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Dr. Bob is Robert Hsiung, MD,
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Posted by floatingbridge on June 7, 2011, at 12:16:00
In reply to Re: Please, any antidepressant best to help anxiety » sleepygirl2, posted by Phillipa on June 7, 2011, at 11:38:00
Phillipa, your post arrived as I was typing mine. No implication that you are not med savvy. Looked like I was the first respondent. Just timing.
fb
Posted by hyperfocus on June 7, 2011, at 14:50:35
In reply to Please, any antidepressant best to help anxiety, posted by sleepygirl2 on June 7, 2011, at 11:08:09
Sorta like what I asked fb in the other thread - could you describe your anxiety? Is it like phobic or neurotic or obsessive thoughts worrying? Is it something specific or generalized? Or is like more excess stimulation? Or like racing thoughts? Or panic attacks?
Did you have it before you started the meds?
Posted by Phidippus on June 7, 2011, at 14:52:41
In reply to Re: Please, any antidepressant best to help anxiety » Phillipa, posted by sleepygirl2 on June 7, 2011, at 12:07:53
> No, my Pdoc says bipolar II.
I am bipolar II and am successfully treated with Lithium and Clomipramine, a TCA. IMHO, TCAs are the best way to go when treating anxiety. Try Amytriptyline or a small dose of Imipramine.
P
Posted by Christ_empowered on June 7, 2011, at 15:52:22
In reply to Re: Please, any antidepressant best to help anxiety » sleepygirl2, posted by Phidippus on June 7, 2011, at 14:52:41
OK, I didn't really like BuSpar (buspirone), but it does do a good job of boosting antidepressants and it can reduce anxiety a bit. So..maybe some BuSpar? The problem is dosing. I didn't get a response until I hit 60mgs. Most docs start at 15.
Neurontin, Lyrica, supplements (3 grams niacinamide, some taurine...love that combo, personally). I guess TCAs are an option, but they're not the easiest pills to take. If you opt for one, I'd say Tofranil-PM (once nightly Tofranil...beats the old multi-dose stuff in terms of convenience, and functions as a sleeping pill). Low dose zyprexa PRN. Low dose risperidone PRN. Low dose Abilify every day (but not with BuSpar). I've read that trimipramine (surmontil) is good for anxiety, but I've also read that its the most sedating TCA the world has ever seen, so maybe that one's not for you.
Sorry you're feeling terrible.
Posted by Phidippus on June 7, 2011, at 16:16:56
In reply to Re: Please, any antidepressant best to help anxiety, posted by Christ_empowered on June 7, 2011, at 15:52:22
5 mg Zyprexa is a very good option PRN. I don't agree with Risperidone, as it has a high incidence of EPS and akathisia.
Clomipramine is the gold standard for depression, is the standard TCA used to treat OCD and can be taken at night to aid with sleep.
P
Posted by emmanuel98 on June 7, 2011, at 19:21:16
In reply to Re: Please, any antidepressant best to help anxiety » sleepygirl2, posted by hyperfocus on June 7, 2011, at 14:50:35
I've recently started having constant anxiety for the first time in my life. I have struggled with bad depression for a few years. The anxiety is completely physical. I feel sick. I eat when I'm hungry but food tastes like cardboard. I breathe shallowly and have to constantly remind myself to take deep breaths. My limbs feel tingly and My head feels strange, like I am walking underwater. Things seem unreal. It is hard for me to feel connected to people since it seems they are talking from underwater. I do deep breathing exercises constantly and do mindfulness exercises (I take a DBT class) and I try to schedule myself up to distract myself.
NOthing works for more than a few minutes.
I have a prescription for lorazapem for sleep and have been taking half doses during the day to try to control this, but it has only a minimal effect. If I take a full dose, I fall asleep.
I just started working with a DBT therapist with whom I have had to make a contract for safety. That's when the anxiety started. She thinks the anxiety is due to having the option of suicide shut down. In the past, suicidal thoughts and plans calmed me.
I have never before experienced bad anxiety for more than a day or two and it is horrible, worse than depression.
I take parnate for depression, but I think the stimulating effect of the parnate makes the anxiety worse and harder to control. It's not controlling my depression anymore anyway, so I am cutting back the dosage.
