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Opinions - Best medication for severe anxiety

Discussion in 'Downers and sleeping pills' started by spinning, Jul 10, 2010.

  1. spinning

    spinning Newbie

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    Hi all.

    My ghost would like to know what is the best medication for anxiety in your opinion. Severe anxiety I mean, as in my ghost cannot eat ,sleep or do anything atm because of it.
    My ghost also has a long medical history of anxiety and panic attacks but her doctor won't give her any meds for the anxiety, instead she gives her meds for the nausea. She doesn't understand this. :confused: Think its time for ghost to see a new doc.
     
  2. Space Numpty

    Space Numpty Palladium Member

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    Well, on a short term basis, benzodiazepines are hard to beat, but they have strong addiction concerns, swift tolerance build and potential for rebound anxiety if one tries to withdraw without tapering, so doctors rarely prescribe them long term unless one lives in the USA where they are often handed out like twinkies.

    The longer term treatment tends to be an anti-depressant, usually from the SSRI family, and if the anxiety is severe it can be combined with a low dose of an anti-psychotic such as Chlorpromazine.

    Hope that helps :thumbsup:
     
  3. spinning

    spinning Newbie

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    Thanks for that :) Ghost has tried SSRI's - for more than a year at a max dose. Didn't help. But I'm gonna see about the anti psychotic in combination, thx a mil :)
     
  4. Space Numpty

    Space Numpty Palladium Member

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    Aside from what a doctor may give, has You tried any ethnobotanicals to help with anxiety? (natural remedies). There are a few that some people, SWIM included find really quite effective.

    If You wants to know more then see here

    I am reasonably knowledgable and experienced in this area, You is welcome to pm him if they have any specific questions. I know how horrible and utterly exhausting constant anxiety is.

    Where does You come from? SWIM asks because from what You has described it would appear their anxiety is really rather extreme and I feel they would geniunely benefit from a short controlled course of Benzodiazepines. If You is UK based then getting a script for benzos out of a doctor can be like getting blood out of a stone though.
     
  5. DextroClonazyCodone

    DextroClonazyCodone Silver Member

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    Some folks with severe anxiety actually find a short course of benzos with long term psychotherapy the most effective tool. A good deal of therapists suck, but there are some good ones. Just get some recommendations from you's psychiatrist.
     
  6. Space Numpty

    Space Numpty Palladium Member

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    The poster above reminded SWIM of another option. Go back to yous doctor and ask to be referred to a Psychiatrist. They are far better equipped to give the medication they think you need. GP's are just that "General" Practitioners, and whilst some are great when it comes to things like depression, most dont realy understand it.

    Worth a try :thumbsup:
     
  7. trans-human

    trans-human Silver Member

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    As previous posters have mentioned, benzodiazepines are usually very effective for relieving anxiety, especially in the short-term. If you's anxiety is constant, a benzodiazepine with a relatively long duration of action would probably be best. If this is the case, I would recommend clonazepam (brand names include Klonopin and Rivotril). However, diazepam (Valium), oxazepam (Serax) and lorazepam (Ativan) are also prescribed for this purpose. If you's anxiety usually manifests itself in the form of panic attacks, then a short-acting benzodiazepine is often the preferred treatment. The benzo most often prescribed in this case is alprazolam (Xanax, Niravam, etc.) Lorazepam (Ativan) is sometimes used instead. In either case, I believe it would be best if an antidepressant with anxiolytic properties also be prescribed for daily use. Antidepressants best suited for anxiety would include SSRI's such as sertraline (Zoloft) paroxetine (Paxil) and citalopram/escitalopram (Celexa/Lexapro) or an SNRI such as venlafaxine (Effexor)

    That being said, You will obviously first have to find a doctor qualified to prescribe such medication (preferably a psychiatrist).

    In the meantime, there are substances that can be purchased legally over the counter that have the potential to effectively relieve anxiety. Although there are many OTC products that claim to relieve anxiety, the substance I have in mind for you's case is called phenibut. You will have to research phenibut, because there is much to be said about it, and I could not possibly list everything in this post. SWIM definitely recommends that You research this novel drug; it is a derivative of GABA that is capable of passing the blood-brain barrier, and is reported by several users to have effects that are very similar and often equally effective to benzodiazepines.

    Good Luck. SWIM hopes You is able to get his/her anxiety under control as soon as possible.
     
  8. godztear

    godztear Silver Member

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    I would have to say Tetrahydrocannabinol, also known as THC. This is the substance found in the marijuana plant, specifically the flowers. This is often smoked as dry matter or is extracted and used for edible products such as butter or oil.

