Help! I'm nervous and I can't do anything.
November 24, 2008 12:24 PM   Subscribe

I have Stratterra, Adderall, and Xanax. What can I do to get serious anxiety and ADD symptoms under control, quickly and for the short-term?

I'm struggling with the symptoms of ADD along with a very high level of anxiety (this is a recent and hopefully temporary development). I'm taking the LSAT in 2 weeks and suddenly dealing with an extremely stressful relationship situation on top of the pressure of last-minute studying for something that's very challenging and important to me; please understand that my question is motivated by my desire for a short-term coping strategy (I can only get an appointment with my psychiatrist/therapist after the LSAT, but he'll take it from there, thanks).

I took Adderall in the past and have a handfull of those left; recently, I was prescribed Strattera instead since Adderall isn't available where I live (outside the US). I've been taking about 25 mg a day for a bit more than a month, although I've skipped a few pills (accidentally, because, well, I have ADD, and purposely, because of the following...)

I haven't noticed a substantial improvement in my ability to focus and concentrate, which is very critical to me right now, immediately, until the LSAT (on Dec 6th). I have noticed a huge rise in my base level of anxiety since I started on Strattera - I don't recall having a "base level" of anxiety in the past at all, actually; whenever I have a calm or empty moment, i.e. when I'd usually be daydreaming for a minute in the middle of the day for example, I feel an underlying physical sense of dread. I've also had a lot of trouble sleeping and woken up before I've slept enough with my heart pounding an hour before my alarm is set several times recently. I don't know whether this is caused by the Strattera or having reached a threshold of stress and chaos that I can no longer cope with; however, I understand that Strattera is often prescribed off-label as an anti-anxiety drug, so it's surprising that it would have the opposite affect on me. Life's been rough and I'm constantly nervous in a way that interferes with my daily life, interactions, and (right now) ability to study for the LSAT. Is this anxiety a common, or even possible, side affect of Strattera?

I don't want to stop taking Strattera in case it is actually helping because I can't experiment with letting my concentration get worse right now (because of the LSAT!). It could turn out that I'd have even worse ADD symptoms and anxiety if I went off it right now. However, I also obviously can't handle any additional anxiety. So, one option is to experiment with a higher dose of Strattera to see if it helps me feel calmer or more focused - could I here some knowledgeable/experienced opinions on whether this is a good idea?

The other option is to take my small dose of Strattera plus an Adderall, which does significantly improve my concentration, mood, and performance more than anything else. My concern is whether it will be counter-productive or harmful to mix these medications.

I've also been dealing with the extreme anxiety by taking Xanax occasionally (maybe twice a week, when I'm really hurting for sleep) and/or over-the-counter sleeping pills, but the past week they've only kept me calm enough to sleep for about 6 hours and I'm exhausted. I don't want to mix drugs too much or do anything dangerous or habit-forming (I'm well aware of this risk and consider it each time I use these medications), but I need to have some measured input about whether this is the best thing I can do for the next 2 weeks. I don't need to "stick it out" right now and risk totally falling apart/bombing the LSAT (I also can't just take it in February, since I'm abroad and it's not offered abroad after December).

I really can't afford to lose another day to anxiety and distraction right now - not only will it affect the LSAT, but it's putting a huge strain on the relationship that's causing it, which is becoming a rapidly-accelerating vicious circle. So, how can I stop this and use what I have to make myself functional right now? I've also been using my normal, healthy coping methods (coffee, exercise in the right amount/at the right time, healthy food, chatting with positive and supportive friends, taking breaks, etc). I usually know how to handle myself but I feel like my brain is totally out of control and trying to sabotage me.

