know.
Thanks,
Courtney
Posted by myco on April 12, 2009, at 0:38:07
In reply to Buspar or Celexa for extreme GAD, posted by Cseagraves on April 11, 2009, at 20:50:51
*poke poke. still searching C? :oP
> Hi again!
>
> Been reading alot today. Have been trying to find a med that is directly geared toward anxiety and panic disorder. I always have severe reactions to ssri's and I'm thinking its because I'm not depressed. Maybe those particular chemicals in my brain do not need adjusting. This whole anxiety/panic/agoraphobia didn't hit me until about a year and a half ago. This is not something I have been struggling with for years and years.
>
> TCA's don't work either.
>
> The only benzo I can take that really helps for a short period is xanax. (Have tried all the others). I have just as severe side effects to antipsychotics. I don't think I need them either. My body totally rejects these meds.
>
> The only thing I need is help with these awful anxieties and panic. This constant fear that I feel, I am always in flight or fright mode.
>
> My body seems to have a very low tolerance to meds. (I can't even take pain pills)
>
> The two meds I found today that looked like they might be what may help is Buspar or Celexa.
>
> If anyone has had experience with these for extreme and debilitating anxiety, could you please let me know.
>
> Thanks,
>
> Courtney
Posted by Phillipa on April 12, 2009, at 0:39:16
In reply to Buspar or Celexa for extreme GAD, posted by Cseagraves on April 11, 2009, at 20:50:51
Celexa made me tired but why not the xanax? If it works take it. Love Phillipa
Posted by Phillipa on April 12, 2009, at 0:40:20
In reply to Re: Buspar or Celexa for extreme GAD » Cseagraves, posted by myco on April 12, 2009, at 0:38:07
Myco hi. Love Phillipa
Posted by X-ray on April 12, 2009, at 5:46:07
In reply to Buspar or Celexa for extreme GAD, posted by Cseagraves on April 11, 2009, at 20:50:51
Hi,
I have been on Buspar for 16 years.
This drug is good for anxiety.Buspar has been approved for GAD since 1986,
but I don't suffer from this kind of worry.Buspar is a mild drug that has few side effects.
This medication is underestimated by many people.The reason is that it doesn't offer immediate relief.
I don't really feel Buspar in my body.If I would quit this drug, I would surely notice.
Buspar is doing a great job with my anxiety.I think that you should try this medicine.
But you might need a more potent drug.Best regards,
X-ray
Posted by bleauberry on April 12, 2009, at 8:21:23
In reply to Buspar or Celexa for extreme GAD, posted by Cseagraves on April 11, 2009, at 20:50:51
On one hand it is a good thing that you have weeded out so many meds, because that narrows down the choices and makes the picture a little clearer. On the other hand it is saddening you have had to suffer through all this.
Four suggestions popped into mind. Two are easy, two not so easy.
The easy ones:
Spend about $50 at a health food store or online. What you want are: Tryptophan; A product made by NOW brand that has Gaba, Glycine, and Magnesium in it. If you aren't already taking magnesium, it is worth adding to your diet if you tolerate it. And take Niacinamide. All of these are calming supplements. Experiment with the Tryptophan and the other supplements. They stand a good shot of working.Buspar is easy. Anyone should be able to prescribe this in a blink without hesitation. Whether it works, and whether you can tolerate it, is another story. There is only one way to find out.
The harder ones:
Nardil. This is the champion. Not many doctors prescribe it. That what makes it hard...finding someone to prescribe it.
Adrenal Cortex Extract; or Isocort; or Licorice Root; or Hydrocortisone 2.5mg-20mg). Huh? What's this stuff all about? Well, what you described...the anxiety, panic, med and supplement sensitivities, its onset, etc...is what adrenal fatigue looks like. How to find out if you have it? There is a test called Adrenal Stress Index. It is very common with Integrative MDs, Alernative MDs, and Naturopaths. That's the hard part...breaking out of your comfort zone to see one of them instead of your regular doctor, for a second opinion if nothing else. The easy part is, they do this test all the time. If you have low cortisol, your symptoms are fairly easily fixed with few or no medicines.