    It is illegal to posses, without a prescription in most places, but if one struggles from anxiety attacks, then it will do the trick. Some people will say it will intensify, but chemical compounds simply do not work in that way. They most often have the opposite effect on what is not maintained by normal body functions therefore making them capable of being sold to the public.

    THC works on the cannabinoid receptor in the brain. It will help reduce anxiety and all around stress under most circumstances. I am not a doctor but speak only out of witnessing other people dealing with similar circumstances.
     
  9. Jatelka

    Jatelka Psychedelic Shepherdess Platinum Member & Advisor

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    ^^^ Marijuana can worsen feelings of anxiety for many, and blithely advising it as a solution is not in keeping with DF's harm reduction ethos
     
  10. spinning

    spinning Newbie

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    Changed doc- I got xanax and sleeping pills at a max dose :) . Thanks everyone who replied and I agree Jatelka.. marijuana can and does worsen anxiety for many!
     
  11. PsychoActivist

    PsychoActivist Palladium Member

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    Hi Spinning,

    Please try to bear in mind what has been forementioned in the previous posts about benzodiazepines. They can be extremely addictive and for many can produce extreme cravings for more.

    SWIPA suffers from severe anxiety as well and has been down most paths. Tried just about everything. He was also at one time prescribed Alprazolam (Xanax) along with a hypnotic benzo to take at night - Temazepam (Restoril).

    He kept getting the dosages of both meds slowly increased until before he knew he was prescribed up to 6 mg's of Alprazolam (3 bars a day) and 60 mg's of Temazepam at night (where 30 mg's is actually the highest recommended dosage by the FDA I believe).

    Yet, this was still not enough. Even at 90 2mg Alprazolams and 60 30mg Temazepams a month, his prescriptions would be empty in about a week. He never sold any just would take them all. He spent most of his time in a blackout and most of his friends and family did not even want to be around him.

    On top of all of this both drugs would produce extreme cravings for alcohol - which by the way is the reason he began to get the anxiety in the first place - he had quit drinking. So he began drinking again on top of the benzos. This is EXTREMELY dangerous. Benzodiazepines have a very high lethal dose when taken alone (by this I mean from the drug itself not if one were to get behind the wheel of a car etc...) but when combined with the smallest amount of alcohol they can be extremely deadly.

    I am not telling your ghost this to try and scare it (ha) It's just someone who isnt quite PsychoActivists experience. A lot of people can be fine taking Benzo's and not abuse them. All of this varies dramatically depending on the individual.

    In closing, my final word of advice to your ghost is one thing SWIPA has learned about anxiety, is that the further one falls deeper and deeper into it and cuts themselves off from the world the worse it becomes and the harder it is to recover. After the spell with the Benzo's he kept trying different things including ethnobotanicals, counseling/therapy etc... Until he finally began slowly coming out of his shell by leaving his house, going out with friends, trying the best he could to be social, not much else helped. It was very hard for him but it TRULY DID get better. He still suffers from anxiety to this day but not half as bad.

    Good luck to you.
     
  12. AddyCrazy

    AddyCrazy Silver Member

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    THC by itself will increase someone's anxiety severely one of the compounds isolated from marijuana that has been proven to have anxiolytic properties is CBD or cannabidiol. Indica strains tend to have higher contents of this either in equal or a greater quantity as THC causing the much more sedating and generally relaxing high. But getting to the core of your anxiety is the best thing for it and staying away from stimulants, exercising, eating healthy and maintaining healthy relationships with the people around will all help. In the short - medium term benzodiazepines do work well but SWIM suggests trying the lowest possible dose and bump up slowly as it will slow your tolerance build up.
     
  13. Pieces Mended

    Pieces Mended Silver Member

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    I need to find an experienced, established psychiatrist who has his own private practice. Notice I used "his own"-independent doctors spend far less time worrying about their trend in which drugs they use, thus they use the ones they find most effective- and male psychiatrists tend to view these strictly as chemical issues to be treated as best possible with medication. Female psychiatrists tend to attempt to step on the feet of the psychology profession and often are a nightmare to deal with in regards to prescriptions. *This is not always true, I am not sexist and actually feels females make better psychologists. I feel it is a pragmatic vs nurturing approach).

