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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 17 of 17. This is the beginning of the thread.
Posted by lepus on August 18, 2010, at 14:24:33
I have been dealing with severe agoraphobia for about 5 years. I have barely left the house in that time. I'm currently on Klonopin, 1mg 3x a day. I also have Xanax to use as needed.
Lately, the anxiety seems to be getting worse. I think it is partially because the agoraphobia has gone on so long and I feel my life slipping away.
Clearly, I need more medication as exposure therapy doesn't seem to be working at all.
I have been on several SSRIs, SNRIs, tricyclics, Depakote, Trileptal, and some atypical antipsychotics. I have been on a lot of meds in my years of dealing with anxiety and agoraphobia.
My most recent meds trial was with Imipramine. I had some luck with it at one point in my life. However, it was a nightmare this time. My panic attacks actually became worse.
At this point my doctor is giving me the choice of Abilify or Seroquel XR. I'm afraid of Abilify because I've read anxiety is a side effect. I would only start on 2mg of Abilify. Seroquel XR concerns me because I'm med sensitive (have unusual reactions) and you have to start at a high dose (50mg).
I need help. I have to try another medication despite my fears of side effects and feeling worse, as I often have in the past with meds. I am at the end of my rope. If anyone can provide some guidance I would be very appreciative. Which med is better? Any other ideas? I know mileage varies. I just need a miracle. Desperately.
Posted by Bob12 on August 18, 2010, at 15:03:19
In reply to Help, please. Severe anxiety/agoraphobia, posted by lepus on August 18, 2010, at 14:24:33
Hi,
I wish you good luck. I have grappled with anxiety for many years as well. Have you considered getting a pet cat? That may help.
I also have a love hate relationship with Zyprexa which you can start at a low dose of 2.5 mg. It causes weight gain but will probably calm you down,
Hope you find relief.Bob12
Posted by lepus on August 18, 2010, at 15:22:03
In reply to Re: Help, please. Severe anxiety/agoraphobia, posted by Bob12 on August 18, 2010, at 15:03:19
> Hi,
> I wish you good luck. I have grappled with anxiety for many years as well. Have you considered getting a pet cat? That may help.
> I also have a love hate relationship with Zyprexa which you can start at a low dose of 2.5 mg. It causes weight gain but will probably calm you down,
> Hope you find relief.
>
> Bob12Thanks for your input, Bob. I do have a dog. She is a wonderful companion but no substitute for real, human companionship and simply the ability to get my own groceries or travel! I've missed out on so much of my life. I need to break the back of this agoraphobia.
Posted by Bob12 on August 18, 2010, at 15:44:45
In reply to Re: Help, please. Severe anxiety/agoraphobia, posted by lepus on August 18, 2010, at 15:22:03
Try this link:
http://www.anxietynetwork.com/pdmed.html
Bob12
Posted by lepus on August 18, 2010, at 15:58:08
In reply to Re: Help, please. Severe anxiety/agoraphobia, posted by Bob12 on August 18, 2010, at 15:44:45
What a wonderful link, Bob! I thought I had seen every page on the Web for anxiety disorders but I had not seen that one. I noticed it didn't mention atypical anti-psychotics but did mention MAOIs as being very effective. I have a feeling I might end up on an MAOI one of these days.
Thank you for the link!
Posted by morgan miller on August 18, 2010, at 16:04:44
In reply to Help, please. Severe anxiety/agoraphobia, posted by lepus on August 18, 2010, at 14:24:33
>Clearly, I need more medication as exposure therapy doesn't seem to be working at all.
How long have you been in therapy? Unfortunately, sometimes you get worse before you start to get better.
Have you ever tried psychodynamic group therapy? It may be difficult to find a good one, it's hard enough to find a really good intelligent genuinely empathic/compassionate therapist.
>At this point my doctor is giving me the choice of Abilify or Seroquel XR. I'm afraid of Abilify because I've read anxiety is a side effect. I would only start on 2mg of Abilify. Seroquel XR concerns me because I'm med sensitive (have unusual reactions) and you have to start at a high dose (50mg).
Why do you have to start Seroquel at 50? Something is seriously wrong with the current state of psychiatry. You can start much much lower than that and get some relief. It may take a few weeks, but you can get some relief. I'm not crazy about Seroquel, way over prescribed IMHO. I guess you've already tried Zyprexa. If you have tried Zyprexa and don't think it can help, I would start with a very low dose of Abilify and stay there for a while, 3 or 4 weeks, if you notice improvement after 1 week before thinking about an increase. Maybe 2 mg will be enough.
Have you ever tried a low dose of lithium?
Have you tried a good brand of St. John's Wort? Perika, Kira, New Chapter's Serofin
Are you taking fish oil as an adjunct to medication therapy?
Sorry you are not doing well. I understand, believe me, it's horrible to not be able to leave the house and live life.