I would see Buspar, Nardil, and the supplements as things that hide the symptoms and/or partially fix the problem. I see treating adrenal fatigue as fixing the actual problem. I would not have mentioned it except for the excellent history you gave, and your description of symptoms, which are strongly suggestive this needs to be looked at. Your regular doctor won't know much about it, and an Endocronologist will give you a worthless test that only tells if your adrenal glands are dead or alive but not whether they are ill. The ASI test shows that status of your cortisol over an entire daily 24 hour curve so you can see exactly what is going on and how it fits the symptoms you feel throughout the day.
Posted by rvanson on April 12, 2009, at 8:48:48
In reply to Buspar or Celexa for extreme GAD, posted by Cseagraves on April 11, 2009, at 20:50:51
> Hi again!
>
> Been reading alot today. Have been trying to find a med that is directly geared toward anxiety and panic disorder. I always have severe reactions to ssri's and I'm thinking its because I'm not depressed. Maybe those particular chemicals in my brain do not need adjusting. This whole anxiety/panic/agoraphobia didn't hit me until about a year and a half ago. This is not something I have been struggling with for years and years.
>
> TCA's don't work either.
>
> The only benzo I can take that really helps for a short period is xanax. (Have tried all the others). I have just as severe side effects to antipsychotics. I don't think I need them either. My body totally rejects these meds.
>
> The only thing I need is help with these awful anxieties and panic. This constant fear that I feel, I am always in flight or fright mode.
>
> My body seems to have a very low tolerance to meds. (I can't even take pain pills)
>
> The two meds I found today that looked like they might be what may help is Buspar or Celexa.
>
> If anyone has had experience with these for extreme and debilitating anxiety, could you please let me know.
>
> Thanks,
>
> CourtneyBuspar actually made me feel weird, somewhat agitated.
Celexa was much better then most AD's for giving *some* help with anxiety, but not very much.
Needless to say the benzo's, like Ativan, Xanax and Klonopin are much better for severe anxiety such as you describe, but finding a Pdoc to prescribe them is a hardship these days due to the FDA rules and the general fear the doctors have of using them and/or becoming dependent.
Have you been on Nardil, Zoloft or Paxil yet?
For some few Zoloft works on anxiety, but for many it seems to be a bit stimulating for them from what I have read over the years.
BTW, what medications if any, are you currently using now?
Posted by odon on April 12, 2009, at 11:48:26
In reply to Re: Buspar or Celexa for extreme GAD, posted by bleauberry on April 12, 2009, at 8:21:23
I just have a question,I hope bleauberry can answer this.Is it possible anti-depressants stop working because high levels of cortisol are lowered--which is one factor in making them WORK.---However if you use an antidepressant for years with good results,then when the drug slowly stops working maybe the medication lowered cortisol levels too much.--I do realize this is a hard question.
Posted by myco on April 12, 2009, at 12:16:27
In reply to Re: Buspar or Celexa for extreme GAD, posted by bleauberry on April 12, 2009, at 8:21:23
Hi Bleuberry,
Any evidence youve come across, either through studies or second hand experience, that buspar can be combined safely with Nardil?
thnx
m> On one hand it is a good thing that you have weeded out so many meds, because that narrows down the choices and makes the picture a little clearer. On the other hand it is saddening you have had to suffer through all this.
>
> Four suggestions popped into mind. Two are easy, two not so easy.
>
> The easy ones:
> Spend about $50 at a health food store or online. What you want are: Tryptophan; A product made by NOW brand that has Gaba, Glycine, and Magnesium in it. If you aren't already taking magnesium, it is worth adding to your diet if you tolerate it. And take Niacinamide. All of these are calming supplements. Experiment with the Tryptophan and the other supplements. They stand a good shot of working.
>
> Buspar is easy. Anyone should be able to prescribe this in a blink without hesitation. Whether it works, and whether you can tolerate it, is another story. There is only one way to find out.
>
> The harder ones:
>
> Nardil. This is the champion. Not many doctors prescribe it. That what makes it hard...finding someone to prescribe it.