I can't get an appointment with my psychiatrist until after the LSAT, so I'm asking you in the meantime; I'd really appreciate answers other than "therapytherapytherapy". Yeah, I know, but it's just not possible right now, and I need a solution or at least a strategy right now; having stated that "go see your doctor" and "get therapy" are not relevant for me, I'll also say that seeing this page full of "therapy" answers would be totally demoralising as it's advice that I can't take, even though I will as soon as that changes. Please respond if you have advice that I actually can take, given what I've told you. Thank you very much if you can help me cope.
posted by anonymous to Health & Fitness (25 answers total) 2 users marked this as a favorite
 
I can only get an appointment with my psychiatrist/therapist after the LSAT

Call him/her now. My psychiatrist will discuss medication over the phone if I've missed a dose or am worried about mixing stuff. No one here should be telling you "Yeah, go ahead!" if they haven't examined you.
posted by desjardins at 12:41 PM on November 24, 2008


Hm. Yeah that's a lot of stuff. I know from experience that Xanax is pretty fast to work, but yeah, doesn't last that long and is potentially quite addicitve.

I can't comment on the other medications as I have no experience with them.

I can tell you for sure, despite wanting to be 'alert' for your exam, or focusing, that coffee or soda or anything with caffeine in it is likely to exacerbate or trigger anxiety symptoms if you are prone to them.

Also from my experience, I have not yet found anything that is western medicine that for me - short term - doesn't reduce anxiety without also making one more prone to sleepiness. I have finally found a very kick-ass acupuncturist who has helped tremendously, but prior to her I had gone to 3 others that were unable to do jack for me despite their years of experience. So: if you can find a reallllllly good acupuncturist, that may help.

Finally - if you are not doing aerobic exercise regularly (at least 3-4 times a week) and for long enough (get the heart rate up for 20-30 minutes), I recommend doing so. I did read that you are doing exercise when you can, but not the quantity/type. If you are doing enough already, nevermind. : )

good luck!
posted by bitterkitten at 12:41 PM on November 24, 2008


No, you shouldn't blindly "experiment" with mixing-and-matching leftover meds, or randomly stopping or upping your own dosage of a current prescription. Even if you do it with the blessing of random people on the Internet.

Your psychiatrist has an emergency number. Use it. I know you said several times that's not the answer you want to hear, but it's still the correct answer.
posted by ook at 12:42 PM on November 24, 2008


Yes, this is exactly what the "if you have an emergency and need to reach me immediately.." stuff is for when you get your doctor's voicemail.

If your doctor really really really can't see you, s/he will direct you to a colleague who can, or tell you to go to the hospital.

I mean, people go to school for years to become psychiatrists - no one is going to be able (or willing) to tell you this stuff over the Internet. Take care!
posted by giraffe at 12:48 PM on November 24, 2008


I thoroughly agree that you shouldn't self-prescribe without talking to a psychiatrist or at least knowing something about pyschiatric pharmacology, but I think ramping down the Strattera and adding regular exercise and more sleep would be vaguely in the right direction. Personally I would throw out the drug cocktails altogether and stick entirely to borderline doses of kava, Betaloc, and Adderall, but that's just me.
posted by crapmatic at 12:50 PM on November 24, 2008


So basically you're asking random strangers on the Internet how to self-medicate? Let me answer for the room by suggesting that this is a terrible idea.

Seriously, if you're this stressed about taking the LSAT, what makes you think you can keep it together in law school? I'm in my 3d year now, and let me tell you, the stress of the LSAT is nothing compared to the stress of your first round of finals, and that in turn is nothing compared to the job search. Law school isn't something you can just
"cope with" for two weeks. It's three years. And you can't sleepwalk through the first three months of the semester and then just sweat out finals like you're trying to sweat out the LSAT. It takes concerted effort the whole time if you want to do even halfway decently.

So my first piece of practical advice is to not embark upon radically stressful life-changing projects until you've got yourself under control. Law school is full of high-energy, motivated, driven, highly competent people, and the profession really doesn't have much time or patience for people who are struggling. I think you'll find that the amount of sympathy people have for you is rather limited. It's sad, but that's just the way it is. If the LSAT isn't something you can just fold into your regularly scheduled activities without extraordinary coping methods, then take it from me, law school is not for you.

But assuming that you're going to do this anyways, one practical piece of advice I've got is that LSAT takers don't generally show radical improvement with study. You don't actually have to know anything to ace the LSAT; it isn't like the SAT, which tests substantive knowledge of particular subjects. If you can't read with excellent comprehension, there isn't a lot in the way of clever tricks you can use to do well on the LSAT, which is a test of how quickly you test as much as it is of anything else, and a week spent reading a ton isn't going to make up for not having spent the last ten years doing so. The logic games are worth looking at, if only to get a feel for the kind of shenanigans they pull, but again, it's the kind of thing that you either get or you don't, and hours spent in study isn't going to change that much.

