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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 20 of 20. This is the beginning of the thread.
Posted by jono_in_adelaide on August 21, 2012, at 20:54:36
My anxiety has returned after an 8 month absence, despite still being on
Zoloft 100mg day
Edronax 4mg twice a day
Xanax 1mg twice a day
Risperidone 1mg at nightI have upped the Xanax to 1mg three times a day as a short term fix, but am wondering wether it might be worth trying a beta blocker?
Anyone had much sucsess with them?
Posted by Emme_v2 on August 21, 2012, at 21:02:15
In reply to Anxietys back - beta blockers?, posted by jono_in_adelaide on August 21, 2012, at 20:54:36
> My anxiety has returned after an 8 month absence, despite still being on
>
> Zoloft 100mg day
> Edronax 4mg twice a day
> Xanax 1mg twice a day
> Risperidone 1mg at night
>
> I have upped the Xanax to 1mg three times a day as a short term fix, but am wondering wether it might be worth trying a beta blocker?
>
> Anyone had much sucsess with them?Yes. A low dose of a beta blocker has been helpful for me. It started as a means to offset a high heart rate from Effexor. I didn't stay on the Effexor, but we found the beta blocker was great for anxiety.
Posted by SLS on August 21, 2012, at 21:29:06
In reply to Anxietys back - beta blockers?, posted by jono_in_adelaide on August 21, 2012, at 20:54:36
> My anxiety has returned after an 8 month absence, despite still being on
>
> Zoloft 100mg day
> Edronax 4mg twice a day
> Xanax 1mg twice a day
> Risperidone 1mg at night
>
> I have upped the Xanax to 1mg three times a day as a short term fix, but am wondering wether it might be worth trying a beta blocker?
>
> Anyone had much sucsess with them?
I have never used a beta blocker, so I have no experience to relate to you. However, I noticed that you are taking reboxetine (Edronax). I found it extremely anxiogenic and put me in a suicidal state. How did reboxetine help you when you first started taking it? How long have you been on it?Have you tried Paxil? *
Although most of the SRIs have been used successfully to treat GAD, Paxil and Effexor seem to be the most effective.
* Paxil should be avoided during pregnancy. Birth defects involving the heart valves (valvulopathy) occur with this drug. In addition, lung function of the newborn (pulmonary fibrosis and persistent pulmonary hypertension) have been associated with Paxil use during pregnancy.
- Scott
Posted by jono_in_adelaide on August 21, 2012, at 22:05:13
In reply to Re: Anxietys back - beta blockers? » jono_in_adelaide, posted by SLS on August 21, 2012, at 21:29:06
" I found it extremely anxiogenic and put me in a suicidal state. How did reboxetine help you when you first started taking it? How long have you been on it?"
Quite the opposite here, I found that within a week of starting reboxetiner, i felt much better in terms of depression, and somewhat better in terms of panic attacks.. it didnt do anything for the generalised anxiety either way/
I have tried Effexor, Paxil, Zoloft, Celexa and Prozac, and to be honest, none of them have helped with either the depression or anxiety - I am taking zoloft because my doctors mental alogorythm is "panic disorder = ssri"
Noradrenalin type drugs (Edronax, Nortryptyline, Dothiepin) have helped the depression, and benzos and risperidone have helped the anxiety.
SSRI's for me have all been placebos
Posted by brynb on August 21, 2012, at 22:12:05
In reply to Anxietys back - beta blockers?, posted by jono_in_adelaide on August 21, 2012, at 20:54:36
Hi Jono-
Anxiety is/was a major issue for me and I used to rely heavily on benzos. I tried beta-blockers and they didn't do anything for me.
Vistaril (as a prn) is pretty helpful, and Lexapro has been good for my anxiety too. Actually, now that I don't take benzos on a regular basis anymore, my anxiety has gotten much better.
Good luck,
b
Posted by jono_in_adelaide on August 21, 2012, at 22:21:44
In reply to Re: Anxietys back - beta blockers? » jono_in_adelaide, posted by brynb on August 21, 2012, at 22:12:05
Yeah, my plan was actualy to quit the Xanax and see how I did just on antidepressants and low dose risperidone, because i had spent 8 months feeling pretty good, and felt that tie time mihgt be right for a taper..... then bam, it was back.
Giving it some thought,I might speak to my doctor about increasing the Xanax to 1mg three times a day, becase I know it works, and it wont be intorducing yet another drug to my cocktail
Posted by SLS on August 21, 2012, at 22:41:24
In reply to Re: Anxietys back - beta blockers?, posted by jono_in_adelaide on August 21, 2012, at 22:05:13
> " I found it extremely anxiogenic and put me in a suicidal state. How did reboxetine help you when you first started taking it? How long have you been on it?"