>
> Adrenal Cortex Extract; or Isocort; or Licorice Root; or Hydrocortisone 2.5mg-20mg). Huh? What's this stuff all about? Well, what you described...the anxiety, panic, med and supplement sensitivities, its onset, etc...is what adrenal fatigue looks like. How to find out if you have it? There is a test called Adrenal Stress Index. It is very common with Integrative MDs, Alernative MDs, and Naturopaths. That's the hard part...breaking out of your comfort zone to see one of them instead of your regular doctor, for a second opinion if nothing else. The easy part is, they do this test all the time. If you have low cortisol, your symptoms are fairly easily fixed with few or no medicines.
>
> I would see Buspar, Nardil, and the supplements as things that hide the symptoms and/or partially fix the problem. I see treating adrenal fatigue as fixing the actual problem. I would not have mentioned it except for the excellent history you gave, and your description of symptoms, which are strongly suggestive this needs to be looked at. Your regular doctor won't know much about it, and an Endocronologist will give you a worthless test that only tells if your adrenal glands are dead or alive but not whether they are ill. The ASI test shows that status of your cortisol over an entire daily 24 hour curve so you can see exactly what is going on and how it fits the symptoms you feel throughout the day.
Posted by myco on April 12, 2009, at 12:36:51
In reply to Re: Buspar or Celexa for extreme GAD, posted by odon on April 12, 2009, at 11:48:26
Ive read studies showing that high levels of cortisol are a "predicter" of "poor response" to AD's (I think the study used MAOI's as an example). This provides an interesting correlation for your question there. The answer is it's possible for sure....research a lil if you have time - literature support for your idea is out there to aid in a line of argument.
:o)
> I just have a question,I hope bleauberry can answer this.Is it possible anti-depressants stop working because high levels of cortisol are lowered--which is one factor in making them WORK.---However if you use an antidepressant for years with good results,then when the drug slowly stops working maybe the medication lowered cortisol levels too much.--I do realize this is a hard question.
Posted by Cseagraves on April 12, 2009, at 13:54:10
In reply to Re: Buspar or Celexa for extreme GAD, posted by bleauberry on April 12, 2009, at 8:21:23
Thanks for all the info. I am indeed (was tested) in adrenal stress and have been being treated for it. My cortisol levels are out the roof so I am also being treated with Super Cortisol Support and Adrenal Rebuilder. I also drink a tincture of Adrenal Support Rebuilder along with this 2 to 4 times a day.
Thanks to Myco and others here, I have decided to give Nardil a shot. Parnate would be to stimulating for my issues. Everyone just bare with me while I get through my first couple of weeks. Keep your fingers crossed. I'll probably try and give a day by day posting once I get started which won't be until around the 24th of April since I still have Zoloft in my system.
Thanks again for the support!
Courtney
Posted by Cseagraves on April 12, 2009, at 13:58:12
In reply to Re: Buspar or Celexa for extreme GAD » Cseagraves, posted by rvanson on April 12, 2009, at 8:48:48
Just came off of Zoloft a few days ago after having a severe allergic reaction. So that's it. I'm done with the ssri train. Have been on pretty much everyone now and am tired as none of them work. As I said before, I don't think my issue has to do with seratonin and the way antidepressants work. I'm not depressed, just highly anxietal.
Am going to start Nardil next.
Thanks,
Courtney
Posted by myco on April 12, 2009, at 14:10:41
In reply to Re: Buspar or Celexa for extreme GAD, posted by Cseagraves on April 12, 2009, at 13:58:12
We'll be supporting you the whole way hun
*hugs
Just came off of Zoloft a few days ago after having a severe allergic reaction. So that's it. I'm done with the ssri train. Have been on pretty much everyone now and am tired as none of them work. As I said before, I don't think my issue has to do with seratonin and the way antidepressants work. I'm not depressed, just highly anxietal.
>
> Am going to start Nardil next.
