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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 15 of 15. This is the beginning of the thread.
Posted by UgottaHaveHope on December 25, 2006, at 17:26:39
I never knew anxiety or depression existed until 1997, when out of the blue I was overwhelmed with nervous energy. At first, I thought it derived from concerns over a tightness in my chest, then scalp problems and (most recently) a longstanding dry cough.
However, now I have come to realize those were all masks for anxiety, but for what type of anxiety I do not know. Here is the best way I can explain it: It's like walking through a haunted house, and knowing you are going to get scared, but not when. In other words, I become obsessively worried about worry. I just have this fear ... of fear. It last all day, every day.
Seroquel has helped a little bit in "blunting" the race of fear, but when I am worked up as I am know, the 400mg doesn't seem to help. Can anyone relate to this? Any med suggestions? Any insight on that type of anxiety? My mind just races and races with fear.
Posted by Quintal on December 25, 2006, at 18:26:24
In reply to What is this anxiety that comes out of nowhere?, posted by UgottaHaveHope on December 25, 2006, at 17:26:39
> Seroquel has helped a little bit in "blunting" the race of fear, but when I am worked up as I am know, the 400mg doesn't seem to help. Can anyone relate to this? Any med suggestions? Any insight on that type of anxiety? My mind just races and races with fear.
Yes, I have that feeling often. Seroquel generally dulls everything down - feels a bit like a barbiturate to me, but it seems to take all the colour out of life with it. Benzos are an obvious choice if you haven't taken them already, then perhaps Lyrica or even an anxiolytic MAOI like Nardil? I presume you tried some SSRIs etc.?
Opiates are also good anxiolytics.
Q
Posted by UgottaHaveHope on December 25, 2006, at 20:33:44
In reply to Re: What is this anxiety that comes out of nowhere? » UgottaHaveHope, posted by Quintal on December 25, 2006, at 18:26:24
I have been diagnosed with GAD and depression. Meds I have tried since 1997
Lamictal
Neurontin
Effexor
Lexapro
Celexa
Prozac
Paxil
Serzone
Adderall
Xanax
Klonopin
Valium
Buspar
SeroquelI am currently: 400mg of Seroquel and 2mg of Klonopin. Any suggestions on what to try next? The pdoc mentioned Ensam perhaps. Seroquel is the only one I have had a positive reaction to, and I am wondering why? Thanks for your feedback.
Posted by Quintal on December 25, 2006, at 21:17:38
In reply to Re: Meds I have tried .. SLS, MedEm, Blue, Yxibow?, posted by UgottaHaveHope on December 25, 2006, at 20:33:44
Sorry to butt in again, but the symptoms you're describing sound in some ways like panic. Have you ever tried a beta blocker to test your response (assuming you don't have asthma or something else contraindicated)? To my mind EMSAM is the type of stimulating AD that is likely to make anxiety and racing thoughts worse, but there are exceptions.
It's also possible that the racing thoughts are of bipolarish origin and you're experiencing mixed states - yet you've already tried Lamictal without success. How about a GABAergic anticonvulsant like Depakote or Lyrica (it's also licensed for GAD and is supposed to be more effective than Neurontin)? Lithium may also be worth a try.
I'm not sure why you responded to Seroquel and none of the others but it could have something to do with Seroquel being so rapidly effective at slowing racing thoughts. It is also the only med licensed as a monotherapy in the treatment of depressive episodes in bipolar disorder so this suggests it has both mood stabilizing and antidepressant actions. It also has some anxiolytic effect. Apparently Seroquel has been abused for that reason (!):
http://ajp.psychiatryonline.org/cgi/content/full/161/9/1718
Q
Posted by Phillipa on December 25, 2006, at 22:41:55
In reply to What is this anxiety that comes out of nowhere?, posted by UgottaHaveHope on December 25, 2006, at 17:26:39
Michael that is me to a tee. E-mail me okay? Love Phillipa
Posted by med_empowered on December 25, 2006, at 22:56:36
In reply to Re: What is this anxiety that comes out of nowhere? » UgottaHaveHope, posted by Phillipa on December 25, 2006, at 22:41:55
First, I'd look at your life itself--stressors, problems, etc. Consider counselling along with whatever else you're doing, or at least reflect on your existence. This helps a lot.