>
> Quite the opposite here, I found that within a week of starting reboxetiner, i felt much better in terms of depression, and somewhat better in terms of panic attacks.. it didnt do anything for the generalised anxiety either way/
>
> I have tried Effexor, Paxil, Zoloft, Celexa and Prozac, and to be honest, none of them have helped with either the depression or anxiety - I am taking zoloft because my doctors mental alogorythm is "panic disorder = ssri"
>
> Noradrenalin type drugs (Edronax, Nortryptyline, Dothiepin) have helped the depression, and benzos and risperidone have helped the anxiety.
>
> SSRI's for me have all been placebosDo you have GAD?
How did you do with Nardil? What dosage?
I benefit from MAOIs when they are combined with a TCA; desipramine and nortriptyline specifically.
How about Abilify? Although it has the reputation of producing akathisia-like startup effects that can last a week or two, it often acts as a potent anxiolytic.
I wish I had a better memory. I don't recall if you have already tried Neurontin. What about amphetamine?
Quetiapine (Seroquel)? Quetiapine does a nice job of reducing anxiety and promoting sleep. It's active metabolite, norquetiapine, produces TCA-like NE reuptake inhibition which becomes more apparent at higher dosages.
Doxepin (Sinequan)? Doxepin is a tricyclic that is often effective to treat anxiety along with depression.
Buspirone (Buspar)? Busirone is often underutilized because people don't give it the 2 - 3 weeks necessary for it to produce results.
Lamotrigine (Lamictal)? Lamotrigine often acts as an augmenter of antidepressants. It can help to "smooth out" anxiety, but is not generally known to abolish it. However, when added to aripiprazole (Abilify), a nice antidepressant effect can emerge. For me, anxiety is reduced as well using this combination. I take 200 mg/day of lamotrigine and 10 mg/day of aripiprazole.
- Scott
Posted by jono_in_adelaide on August 21, 2012, at 23:23:20
In reply to Re: Anxietys back - beta blockers? » jono_in_adelaide, posted by SLS on August 21, 2012, at 22:41:24
Havent tried Nardil as yet - thats my last resort!
I am being treated by a PCP here in Darwin, as there are few psychiatrists, and those there are seem to be ke[pt busy treating psychotic patients.
I'm thinking I might get a referal to my old psych in Adelaide and fly back for a consult - he will be much more willing to let my increase the Xanax if I need to than my PCP will. (18 months ago, I was taking 3mg per day, then went down to 2mg, then 1mg without problems, the back to 2mg...... withdrawl symptoms were very mild, so I dont think having a flexible doseage would be a problem for me)
God, I'd like someone to invent one pill I could take once a day that would make everything all right!
Posted by Phillipa on August 21, 2012, at 23:28:02
In reply to Re: Anxietys back - beta blockers?, posted by jono_in_adelaide on August 21, 2012, at 23:23:20
Jono throughout the years I also have had no problems decreasing benzos xanax in particular and at times of increased stress have required a higher dose. Beta blockers if have thyroid issure inderol are contraindicated. I was once given low dose lopressor 25mg due to thyroid and found it extremly tiring so quit it easily. Phillipa
Posted by jono_in_adelaide on August 22, 2012, at 3:22:12
In reply to Re: Anxietys back - beta blockers? » jono_in_adelaide, posted by Phillipa on August 21, 2012, at 23:28:02
Yeah, when i dropped the Xanax from 3mg to 2mg and 2mg to 1mg it was easy - from 3 to 2 I didnt notice anything, and from 2 to 1 i just felt "funny" for a couple of days, dull headache and a bit queezy, like i had a stomach bug.
i think whet I am on is working, and I'll stick with it, and just increase the Xanax for a while, and cut it back again when things get better.
Posted by confused-in-tn on August 23, 2012, at 12:02:29
In reply to Re: Anxietys back - beta blockers? » jono_in_adelaide, posted by SLS on August 21, 2012, at 21:29:06
> > My anxiety has returned after an 8 month absence, despite still being on
> >
> > Zoloft 100mg day
> > Edronax 4mg twice a day
> > Xanax 1mg twice a day
> > Risperidone 1mg at night
> >
> > I have upped the Xanax to 1mg three times a day as a short term fix, but am wondering wether it might be worth trying a beta blocker?
> >
> > Anyone had much sucsess with them?
