Best treatments for anxiety?

November 3, 2007 9:28 PM

Best treatments for anxiety?

I have really bad anxiety. I really need to get a handle on this because it creates a lot of problems in my life. What are the best treatments for chronic, intense anxiety? I will consider pharmaceuticals, herbs, supplements, and anything else.

I have tried a number of antidepressants in the past. None of them did a thing except Celexa, which made my anxiety DISAPPEAR!! However, I had extreme side effects that forced me to go off the medication. This experience made me believe that my anxiety is chemically based. I have tried intense exercise; it helps a bit, but not enough.

The more anxious I get, the more I turn to others for reassurance. I fear that I am frustrating those around me with my constant worries, and this makes me angry at myself. However, I can't seem to control it. Mefites, what has worked for you?

posted by mintchip to health & fitness (31 comments total)

Drugs. See a psychiatrist. The fact that Celexa worked better than anything else strongly suggests that your anxiety can be helped with medication. The fact that the side effects forced you to go off of the medication suggests that picking the right medication for your needs is probably going to involve a significant investment in time and effort. In the end, though, it'll beat the crippling anxiety, so persevere.
posted by infinitywaltz at 9:41 PM on November 3, 2007

Medication combined with therapy is usually considered most effective, and I agree that starting with a psychiatrist is probably a good way to go.
posted by occhiblu at 9:46 PM on November 3, 2007

2nd the combination of meds and therapy. Do see a psychiatrist, not your regular doctor - there are so many drugs out there want to have a specialist who really knows the options.
posted by metahawk at 10:09 PM on November 3, 2007

I know those Celexa side effects. BLECH.

Cognitive Behavioral Therapy is, as far as I know, the best longterm solution. There are many books that can help you escape or modify the worrying thoughts on your own, but it's much easier, imo, to accomplish that with the help of a counselor. Really, just buy this book to start with.

Lifestyle changes that make a big difference beside exercise are a regular sleep pattern, Vitamin B (I think it's B12 that impacts stress management, but I highly recommend a big, bulky B Complex daily, especially if you drink alcohol, which strips them from your body), and monitoring blood sugar-impacting food. I also take a lot of solace in all manner of routines and systems, and though ymmv, my anxiety has to do with my life falling apart and winding up in debt and a mental hospital, so using tools like task lists help me feel more in control, and less like I'm being swept away in the current of unmanagable thoughts.

Xanax is fucking great. It's habit forming, so hopefully you can find another way to manage your anxiety daily, but having it around for me is a must.
posted by Ambrosia Voyeur at 10:19 PM on November 3, 2007 [1 favorite has favorites]

I used pot for a while, it really mellowed me out and helped me short-circult negative feedback loops that I got caught in. I don't advocate any law breaking, of course, and pot has the reverse effect on some people - making them more nervous and paranoid.

Probably healthier and definitely more legal: I had a very good experience with a mix of prescription drugs and cognitive behavioral therapy. I only used the drugs for about six months, then gradually tapered off, but they helped get me to the point where CBT worked.

After a few years of practice, CBT begins to boil down to recognizing and rejecting self-defeating thoughts, and facing your fears head on. CBT gives you the tools to do this.
posted by croutonsupafreak at 10:37 PM on November 3, 2007

CBT didn't work for me. What did work was a combination of three things:
1. Buspar. But it takes a few weeks to kick in.
2. Therapy. Takes longer to kick in!
3. Changing my life. Therapy helped me to realize what was causing the anxiety and to find the courage to change those things. In the long run, I think that's the only cure.
Seven years pretty much anxiety free, except for a recent bout, but I know the causes of that and am dealing with it.
Good luck, I know it's a crippling problem. Pooh-poohed it until it happened to me.
posted by conifer at 10:42 PM on November 3, 2007

Mother's little helper, not.

