![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 17 of 17. This is the beginning of the thread.
Posted by g_g_g_unit on March 4, 2011, at 2:54:08
As I've noted on here before - countless times I imagine, so my apologies in advance if you're already familiar with my case history - I've suffered from relatively severe OCD since age 19, and am not exactly a stranger to anxiety. Looking back, however, what I've come to realize is that the hyper-vigilance induced by the OCD became a convenient mechanism for overcoming my ADD symptoms (a theory my psychiatrist very much agrees with).
Since immigrating a year ago though, I've been experiencing a strain of anxiety that's far more insidious, and which basically resembles a 24/7 panic-attack, typically accompanied by feelings of dissociation, mental blankness, a fear of losing control, etc. I am usually the kind of person who will force my way through a problem, but even relatively simple things like journeying into the city or riding a train have now become problematic. I should add that the anxiety has never actually erupted into a real panic attack, thankfully.
Since this problem has arisen, I've tried clomipramine, which didn't help, as well as Buspar, which made me wanna crawl out of my skin, and even Stablon, which again didn't work out. Neurontin completely suppressed the feeling, but was accompanied by daytime sedation, intense apathy, brain fog, etc.
My new psychiatrist is trying to treat my attention issues and has prescribed Dexedrine, which just seemed to push me further into a state of overstimulation, and now Strattera, which isn't as bad Dexedrine, but still seems to leave me in variable states of feeling either stoned and sedated or attentive and wired.
I called him yesterday to update him on Strattera and he said that we'd need to find a way to treat the anxiety. He asked me if I'd ever tried benzodiazepines, to which I replied no, but mentioned the positive reaction I had to Neurontin, and he said he's going to investigate it before our next meeting (since it's more typically prescribed by neurologists).
I'd really prefer not to take Neurontin again. He's under the impression that SSRIs were a total bust for me, but that isn't necessarily true - they simply made my attention a whole lot worse, but given the ADD thing, that retrospectively makes sense.
I was wondering if it would make sense to possibly revisit SSRIs now? Do they work for severe, phobic anxiety? I really can't recall much from the brief amount of time I spent them. I'm not aiming to get rid of the OCD, since CBT helps with that, but I need to find a way to keep my physical anxiety (and the associated dissociation, etc.) under control. From the little amount of research I've done, it seems like low levels of 5-HT (due to depression) might be resulting in a norepinephrine excess.
I really don't want to make my ADD worse or end up in a stupor, so would prefer not to take atypicals or anything. The one I did try - Seroquel - just gave me akathisia anyway.
I was thinking of suggesting Effexor?
Nardil also seems ideal - in fact, I've developed this unfortunate, compulsive fixation on it - but I already tried it about 2 years ago and only lasted 3 months due to the insomnia, etc. I also don't thinking it would be very helpful for ADD; I recall feeling pretty spacey.
Thanks!
Posted by B2Chica on March 4, 2011, at 8:50:42
In reply to Suggestions for severe, stubborn anxiety?, posted by g_g_g_unit on March 4, 2011, at 2:54:08
i thought i read someone saying they used prozac to help with OCD, but maybe do an archive search for that.
i know you said you didnt want to try atypicals, but...if you did i would suggest zyprexa. it Completley helps with anxiety and helps with OCD. i've been on 5 and 10. 10 works the best for crazy anxiety, but could probably get by with 5 as that's all i needed to help with ocd in past.
my ocd was increased by anxiety so once that calmed down ocd was better.non-benzo's i've only tried gabapenting (neurontin) and you said you didnt want to go that route again.
sorry not much more help.best wishes
b2c.
Posted by jms600 on March 4, 2011, at 11:00:30
In reply to Re: Suggestions for severe, stubborn anxiety? » g_g_g_unit, posted by B2Chica on March 4, 2011, at 8:50:42
Hi g_g_g_unit. I know what your going through. I"m experiencing a pretty rough patch of anxiety too at the moment. I'm currently on 20mgs Cipralex, 600mgs lithium, 40mgs buspirone and 10mgs Zyprexa - and I'm still getting severe GAD and panic disorder, along with moderate depression. I also take Valium on an as needed basis.