>
>
> I have never used a beta blocker, so I have no experience to relate to you. However, I noticed that you are taking reboxetine (Edronax). I found it extremely anxiogenic and put me in a suicidal state. How did reboxetine help you when you first started taking it? How long have you been on it?
>
> Have you tried Paxil? *
>
> Although most of the SRIs have been used successfully to treat GAD, Paxil and Effexor seem to be the most effective.
>
> * Paxil should be avoided during pregnancy. Birth defects involving the heart valves (valvulopathy) occur with this drug. In addition, lung function of the newborn (pulmonary fibrosis and persistent pulmonary hypertension) have been associated with Paxil use during pregnancy.
>
>
> - Scott>I take propranalol,xanax and depakote for my anxiety and mood disorder,it helps a bit. I found that Paxil increased my anxiety to the point of my one and only ER visit-that's when we tried the beta blocker. I'd say its worth a try. Good luck
Posted by phidippus on August 27, 2012, at 23:14:23
In reply to Anxietys back - beta blockers?, posted by jono_in_adelaide on August 21, 2012, at 20:54:36
Beta Blockers don't treat anxiety. they treat the symptoms of anxiety-the parasympathetic response your body has to fear.
Only one beta blocker ever improved my anxiety: Pindolol. It works because it is 5ht1a agonist, like Buspar, another anxiolytic. 5ht1a agonism essentiallly helps treat anxiety and depression.
Its worth a try!
Eric
Posted by confused-in-TN on August 30, 2012, at 14:47:23
In reply to Re: Anxietys back - beta blockers? » jono_in_adelaide, posted by phidippus on August 27, 2012, at 23:14:23
> Beta Blockers don't treat anxiety. they treat the symptoms of anxiety-the parasympathetic response your body has to fear.
>
> Only one beta blocker ever improved my anxiety: Pindolol. It works because it is 5ht1a agonist, like Buspar, another anxiolytic. 5ht1a agonism essentiallly helps treat anxiety and depression.
>
> Its worth a try!
>
> >But that gets back to the chicken and the egg thing. Does your body sense the physical symptoms and interpret them as anxiety or does the anxiety cause the symptoms or is it an endless cycle? Anyway if beta blockers help....which in my case they seem to, why not? Best to all.
Posted by phidippus on August 30, 2012, at 21:13:48
In reply to Re: Anxietys back - beta blockers?, posted by confused-in-TN on August 30, 2012, at 14:47:23
Does your body sense the physical symptoms and interpret them as anxiety or does the anxiety h turnscause the symptoms or is it an endless cycle?
You have a system in your body which turns on automatically when you're under conditions of stress, called the sympathetic system. It causes your heart rate to rise, blood pressure to rise, sweating, pupils dialating, etc. People with anxiety disorders have this sympathetic system turned on all the time and at too high a level.
Beta blockers block the signals of the sympathetic system, such that you don't have those arousal symptoms. You still experience the feeling of fear, though.
Wikipedia:
"As beta adrenergic receptor antagonists, they diminish the effects of epinephrine (adrenaline) and other stress hormones."
"
Beta blockers block the action of endogenous catecholamines epinephrine (adrenaline) and norepinephrine (noradrenaline) in particular, on β-adrenergic receptors, part of the sympathetic nervous system which mediates the fight-or-flight response. Three types of beta receptors are known, designated β1, β2 and β3 receptors. β1-adrenergic receptors are located mainly in the heart and in the kidneys. β2-adrenergic receptors are located mainly in the lungs, gastrointestinal tract, liver, uterus, vascular smooth muscle, and skeletal muscle. β3-adrenergic receptors are located in fat cells."Do you have panic disorder?
Eric
Posted by confused-in-TN on August 30, 2012, at 22:10:19
In reply to Re: Anxietys back - beta blockers? » confused-in-TN, posted by phidippus on August 30, 2012, at 21:13:48
> Does your body sense the physical symptoms and interpret them as anxiety or does the anxiety h turnscause the symptoms or is it an endless cycle?
>
> You have a system in your body which turns on automatically when you're under conditions of stress, called the sympathetic system. It causes your heart rate to rise, blood pressure to rise, sweating, pupils dialating, etc. PeU experience the feeling of fear, though.
>
> Wikipedia:
>
> "As beta adrenergic receptor antagonists, they diminish the effects of epinephrine (adrenaline) and other stress hormones."