Frankly, you do not want a drug solution as all of the drugs which address this are habit forming and filled with problems. Meditation, yoga, a good therapist, more sex, they are your solutions, not a pill.
posted by caddis at 11:01 PM on November 3, 2007 [1 favorite has favorites]

Lexapro is derived from Celexa, it's more concentrated so you take fewer mg and it has fewer side effects.
posted by lhall at 11:32 PM on November 3, 2007

Also, to respond to people telling you that it can be handled without the use of pharmaceuticals - sometimes it really is just chemical. Yes, yoga and meditation are great; I tried all of those things...after I started taking the pills.

Before? The idea of speaking to a stranger about myself or leaning over in front of a bunch of strangers freaked me out so badly that I would have never considered it. I mean, I had trouble ordering pizza over the phone, getting up from a restaurant table to go to the bathroom, or eating meals in front of my boyfriend's family.

Now, with Lexapro, I function like a normal person. I still have all the highs and lows that you'd expect to have, emotionally and with regards to anxiousness and stress. I'm still the same person. Unmedicated, my highs and lows were way too high and way too low. It interfered with my life and with my ability to be myself.
posted by lhall at 11:38 PM on November 3, 2007

I never found a drug that helped enough, which sucks. But two things that definitely increase your ability to deal with anxiety are exercise and getting enough sleep. Sex too, really. These things are good for the soul. They may appear unsatisfying as they aren't "the" answer, but they definitely do aid. Try to get all three. Two of them you can do for sure.
posted by kookoobirdz at 11:39 PM on November 3, 2007

I'm with caddis on this one...Start with those simple things, at least as a foundation to build on.
posted by sneakyalien at 12:21 AM on November 4, 2007

see a psychiatrist. i've found a lot of success with lexapro. lots of exercise helps, too. try to get morning sun and keep regular bedtimes. even if i'm only running an hour short of the usual 8 hours, i find that it totally wrecks my mood. get a sleeping pill if you have to.

but above all, see a psychiatrist! therapy may help, too.
posted by thinkingwoman at 1:04 AM on November 4, 2007

lots of exercise helps, too.

Hell yeah it does. My anxiety attacks were quite mild, but they stopped altogether when I started exercising regularly. If yours are severe you'll definitely need psychologist/psychiatrist help, but please don't discount the value of exercise.

(And by exercising regularly I mean 30 minutes on a bike four times a week.)
posted by bluishorange at 1:26 AM on November 4, 2007 [1 favorite has favorites]

CBT for me. Cleared up some of my OCD too, but might need to get more to top that one off.
posted by wackybrit at 2:05 AM on November 4, 2007

Celexa has a more recent version called 'Lexapro' and a generic called 'Citalopram'. Some people report not having the side effects with one or the other of those.
posted by SpecialK at 2:08 AM on November 4, 2007

caddis, anyone who levels blanket condemnations at psychiatric medication is a simpleton.

meds CAN be helpful, though the effects and side-effects vary from person to person. you should work with your doctor to figure out what works for you.

some people require meds for life as prophylaxis. just like dandruff shampoo - you don't have a dandruff problem when you use it.

others (like me) might use meds for a short period after experiencing trauma, in order to stabilize one's mood such that one can deal with a situation rationally and productively.

habit forming? one could define air and water as habit forming. use what works.
posted by randomstriker at 2:14 AM on November 4, 2007

Xanax is the shit for carpet bombing anxiety but it's no good for the long term. Still, it'll totally bust up anxiety attacks if you only take it when you feel one coming on.
posted by Justinian at 2:50 AM on November 4, 2007

Nthing checking out lexapro, as it's very chemically related to celaxa but with fewer side effects. Also while I wouldn't recommend xanax on a daily basis, having some on hand to take when you feel an attack coming on in an unavoidable situation is a *great* help. One big factor in anxiety is the fear of having an anxiety attack, so just knowing you have something on hand that can nip it in the bud can lower the likelihood of the attack occuring.
posted by happyturtle at 3:53 AM on November 4, 2007

Doctor Daniel Amen says the most powerful chemical prescription for your anxiety set point is: No Caffeine, No Nicotine, No Alcohol.

If No is more extreme than you want to go, you definitely ought to try reducing.