Posted by sleepygirl2 on June 7, 2011, at 19:47:36
In reply to Re: Please, any antidepressant best to help anxiety » sleepygirl2, posted by floatingbridge on June 7, 2011, at 11:54:26
Perhaps a seroquel increase is likely. I don't know what that would feel like. Maybe more sedation. Sometimes sedation is a good thing, a lot of times it isn't. It's hard to worry when you're asleep....unless you dream ;-)
If I get really desperate I'll take a little klonopin. My Pdoc would probably rather I didn't, so I haven't. I started .5 down from 1mg about 2 weeks ago.
I think that I am having withdrawal effects, effects on sleep, my gut, restlessness, irritability, anxiety.
I'm a bundle of nerves usually, but this is more intense.
It has felt almost constant.
Posted by sleepygirl2 on June 7, 2011, at 19:57:23
In reply to Re: Please, any antidepressant best to help anxiety » sleepygirl2, posted by hyperfocus on June 7, 2011, at 14:50:35
It's like excess stimulation, running on high idle, feeling on edge, vigilant, fear about being judged, anxious about going to work. It's fairly generalized, but usually about being with people.
Obsessive? Not really, thank god. Maybe that's the seroquel, I might be ruminating otherwise at bedtime.
No panic attacks, thankfully.
I did have lots of anxiety before the meds.
Thanks hf :-)
Posted by sleepygirl2 on June 7, 2011, at 19:58:48
In reply to Re: Please, any antidepressant best to help anxiety » sleepygirl2, posted by Phidippus on June 7, 2011, at 14:52:41
Thanks, what are your side effects from the TCA?
-sleepy
Posted by sleepygirl2 on June 7, 2011, at 20:05:18
In reply to Re: Please, any antidepressant best to help anxiety, posted by Christ_empowered on June 7, 2011, at 15:52:22
Thanks christempowered
I hope things are going well for you :-)Zyprexa eh? I wonder what that feels like. People seem to like it except for the weight gain.
I must admit when I hear risperdal I think EPS though I know not everyone on it has had to deal with that.
I was anxious on abilify :-(
Lyrica huh? Anticonvulsant? Similar to lamictal I wonder?
I took neurontin such a long time ago I don't remember what it was like.
Posted by sleepygirl2 on June 7, 2011, at 20:19:02
In reply to Re: Please, any antidepressant best to help anxiety, posted by emmanuel98 on June 7, 2011, at 19:21:16
I can unfortunately relate to what you describe. It is a horrible feeling. It isn't like that for me right now thank god. I remember that though. It felt like my brain just couldn't handle any more. I hope it eases for you soon.
Anything else getting you anxious? Sometimes it just helps to talk even if the anxiety is off the charts.
Posted by jono_in_adelaide on June 7, 2011, at 22:27:13
In reply to Please, any antidepressant best to help anxiety, posted by sleepygirl2 on June 7, 2011, at 11:08:09
Could you add Atarax (hydroxyzine) 50mg three times a day to the regimen? This is a mild antihistamine with tranquilizing properties.
I found 1mg of risperidone at ebdtime has helped my anxiety enormously
Alternatively, doxepin (Sinequan) was found to be as effective as Librium in relieving anxiety, though it can cause a lot of drowsiness
Posted by Phidippus on June 7, 2011, at 22:30:48
In reply to Re: Please, any antidepressant best to help anxiety » Phidippus, posted by sleepygirl2 on June 7, 2011, at 19:58:48
At first I had EPS, but that went away after awhile. I didn't get too many other side effects.
P
Posted by floatingbridge on June 7, 2011, at 23:25:34
In reply to Re: Please, any antidepressant best to help anxiety » sleepygirl2, posted by Phidippus on June 7, 2011, at 22:30:48
What is EPS?
Thanks.
Posted by Phillipa on June 7, 2011, at 23:28:47
In reply to Re: Please, any antidepressant best to help anxiety » Phidippus, posted by floatingbridge on June 7, 2011, at 23:25:34
Extra Paramydal Syndrome. Phillipa
Posted by jono_in_adelaide on June 8, 2011, at 3:13:08
In reply to Re: Please, any antidepressant best to help anxiety » Phidippus, posted by sleepygirl2 on June 7, 2011, at 19:58:48
Maybe ask your doc for a trial of doxepin - it is a tricyclic that has pronounced anti anxiety efects.
If can cause sedation/make you drowsy, but you get tolorant to this effect..... best way is to start low, say 25mg at night, and slowly increase to an effective dose, maybe 75mg-150mg at night.
I think a benzo such as lorazepam, diazepam etc is still the gold standard for anxiety, but if you cant use benzos, doxepin would be well worth a try.
Remeron would also be worth a mention, starting at 15mg at night for 2 nights, then 30mg at night.