    Despite what nearly everyone will tell you, Benzos can ABSOLUTELY work for decades without even touching the dose after it has been correctly prescribed. This is why You should find a more experienced doctor not afraid of big-brother looking over his newly acquired prescription pad. I have been on benzos coming up on five years and the dosage on his current medication- Valium- has stayed consistant for over 18 months with no loss in positive impact. That is after transitioning from Xanax, where he actually went from 3mg daily (this could be 30-60mg daily of Valium) down to the minimum 30mg. He feels wonderful. Worrying about the online hysteria of addiction and tolerance, SWIM brought up the subject. His Psych indicated he has more than two dozen General Anxiety Disorder patients on Valium, none of whom asked for a dose increase or reported a problem in over a decade on this the specific benzo. He also feels that Clonazepam has similar benefits as a life-long solution.

    Benzos get a label as being "addictive" "habit-forming" and "tolerance building" because of shorter acting drugs like Xanax (Alprazolam) and Ativan (Lorazipam)- both of which are considered short acting. This means the patient will feel the entire up, peak, plateau, then crash between doses. Anyone care to guess how often those patients probably re-dose early?

    Long-acting benzos such as Diazepam and Clonazepam are created to have such long half-lives, the drug eventually develops a steady amount in your body. It's nearly the same concept as an SSRI- I would take it in the morning and evening (perhaps three times depending on many factors)- and the anxiety is level indefinitely. Within a month or two, a single dose won't even be noticed, as it will be dwarfed by the amount circulating in your body already. I know this from Diazepam and days when he forgot to take his first two doses, then took his third late with no negative impact.

    Bottom line, to emphasize again: find a Psychiatrist who will at least offer benzos as part of you's starting treatment plan. If they seem leery, move on- that is, of course, unless you have a drug-seeking history or criminal record, ect- things that throw red flags. Once you've found the doctor you trust, work with him and be honest. Mention that you've read the very long-lasting benzos have an extremely low tolerance and abuse rate, and that you'd like their feedback on that.

    SSRI's are prescribed by general practioners because yes, they can help anxiety. But, more important to the doctor, they are not a controlled substance. The doctor doesn't have to sweat what happens, because he's not on the hook because he took the most conservative route possible. This is why, for about the fourth time, SWIM emphasizes that Psychiatrists are the only doctors he trusts to have a back-and-forth exchange of treatment plans. For two years when SWIM needed a change in his prescriptions, he'd research myself and present the idea to the GP. He always agreed with SWIM's logic.

    That was nice for SWIM, but after he ran out of ideas he realized that his GP was basically allowing SWIM to sign his own scripts and had no real treatment plan laid out. After four visits to a renound psychiatrist, everything was 100% better than before. Not only that, but I would just get 3 months of refills each visit. GP's are watched like hawks about this stuff. Psychiatrists are busy prescribing anti-psychotics and schedule II drugs left and right to people who can barely function in society. Writing mild benzos to an anxiety patient is about as worrisome to them as a general practitioner writing a script for 30 vicodin after you have your arm in a cast for six weeks.

    I know this is long-winded, but SWIM must emphasize that SSRI and SNRI drugs should NOT be the first line of treatment. Neither should Xanax or Atvian- not unless You has severe panic attacks for 15 minutes sporadically and is fine the other 98% of the time. Starting with something like Valium in a low dose makes absolutely the most sense. It's the easiest benzo to taper off from, it has 5% of the side effects Serotonin drugs do, and it's proven to work in nearly everyone.

    That's swim's... well, he was going to say $.02, but more like $.75
     
  14. AddyCrazy

    AddyCrazy Silver Member

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    SWIM personally doesn't believe using benzo's on a constant basis for a long time is all that good. Although for a couple years clonazepam and diazepam are not as bad especially coming off of them but ones dose will certainly go up so trying to use the lowest effective dose possible and if an ex substance abuser then definitely make sure you keep in line. I do think that AD's can be effective although if you only have anxiety and no depression then I would say CBT and a moderate term(like 5 years at the very most) long acting benzo regimen is definitely the a very good treatment course.
     
  15. Pieces Mended

    Pieces Mended Silver Member

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    SWIM hates to question you's logic, but I don't believe any drug study has been done that shows 5 years on a given substance would be any better than an indefinite period. I have had long discussions with his psychologist regarding dependence and tolerance. His experience, which SWIM totally agrees with based on personal experience, is that tolerance might change for the first six months or so, but then levels off- UNLESS the patient increases their usage without cause. If the patient starts taking 40mg daily without consulting after five years on 30mg, then yes, their tolerance will build.