So if you're doing well on the practice exams, then stop worrying. You aren't going to do that much better even if you do spend 160 of the next 240 hours studying. Take a walk. Play a video game. Deal with the rest of your life. Even if you aren't doing as well as you'd like, then you should still do this: killing yourself until the 6th isn't likely to improve your performance, but it may well harm it. You'll do much better if you're well-rested and focused than if you cram that extra few hours. Take it slow. Relax. Do something else. Stop clogging up your brain with silly logic puzzles and just let it process. Instead of spending all your time on this, spend an hour or so each day. I assume you have other things to do with yourself. Do them. Who knows, taking care of the rest of your life may actually reduce your stress levels?

The other suggestion might be to take a pass. If you're afraid you're not likely to do well for reasons which are ultimately temporary, then take a year off. Get a job. Even yourself out. Get therapy. Then, once you've spent more than two weeks preparing, sign up again. Unlike the SAT, where your best score is reported, the LSAT is reported as an average of all scores, so if you do poorly this time, even acing it next time will leave you with an only mediocre score. And that time off will give you a chance to think about whether this is something you want to do anyways.

The only real, concrete suggestion I have has been made already: get regular exercise. At least 30 serious minutes a day, preferably aerobic. You will feel worlds better. Maybe not tomorrow, but by the time your exam rolls around, you will. It will also help you sleep better.

But don't start screwing with your meds right before something like this. Call your psychiatrist and get an over-the-phone consult if you must, but these medicines aren't intended to work overnight. It can take months for your body to properly adjust. Screwing with dosages now is a Very Bad Idea.
posted by valkyryn at 12:54 PM on November 24, 2008 [2 favorites]


Response by poster: Call your psychiatrist to discuss meds.

My (admittedly limited) understanding is that Xanax is an extremely powerful drug that is not to be messed with and has pretty severe withdrawal effects. I wouldn't touch it.

Strattera can cause people to wake up early, so that may account for the lack of sleep. But I doubt it's Strattera that's causing your anxiety; more likely it's a coincidence and the anxiety levels have been steadily building and you noticed them around the same time you started taking Strattera, leading you to make a connection. LSAT anxiety, plus worrying-about-Strattera anxiety, plus relationship anxiety, creates more anxiety, so you get anxious about your anxiety, creating more anxiety . . . To the point where your Strattera probably isn't doing crap due to your heightened anxiety levels. You need to break the cycle.

Have you checked out the book "Feeling Good"? I know your immediate instinct right now is to study for the LSAT as much as possible, but it sounds like that's not working for you right now. Perhaps reading the book and going through some of the CBT exercises may help you a bit. It is worth a shot.

Is marijuana an option? Does it relax you at all? If it does, can you take some as a meditation aid and spend some time trying to clear your head? Obviously, do not take this in combination with the other meds if you can help it.
posted by Anonymous at 12:55 PM on November 24, 2008


follow-up from the OP
I didn't ask "should I call my psychiatrist" (I can't), "am I smart enough to do well on the LSAT" (absolutely, if I don't have a huge amount of interference from anxiety and ADD symptoms that are flaring up right now), "what should I do with my life" or "should I just forget about my goals and go for a walk".

I specifically said that I'm having a significant but recent and hopefully temporaryincrease in anxiety/other symptoms. Before that, I was doing fine; however, now I really need to relax, focus on doing LSAT practice tests to prepare myself, and not sabotage an important relationship that's falling apart. (I'm not even nervous about my ability to do well on the LSAT; I'm freaking out about my ability to get a good night's sleep the night before and sit down and concentrate on anything for several hours though, and if I can't do that, I can't perform up to my intellectual potential on the LSAT.) I need a coping strategy to turn down the crazy stuff my brain is doing that will get in the way of me succeeding at these things in the immediate future, things which I would otherwise be perfectly capable of.

