Anxious about anxiety and anxiolytics...
August 1, 2011 7:55 PM   Subscribe

I am on my way to an appointment tomorrow because I would like to do something about anxiety or stress response or whatever you'd like to call it. I am familiar with a lot of different anti-anxiety meds from my schoolwork, as well as things used off label. But my knowledge is more from the 'how the drugs work in the brain' side, vs. the clinical indications.

You are not my doctor. I am going to the doctor tomorrow, but I'd love to hear the hive thoughts on this to be best prepared.

Some days, I get home from work and spend the entire evening in a flight or fight mode. Or it happens in anticipation of the next day. It's never un-caused, that is, I know exactly what event is causing, and if I could, I would just eliminate the situation (medical problems, crappy job, crappy commute, difficult consumer relations issues). But I'm never going to be able to eliminate everything that can do this to me, on account of there are a lot of humans around. My symptoms seem similar to what I've heard of in a panic attack, except it's never just out of the blue or unexplained. And it's more of the just feeling superhigh strung (nausea, sweating,grinding my teeth) versus passing out or having palpitations. And it lasts a long time, basically it can last all evening, until I take Benadryl or something to make me physically tired finally and go to sleep. On realllly bad days, I can cry for hours. Needless to say, the evening is a waste and I feel like crap the next day. Timing wise, this can happen three days in a row or once a week or not for months. The timing is a reaction to my external world, rather than an unexplained blue or anxious feeling.

But yes, I understand it is my own internal reaction to the external world -- I have done a lot of work to improve that: I know I let things 'get to me' more than other people. I've had several years of CBT and then psychoanalysis to understand this, and I am waaaaay better than I was before therapy. That crying thing used to happen several times a week. I also do a lot of self-calming things, as recommended. And I exercise. I take the dog for a walk. I try to do something I enjoy. All of these things help, and I guess I could survive this way, but I would like to improve things. I think some chemicals are now in order.

But which? Last year, my doctor gave me something to take at bedtime, which made me sleepy and had less of a hangover than Benadryl. But it wasn't for anxiety. And it helped so little, I stopped taking it after 6 months. I'm very reluctant to take anything chronically. I'd just like something that would help me feel better in acute situations. The doctor was leary of giving me benzodiazepines, or specifically lorazepam, which I'd had a former prescription of from my shrink. I didn't push it, because she had suggested the other nighttime drug, so I was willing to try that and avoid the possible dependence issues of lorazepam. (BTW, though the lorazepam had been prescribed specifically for these types of 'attacks' - days when I couldn't leave my apartment because I couldn't stop crying, etc. I never had any issues with abuse or dependence. I understand very well the mechanics of the drugs and why taking them every day is going to get me nowhere.)

So, are there other options besides benzodiazepines? Is Xanax a better choice than lorazepam? If benzos seem like the way to go, any suggestions for an approach with my doctor?

Part of the reason I think there is a physiological side to this is that both of my parents have obvious anxiety issues. My dad used to have a lot of panic attacks - maybe he still does, but I don't see. My mom has high blood pressure (medicated) and her doctor has given her a Xanax prescription (which she won't take...) Both of my parents spend way too much time ruminating and worrying and expending energy on anxiety. They are downright twitchy with anxiety a lot of the time. I won't describe further branches of the family, but I can't help but feel that some of my symptoms are inherited and biological (and of course, reinforced by living with my parents).
posted by Tandem Affinity to Health & Fitness (10 answers total) 5 users marked this as a favorite
 
Benzodiazapines are pretty addictive and are not meant for long term use. I was on klonopin for 3 years (my doctor was pretty open with prescribing them). I didn't realize how bad the withdrawal would be until I weaned off them and quit. I was only taking 1 to 1 1/2 mgs a night to sleep, but it took me about a month after weaning down to .25 mg a night over a couple weeks.

It was pretty bad, so I would recommend being careful if you do decide to take them. You may want to consider looking at other ways to handle your ruminations and stress including biofeedback and CBT as well as mindfulness and meditation. You may be able to control these issues on your own without drugs.
posted by TheBones at 8:09 PM on August 1, 2011


Benzo withdrawal is a bitch, and in my experience the doctor minimized the effects of withdrawal a bit, so it's good that your doctor is iffy about it. That said, my [non doctor] advice is that from what you've said, benzos can help a lot with that sort of spike with anxiety, and just by how extreme that spike seems to be for you.

However, I don't know why the doctor was reluctant to give them to you -- ie history of addictions, other medications, etc. In my experience, though, I did everything simultaneously -- exercise, diet, therapy, antidepressants -- and nothing, NOTHING, worked quite as well as benzos for those sudden, terrible spikes in anxiety. And yes, it's absolutely physical as well as mental. Feel free to memail me if you want more specifics.
posted by sweetkid at 8:16 PM on August 1, 2011 [1 favorite]


I once took Lexapro for a while after I went to the doc complaining of depression and anxiety. My experience was that it made the anxiety nearly non-existent, but it also made the depression worse. This doesn't happen for everyone (in fact for most people, it's a really helpful drug). It is indicated for treatment of generalized anxiety disorder as well as depression, so your doc would probably not have any qualms about prescribing it. That said, if I were you, I would probably ask my GP for a referral to a psychiatrist. Pretty much all many psychiatrists do nowadays is prescribe/monitor meds. They could recommend a benzo or non-benzo for you, and keep trying until something works. FWIW, I happened to visit my doctor while having an acute anxiety episode and she gave me some clonazepam. I used it very rarely, but it helped me push through, and because I only took it rarely I had zero issues with withdrawal.
posted by eldiem at 10:16 PM on August 1, 2011