Seroquel really isn't the best thing for anxiety--my guess is that if you react well to neuroleptics for anxiety, it means there's more agitation and other factors involved than with "simple anxiety". I think you might want to try a benzo, but maybe not klonopin--its cool for a while, but it really is a depressing drug long-term. My vote would go for Ativan, which you would need to take either as-needed or on a regular dosing schedule, several times daily. Its not as potent as Klonopin, but it goes to work faster and is pretty neutral with regards to effects on mood (neither lifts nor lowers for a lot of people). Plus, unlike Klonopin, it wears off after several hours and does so gently (unlike xanax) so its the cleanest benzo I can think of. Dosages vary; you might do OK with 2mgs a day; if you're having mixed-episode level anxiety, you might end up more in the 6-10mgs/day range.
A beta blocker might help, too. I personally wouldn't use one for a long time (depression) or in high doses (just a bad idea), but they can help with other stuff, especially with benzos (you get synergy there). Propranolol is the major one for this kind of thing, but others are available.
Neuroleptics really aren't a good idea long term, since you could end up making your mood worse (neuroleptic induced dysphora) and you run all kinds of risks (diabetes, obesity, tardive dyskinesia, etc.) but they might be good PRN. A mood stabilizer might help; personally, I'd go for Trileptal, since the blood work is minimal (check your blood sodium ever now and then) and the side effects are relatively mild. Dosages vary, but personally I found that it wook 600mgs to work, 900mgs to work on intense problems, and 1200mgs made me stupid. Your results will vary, of course.
Diet is important. Nutrients are important. I appreciate this even more now that I'm off all medications than I ever did while I was on them. B-Vitamins help a lot; huge niacinamide doses bind to benzo receptors and may help anxiety and ((possibly)) schizophrenia, so that's something to consider. Taurine, fish oils, and choline are examples of other supplements that might help.
Good luck.
Posted by yxibow on December 26, 2006, at 1:47:35
In reply to What is this anxiety that comes out of nowhere?, posted by UgottaHaveHope on December 25, 2006, at 17:26:39
> I never knew anxiety or depression existed until 1997, when out of the blue I was overwhelmed with nervous energy. At first, I thought it derived from concerns over a tightness in my chest, then scalp problems and (most recently) a longstanding dry cough.
>
> However, now I have come to realize those were all masks for anxiety, but for what type of anxiety I do not know. Here is the best way I can explain it: It's like walking through a haunted house, and knowing you are going to get scared, but not when. In other words, I become obsessively worried about worry. I just have this fear ... of fear. It last all day, every day.
>
> Seroquel has helped a little bit in "blunting" the race of fear, but when I am worked up as I am know, the 400mg doesn't seem to help. Can anyone relate to this? Any med suggestions? Any insight on that type of anxiety? My mind just races and races with fear.
Some of it sounds like Somatiform conditions -- especially the cough. Other parts sound like an autonomic nervous system gone full blown, the fear of fear. And there's a tone of OCD to it as well. If the Seroquel is doing something, so much the better, its the weakest of the neuroleptics except for the sleep part which I know all too well.
Perhaps an admixture of a benzodiazepine for a short while -- I know Ativan was mentioned, it does have more immediacy like Xanax, but that's also a problem getting off of it.
Klonopin does not cause depression in everyone, and Valium has an even longer half life. Neither does propranolol cause depression in everyone, but I guess perhaps I have a high tolerance for it and Valium; people with OC spectrum disorders generally have a high tolerance for a lot of medications.
It does sound like you've been through quite a laundry list of medications, but have any of them ever been polypharmacy -- that is, multiple drugs acting for a single purpose as opposed to running through the list and throwing each bottle away. Sometimes a combination of medications is necessary.
Thirdly, while this is a medication board I think there is also a need for some form of psychotherapy to get to the crux of things, because the topic bears a question -- what is the anxiety and where is it coming from? Is it simply innate GAD or the like, or is there more to it?The two work hand in hand, medication will not wash everything away.
Anyhow, just my view
-- tidings
Posted by jimmygold70 on December 26, 2006, at 11:13:32
In reply to What is this anxiety that comes out of nowhere?, posted by UgottaHaveHope on December 25, 2006, at 17:26:39
How old you were back then in 1997?
Let's admit it's kind of an anxiety disorder. I don't find diagnoses that useful but panic disorder + agoraphobia and maybe comorbid generalized anxiety disorder, or anything in between. Are there any other symptoms?J
> I never knew anxiety or depression existed until 1997, when out of the blue I was overwhelmed with nervous energy. At first, I thought it derived from concerns over a tightness in my chest, then scalp problems and (most recently) a longstanding dry cough.