Before everyone clamours that I still need to see or call my psychiatrist, I said that I want and intend to do so but it's not possible right now. I don't have another option or another doctor to call; not every place in the world has the resources that the USA does. I'm hoping to find some reasonable advice here since there's a wide pool of educated people on this site, and there's only one decent psychiatrist in the country I live in (which is also not a claim I'm asking to analye in this question, thank you.)
posted by jessamyn at 1:29 PM on November 24, 2008


Not sure what country you're in, but I'd talk to a pharmacist. You might even consider calling the psychiatrist or a pharmacist in the US from wherever you are. You really need someone who has a deep understanding of the effects of these drugs.
posted by theora55 at 1:58 PM on November 24, 2008


valkyryn's answer made my jaw drop.

Speaking as a current law student and friend to many law students and lawyers: please do not feel like you cannot succeed in law school and as a lawyer. Nothing in your post or follow-up suggests that you are so grotesquely debilitated. I know some pretty anxious people who made it through just fine. Also, people who gave birth during 1L year. People with significant disabilities, mental and physical. Etc. You'll be fine! You'll be great!

Also, it's not true that you can't improve your score by studying. I improved by 20 points. Many people I know also improved, some more, some less.

That said, is there anything that has ever relaxed you in the past that you haven't tried? It's hard to suggest anything because everyone is different. If you haven't run through the cliches - hot bath, reading a soothing children's book, good sex - then perhaps they're worth a try.

I understand that you're not in the US. Are you a US citizen, though? Do you have US health insurance? You may have access to a hotline with a nurse or pharmacist on the other end though that insurance provider. If you can make an international call, then I think you are almost certain to be able to find SOMEONE who is licensed to answer your specific medical questions about drug interactions (as I am not).
posted by prefpara at 2:21 PM on November 24, 2008


Careful with that Xanax.

In the line of sedatives according to their potency, it goes: Valuim, Ativan, and then Xanax. And the additiction potential for Xanax is very high, compared to
Valium.

Anxiety disorders thrive on re-inforcement. Meaning, that if something gives you anxiety, and then you tell your youself that it certainly will give you those thoughts and feelings again, thats re-inforcing the anxiety. Dont do that.
posted by captainsohler at 2:28 PM on November 24, 2008


I have taken Xanax, as needed, for anxiety for over 3 years without ever increasing my dose or experiencing any withdrawal effects when I don't take it. I understand that there is serious potential for addiction, but it can be taken responsibly. Please don't make this anxious person more anxious about taking a medication used to treat anxiety.
posted by kamikazegopher at 2:42 PM on November 24, 2008


If it's the relationship causing the anxiety, can you take a break from it for a few weeks?
posted by desjardins at 2:46 PM on November 24, 2008 [1 favorite]


I read your post, and your follow-up.

The thing is, if you want to know how to reduce your stress, people are giving you good advice -- take a walk, cut down on caffeine, don't worry about cramming.

But maybe what you are asking is, what combination of the pills you have will fix your anxiety. Again, people are giving you the right advice -- call a doctor, call your doctor, call your pharmacist.

But then again, maybe you really are asking, what combination of pills should I take if I cannot or will not consult an expert? That's a slippery slope, especially since they are not all three prescribed to you, for your use right now. Consider, too, what happens to people who get caught breaking the law, who also want to practice law.
posted by Houstonian at 2:58 PM on November 24, 2008 [1 favorite]


Response by poster: No person with a medical degree who has any interest in avoiding lawsuits is going to tell you on the basis of this post that you need 25mg of Strattera with 1mg of Xanax, or 5mg of Adderall, 2mg of Xanax, and 50mg of Strattera, or any other random combination of drugs. From a doctor's standpoint that is like holding up a big sign that says "HEY LAWYERS DO YOU LIKE MALPRACTICE SUITS?" And from YOUR standpoint it is the worst idea ever, because nobody here knows your medical history and you have no idea if the person responding even knows what they're talking about. This is not aspirin and B-vitamins here, you are dealing with powerful stimulants and anti-anxiety drugs.

You want a quick pharmocological fix and it is quite probably you're not going to get it here. Maybe you can find another forum where it's possible to respond more anonymously, or maybe if you provide an anonymous email address someone will take a bite.
posted by Anonymous at 3:27 PM on November 24, 2008


Mixing drugs (especially these ones) without consulting your doctor is dangerous, potentially life-threatening.