Oh, I didn't even realize you were talking about going to a GP, not a psychiatrist. Please get a recommendation for a psychiatrist, to get a proper medical assessment for these types of drugs.
posted by sweetkid at 10:19 PM on August 1, 2011


Bad withdrawal shouldn`t necessarily rule out taking a drug that will help you. It`s many, many days of being helped vs. a few days of suffering through the withdrawal. I was on clonazepam for three years and stopped pretty much cold turkey when I was pregnant. I had about two sleepless nights and that was all. I`m not sure whether that`s the right way for you to go, but I just wanted to offer that perspective.
posted by kitcat at 11:06 PM on August 1, 2011


Are you still anxious when you're not having an attack? It sounds like your anxiety manifests really differently from mine-- I almost never had panic attacks, but my "base state" was way more anxious than is healthy. CBT and meds (specifically Abilify) have worked wonders for me, but you might need something different.
posted by nonasuch at 7:29 AM on August 2, 2011


Thank you all for relating your experiences. I think I agree with the need for a referral rather than just going with the gp's thoughts. I just a had a few more thoughts, and maybe some clarification.

It is good to hear firsthand that the benzo withdrawal is an important phenomenon. My idea of a dosing schedule would be one dose per evening, with three consecutive evenings being the max.

In reply to nonasuch, and relevant to why I think this would work for me, is that I mainly have these 'bad times' the night after or before high stress events things, or maybe randomly a night or two way in advance. My base state is good, and I think that is a direct benefit of therapy. I am able to calm down spontaneously *eventually*, especially if I have a weekend in there. But it can be days of highstrungness, and I'm tired of having those days pretty much wasted on irrationality.

I guess this is part of why I am averse to any sort of chronic longterm treatment. I think treating my base at this point is superfluous -- the base is mostly calm. I just want something that could tame the spikes a bit (thanks, sweetkid, for that vocabulary -- 'spikes' is exactly how i see these 'bad times'). I am also on several daily medications due to some physical issues (inflammatory arthritis). My liver is already working hard, and I have some gastrointestinal issues, so I'd rather add to that sort of thing as few days as possible.
posted by Tandem Affinity at 8:07 AM on August 2, 2011


Being a total lay person with no medical background, your plan seems reasonable to me, based on the fact that my personal experience with benzos was good. They are fast acting (unlike antidepressants) so they would work well taken on an "as needed" basis. You would want to consult your doctor about guidelines for staying below the level of physical addiction. For me, I was taking 1 mg clonazapam twice a day for more than five years. I just tapered off over a 6 week period. I noticed some small side effects when I took the next step down but nothing significant. I now take it as needed (1 mg once or twice a week) and for me it does it good job of keeping the anxiety from making me sick.

BTW I strongly endorse getting a referral to real psychiatrist. There are SO many different psych meds and each person reacts differently. Most gp's seem to have a general rule of thumb for prescribing this stuff but they don't have the depth of knoweldge to really respond to your personal situation (pattern of anxiety, family history, liver concerns). Good luck!
posted by metahawk at 1:22 PM on August 2, 2011


I second/third the suggestion to get a referral to a psychiatrist for a psychopharm consultation instead of getting prescriptions from your GP. In addition to the reasons sweetkid et al. mention, there's also the fact that any doctor prescribing you psychiatric medication should see you on (at least) a monthly basis until you're well acclimated to your med regimen. Not only would a psychiatrist be more helpful in this process, but it would also save you a lot of time an aggravation, as unlike GP's, psychiatrists actually keep to their schedule.

Whichever kind of doctor you ultimately end up going to, I think it'd be best to go in open to whatever medical treatment plan your doctor recommends. I hear your reasoning regarding daily medications, and certainly your doctor should take the medications you're already on and your liver function into consideration, but in many cases with pain and anxiety, an ounce of prevention is worth a pound of cure. If your doctor thinks low daily levels of an SSRI or SNeRI like Zoloft or Strattera could keep the anxiety from becoming an issue, that's ultimately going to be a much gentler and more sustainable treatment plan than an 'attack dose' of a benzodiazepine three or four times a week. Benzodiazepines, as previously mentioned, are habit and tolerance forming. Used only occasionally or over a short period of time, they're very safe and effective but the frequency of use you describe would be pretty tricky to keep from bleeding into daily use, at which point you'd start to get into the dependence and increased seizure risk issues.

So, yeah, anyway, just some thoughts, IAMYD etc. Good luck, and glad to hear you're getting yourself some help with your anxiety.
posted by patnasty at 4:49 PM on August 2, 2011


Thanks again to all -- I've marked you all as best, because it was really hearing the spectrum that put me in the right mindset to talk with the doctor. I have a script for Ativan for now, and will escalate to a psychiatrist if this isn't satisfactory or my 'spikes' get more regular.
posted by Tandem Affinity at 7:19 PM on August 2, 2011 [1 favorite]


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