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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 22 of 22. This is the beginning of the thread.
Posted by Terese on February 21, 2002, at 8:14:08
I've been diagnosed with Generalized Anxiety Disorder and Panic Disorder. aside from occasional panic attacks, I feel extremely nervous and uncomfortable most of the day. I had this 3 years ago and was treated for about 8 months and then was "normal". now it came back! Three years ago, I was on Paxil which worked well but I put on weight, zoloft but had sexual issues, and serzone which I wasn't on long because I started to feel better. so after about 8 months, discontinued meds and life was good.
A few weeks ago, the anxiety and panic attacks came back. This time around, my doctor first suggested Serzone but I am worried about the liver warnings. So, he put me on Effexor XR one week ago. I know these take some time to work but I'm worried about some of the things I'm reading on the forums. Such as weight gain and withdrawal. I've read some positive things about WEllbutrin.
For Anxiety, what has been your best experience? The 2 items I cannot tolerate are weight gain and sexual dysfunction.
thanks,
Terese
Posted by skills on February 21, 2002, at 9:36:21
In reply to what meds work best for Anxiety?, posted by Terese on February 21, 2002, at 8:14:08
You could try a benzodiazepine like a low dose of Quazepam and on event of a panic attack try 1-2mg of Lorazepam.......peace, skills
Posted by terese on February 21, 2002, at 10:45:11
In reply to what meds work best for Anxiety?, posted by Terese on February 21, 2002, at 8:14:08
I should also mention I take Xanax as needed. My doc thinks I need an AD as well so that is what I am asking for advice on.
many thanks!
Terese
Posted by OldSchool on February 21, 2002, at 13:17:26
In reply to what meds work best for Anxiety?, posted by Terese on February 21, 2002, at 8:14:08
Here are the best drugs for Generalized Anxiety Disorder:
1) Buspar...formally FDA approved for GAD
2) Paxil...again FDA approved for GAD
3) Effexor XR...FDA approved for GADAlso, benzos are very useful in controlling panic and anxiety.
Posted by Alan on February 21, 2002, at 14:07:54
In reply to what meds work best for Anxiety?, posted by Terese on February 21, 2002, at 8:14:08
> I've been diagnosed with Generalized Anxiety Disorder and Panic Disorder. aside from occasional panic attacks, I feel extremely nervous and uncomfortable most of the day. I had this 3 years ago and was treated for about 8 months and then was "normal". now it came back! Three years ago, I was on Paxil which worked well but I put on weight, zoloft but had sexual issues, and serzone which I wasn't on long because I started to feel better. so after about 8 months, discontinued meds and life was good.
>
> A few weeks ago, the anxiety and panic attacks came back. This time around, my doctor first suggested Serzone but I am worried about the liver warnings. So, he put me on Effexor XR one week ago. I know these take some time to work but I'm worried about some of the things I'm reading on the forums. Such as weight gain and withdrawal. I've read some positive things about WEllbutrin.
>
> For Anxiety, what has been your best experience? The 2 items I cannot tolerate are weight gain and sexual dysfunction.
>
> thanks,
> Terese
**********************************************
Try reading this webpage:http://bearpaw8.tripod.com/pd.html
The BZD's alone are what sounds like you need to try. Scroll down to the med treatments if the whole page is too long (it's great, crystal clear reading though - well worth reading it all if you want to understand what you're dealing with!).
Some people (like me) do not need an AD at all and there is no reason to not consider BZD monotherapy long term (or short) if you have no history of drug abuse...the section on BZD's is very clear about this and gives good reasons why this is so.
My pdoc - a specialist in treating anxiety disorders was so impressed with this link that I forwarded to them that they forwarded it to their entire staff to read as a primer and as something to give to patients that were interested.
More and more patients and doctors are not buying the necessity of polypharmacy in the area of anxiety disorders when BZD's work and have worked so well for so long for so many.
If your doc doesn't listen to what you are telling them, then seek a second opinion from a pdoc that specialises in the anxiety disorders that know this med and how to diagnose, prescribe, and manage them properly.
I went through 10 years of going from doc to doc (4) until I found someone that listened to what I felt best on. I've been on BZD momotherapy for several years now and regret never having given them a try on equal footing with the AD's...I was never given the chance because the rage being the new ssri's were going to be the wonder drug.....no withdrawl. Poppycock! Every med psychotropic or not has a tapering process, not just BZD's.