For the ADHD there are things you can change in your diet and environment to help this. Avoid foods like donuts and sodas that will send you on a sugar high and then let you crash a few minutes later. Work on getting distractions out of your environment (things like unplugging or turning the TV around).
posted by silkygreenbelly at 4:39 PM on November 24, 2008


oh yeah, and exercise and get good nights sleep.
posted by silkygreenbelly at 4:40 PM on November 24, 2008


I have had really good results for anxiety using this device. I find it is most effective when used regularly, for at least 15 minutes straight. Make it part of a routine. Find a quiet place. Light a candle. Pick something positive to think about (I literally just sit and visualize holding my cats) and control your breathing. If you learn to do this consistently, it comes with most of the benefits people associate with meditation - and it's mumbo-jumbo free.

The anxiety I used this thing to battle may not have been extreme by global standards but it was the worst I'd ever experienced in my own life. Not anything I want to talk about, but it was a very stressful period of several months. This helped me get through.

It's not a pharmacological solution, which seems to be what you're focused on. But that's probably a good thing. You can probably use the emWave with whatever medication you're on and not worry at all about interactions.
posted by scarabic at 4:44 PM on November 24, 2008


One skill lawyers need is the ability to give good, accurate advice.

I'd like to add, it is also the ability to respect the law, and to seek the advice of professionals for areas outside of their expertise.

Strattera can take a month to work, and can make you feel groggy at first. The poster states you are not to have prescriptions of Adderall where he lives. And Xanax is a Schedule IV drug in the US and internationally.

With those types of drugs, shouldn't we all use caution before advising him how many to take, or which combination to take them in?

This is one of the many times that I wish people would tell us "I think" or "I know" when diagnosing or prescribing treatments/cures. We spend a few seconds reading a question, and then state what we would prescribe if we were the doctor, but the poster has no idea if we are qualified (that is, we have an MD) or if we just think we know. The few doctors here usually start by saying, "This is what I think, but you've really got to see your doctor". But others, who are not doctors, speak with such authority. What if the poster follows some advice given here, based in part on believing its from a person with medical credentials, and it injures him?
posted by Houstonian at 5:03 PM on November 24, 2008


Anxiety issues tend to build on themselves - ie you get a little anxious, you start breathing shallowly, heart racing, then realise you're anxious so GET more anxious.
Realise that it's just a little anxiety, and practice deep breathing exercises. Breath out as much as you can, roll your shoulders up, back, and drop them.

Drop all caffeine use altogether.

I'd consult your psychiatrist, but a common side-effect of strattera use is sleeping problems. If that's the bigger issue for you at the moment, then you may want to wait til you're a bit more stable before starting up on it? While in the long term it should be helpful, it may destabilize you a little while it's kicking in.

Xanax... is pretty addictive. :/
Try and restrain your use of it, and practice breathing etc first.

Practice good sleep hygiene. Go download these free sleep tracks or something similar and listen to the sleep one before going to bed. Remember, time you spend relaxing, lying in bed, is still restful to your mind and body. Practice counting your breathing. If you're worrying about things, write down your worries in summarised form on a piece of paper, and tell yourself that see? You've written them down, you won't forget, you can pick up worrying about it in the morning if you need to. It's a good trick to get the subconscious to drop it for a bit.

If you're not getting enough sleep at night, take a nap after lunch - say using the pzizz nap track above. Again, time spent quietly resting is good for your body and mind, you don't need to worry about 'not being asleep'.

Good luck on your LSAT!
posted by Elysum at 5:39 PM on November 24, 2008


Since you're anonymous, I can't reply to you directly, nor can I reply anonymously. I have some experience with all of these issues, drop me a mefi mail if you want to know more since I'd rather not broadcast it.
posted by Raichle at 6:23 PM on November 24, 2008


I'm a pharmacist. Insomnia is definitely a possible side effect of the Strattera. You might consider stopping (with your doctor's okay, of course). He/she will likely tell you it is ok to stop, since people typically don't need to taper off of it. (Info from the manufacturer here)

If you can't sleep, you can't think. I very much doubt that a higher dose of Strattera will help, and it may make the insomnia worse. It is absolutely possible that your nervousness and anxiety are side effects of the Strattera.

