Help me gauge my anxiety levels.
June 6, 2012 1:29 PM   Subscribe

How will I know if my anti-anxiety medication is working?

A new psychiatrist has prescribed 5mg (3x daily) Buspar for anxiety. I'm also on 10mg of Adderall. I've recently been diagnosed with ADD, which I have always experienced as having a cacophony of thoughts pinging around in all directions. I've got no hyperactivity and I'm actually very introverted and not much of a talker, unless it's one of a handful of topics I hyperfocus on. Anyway, before seeing this Doctor, I wouldn't have described myself as anxious to any excessive degree. I have had a tendency to be rather tightly wound, and have had more than one person tell me I "can't relax," but I always assumed that was just a personality thing.

The Doctor seemed to take my ricocheting thoughts as worry, though I would not necessarily characterize them that way. I don't spend time inventing disastrous ways in which people I know might be injured, for example. However, I have noticed a tendency for negative thoughts or images to "get stuck" and return unwanted throughout the day. I carefully avoid trigger material such as horrible images, tales of animal abuse, depictions of drowning; though some of the triggers are much more benign such as touching clumps of hair, feeling very thin wires against my skin (as in handling bobby pins), earworms, certain smells. These things can become very vivid and disruptive to my thoughts. Many times, I listen to podcasts at night to drown out repetitive thoughts or songs. I suppose these are symptoms of Generalized Anxiety Disorder? I'm honestly not sure, since I've gone over 30 years living with competing trains of thought zooming around my mind, not all of them pleasant.

I've been on Buspar for two weeks now and I'm not sure if it's working. I can't say my mental processes are any less cluttered. For example, last night I fell asleep much later than I would have liked because some bloody terrible song from a movie preview kept lurking around my mind. I'd like to find some way of knowing if I feel less anxious, but I can't say I felt anxious before to begin with. The Buspar is giving me headaches and nausea, so I'd rather get off it if it isn't helping. It also seems to have an unpleasant sexual side effect of making me nearly black out at the point of orgasm. I think it might be helpful to be able to tell my doctor if it helped with the anxiety, but I have no idea if it has. I know YANAD, but I have absolutely no experience with psychotropic meds.

Suggestions? Are there ways I can "measure" my anxiety?
posted by Kitty Stardust to Health & Fitness (11 answers total) 2 users marked this as a favorite
My doctor put me on Buspar a while ago, and yeah, subjective symptoms are really hard to keep track of. The next visit, a month later, when I went in the nurse said, "is your anxiety better?" and I just went, "I dunno."

But over time I realized it has helped - one of my anxiety issues was that I would not answer the phone, and I would not check messages. After a while I stopped checking emails from certain people. What if it was something bad? I didn't want to stress out over bad news (but then I stressed about not checking because what if?) After a few months on buspar, though, even though I still get those "oh my god, what if?!" *thoughts*, I actually CHECK my messages shortly after noticing them.

So if you really want it to work, give it some time - two weeks is pretty short, and you might not be at the right dosage yet. Think about some of the things that you worry about, and see if they've been *alleviated*. They might not disappear, but they should diminish.

HOWEVER, if you are having serious side-effects, I would talk to your doctor. 5mg 3x/day might be a little high - my doctor started me on 5mg 1x/day and then bumped me up a month later - I haven't had any bad side-effects.
posted by Lt. Bunny Wigglesworth at 1:41 PM on June 6, 2012

You haven't given it enough time to start working. I'm on anti-anxiety medications as well, and my doctor said I'd start seeing some change at week 4 but no real difference until week 6. The side effects should go away within two weeks. FWIW, I'm going on week six and haven't noticed a difference in anxiety either. It could just be the medication isn't working for you.

Do you have a 4 week follow-up with your doctor? He might be able to prescribe you something to counteract the side effects of the Buspar if they haven't passed by then. My doctor ended up having to do that because of a sexual side effect as well.
posted by Autumn at 1:42 PM on June 6, 2012


I have anxiety and I take Celexa. I used to wake up in the middle of the night with one thought, now, it wasn't really anything that would cause me worry, perhaps it was an issue with a spreadsheet I was working on, or wondering about what gate the flight I was taking would be at, nothing particularly worrisome, but something that required some thought. Also, I would have some dumb song in my head. (Lipstick-Jedward, it would never be anything good.)

Then I'd focus, and think, and I couldn't sleep. Then I'd feel anxious, but I couldn't put my finger on what I was anxious about, but it felt TERRIBLE!

I tried more B-Complex vitamins, because those racing thoughts--sometimes are a lack of b-vitamins and I'm perpetually anemic.

I started with Celexa and I don't have those episodes anymore. I'm alot calmer, I take things much easier, that "tightly-wound" feeling has eased. Do I miss my imagination? A bit.

In the end, this works for me. I started with Prozac, which was awesome, right until I broke out in hives. Then I switched.