Remember, YOU are the boss, your doc is your employee. Don't feel better and are not provided options? Go elsewhere. Second opinions and third opinions are given and sought out every day in medicine as you know.
Best,
Alan
Posted by Alan on February 21, 2002, at 14:13:55
In reply to Re: what meds work best for Anxiety?, posted by Alan on February 21, 2002, at 14:07:54
Terese -
Another good link to read about the latest on BZD's. If you get the "too addictive" line from your doc, then you'll know more about your situation than the doc with these two links that I've provided. Take this one in with you if you want - not as proof, but to show that you know what you're talking about and that you are educating yourself. Don't be pushed around on an endless track by medical idealogues who blame the patient for not responding well to a med like an ssri instead of the other way around.
http://panicdisorder.about.com/library/weekly/aa031997.htm
Alan
Posted by tammy on February 21, 2002, at 14:46:28
In reply to Re: what meds work best for Anxiety?, posted by Alan on February 21, 2002, at 14:13:55
hi,
i have anxiety/ocd, and i was on wellbutrin just took the last one tuesday..... (was on it for 4wks) im like alan and dont need a ad, im not depressed just nervous as H*LL....... wellbutrin made me feel ok, but really didnt do anything about anxiety actually the first 2 wks made it worse, it might have eased (very little) the racing thoughts, so he put me on celexa to try. i'll start that next tuesday......
and i also have ativan just incase...... :)
my experience
good luck
Tammy
Posted by Alan on February 21, 2002, at 17:35:39
In reply to Re: what meds work best for Anxiety?, posted by tammy on February 21, 2002, at 14:46:28
> hi,
> i have anxiety/ocd, and i was on wellbutrin just took the last one tuesday..... (was on it for 4wks) im like alan and dont need a ad, im not depressed just nervous as H*LL....... wellbutrin made me feel ok, but really didnt do anything about anxiety actually the first 2 wks made it worse, it might have eased (very little) the racing thoughts, so he put me on celexa to try. i'll start that next tuesday......
> and i also have ativan just incase...... :)
> my experience
> good luck
> Tammy
********************************************
Ativan just in case? Does that mean that it works for you? Wellbutrin is for most, an activating drug and is rarely as successful as BZD's or even AD's. If ativan works for you why are you not taking it to releive your anxiety full time or at least PRN?BZD monotherapy is what is indicated if you don't respond well to these other therapies - for that matter, even if you do get a response with the other therapies:
http://panicdisorder.about.com/library/weekly/aa031997.htm
and
http://bearpaw8.tripod.com/pd.html
The 2nd link - scroll down to meds including the AD's and the ssri's and then the Benzodiazapines.
If you want to really understand your disorder, please take the time to read this well written, concise, and extremely accurate comprehensive view of panic disorder. It's the best I've found on the internet. My pdoc thinks so too! So much so that they forwarded the link totheir entire staff - a group that specialises in the treatment of anxiety disorders.Happy reading.
Alan
Posted by BobS. on February 21, 2002, at 18:57:32
In reply to Re: what meds work best for Anxiety?, posted by Alan on February 21, 2002, at 14:07:54
Alan,
See posts above regarding GAD/...
Have you any interest in putting to rest the notion, not science, that SSRIs are useful in anxiety disorders? I also wasted 10 years on them. Jay was the poster above and wants to start a campaign. The bearpaw guy came from the Tapir forum. He would be a great source to help counter this SSRI crap, but he's not angry like me. Jay seems like he is. I am waiting to hear from Jay.
Posted by tammy on February 21, 2002, at 22:38:25
In reply to Re: what meds work best for Anxiety? » tammy, posted by Alan on February 21, 2002, at 17:35:39
im not taking the ativan on a regular basis, cause really i think im afraid to, i will read up on the sites u listed.... thanks again
Tammy
Posted by Waterlily on February 22, 2002, at 19:14:23
In reply to Re: what meds work best for Anxiety?, posted by Alan on February 21, 2002, at 14:07:54
Alan, I am intrigued by the information in the link you posted, but from what I read it addresses panic attacks - not GAD. Perhaps I didn't read enough of it? I do have panic attacks every now and then, but also have GAD and depression. I take Wellbutrin SR 150 mg. twice a day for depression and have Ativan on hand for panic attacks. I have tried Paxil, Zoloft, Prozac, and imipramine for the GAD, but only imipramine helped at all and the SSRIs had the nasty sexual side effects. I don't like the dry mouth that imipramine gives me and would like to avoid going back on. I would love to take Ativan (or another benzo) for GAD on a daily basis if it was indicated because it is pretty much the only thing that allows me to relax. I do not drink alcohol at all, nor have I ever taken recreational drugs.
