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'anticipatory anxiety' treatment-please help

Posted by Peter on August 26, 2003, at 19:22:36

Hi all:
wow. I've posted recently, but I wanted to start this new thread instead of burying a post within one of my older ones; I think this way more people would see it and I can get more responses, 'cause I need a lot of advice. Sorry if I should have added it to an older one, Dr. Bob; redirect if necessary(-:
Here's a little background before I pose my question (for those who have already read my posts regarding what I've been struggling with these past 2 weeks, please forgive me and skip to the bottom): my doc had me taking multiple combos of varying doses of the following meds all throughout this past winter, spring, and early summer:Lamictal (50-100mg), prozac (5-10mg), adderall (35-45mg), straterra (10-25mg), klonopin (2-3mg), temazepam (15-30mg), ambien (5-10mg), trazadone (25-50mg).
I was originally diagnosed in 1996 with bipolar disorder; my pdoc has often told me I faLL somewhere within the 'milder' areas of the 'bipolar spectrum.' He said I have a comorbid condition that is difficult to pinpoint or catagorize, as it touches on elements of different disorders - adult ADHD, bipolar, social anxiety, depressive anxiety, general anxiety, etc. Sometimes I'm more symptomatic in some areas than in others, and he has altered my med regimes more times than I can count over the years. He's had me on numerous 'cocktails' since '96, many of which involved AC mood-stabilizers and/or lithium, and some which did not. I've taken SSRI's, 'atypical' AD's, dopamine agonists, beta-blockers, stimulants, benzos, and the list goes on.
The most recent cocktail I mentioned above seemed to keep my symptoms somewhat at bay. However, in June, my various anxieties began to heighten, and doc began to have me taper off each med for means of the process of elimination (to see what med[s] was exacerbating my symptoms).
Well, as it turned out, by the middle of June, he had tapered me off of every med except for klonopin and temazepam!
The last taper was for adderall, and it was swift and painful. In the proceeding weeks, my anxieties - general, obsessional, and social - went through the roof.
In the past, SSRI's, though they've had their downsides for me, have always treated my core anxieties better than any other med class. During this recent time of acute anxiety, I asked my pdoc if I could resume the SSRI I had with me (Prozac). He said no, simply because I was too anxious and the acute SE's of an SSRI can make things even worse for a while before the therapeutic effects take hold. So, instead, he said, we should concentrate on rapidly lowering my overall anxiety levels by doubling my daily klonopin intake. He said if I don't feel 80% better within 4 days of the raised klonopin, or if I feel a bit better but really tired, I should resume the adderall 20mg (10 mg bid)-i.e add it to my raised klonopin. Though he had me taper off of it less than a month beforehand, he said the adderall has a stimulating yet calming effect on me and could help my ADD symptoms while counteracting klonopin-fatigue.
Ok. The higher klonopin dose did lower my OVERALL anxiety levels, but I still felt tired and socially withdrawn, so after agonizing about it in my head (and a lot of people here can testify to that), I resumed the adderall. The adderall helped me during the day as it worked, but, because it's a lower dose and not combined with any other meds, I was more sensitized to the 'crash' and spent the early evenings up until bedtime feeling like a lobotomized zombie.
This stressed me out more and I even called the doc who was covering for my pdoc, as he is away on vacation for a few weeks. This doc said I should keep taking it a few days and the acute withdrawal from the stimulant I go through in the early evening might improve. (I know for a fact that adding a 3rd dose early evening would improve this greatly, but I don't want to start raising adderall doses without doctor's consent).
Ok. It all sounds sensible, right? Well here's the problem. While all this craziness has been happening, I've been on vacation overseas, staying in a nice, isolated, underpopulated area; I haven't even left the confines of this place.
Well I just got some calls from friends around Europe whom I haven't seen in years asking me to visit them in different countries, meet their friends, etc. Hello! Social anxiety time! What I call my 'anticipatory anxiety,' went through the roof. And this kind of anxiety for me is the most debilitating, because it causes me to make one excuse after the next - one 'raincheck' after the next, because I'm too anxious to do anything new or meet new people. I usually say I'll do something and opt out at the last minute out of sheer terror - this has destroyed a multituded of relationships I've been in, not to mention trigger intense depressive episodes in me as I ponder my debilitations.
Well, all these feelings returned when I got these phone calls. My initial reaction inside was 'man I gotta figure out a way to get out of this!' And then I got all depressed, because I DON'T WANT TO BE LIKE THIS - so socially avoidant, isolating, etc. And, though I haven't given the adderall+klonopin combo a sufficient trial, i know from past experience that only SSRI's can target and treat this kind of anxiety in me - neither klonopin nor adderall, nor a combo of both will do it.
Now, I have prozac 10mg pills with me, and I'm very tempted to drop the stimulant (I have only been on it every other day for a few days), and begin the prozac, like 5mg every other day, titrating slowly, and maintaining my higher-dose klonopin to help alleviate any uncomfortable acute SE's. I don't know what my normal pdoc would say to this, as he's still away and I can't reach him. Even though he said 'no' when I asked him last time, it was because he wanted me first to get on the higher klonopin dose before doing anything else.
But I'm pretty sure the doc covering for him wouldn't give me the green light on a totally new med regime-after all, I'm not his patient and he doesn't know me. I've never 'self-medicated' with an SSRI, but I just have a feeling in my gut that it will help me get through the next few months of travelling/meeting people/socializing, in a way that the adderall+klonopin combo will not.
It's really a dilemma. My pdoc gets back in 1-2 weeks, but I could already by that time be beginning to experience the benefits of the SSRI in time to be able to take on the invites of my friends and travel.
Mind you, various trials have proven that the SSRI is not the 'ideal' solution for me, just as is the case with any other of the many meds I've taken. But I can't start something COMPLETELY new, and at least I'm familiar with SSRI effects. So I have a choice yet again that I can't seem to decide upon - give the adderall+klonopin a few more days like the substitute pdoc said, stay isolated from crowds, and make up more excuses to my aquaintances about my 'not being able to make it this time around.' Or start up the SSRI, even though it holds its own risks, and maybe feel crappy for a few weeks until i start feeling better. Yet another thing I'm concerned with is that prozac has such a long half-life, which is great for minimizing withdrawal, but not so good if you start it up, feel like crap, and want it out of your system immediately.
In terms of going back to taking ONLY the klonopin WITHOUT adderall, I just don't like the extreme feeling of dullness, like I'm under water - it's just unpleasant and I find I'm just as socially avoidant, even though it has pushed my overall anxiety levels down. But these more specific areas of anxiety are not being targeted and treated as an SSRI would do.
Any advice? Sorry again for the length! Man I don't think I'm capable of writing a short post!




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