Posted by jms600 on June 8, 2011, at 5:10:00
In reply to Please, any antidepressant best to help anxiety, posted by sleepygirl2 on June 7, 2011, at 11:08:09
> I take 150mgs effexor xr, which seems to get me a bit labile at higher doses, .5 mg klonopin (recently decreased from 1mg), lamictal 200mgs, seroquel 50mgs.
>
> Is there an AD better than others at managing anxiety?
> Is there a dose at which seroquel might be helpful?
> I won't be able to raise klonopin. I will see my Pdoc soon and see what he says, but anyone have any thoughts?
> Very much appreciated!
>
> (I have anxiety and depression or bipolar II)To start with you could try switching to Seroxat. It helped my anxiety - especially when I combined it with a low dose of Stelazine (2mg). Trouble is I found Seroxat to have the worst side effects of all the SSRIs - terrible weight gain, excessive daytime drowsiness, total loss of libido. However, not all people get those side effects so it may be worth considering.
I read on here time and time again about people with anxiety disorders having a lot of success with Nardil. It seems to be the gold standard for depression combined with a lot of anxiety. On the downside is the side effects and dietary restrictions (guess there's always a trade-off). It's definitely worth a go if other meds fail.
Posted by sleepygirl2 on June 8, 2011, at 18:04:33
In reply to Re: Please, any antidepressant best to help anxiety, posted by jono_in_adelaide on June 8, 2011, at 3:13:08
Thanks jono :-)
Posted by sleepygirl2 on June 8, 2011, at 18:07:55
In reply to Re: Please, any antidepressant best to help anxiety » sleepygirl2, posted by jms600 on June 8, 2011, at 5:10:00
Thanks jms :-)
Posted by torrid on June 8, 2011, at 19:20:02
In reply to Re: Please, any antidepressant best to help anxiety » sleepygirl2, posted by Phillipa on June 7, 2011, at 11:38:00
> Just my opinion meant kindly I feel anxiety leads to depression control it and no depression. Are you saying a bit confused that anxiety plus depression is bipolar II? Thanks Phillipa
Phillipa, that's true for me too, anxiety, overwelming anxiety causes my depression.
Posted by Phillipa on June 8, 2011, at 22:24:13
In reply to Re: Please, any antidepressant best to help anxiety » Phillipa, posted by torrid on June 8, 2011, at 19:20:02
I feel it happens that way for quite a few of us. Hence I feel this is a different type of depression than the sleepy kind of feelings first where can't move Phillipa
Posted by torrid on June 9, 2011, at 16:33:41
In reply to Re: Please, any antidepressant best to help anxiety » torrid, posted by Phillipa on June 8, 2011, at 22:24:13
It's totally different then true depression, I've had true depression a couple times and those with treatment resistant depression have my sympathy. My anxiety type depression is with out sadness and I can still laugh and smile at the little things like kids at play.
Posted by Phillipa on June 9, 2011, at 21:10:41
In reply to Re: Please, any antidepressant best to help anxiety » Phillipa, posted by torrid on June 9, 2011, at 16:33:41
Same here. Phillipa
Posted by floatingbridge on June 10, 2011, at 4:31:43
In reply to Please, any antidepressant best to help anxiety, posted by sleepygirl2 on June 7, 2011, at 11:08:09
Sleepygirl,
How are you hanging in there?
I thought of you after reading about luvox, used for social phobia, gad, other anxiety disorders. It's fallen from fashion a bit. I'm not reccommending it, just presenting it as something not mentioned yet.
Very Best,
fb
Posted by morgan miller on June 14, 2011, at 3:32:46
In reply to Please, any antidepressant best to help anxiety, posted by sleepygirl2 on June 7, 2011, at 11:08:09
Too much medication going on here IMO. Try to find a way to get off seroquel, you're on a fairly low dose, so it may not be too difficult. Consider adding about 300 mg lithium instead of seroquel if you need something to take the edge off. A low to moderate dose of depakote would be another better option. Seroquel and other AP's are way overdiagnosed and likely do more harm than good in the long run.
I would choose escitalopram(lexapro) or sertraline(zoloft) over effexor any day. I think both of these SSRIs would be far far more effective for anxiety, Zoloft being the best of the two for depression.
Make sure you're doing everything possible other than medication to improve your mental and physical well being. Diet, exercise, therapy, lifestyle(including healthy friendships and fun) and even supplements all go a long way to improve mental well being.
This is the end of the thread.
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