Posted by LizV on February 24, 2002, at 23:19:34
In reply to Re: what meds work best for Anxiety?, posted by Alan on February 21, 2002, at 14:07:54
Looking for suggestions...
My daughter is a 21 year old college senior who has been treated with Effexor XR 75 mg for about a year. She had struggled with severe insomnia for about 2 years and was given Paxil and Klonopin originally, but was excessively tired on the Paxil and so was switched to Effexor XR after about two months. She weaned off the Klonopin (which had only been used a bedtime) after awhile and just used Xanax once in awhile, to help her sleep. Her therapist suggested a change to Buspar, since she still was having problems with anxiety, so she has now been off Effexor for 2 weeks (she was tapered off, after being on the Buspar for 2 weeks). She immediately had withdrawal symptoms (dizziness, diarrhea, nausea) but those improved a little after a week or so. She is now feeling like she is losing control and feeling much more anxious...mind is racing, having severe insomnia, etc. We aren't sure if it's the withdrawal from Effexor or reaction to Buspar. Wondering if anyone has had any experiences with this, or if they could suggest another med to try. We're considering trying Paxil again, since that didn't have much of a trial. She really doesn't want to go back on the Effexor since getting off has been so bad. We're beginning to lose hope that Buspar is going to do any good and we're wondering if it's the culprit right now anyway. Sorry for this long, rambling message. Just looking for any input that may be out there. Thanks.
Liz
Posted by Alan on February 25, 2002, at 9:35:09
In reply to Re: what meds work best for Anxiety?, posted by LizV on February 24, 2002, at 23:19:34
> Looking for suggestions...
> My daughter is a 21 year old college senior who has been treated with Effexor XR 75 mg for about a year. She had struggled with severe insomnia for about 2 years and was given Paxil and Klonopin originally, but was excessively tired on the Paxil and so was switched to Effexor XR after about two months. She weaned off the Klonopin (which had only been used a bedtime) after awhile and just used Xanax once in awhile, to help her sleep. Her therapist suggested a change to Buspar, since she still was having problems with anxiety, so she has now been off Effexor for 2 weeks (she was tapered off, after being on the Buspar for 2 weeks). She immediately had withdrawal symptoms (dizziness, diarrhea, nausea) but those improved a little after a week or so. She is now feeling like she is losing control and feeling much more anxious...mind is racing, having severe insomnia, etc. We aren't sure if it's the withdrawal from Effexor or reaction to Buspar. Wondering if anyone has had any experiences with this, or if they could suggest another med to try. We're considering trying Paxil again, since that didn't have much of a trial. She really doesn't want to go back on the Effexor since getting off has been so bad. We're beginning to lose hope that Buspar is going to do any good and we're wondering if it's the culprit right now anyway. Sorry for this long, rambling message. Just looking for any input that may be out there. Thanks.
> Liz
*************************************************
Yes. The benzodiazapines other than Klonopin. There is xanax, ativan, and valium. If your doctor brings up anything about short term teatment only or the word "addictive", they are way behind the times. BZD monotherapy is what I finally settled on after the AD class and polypharmacy didn't work. Many more eventually end up there anyway. With the drug co's. pushing the new savior as ssri's for anxiety disorders it's hard to cut through all of the static and promotion of a drug that works perhaps about 50% of the time while the BZD's are up in the 85-90% range.Please read these links about meds to educate yourself before going to talk to your doc with your daughter. They are extremely helpful:
http://bearpaw8.tripod.com/pd.html
Scroll down to the benzodaizapines and the AD's and ssri's for good descriptions on each. The whole page is worth reading if you want to help your daughter.
ALSO:
http://panicdisorder.about.com/library/weekly/aa031997.htm
The above 2nd link is especially helpful if your doc gives you the "addiction" line (now obselete). Amongst cutting edge specialists that treat anxiety disorders BZD's are the first line of long or short term therapy as described in the first link and as approved by as prestigious an organisation as the World Health Organisation.