I have personally found this prescription very helpful for my own (psychiatrist diagnosed) General Anxiety Disorder.

Xanax works great but it's addictive. If I could keep a few in the medicine cabinet for really bad days I would, but my doctor doesn't want to prescribe benzos.
posted by bukvich at 4:13 AM on November 4, 2007

Nthing Lexapro - it was tremendously helpful for me. Klonopin or Ativan may help you calm down in a pinch or sleep if that's a problem, but they can make you sleepy if you take it during the day. People say they're addictive but I've been using Klonopin on and off for years without having to increase the dose or having any kind of withdrawal effects. It depends on your personality - if you're the addictive sort, it might be a good idea to avoid benzodiazepines. Getting enough sleep helps a lot, too, so if you also have insomnia I'd try to address that, too. Nothing exacerbates anxiety like exhaustion.
posted by walla at 5:20 AM on November 4, 2007

There are many things to try. You mentioned exercising, which helps, so keep it up. Aerobic exercise is often mentioned as good for this. I know an hour's walk or half an hour on an aerobic exercise machine a day is very good for me.

Cutting out caffeine, alcohol, recreational drugs, and sugar can be helpful. I find a low-carb diet can be helpful. ymmv. Get enough sleep. Eat a good diet (you know what that is). All of these things can contribute their 5% of reducing overall anxiety.

Try not to avoid things because of anxiety. Avoidance can make anxiety stronger. Practice with the feared situation, graduated exposure, can help.

You didn't mention what sort of anxiety you have: a specific fear, social anxiety, random panic attacks, etc. The treatments can be a bit different for each. MAOIs can be useful for social anxiety, if your doctor will even prescribe it for you, and if you can adhere strictly to the associated dietary restrictions.

If celexa helped but the side effects were too much, did you try varying the dose downward a bit? Also, did you try waiting long enough? Some side effects of SSRIs will go away over time or become less severe. You didn't mention what the side effect that bothered you was. If it was insomnia, your doctor might add some kind of sleep aid.

You could also try lexapro, which is the useful isomer of celexa, allowing you to take half the overall dose while getting all the intended effects. Fluvoxamine might be another possibility if you haven't tried it. But this is for your doctor and you to talk about.

The Anxiety and Phobia Workbook, mentioned above, is very good. It goes over all kinds of things like meditation, cognitive distortions, diet, etc.

I've never found a magic cure-all for anxiety, but these things can help and make the difference between a good day/week and a bad day/week. Give the ones you can a try and see what works for you. And talk to your doctor/psych. If you don't get satisfaction, look for another doctor. Good luck.
posted by DarkForest at 5:37 AM on November 4, 2007

Oh, one more thing: omega-3 oils. Try a tablespoon of flax oil (I use Spectrum, unflavored) in the morning. I find it calming.
posted by DarkForest at 5:44 AM on November 4, 2007

Klonopin has been great for me because I can only take as needed - I'm not on some schedule. I think what the drugs do is calm your body down enough so that you can rationally see through the anxiety. It's very difficult at the beginning to solely use mind power to overcome your physical reactions. Drugs provide an initial shortcut, and things like yoga and meditation help with this for the long run.

Also, cutting down on caffeine (or completely forgoing it) does wonders for my anxiety levels.

You mentioned needing reassurance and frustrating those around you - this is something that talk therapy can help you with. Drugs won't teach you a better way to interact with people. In my experience, reassurance-seeking becomes an insidious habit, and I find myself doing it even when I'm calm. If I don't immediately get the reassurance I seek, that then provokes anxiety, and I get more pushy. I'm working on overcoming the mental habit that leads me to believe I somehow need reassurance.
posted by desjardins at 7:22 AM on November 4, 2007 [1 favorite has favorites]

things I have heard good stuff about are:

eating better and more regularly, nix the booze, cigarettes, and coffee, meditation and yoga, and more exercise.
posted by jannw at 7:35 AM on November 4, 2007