I've asked my doc about Nardil but he's reluctant as it's an MAOI.
I can't say Cipralex has been particularly good for my anxiety. Zyprexa is supposed to be really good for anxiety but I'm on 10mgs per day of the Velotab type yet it's doing virtually nothing - apart from making me gain weight.
I seemed to do okay (*but just okay) on Effexor so you could try that again - but be wary of raising the dose to high if noreadrenaline is an issue with you.
I'd also recommend trying a benzo on an as needed basis.
Good luck!
Posted by Phillipa on March 4, 2011, at 11:28:11
In reply to Re: Suggestions for severe, stubborn anxiety?, posted by jms600 on March 4, 2011, at 11:00:30
If you have not taken a benzo before they do work unfortunately after 41 years they don't for me anymore. But wow in the beginning worked like a charm. Benzos alone no other meds involved. And at times I'd just stop taking them as didn't need them. I was so med niave could be why. Phillipa
Posted by g_g_g_unit on March 4, 2011, at 20:52:39
In reply to Re: Suggestions for severe, stubborn anxiety? » g_g_g_unit, posted by B2Chica on March 4, 2011, at 8:50:42
> i thought i read someone saying they used prozac to help with OCD, but maybe do an archive search for that.
Thanks. Unfortunately, I've tried Prozac on two separate occasions now, but had to stop it each time due to insomnia.
>
> i know you said you didnt want to try atypicals, but...if you did i would suggest zyprexa. it Completley helps with anxiety and helps with OCD. i've been on 5 and 10. 10 works the best for crazy anxiety, but could probably get by with 5 as that's all i needed to help with ocd in past.
> my ocd was increased by anxiety so once that calmed down ocd was better.Yeah, I'm not crazy about the idea of atypicals, though if it comes to that, I'll keep Zyprexa in mind.
>
> non-benzo's i've only tried gabapenting (neurontin) and you said you didnt want to go that route again.
> sorry not much more help.
>Yeah, Neurontin was really helpful in certain respects, but always left me feeling completely deprived of motivation and just, well, dead inside. It was weird.
Posted by g_g_g_unit on March 4, 2011, at 21:02:36
In reply to Re: Suggestions for severe, stubborn anxiety?, posted by jms600 on March 4, 2011, at 11:00:30
> Hi g_g_g_unit. I know what your going through. I"m experiencing a pretty rough patch of anxiety too at the moment. I'm currently on 20mgs Cipralex, 600mgs lithium, 40mgs buspirone and 10mgs Zyprexa - and I'm still getting severe GAD and panic disorder, along with moderate depression. I also take Valium on an as needed basis.
Wow, that's quite the combination. I'm sorry (and surprised) to hear that you're still suffering.
>
> I've asked my doc about Nardil but he's reluctant as it's an MAOI.Sure, but what else does he propose if your current combination isn't working?
>
> I can't say Cipralex has been particularly good for my anxiety. Zyprexa is supposed to be really good for anxiety but I'm on 10mgs per day of the Velotab type yet it's doing virtually nothing - apart from making me gain weight.Yeah, it's kinda weird - browsing through the archives, the responses re: SSRIs for anxiety are actually kinda mixed. I'd always assumed they were something of a gold-standard, or at least a safe, non-addictive first-line agent. I was hesitant to return to them, given the attention-difficulties they produced, but always figured I could fall back on them if need be.
>
> I seemed to do okay (*but just okay) on Effexor so you could try that again - but be wary of raising the dose to high if noreadrenaline is an issue with you.Did you find that Effexor was better for anxiety than Cipralex?
>
> I'd also recommend trying a benzo on an as needed basis.
>
> Good luck!
Posted by sigismund on March 5, 2011, at 13:22:39
In reply to Suggestions for severe, stubborn anxiety?, posted by g_g_g_unit on March 4, 2011, at 2:54:08
I wonder if that which helps your anxiety will make your dissociation and brain fog worse?