>
> Thanks,
>
> Courtney
Posted by Zana on April 12, 2009, at 14:19:23
In reply to Re: Buspar or Celexa for extreme GAD » Cseagraves, posted by myco on April 12, 2009, at 14:10:41
I think doing a daily post is a great idea! I may do it myself since I have just started on pristiq and am, for the first time in 20 years of doing the med thing, keeping a journal.
We'll be watching for your posts. Good luck
Zana
PS The discussion of the adrenal connection is fasicinating. I'm going to ask my pdoc about it when I see her next week.
Posted by linkadge on April 12, 2009, at 18:02:53
In reply to Re: Buspar or Celexa for extreme GAD, posted by Zana on April 12, 2009, at 14:19:23
Nardil has a strong serotonergic effect. If SSRI's don't help anxiety (or make it worse), you might want to try a gabaergic drug like gabapentin or perhaps low dose of seroquel.
Linkadge
Posted by myco on April 12, 2009, at 18:05:51
In reply to Re: Buspar or Celexa for extreme GAD, posted by linkadge on April 12, 2009, at 18:02:53
Hi Link,
What's your current med regime?
myco> Nardil has a strong serotonergic effect. If SSRI's don't help anxiety (or make it worse), you might want to try a gabaergic drug like gabapentin or perhaps low dose of seroquel.
>
> Linkadge
Posted by bleauberry on April 12, 2009, at 18:47:12
In reply to Re: Buspar or Celexa for extreme GAD-Bleauberry, posted by Cseagraves on April 12, 2009, at 13:54:10
> Thanks for all the info. I am indeed (was tested) in adrenal stress and have been being treated for it. My cortisol levels are out the roof so I am also being treated with Super Cortisol Support and Adrenal Rebuilder. I also drink a tincture of Adrenal Support Rebuilder along with this 2 to 4 times a day.
I wasn't sure what you meant by cortisol being out the roof. If that means too high, then most antidepressants will squash it down. Phosphatidyl Serine as well as high dose Vit C will squash it down too. If it means too low, that's a different story. Then you definitely need support. Most people I've talked to end up on hydrocortisone, but some do well with adrenal cortex extracts. Other supplements don't usually do much in the real world. Another thing to consider is that the adrenals may be fine...the problem is they are receiving erroneous instructions from the pituitary gland. If that is the case, adrenal treatments can still help, through feedback loops, to smooth out the instructions.
>
> Thanks to Myco and others here, I have decided to give Nardil a shot. Parnate would be to stimulating for my issues. Everyone just bare with me while I get through my first couple of weeks. Keep your fingers crossed. I'll probably try and give a day by day posting once I get started which won't be until around the 24th of April since I still have Zoloft in my system.
>
> Thanks again for the support!
>
> CourtneyI am very sensitive to supplements, meds, and even foods. I am very sensitive to things that cause anxiety. I recently tried Parnate for a few days just to test the waters. I was amazed at the rapid antidepressant effect. But even more amazing was the way it made me feel relaxed and completely free of anxiety in social situations. I just wanted to share that, because when people think of Parnate being too stimulating, I don't think that is always accurate.
Posted by bleauberry on April 12, 2009, at 18:55:21
In reply to Re: Buspar or Celexa for extreme GAD » bleauberry, posted by myco on April 12, 2009, at 12:16:27
> Hi Bleuberry,
>
> Any evidence youve come across, either through studies or second hand experience, that buspar can be combined safely with Nardil?
>
> thnx
> mI have never looked into this. My first guess would be it is ok, but then again, I have some doubts. For example, there have been cases of serotonin sydrome with buspar combined with ssris. Very rare, but it has happened. The other thing is that buspar's metabolite turns into an alpha antagonist, which stimulates the release of norepinephrine. I don't know if that would be a problem with an MAOI or not, but I think it has the potential.
All that said, the combination has probably been done before. I just can't recall ever hearing of it or seeing any contraindications for it.
You might want to start a new thread on that question. Others may come in with some better answers for you.
I guess if you are considering buspar, then anxiety must be an issue despite nardil? If so, I just wanted to comment that at places like askapatient.com, revolutionhealth.com, patientslikeme.com, and such, a well liked combo is Parnate+Klonopin.