I 2nd the CBT recommendation; it's not easy like taking a drug, you actually have to take yourself in hand and fix your own life, but your therapist will help. Exercise and doing fun stuff helps too. To me, anxiety feels like alcoholism in that you are always a recovering anxious person; I do think that you CAN learn to hate that feeling and can learn to stop triggering it. Good luck!
posted by kenzi23 at 9:42 AM on November 4, 2007

randomstriker, my comment is directed at mother's little helpers, tranquilizers. They really work against anxiety, but are bad news and highly addictive. SSRIs might benefit some people and I have no issue with those.
posted by caddis at 9:46 AM on November 4, 2007

Having a scrip for 12 .25 mg doses of Xanax > Hitting myself in the face with a hairbrush over and over.

Don't hate on educated and targeted use of Tranqs.
posted by Ambrosia Voyeur at 11:53 AM on November 4, 2007

Sorry for the length of this post, but I would like to make a very important point concerning anxiety and biology.

I would definitely look into Cognitive Behaviorial Therapy. It can help you - even if it is "chemical," or "biological." There are many misconceptions, thanks mostly to Big Pharma, that if you have a "biological," or "chemical," depression - you need a drug. This is simply NOT true. In fact, every single case of anxiety and/or depression is "biological" and/or "chemical"!! Our brains are a slush of chemicals that operate in a most incredible way that produces intense feelings of joy, despair, and all things in between. But ALL of these "feelings" and "emotions" are the result of biology. For example, when a lion appears out of the corner of your eyes, you will experience a chemical reaction of fear. It is biological. It may be,"situational," but it's still being fueled by a change in chemistry. Think on this - a man might see a very attractive female - (situational) - and become aroused and might even have a common response: an erection. That is biology. Yet, all caused by thought. No drugs were needed to elicit the response. There are many examples, but the point being that thoughts alone can change brain chemistry.

Cognitive Behavioral Therapy, when practiced with skill, can allow one to control the chemicals, the biology (call it what you want) and thereby see a drastic reduction in how you relate to the world - for better or worse. Separating anxiety and depression into "situational" and "biological" is tricky. One may, in fact, be triggered by genes that are prone to anxiety, but the actual brain process taking place at the time of an acute episode is the same. Our thoughts are the slush, the slush is our thoughts. For anxiety, drugs can be a benefit when you are in need of immediate treatment (calm). However, these drugs should be used with caution, short-term and not used as the mainline defense against anxiety. CBT - putting yourself in control of the slush - can be very effective and without the potential long-term damages from adding chemicals to our natural brain soup. Good luck to you!
posted by Gerard Sorme at 1:03 PM on November 4, 2007

People say they're addictive but I've been using Klonopin on and off for years without having to increase the dose or having any kind of withdrawal effects. It depends on your personality - if you're the addictive sort, it might be a good idea to avoid benzodiazepines.

This is 100%, completely wrong.

Benzodiazepines are both psychologically and physically addicting. Getting hooked on benzos does not - repeat does not - "depend on your personality". If you take a benzodiazepine every day for more than a short period of time you will get physically addicted to it.

I can't speak to walla's lack of withdrawal effects except to speculate that "on and off" means he never took them consistently enough to get addicted, but really, saying it depends on your personality as to whether you get hooked is misleading and dangerous.

I love me some benzos but jesus.
posted by Justinian at 2:08 PM on November 4, 2007 [1 favorite has favorites]

this is a minor thing but the one thing I got of value out of that anxiety and phobia workbook that I had for a while. It suggested that when you are having an anxiety attack you say out loud "stop stop stop". It can break you out of your thought pattern and give you a little space to think straight.

It works well for me...I've been hitting the ol' anxiety pretty hard lately.
posted by sully75 at 4:51 PM on November 4, 2007

"Benzodiazepines are both psychologically and physically addicting. Getting hooked on benzos does not - repeat does not - "depend on your personality". If you take a benzodiazepine every day for more than a short period of time you will get physically addicted to it."

Thank you, Justinian. This is absolutely true.
posted by Gerard Sorme at 5:15 PM on November 4, 2007