Posted by jms600 on March 5, 2011, at 16:50:33
In reply to Re: Suggestions for severe, stubborn anxiety? » jms600, posted by g_g_g_unit on March 4, 2011, at 21:02:36
> > Hi g_g_g_unit. I know what your going through. I"m experiencing a pretty rough patch of anxiety too at the moment. I'm currently on 20mgs Cipralex, 600mgs lithium, 40mgs buspirone and 10mgs Zyprexa - and I'm still getting severe GAD and panic disorder, along with moderate depression. I also take Valium on an as needed basis.
>
> Wow, that's quite the combination. I'm sorry (and surprised) to hear that you're still suffering.
>
> >
> > I've asked my doc about Nardil but he's reluctant as it's an MAOI.
>
> Sure, but what else does he propose if your current combination isn't working?
> >
> > I can't say Cipralex has been particularly good for my anxiety. Zyprexa is supposed to be really good for anxiety but I'm on 10mgs per day of the Velotab type yet it's doing virtually nothing - apart from making me gain weight.
>
> Yeah, it's kinda weird - browsing through the archives, the responses re: SSRIs for anxiety are actually kinda mixed. I'd always assumed they were something of a gold-standard, or at least a safe, non-addictive first-line agent. I was hesitant to return to them, given the attention-difficulties they produced, but always figured I could fall back on them if need be.
>
> >
> > I seemed to do okay (*but just okay) on Effexor so you could try that again - but be wary of raising the dose to high if noreadrenaline is an issue with you.
>
> Did you find that Effexor was better for anxiety than Cipralex?
>
> >
> > I'd also recommend trying a benzo on an as needed basis.
> >
> > Good luck!
>
>
Yes - I do believe that I did better with Effexor than I have done with Cipralex. So much so, that I'm going to ask my p/doc to put me back on Effexor when I see him again in a fortnight. I don't think the Effexor was a fantastic drug, but compared to Cipralex it's more effective (for me anyway - can't comment on anyone else).Why I find Effexor a more effective drug, I don't know. Maybe someone else on here could offer a reason..?
Posted by g_g_g_unit on March 6, 2011, at 3:42:18
In reply to Re: Suggestions for severe, stubborn anxiety?, posted by sigismund on March 5, 2011, at 13:22:39
> I wonder if that which helps your anxiety will make your dissociation and brain fog worse?
I suppose so? That was certainly the case with Neurontin. I read a post in the archives from SLS who said that depersonalization often occurs when anxiety is superimposed over anhedonia. Most treatments can probably help with the former, but not so much the latter. Still, the anxiety is so unbearable that I don't really have a choice.
Posted by g_g_g_unit on March 6, 2011, at 3:46:34
In reply to Re: Suggestions for severe, stubborn anxiety? » g_g_g_unit, posted by jms600 on March 5, 2011, at 16:50:33
>
> Yes - I do believe that I did better with Effexor than I have done with Cipralex. So much so, that I'm going to ask my p/doc to put me back on Effexor when I see him again in a fortnight. I don't think the Effexor was a fantastic drug, but compared to Cipralex it's more effective (for me anyway - can't comment on anyone else).
>
> Why I find Effexor a more effective drug, I don't know. Maybe someone else on here could offer a reason..?
>So you found Effexor suitable for anxiety? My problem seems to be that anything that works on norepinephrine makes my condition worse. I couldn't even tolerate Anafranil - the "gold standard" OCD treatment - at *any* dose. I realize Effexor isn't a particularly potent NRI, so maybe I'd be okay on it?
Has anyone here been unable to tolerate other NRIs, but found they were okay with Effexor?
I'm thinking that's what I might suggest at our next meeting.
Posted by linkadge on March 6, 2011, at 6:58:27
In reply to Re: effexor and norepinephrine » jms600, posted by g_g_g_unit on March 6, 2011, at 3:46:34
Even though effexor is supposedly not noreadrenergic till higher doses, I noticed a number of unpleasant cardiac side effects even at 37.5mg. Ultimately, I abandoned it because of the cardiac side effects.