Morgan
Posted by morgan miller on August 18, 2010, at 16:16:41
In reply to Help, please. Severe anxiety/agoraphobia, posted by lepus on August 18, 2010, at 14:24:33
Here are some supplement suggestions that I've been suggesting to others that have really been helping me lately. I'm bipolar and have experienced tons of anxiety, depression, and agitated fatigue(more recently).
A good Multivitamin-a must-who knows what essential nutrients the medications we take are depleting-I know Lamictal depletes folate.
Fish oil-a must-better mood, more energy, brain health/protection, heart health/protection, eye health/protection, healthy cholesterol, may help better process fats
Magnesium Glycinate-also a must-for sleep, mood, anxiety, depression-should be taken almost daily-Magnesium assists in the production of serotonin and catecholamines dopamine and norepinephrine
Glycine-great for sound sleep-Also protects against glutamate excitotoxicity, something implicated in bipolar.
Holy Basil-New Chapter-smooth relaxing and uplifting herb-haven't used it lately but plan to add it back into my regimen-blood sugar control as added benefit-you may need this with Seroquel
Cordyceps-best to buy in bulk(need to find a good supplier) powder-may need up to 2 to 4 grams to notice mood/energy lift-I think I notice anxiety relief with this as well-has immune boosting and cancer preventative properties
Reishi-Paul Stamets' brand(expensive, maybe look for a more affordable but good brand)-may be good for sleep, mood and energy-has been shown to have immune boosting properties.
Schizandra-Planetary Herbals Schisandra Adrenal Complex-feeling a smooth energy, anxiety relief and mood boost-subtle but good-also increases glutathione and is good for liver health-taking medication requires taking extra care of the liver
Ashwagandha-Himalaya Herbs-good for relaxation, anxiety, sleep, and energy-may stimulate thyroid fuction-could be good for weight loss-modulates cortisol-improves immune health through Th1 immunity stimulation.
Rhodiola-New Chapter, 100 mg-I like the energy boost in low doses-could be overstimulating and agitating, but then again, some of the antidpressants you listed can do the same
Chyavanphrash-Himalaya Herbs-I may feel better from this, not sure with everything else I'm taking-Liver health, energy boosting, supports immune function, healthy blood sugar
You may also want to consider taking a good Resveratrol product to help with the potential blood sugar/insulin sensitivity issues that come with antipsychotics, including Seroquel.
Many people may not believe that these substances can have a significant enough impact on the way they feel. The fact is, many herbs and medicinal mushrooms have been used for a thousand years or longer and are now finally being given credence through legitimate research studies. I believe herbs, mushrooms, and other supplements will be the wave of the future in treating and preventing many medical issues. I also think drugs will be developed based on some of these substances. One of these, resveratrol, is already being used by Glaxo Smith Kline to develop a drug that may be useful in treating type II diabetes and preserving overall health as we age. Sorry for the mini rant sounding like a personal agenda. Really just trying to educate and help.
Morgan
Posted by morgan miller on August 18, 2010, at 16:18:27
In reply to Re: Help, please. Severe anxiety/agoraphobia, posted by lepus on August 18, 2010, at 15:58:08
> What a wonderful link, Bob! I thought I had seen every page on the Web for anxiety disorders but I had not seen that one. I noticed it didn't mention atypical anti-psychotics but did mention MAOIs as being very effective. I have a feeling I might end up on an MAOI one of these days.
>
> Thank you for the link!I've read of Parnate working wonders for anxiety, social anxiety, and depression.
Posted by angels78 on August 18, 2010, at 17:08:43
In reply to Help, please. Severe anxiety/agoraphobia, posted by lepus on August 18, 2010, at 14:24:33
If it's severe, well try a few SSRI's. I dont think they'll work if its severe, but you never know. If they dont, you can move onto a MAOI, which may help you. But def. try SSRI's first.
Posted by angels78 on August 18, 2010, at 17:10:45
In reply to Re: Help, please. Severe anxiety/agoraphobia » lepus, posted by angels78 on August 18, 2010, at 17:08:43
Sorry, I didn't read your whole post. You have tried SSRI's, have you tried MAOI's for severe anxiety and agoraphobia? I have both and Nardil helped me i'd say about 65% from 0%.
Posted by Phillipa on August 18, 2010, at 17:21:57
In reply to Re: Help, please. Severe anxiety/agoraphobia » angels78, posted by angels78 on August 18, 2010, at 17:10:45
Seriously benzos don't work? Old med but miltown if still prescribed with valium was given to me years ago. Phillipa
Posted by bearfan on August 18, 2010, at 17:35:00
In reply to Help, please. Severe anxiety/agoraphobia, posted by lepus on August 18, 2010, at 14:24:33
Did you give all the SSRIs an adequate trial? Have you tried buspar (it can help some)? You may need to try a MAOI which some people have success. I am not sure if Emsam works, but I've heard night and day stories with Nardil and Parnate
Posted by lepus on August 18, 2010, at 17:55:16
In reply to Re: Help, please. Severe anxiety/agoraphobia, posted by morgan miller on August 18, 2010, at 16:04:44
>
> How long have you been in therapy? Unfortunately, sometimes you get worse before you start to get better.I've been in exposure therapy for only a few months. It hasn't been very consistent either. I have to pay someone to help me with exposure therapy out of pocket, which can be difficult. I live in a fairly rural area in a state that is undergoing massive budget cuts. The aid for people like me isn't available anymore, privately or through the state, and I'm not independently wealthy. There was never much aid to begin with. But doctors are fleeing and the state or county facilities are closing or drastically reducing services.