These meds are always a crap-shoot. It's your brain chemistry and everyone is different. You might have to try something else.
posted by Ruthless Bunny at 1:42 PM on June 6, 2012 [1 favorite]

(um, I meant 5mg 3x/day might have been a little high to START - a 15mg/day dose isn't high in itself)
posted by Lt. Bunny Wigglesworth at 1:42 PM on June 6, 2012

Some of the anxiety stuff also kind of sounds like Adderall side effects to me. I assume the prescriber of the Buspar knows about the Adderall rx?
posted by elizardbits at 1:49 PM on June 6, 2012 [1 favorite]

Yes, my doctor does know about the Adderall. She thinks we may need to raise the dosage, but she wants to make sure it doesn't cause any extra anxiety first. It's the extended release formulation, which I will probably ask to switch away from because my insurance doesn't cover it and it's insanely expensive.
posted by Kitty Stardust at 1:56 PM on June 6, 2012

Basic IANAD disclaimers:

At this point, most practicing psychiatrists consider diagnoses like ADD, Generalized Anxiety Disorder, etc. as being primarily for insurance companies. Rather than being discrete conditions with different pathologies, they are the varied symptomatic presentations resulting from the combination and the degree of penetration of a number of genetic predispositions.

For me personally, after being diagnosed with ADD and mild depression for most of my life, and being treated with therapy and medication with mixed results, as our understanding of these types of mood disorders progressed, my psychiatrist began to see my attentional issues and depressive tendencies as resulting from minor mood instability and anxiety. After changing medications to include a mild mood stabilizer and starting Cognitive Behavioral Therapy, I'm progressing better than I have in years.

So while you might not necessarily experience your racing thoughts as "worry," its possible for it to be a second-order result of the stress from the mental exertion of blocking out these negative thoughts, or something along those lines.

Anyway, it is too early to give up on the Buspar, although you should keep your doctor apprised of any and all side effects. The blackout during orgasm sounds like it could be blood-pressure related, which your doctor would certainly want to know about.

Also, don't worry about needing to give your doctor the "correct" answer about whether the Buspar is working. Your conclusion is only one of a number of factors he'll be paying attention to. He'll listen to how you think it may or may not be working, and he'll be paying attention to both the content of what you're saying as well as how you say it, and look for subtle signs of change in cognition and processing.

My guess is that in any case, unless he thinks the side-effects are potentially harmful, he'll advise you to give it another couple of weeks, after which, if you're still unsure, he might weigh in on some things he's noticed about your affect and behavior during sessions.
posted by patnasty at 2:12 PM on June 6, 2012

I have some anxiety issues, that used to include similar things to what you are talking about, including repeated thoughts or songs or other things while I was trying to go to sleep, although my main complication was persistent nausea that turned out to anxiety and stress induced. My prescriber started me on a SNRI (Seratonin Norepinephrine Reuptake Inhibitor) which is a dual acting drug that can help with depression and anxiety. I had never had depression problems, but it has done a lot to help with my anxiety, especially the more physical manifestations that I was having trouble with and could not control. When I was going through a particularly rough period in my life, she added Buspar to my regime for additional help (3x daily as well, this is a typical dose as Buspar does not stay in your system that long to continue effects with once daily dosing, I worked in retail pharmacy at the time). I stayed on it for a little over a month, but found that the additional relief was negligible to nonexistent. Not saying this would be the case for you in the long run, but I have several other friends that have had similar results. However, I second that you need to give it a little more time to run its course before you can really decide if it works for you.
posted by Quincy at 2:21 PM on June 6, 2012

Kitty Stardust, I have found it helpful to keep a symptom log. One way is simply to note down any time you have what you might think of as an "episode" of ricocheting, negative, intrusive, or zooming thoughts. Another is to characterize each day in the evening. Another, that I've used in the past with good effect, is to record your anxiety level at several set times a day: morning, mid-afternoon, and evening, say. This can be the best way, as you can not only track your anxiety over time but notice patters like whether it's worse early or late in the day. This will give you a record you can refer to if you don't have a general overall sense of whether you're improving or not.

I have a log right now for tracking chronic headaches, that includes columns for recording any triggers I notice, duration, any relief measures I take, and whether it helps. Something similar might be helpful for tracking anxiety.
posted by not that girl at 3:58 PM on June 6, 2012

If your feelings are negatively impacting your life then it's bad enough that you need more help. You don't need any further rationalization than "I don't like the way I feel".

Buspar is acknowledged by most doctors as having a relatively low rate of clinical effectiveness. That doesn't mean it's not worth a shot. You should keep on it for another two weeks or so unless your anxiety worsens. But you should know that Buspar simply doesn't work for most people.
posted by WhitenoisE at 1:29 AM on June 7, 2012

Thank you for the tips. As it turned out, Buspar made me constantly nauseous, so we switched to a low-dosage SSRI. No side effects so far. The biggest difference I've noticed is that I can fall asleep without background noise. I still have annoying thoughts, but I've had some success in redirecting them toward less stressful material.
posted by Kitty Stardust at 9:00 AM on August 6, 2012

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