Linkadge
Posted by bleauberry on March 13, 2011, at 8:53:59
In reply to Suggestions for severe, stubborn anxiety?, posted by g_g_g_unit on March 4, 2011, at 2:54:08
I would just caution to not underestimate the power and spectrum of the plants of the earth. In your case, Lemon Balm tincture.
Longer term you can explore whatever meds you want. But for right now emergency use, Lemon Balm. It can be taken with meds.
That kind of anxiety doesn't just happen for some unknown mysterious reason. Unless you are probing to explore things like cortisol and bacterial infections and food choices, meds will at best help control the symptoms but do nothing to address the cause, which will likely continue to progress and morph over time.
For right now here today though, you need some relief! I've been there. I know exactly the kind of torment you have described. And I've tried a zillion things. In my own emergency stash for such times I carry my proven winners....1)Lemon Balm, 2)Xanax, 3)Klonopin. I much prefer Lemon Balm because at a high enough dose it delivers the same kind of rapid calming that Xanax does, except with some mood boost as well, not much sedation, and a clearer mind instead of a foggy mind.
Posted by jono_in_adelaide on March 28, 2011, at 19:59:44
In reply to Re: Suggestions for severe, stubborn anxiety? » sigismund, posted by g_g_g_unit on March 6, 2011, at 3:42:18
Sertraline + nortriptyline every day (100mg sertraline, 75mg nortriptyline, at bedtime), and a long acting benzo "as needed".... Valium, Librium or Tranxene
Posted by ed_uk2010 on March 29, 2011, at 13:43:48
In reply to Re: Suggestions for severe, stubborn anxiety?, posted by jono_in_adelaide on March 28, 2011, at 19:59:44
> Sertraline + nortriptyline every day (100mg sertraline, 75mg nortriptyline, at bedtime), and a long acting benzo "as needed".... Valium, Librium or Tranxene
I think Valium is more effective than Librium though.
Posted by mtdewcmu on April 2, 2011, at 1:10:44
In reply to Re: Suggestions for severe, stubborn anxiety? » sigismund, posted by g_g_g_unit on March 6, 2011, at 3:42:18
>
> I read a post in the archives from SLS who said that depersonalization often occurs when anxiety is superimposed over anhedonia.That's interesting. Do you have a link? I don't feel anxious all the time, but I think my anxiety manifests in other ways, such as inability to think clearly, and feeling slightly detached from what's going on around me. I have experienced frank depersonalization and derealization in the past.
Posted by g_g_g_unit on April 9, 2011, at 7:28:20
In reply to Re: Suggestions for severe, stubborn anxiety?, posted by mtdewcmu on April 2, 2011, at 1:10:44
> That's interesting. Do you have a link? I don't feel anxious all the time, but I think my anxiety manifests in other ways, such as inability to think clearly, and feeling slightly detached from what's going on around me. I have experienced frank depersonalization and derealization in the past.
>Sorry for the tardy reply. This isn't the exact post I was looking for, but it conveys the same basic sentiment - http://www.dr-bob.org/babble/20090104/msgs/877404.html
Posted by mtdewcmu on April 12, 2011, at 16:08:36
In reply to Re: Suggestions for severe, stubborn anxiety? » mtdewcmu, posted by g_g_g_unit on April 9, 2011, at 7:28:20
>
> > That's interesting. Do you have a link? I don't feel anxious all the time, but I think my anxiety manifests in other ways, such as inability to think clearly, and feeling slightly detached from what's going on around me. I have experienced frank depersonalization and derealization in the past.
> >
>
> Sorry for the tardy reply. This isn't the exact post I was looking for, but it conveys the same basic sentiment - http://www.dr-bob.org/babble/20090104/msgs/877404.htmlActually, I think I found the post you were referring to. Thanks.
This is the end of the thread.
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.