Posted by myco on April 12, 2009, at 18:59:26
In reply to Re: Buspar or Celexa for extreme GAD » myco, posted by bleauberry on April 12, 2009, at 18:55:21
Lookin at augmenting for added energy/stimulation. Nardil is still great on anxiety but I'm missing my get up and go kick it used to give me.
> > Hi Bleuberry,
> >
> > Any evidence youve come across, either through studies or second hand experience, that buspar can be combined safely with Nardil?
> >
> > thnx
> > m
>
> I have never looked into this. My first guess would be it is ok, but then again, I have some doubts. For example, there have been cases of serotonin sydrome with buspar combined with ssris. Very rare, but it has happened. The other thing is that buspar's metabolite turns into an alpha antagonist, which stimulates the release of norepinephrine. I don't know if that would be a problem with an MAOI or not, but I think it has the potential.
>
> All that said, the combination has probably been done before. I just can't recall ever hearing of it or seeing any contraindications for it.
>
> You might want to start a new thread on that question. Others may come in with some better answers for you.
>
> I guess if you are considering buspar, then anxiety must be an issue despite nardil? If so, I just wanted to comment that at places like askapatient.com, revolutionhealth.com, patientslikeme.com, and such, a well liked combo is Parnate+Klonopin.
>
Posted by linkadge on April 12, 2009, at 20:02:40
In reply to Re: Buspar or Celexa for extreme GAD-Bleauberry » Cseagraves, posted by bleauberry on April 12, 2009, at 18:47:12
I don't know if I'd agree with the notion that antidepressants will decrease cortisol.
A number of studies suggest the SSRI's (esp fluoxetine and sertraline) increase cortisol.
The only antidepressnats that have somewhat of a documented anti-cortisol effect are remeron and doxepine / amitriptyline. Some of the antipsychotics also decrease cortisol.
Linkadge
Posted by linkadge on April 12, 2009, at 20:07:38
In reply to Re: Buspar or Celexa for extreme GAD » linkadge, posted by myco on April 12, 2009, at 18:05:51
>Hi Link,
>What's your current med regime?Nothing.
I have been prescribed citalopram but I don't want to go that route again. I end up losing more than I gain.
Linkadge
Posted by myco on April 12, 2009, at 20:10:29
In reply to Re: Buspar or Celexa for extreme GAD, posted by linkadge on April 12, 2009, at 20:07:38
Link:
You once mentioned nortip/zoloft together. Do you have previous with that combo? Was it quite energizing and easy on anxiety?
myco
> >Hi Link,
> >What's your current med regime?
>
> Nothing.
>
> I have been prescribed citalopram but I don't want to go that route again. I end up losing more than I gain.
>
>
>
> Linkadge
>
Posted by linkadge on April 13, 2009, at 6:41:19
In reply to Re: Buspar or Celexa for extreme GAD » linkadge, posted by myco on April 12, 2009, at 20:10:29
I've never taken nortrip/sertraline. I took a combination of clomipramine and sertraline which was pretty good.
Linkadge
Posted by linkadge on April 13, 2009, at 6:43:16
In reply to Re: Buspar or Celexa for extreme GAD » linkadge, posted by myco on April 12, 2009, at 20:10:29
Clomipramine was vastly superior to SSRI's in terms of AD efficacy IMHO. I couldn't take high doses because of rapid heartbeat. So I think I ended up on about 50mg clomipramine and 25-50 mg of sertaline which was fairly effective.
I stoped because of the genotoxic potential of clomipramine. I don't think nortiptyline is genotoxic which is why I'd like to try it in combination with a low dose of SSRI.
Linkadge
Posted by SLS on April 13, 2009, at 7:22:37
In reply to Re: Buspar or Celexa for extreme GAD, posted by linkadge on April 13, 2009, at 6:43:16
> I stoped because of the genotoxic potential of clomipramine. I don't think nortiptyline is genotoxic
Yes. Those TCAs that have a carbon atom in the 5th position of the center ring are genotoxic. The only TCAs that are structured this way are imipramine, desipramine, trimipramine, and clomipramine.
- Scott
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