>
> However, now I have come to realize those were all masks for anxiety, but for what type of anxiety I do not know. Here is the best way I can explain it: It's like walking through a haunted house, and knowing you are going to get scared, but not when. In other words, I become obsessively worried about worry. I just have this fear ... of fear. It last all day, every day.
>
> Seroquel has helped a little bit in "blunting" the race of fear, but when I am worked up as I am know, the 400mg doesn't seem to help. Can anyone relate to this? Any med suggestions? Any insight on that type of anxiety? My mind just races and races with fear.
Posted by blueberry1 on December 26, 2006, at 15:37:49
In reply to What is this anxiety that comes out of nowhere?, posted by UgottaHaveHope on December 25, 2006, at 17:26:39
I know exactly that feeling you are talking about. What it is, I do not know. I call it 'free floating fear'.
Seroquel was not able to get rid of it for me. But zyprexa was. Zyprexa does a better job at blocking it out, whatever it is. You might consider a switch, either a cross-over taper or a direct switch.
I also second the motion on the other posters about benzos. Klonopin or diazepam were all able to get rid of that feeling completely, while xanax did it sort of. On xanax I was relaxed but still could feel that fear lurking under the surface.
I don't know if you are on a ssri antidepressant or not. If you aren't I think a low dose of one is a good base, or a good background, for other things to work. I'm talking like 25mg zoloft, 5mg to 10mg paxil, 37.5mg effexor. Something like that. In my experience only, a small bit of an ssri helps everything else work better when it comes to anxiety fear stuff.
Mileage varies so much, so it is hard to say. I'm sharing my own experiences which seem identical to yours. Right now I am only taking 1.25mg zyprexa and I can feel that fear a little bit every day. To block it out completely I would probably need 2.5mg zyprexa, low dose ssri, and low dose benzo.
Posted by UgottaHaveHope on December 27, 2006, at 13:11:13
In reply to Re: What is this anxiety that comes out of nowhere?, posted by blueberry1 on December 26, 2006, at 15:37:49
I appreciate everyone's responses. Given me a lot to think about. Thanks, Michael
Posted by Phillipa on December 27, 2006, at 18:25:02
In reply to Thanks ... anyone else w/opinion? SLS, Link, Willy, posted by UgottaHaveHope on December 27, 2006, at 13:11:13
Michael what do you think it is? Love Phillipa
Posted by tom_traubert on December 27, 2006, at 23:30:04
In reply to What is this anxiety that comes out of nowhere?, posted by UgottaHaveHope on December 25, 2006, at 17:26:39
I don't have as much pharmacological advice as klonopin is the only benzo I've taken, but I'd like to recommend an excellent book if you haven't already seen it: "The Anxiety & Phobia Workbook"
It really is the only text I've found that is completely straightforward, unpatronizing, informative and well written. It just spells anxiety out so damn clearly.
Best of luck,
tt
Posted by UgottaHaveHope on December 28, 2006, at 0:03:49
In reply to Re: What is this anxiety that comes out of nowhere, posted by tom_traubert on December 27, 2006, at 23:30:04
I already had "Beyond Anxiety" by Bourne, and just bought the new edition you have linked. That book is probably the best ever written about anxiety overall, no doubt. Thanks for your feedback.
Have you ever read "Feeling Good"?
Posted by tom_traubert on December 28, 2006, at 8:44:42
In reply to Re: What is this anxiety that comes out of nowhere » tom_traubert, posted by UgottaHaveHope on December 28, 2006, at 0:03:49
> I already had "Beyond Anxiety" by Bourne, and just bought the new edition you have linked. That book is probably the best ever written about anxiety overall, no doubt. Thanks for your feedback.
>
> Have you ever read "Feeling Good"?No, that's a new one for me--I just looked at the website. I'll definitely check it out.
Thanks,
tt
Posted by Phillipa on December 28, 2006, at 18:24:19
In reply to Re: What is this anxiety that comes out of nowhere » UgottaHaveHope, posted by tom_traubert on December 28, 2006, at 8:44:42
I read and owned the workbook and it was excellent when my high anxiety was new and I could concentrate. But I can't do the excercises. Muscle relaxation,deep breathing, does it contain the new meds too? Love Phillipa
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