>
> "
> Beta blockers block the action of endogenous catecholamines epinephrine (adrenaline) and norepinephrine (noradrenaline) in particular, on β-adrenergic receptors, part of the sympathetic nervous system which mediates the fight-or-flight response. Three types of beta receptors are known, designated β1, β2 and β3 receptors. β1-adrenergic receptors are located mainly in the heart and in the kidneys. β2-adrenergic receptors are located mainly in the lungs, gastrointestinal tract, liver, uterus, vascular smooth muscle, and skeletal muscle. β3-adrenergic receptors are located in fat cells."
>
> Do you have panic disorder?
>
> Eric
Posted by confused-in-TN on August 30, 2012, at 22:26:48
In reply to Re: Anxietys back - beta blockers?, posted by confused-in-TN on August 30, 2012, at 22:10:19
> > Does your body sense the physical symptoms and interpret them as anxiety or does the anxiety h turnscause the symptoms or is it an endless cycle?
> >
> > You have a system in your body which turns on automatically when you're under conditions of stress, called the sympathetic system. It causes your heart rate to rise, blood pressure to rise, sweating, pupils dialating, etc. PeU experience the feeling of fear, though.
> >
> > Wikipedia:
> >
> > "As beta adrenergic receptor antagonists, they diminish the effects of epinephrine (adrenaline) and other stress hormones."
> >
> > "
> > Beta blockers block the action of endogenous catecholamines epinephrine (adrenaline) and norepinephrine (noradrenaline) in particular, on β-adrenergic receptors, part of the sympathetic nervous system which mediates the fight-or-flight response. Three types of beta receptors are known, designated β1, β2 and β3 receptors. β1-adrenergic receptors are located mainly in the heart and in the kidneys. β2-adrenergic receptors are located mainly in the lungs, gastrointestinal tract, liver, uterus, vascular smooth muscle, and skeletal muscle. β3-adrenergic receptors are located in fat cells."
> >
> > Do you have panic disorder?
> >
> > Eric
>
> Yes I have had panic disorder for many years and take propranalol, zanax and depakote. I also have a masters degree in physiological psychology so I know what you are saying. I just put forth the hypothesis that the physical symptoms and our brain 's interpretation of them can become so intertwined they create a feedback loop of sorts. For some helping to control the physical symptoms of fear can help reduce the emotional experience of fear for lack of a better way of putting it. In an over simplified way benzos do the same thing. Just a thought. Best to all.
Posted by phidippus on August 31, 2012, at 15:59:07
In reply to Re: Anxietys back - beta blockers?, posted by confused-in-TN on August 30, 2012, at 22:26:48
>I also have a masters degree in physiological >psychology
Very cool, I'm working on my PhD in Neuroscience.
>the physical symptoms and our brain 's >interpretation of them can become so intertwined >they create a feedback loop of sorts.
I have OCD and understand this loop all to well. In the midst of obsessing, I wish I could take a pill that just blocked the circuit.
Have you ever tried Prazosin for your panic disorder?
Eric
Posted by Phillipa on August 31, 2012, at 18:40:10
In reply to Re: Anxietys back - beta blockers? » confused-in-TN, posted by phidippus on August 31, 2012, at 15:59:07
Eric I did not know this. That is great!!! Discover how to eliminate OCD as need it. Phillipa
Posted by confused-in-TN on August 31, 2012, at 21:58:18
In reply to Re: Anxietys back - beta blockers? » confused-in-TN, posted by phidippus on August 31, 2012, at 15:59:07
> >I also have a masters degree in physiological >psychology
>
> Very cool, I'm working on my PhD in Neuroscience.
>
> >the physical symptoms and our brain 's >interpretation of them can become so intertwined >they create a feedback loop of sorts.
>
> I have OCD and understand this loop all to well. In the midst of obsessing, I wish I could take a pill that just blocked the circuit.
> >
> Have you ever tried Prazosin for your panic disorder?
>
> Eric
>not familiar with prazosin. What is it and what 's its mechanism of action? I 'll try anything except an ssri. Good luck on the Phd. I gave up on mine after nearly completing my dissertation due to a lot of political b.s. hope you have better luck.
Posted by phidippus on September 1, 2012, at 14:42:51
In reply to Re: Anxietys back - beta blockers?, posted by confused-in-TN on August 31, 2012, at 21:58:18
Prazosin is an alpha-adrenergic blocker that is specific for the alpha-1 receptors. Catecholamines like norepinephrine (noradrenaline) and epinephrine (adrenaline) signal through the α1-adrenergic receptor in the central and peripheral nervous systems.
Studies have shown it useful in the trreatment of panic disorder.
Eric
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