Once you understand the basic principles of these meds and have a doc that will listen to what your daughter is telling them, rather than blaming the patient for not responding to the medication agenda that they have preconceived, you'll be on the right track. Please get a second or third opinion if needed. It's done every day in medicine.
Good luck!
Alan
Posted by Automated Lady on February 25, 2002, at 13:24:57
In reply to Re: what meds work best for Anxiety?, posted by Waterlily on February 22, 2002, at 19:14:23
Hi - just wanted to say that I went on Efexor for anxiety and depression and found my anxiety just went after a few weeks. AL x
Posted by BobS. on February 25, 2002, at 19:58:25
In reply to Re: what meds work best for Anxiety?, posted by Automated Lady on February 25, 2002, at 13:24:57
Please listen to Alan. BZDs are the only choice for a "pure" anxiety disorder. I spent 10 years with the SSRIs have finally escaped from them. I have a son about to enter college and another right after him. Both probably have some anxiety disorders, and I am considering options for them but as long as I am alive they will never touch an SSRI for anxiety. Rescue your daughter from SSRIs before its too late.
Regards,
BobS.
BTW, I work in the field of Clinical Trials and after several years of medline reviews and such am convinced that the trials for SSRIs for anxiety are rigged..
Posted by Alan on February 25, 2002, at 21:48:57
In reply to Re: what meds work best for Anxiety?, posted by BobS. on February 25, 2002, at 19:58:25
Well you do know about the FDA policy that allows drug co's to test new drugs repeatedly and throw out the results that they don't like and only submit the favorable ones to the FDA for approval don't you? That's been in effect for years. It's just being used with sophisticated, lawerly type skills nowadays.
No disrespect to those that find releif with AD's for anxiety disorders (but how do they know it wouldn't be better with BZD's if they had never given them a chance in the first place because of all the ssri hype about the idea that they are "non addicting"???)
If properly diagnosed, which is half the problem in the first place with GP's and internists given specialist's tools such as psychotropics, anxiety disorders have by far the best chance of being put under contol using BZD's with success rates far outweighing any AD in sight which is around 50% tops. The BZD's are in the 80 -90% effecacy rate.
It's such a complicated issue with the stigma of improperly prescribed valium in the late 60's and 70's leading to dependence on drugs that were not meant to combat everyday normal anxiety - with no follow-up by the family doc and so on and so on. Dependence began being viewed as "addiction" and then that loaded word was jumped on by the strident "detox" obsessed anti-benzo lobby - a political group that has influenced policy of NHS in the UK, Australia, and Canada to the point that whole medical systems have temporarily and unjustly taken away the doctor's and patient's choice by spreading exaggerated "risk" of "addiction" scaring the providers and patients in equal portions.
The BZD's will and are coming into their own after these misfortunes and the ssri's are just now rearing their heads as to effecacy (with sexual side effects in the statosphere compared to the initial reports of 10% or so) with GP docs (and pdocs!) that are just towing the company line. I went through 3 of them! Finally i found one that specialised in treating anxiety and knew about the BZD's and the hype around ssri's and the pharm. co's ongoing effort to increase market share by claiming that ssri's have no "withdrawl" - basically a backhanded swipe at the now off-brand BZD's - when now that's pretty much all you read about on this bboard and on other anxiety sites....how to withdraw from this ssri or that ssri.
The fact is that ALL drugs need to be tapered slowly - but now the "non habit forming" paxil (classified non-addictive ironically enough) and other ssri's are calling the same phenomenon "poop-out" or withdrawl syndrome" or some other euphemism that amounts to the same likewise problem with the tapering of BZD's - but surprise! - with much more reported frequency than the BZD's. So which med carries the highest risk for the general poulation? Give it another 5 - 10 years and the landscape will change dramatically in the treatment of anxiety disorders when out of the grass roots will be patients and newly informed docs that have started waking up to the fact that they've been trying to fit square pegs in round holes and then blaming the patient if they don't respond. That's not practicing medicine, it's ideological buffoonery.