    Almost all doctors agree to one of three thought processes for benzos. First, they should only be used for short-term (less than six weeks) until a SSRI or other drug becomes effective. Second, they should only be used only "as needed" for those with anxiety attacks and not General Anxiety Disorder. Third, long-acting benzos are just fine for indefinite treatment of GAD. I have never heard of a doctor who is okay with even six months on regular benzo prescriptions unless they decide to keep the patient on the drug until it is no longer effective.
     
  16. timkanu

    timkanu Newbie

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    I certainly would not recomend THC as a anti anxiety. It is more likely to intensify any anxiety.

    The reason that smoked cannabis can have a anti anxiety effect is from CBD (Cannabidiol) which is also contained in various amounts in cannabis. CBD is proven to have antipsychotic effects.

    The reason indica strains of cannabis tend to me more "mongy" and relaxing/sedating that sativia strains or cannabis which are more head high/energetic, is because indica strains have a higher ratio of CBD to THC than sativa strains.

    I say again THC is NOT a good antianxiety medication at all.
     
  17. Troppo

    Troppo Titanium Member

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    What about trying beta blockers? I have heard that propranolol is being used in the inpatient treatment of trauma, at least experimentally. I have not personally tried a beta blocker for anxiety/panic however so cannot vouch for these drugs...just sharing something he read a few days ago.
     
  18. Pieces Mended

    Pieces Mended Silver Member

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    I have been prescribed that exact drug for his anxiety. However, it's important to understand the only function the drug performs is to slow an individuals pulse, lower their blood pressure, and basically keep them from feeling jittery. It does nothing for cognitive or mental issues. The patient will still feel nervous, know they are nervous, but just not have the physical symptoms.

    This is very popular among professional speakers, actors, and other performers who suffer from situational anxiety. I know it is not a great plan for frequent usage, as the body has a physical rebound that will actually make anxiety feel worse if the person is still under the same amount of stress and hasn't just walked off stage.

    You is wise to even be aware of such a treatment though. All too many professionals end up with a revolving refill of xanax for their meetings and presentations when they could be on this much more benign treatment.
     
  19. AddyCrazy

    AddyCrazy Silver Member

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    The 5 year was just a semi-random number but its proven long term benzo use will certainly take its toll on the body and CBT is indisputably the best course of action because it gets to the base of the problems instead temporarily helping them. Don't get it twisted though because I am currently on benzos and was on them for a year then was off for like 8 months because of opiate addiction and recovery and SWIM's psychiatrist decided a few months ago I am at a point in recovery where he can use benzo's responsibly because sometimes thats the only medicinal option for people. BUT swim also goes to therapy 2 x a week and tries to force himself into his anxious situations, for swim its social situations the peak anxiety but I also have a steady level of like 7 out of 10 while on 5mg diazepam 2 x a day. I was on 2 mg of clonazepam but was curious about the "forbidden fruit"(well to some doctor's not SWIM's obviously) and he did a double taper went down on clonazepam and up on diazepam at the time so for a week he was on low doses of both. He plans on asking his doc to up the diazepam dose because it doesn't control panic as well as clonazepam but doesn't make him feel dull and introverted(actually more extroverted as it should) as clonazepam did. But I am rambling now just sharing his experience with severe anxiety. I believe that therapy is the best treatment though because a good percentage of anxiety comes from deep seeded issues and also a lifestyle change is needed to expect any results. If a caffeine user cut down to 0 - 200 mg(2 cups of coffee or 2 20oz Mountain Dews) a day before lunch time. EXERCISE EXERCISE EXERCISE EXERCISE! it helps so much and it helps your meds work better and its just good for you in general. Try to cut down on nicotine as well. Cutting down on recreational/nonmedical drug use may help some people but it WILL help if ones DOC is a stimulant. SWIM's 2 cents

    EDIT: This is SWIM's opinion with the most harm reduction in mind and understands benzo's are a must for people with severe anxiety like SWIM who can not function with the amount of anxiety they experience all the time and in spikes.
     
  20. Pieces Mended

    Pieces Mended Silver Member

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    I agree with You that CBT is by far the best possible option for those with anxiety disorder. If drugs must be prescribed in conjunction that's fine, but CBT will still be a massive help. I know because he went through almost a year of CBT for his anxiety.

    SWIM speaks from a different position than most people with "anxiety problems"- it sounds as though You is in the same boat. Without being on long-acting benzos, SWIM's baseline anxiety while just sitting in front of the TV would be about a 5 on a 1-10 scale. In that situation, it also doesn't take much more than SWIM being stuck in a little bit of traffic before he reaches a 8-9 on the scale. At that point, his pulse is usually over 120 and he's short of breath. So... I think both SWIM and You can relate.