>
> Have you ever tried psychodynamic group therapy? It may be difficult to find a good one, it's hard enough to find a really good intelligent genuinely empathic/compassionate therapist.I have not. I don't think it exists around here. I have a very compassionate therapist but her hands are tied by what is available and the fact that I just cannot get out and go very far.
>>
> Why do you have to start Seroquel at 50? Something is seriously wrong with the current state of psychiatry. You can start much much lower than that and get some relief. It may take a few weeks, but you can get some relief. I'm not crazy about Seroquel, way over prescribed IMHO. I guess you've already tried Zyprexa. If you have tried Zyprexa and don't think it can help, I would start with a very low dose of Abilify and stay there for a while, 3 or 4 weeks, if you notice improvement after 1 week before thinking about an increase. Maybe 2 mg will be enough.The lowest dose available for Seroquel XR is 50mg. I never have tried Zyprexa. I'm not sure why. Perhaps because I do have some blood sugar problems? I don't know why no one has ever mentioned it. I'll ask.
>
> Have you ever tried a low dose of lithium?
>
I have. Lithium made me very ill.> Have you tried a good brand of St. John's Wort? Perika, Kira, New Chapter's Serofin
No, I tend to shy away from these remedies as I also have another medical illness and there are often interactions between meds that doctors just don't understand.
>
> Are you taking fish oil as an adjunct to medication therapy?Tried it. Didn't notice any improvement. Can't hurt to try again.
>
> Sorry you are not doing well. I understand, believe me, it's horrible to not be able to leave the house and live life.
>
Yes, it really is.Thank you for your help.
Posted by lepus on August 18, 2010, at 18:06:39
In reply to Re: Help, please. Severe anxiety/agoraphobia » angels78, posted by angels78 on August 18, 2010, at 17:10:45
> Sorry, I didn't read your whole post. You have tried SSRI's, have you tried MAOI's for severe anxiety and agoraphobia? I have both and Nardil helped me i'd say about 65% from 0%.
MAOI's are the only class I haven't tried. I think my psychiatrist wants me on something that stabilizes me more before she tries an MAOI. My assumption is she suspects I might have some Bipolar II tendencies after the way the other antidepressants made me worse.I just don't want to feel any worse. I'm so tired of the medication merry go round and I'm so tired of being a prisoner in my home.
Posted by lepus on August 18, 2010, at 18:08:48
In reply to Re: Help, please. Severe anxiety/agoraphobia, posted by Phillipa on August 18, 2010, at 17:21:57
> Seriously benzos don't work? Old med but miltown if still prescribed with valium was given to me years ago. Phillipa
They did when I first starting having anxiety. Klonopin was a miracle for me. Now it is just a maintenance drug. Xanax doesn't have much effect either. I usually end up exhausted and still anxious.
Posted by lepus on August 18, 2010, at 18:11:34
In reply to Re: Help, please. Severe anxiety/agoraphobia, posted by bearfan on August 18, 2010, at 17:35:00
> Did you give all the SSRIs an adequate trial? Have you tried buspar (it can help some)? You may need to try a MAOI which some people have success. I am not sure if Emsam works, but I've heard night and day stories with Nardil and Parnate
First, a comment on your name...are you a Chicago Bears fan? Or just a fan of the animal? I love the Chicago Bears personally, although I also like the animal.
Anyway, yes, the SSRIs were given quite lengthy trials unless I started having terrible symptoms where I simply could not take them anymore. For instance, Cymbalta made my heart race horribly.
I tried Buspar a while ago and it did nothing.
I think MAOI's are pretty much all I have left. But she wants me on either Seroquel XR or Abilify first. I guess I'll try the lose dose of Abilify?
Hoping for a miracle.
Posted by 10derHeart on August 18, 2010, at 21:34:45
In reply to Re: Help, please. Severe anxiety/agoraphobia, posted by lepus on August 18, 2010, at 17:55:16
>The lowest dose available for Seroquel XR is 50mg.
Why does your pdoc want you to start with XR? Could you maybe switch to that later if it is a good med for you?
This may be a dumb idea as I am certainly no med expert from personal experience. I do have some small background in medicine and in medication dosing specifically from prior jobs. Because of your sensitivity concerns, would she be open to you trying regular Seroquel (non-XR) as it comes in 25 mg tablets? I believe they are round (but maybe not scored) and can be split with a pill splitter, so you could begin with (roughly)12.5 mg if you wanted.
Just a thought. I hope you find something to help soon. I don't post on this board much, but I have been around Babble for years and I know there are many kind and knowledgeable posters here!
This is the end of the thread.
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