Aside from meds, here are things that have helped me in similar situations:

* Using a timer - I break everything into 10 minute tasks. 10 minutes doing practice test questions. 10 minutes jumping on my trampoline. Just keep going and don't overthink. You know what you need to do. Set a timer and do it. You can do anything for just 10 or 15 minutes.

* "The Feeling Good Handbook" by David Burns, recommended above, is excellent. Many, many editions have been published in the US. It's likely that you can get a copy if you're in an english-speaking country. The exercises are easy and fast and focused on short-term results. You don't need to read the whole book, just do the parts that are relevant to you.

* Whenever I start freaking out about the impossibility of some task, I stop and tell myself, "Not Helpful." Is it helpful to rehash possible bad outcomes? To flip out about the difficulty? No. So get out your timer, set it, and go do something that is helpful.

* Visualize yourself as a genius. Picture the wood paneled law office, the impressive leather-bound law books, you as the legal eagle in the center of it all. How would that person be feeling right before the LSAT? Confident, strong, capable, knowledgeable. Visualize yourself as that keen legal mind. Make it as corny and over the top as you want, but let that energy flow into you. Every time I have done this before a test I have gotten a much higher score than frankly I deserve!

Good luck. I think you will do really well.
posted by selfmedicating at 7:22 PM on November 24, 2008


I'm not a doctor or medical professional of any kind...

I know you don't want to lose a single day, but I'd think that given that the Strattera is causing anxiety and you're not sure it's helping the ADD at all, it might make sense to try going without it for a couple days to see whether that helps with the anxiety. (That seems to make more sense than taking more Strattera which I'd think would just make the anxiety worse, even if it might improve the ADD symptoms.)

How much Adderall do you have? Since you know it works for you (improves your ADD symptoms and doesn't cause anxiety), it probably makes most sense to use that for as many days as possible immediately leading up to the LSATs and the day of. I know you want to be at your best every day, but if that's just not possible, then don't waste your Adderall by taking it on the same day as the Strattera that's probably spiking your anxiety.

Yes, if you're unmedicated for the next week-ish, that will make it harder for you to study/practice for the LSAT on those days, but at least you (hopefully) won't be as anxious and crazy and miserable. And you'll know that you have the known quantity of going down the home stretch on Adderall.
posted by EmilyClimbs at 7:42 PM on November 24, 2008


If Strattera makes you jumpy, make sure you take it first thing in the morning.

Hey people,

When you have ADD, it's really really hard to focus, meditate, visualize, etc. The very definition of ADD is an inability to focus. So, suggestions along these lines are really not helpful. Alot of these behavioral mods don't work for people with ADD like taking breaks etc. since it's really hard to regain focus if you lose it. Ultimately, the right meds to treat the ADD and therapy for the anxiety are going to be the solution here IMO.

@ selfmedication Strattera is actually known to HELP anxiety issues, not aggravate them according to every pdoc I have talked to.

As far as the workbooks, etc for anxiety, I'm on the fence. Behavioral modification only works so long as you can commit to continuing these activities for your whole life. My impression is that undergoing psychoanalysis to find the cause of the anxiety/panic is going to be a longer term solution.

just my two cents.
posted by Raichle at 9:14 AM on November 25, 2008


@ Raichle: you're right, Strattera is generally a good anti-anxiety med, but you don't really know until you've taken one of these drugs what it will do to you in particular. Insomnia is one of the commonly reported (~5%) side effects. Insomnia all by itself could lead to anxiety. Also, strattera has a warning that it can trigger manic episodes or tachycardia (fast heartbeat). Given these "speedy" side effects, it seems plausible to look at the strattera as a possible cause, since the poster did say "I have noticed a huge rise in my base level of anxiety since I started on Strattera." I'm not saying that it would cause anxiety in most people, just that it might be doing so in this case. Response to psych meds is so individual that really a lot of us just have to try many meds before finding the right med, dose, or combo that works.
posted by selfmedicating at 4:05 PM on November 25, 2008


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