So it has nothing to do whether a drug like a BZD is "classified" at all - it's just the docs and co's covering their asses in case of the unlikely event that someone abuses the drug (which rarely ever happens since BZD's don't give you a "high" unless you are combining it with alcohol, etc.) As a matter of fact it's used on the streets illicitly TO COME DOWN FROM A HIGH OR TO GET ONE THROUGH BETWEEN HIGHS, not to get "high" initially.
And after that rant, in the words of Dennis Miller,
Of course that's just my opinion, I could be wrong.
Anyway, it's endless.
Alan
Posted by Frankie on February 27, 2002, at 12:57:27
In reply to Re: what meds work best for Anxiety?, posted by Waterlily on February 22, 2002, at 19:14:23
Hello,
Being that you suffer from primary depression and GAD, Wellbutrin is not the best option. It will worsen the GAD dramatically. A good combo is probably best in your case. I would reccommend Remeron, in combo with Buspar. Neither one will cause sexual side effects, and neither one will worsen your GAD. You might also try Effexor XR, but in combination with a benzo, or Buspar. The final option that I suggest is an SSRI, preferably Celexa or Paxil, with Klonopin. If you overshoot the benzo though, you will have problems with short term memory. Good luck.
Frankie.
Posted by BobS. on February 28, 2002, at 19:13:46
In reply to Re: what meds work best for Anxiety?, posted by Frankie on February 27, 2002, at 12:57:27
Posted by Holly747 on November 13, 2003, at 18:49:10
In reply to Re: what meds work best for Anxiety?, posted by Frankie on February 27, 2002, at 12:57:27
i hope this advice wasnt taken. remeron and buspar cannot be combined! remeron is great for anxiety though put expect weight gain and tiredness.
what do you mean by overshooting benzodiazepines and short-term memory because I am noticing some STM loss
Posted by sandoz-pharm on November 13, 2003, at 21:56:22
In reply to what meds work best for Anxiety?, posted by Terese on February 21, 2002, at 8:14:08
For people like myself, mood stabilizers can be effective for anxiety. Neurontin is a particular one that comes to mind, which seems to be more universally applicable. I'm not sure if my diagnosis truly is bipolar, but the mood stabilizer trileptal is helping my anxiety, and that is usually used for bipolar (and epilepsy). It took about a week before it started working.
L
> I've been diagnosed with Generalized Anxiety Disorder and Panic Disorder. aside from occasional panic attacks, I feel extremely nervous and uncomfortable most of the day. I had this 3 years ago and was treated for about 8 months and then was "normal". now it came back! Three years ago, I was on Paxil which worked well but I put on weight, zoloft but had sexual issues, and serzone which I wasn't on long because I started to feel better. so after about 8 months, discontinued meds and life was good.
>
> A few weeks ago, the anxiety and panic attacks came back. This time around, my doctor first suggested Serzone but I am worried about the liver warnings. So, he put me on Effexor XR one week ago. I know these take some time to work but I'm worried about some of the things I'm reading on the forums. Such as weight gain and withdrawal. I've read some positive things about WEllbutrin.
>
> For Anxiety, what has been your best experience? The 2 items I cannot tolerate are weight gain and sexual dysfunction.
>
> thanks,
> Terese
Posted by Holly747 on November 13, 2003, at 22:06:51
In reply to Re: what meds work best for Anxiety?, posted by sandoz-pharm on November 13, 2003, at 21:56:22
What started you on the idea of a mood stabilizer instead of the traditional forms? My doctor is hard to convince and is helping me less and less every day but there is only a couple other doctors in my city in Canada that are taking new patients. I have to find the cure myself and its frustrating
Posted by Viridis on November 14, 2003, at 0:15:56
In reply to Re: what meds work best for Anxiety? » sandoz-pharm, posted by Holly747 on November 13, 2003, at 22:06:51
Benzodiazepines are still the "gold standard" for anxiety disorders, and are very safe. Klonopin (clonazepam) is probably the easiest to get a prescription for, and is extremely effective. It has low abuse potential, the side effects (usually mild) generally wear off quickly, and for most people the same dose remains effective for anxiety relief indefinitely.
If you haven't tried it, I'd recommend it -- you just have to find a non-benzophobic doctor. The main caution is that if you decide to discontinue it, you'll need to do so gradually, as it's likely to induce dependency. But then, so are most antidepressants and other psychiatric meds.
This is the end of the thread.
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