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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 4 of 4. This is the beginning of the thread.
Posted by Paul Frank on February 20, 1999, at 10:02:38
I was very excited indeed to find this board. Dr. Bob should be congratulated for providing a valuable and much needed service After a week of reading the posts, I decided to take the plunge and post my own story along with some questions. Responses from professionals and non professionals are welcome. I will be as brief as possible.
For as long as I can remember, I have suffered from chronic anxiety. For the vast majority of my life, the anxiety has been manageable and has been more of an inconvenience than anything else. However, there have been a number of times when, following a significant crisis in my life, the anxiety has become acute. While I don't normally experience panic during these times, the acute anxiety is nevertheless quite unpleasant and at times unbearable. In the past, I have only infrequently used sedatives and 99% of the time, just tolerated the misery. Each time, the acute phase lasted between 3 and 5 months and then disappears (Thank God!!). I then return to my previous state of mild but manageable anxiety.
My last such episode occurred 21 years ago. In the interim, I married, and have two wonderful kids. I built a successful career and, in general, have been reasonably content. However I have tended, without good reason, to worry a lot especially about my own and my family's health (I'm terrified of cancer!!). I have always been a worrier.
Six months ago, my wife's doctor found a cyst on one of her ovaries. While we were assured it likely was not cancer, we both worried a great deal, especially me. After about four weeks of this "normal" worry, my anxiety quickly escalated and I found myself once again in the midst of an acute anxiety state. After 21 years of being free of this miserable state, it was very demoralizing to once again find myself in this personal "hell".
After 2 ½ months of this, I finally went to my doctor who felt that some of my symptoms (sleep disturbance, poor appetite and weight loss, lack of interest in things) indicated major depression. I was not convinced, as, in my opinion, most if not all the symptoms of depression can be attributed to chronic, acute anxiety. Nevertheless, she prescribed Prozac 20 mg, and indicated that if it worked, it would help with both the anxiety and depression. I remained on it just short of 4 weeks (no dose increase) and found that the appetite and sleep problems improved, but the anxiety and other "psychic" symptoms did not. She decided this drug was not working for me and started me on Zoloft.
Here are my questions;
1. Have people found that the SSRI's are effective against chronic anxiety with or without depressive symptoms? If so, which SSRI's have people found to be most effective with the latter problem?
2. If one or two SSRIs are unsuccessful, does it make sense to go to another drug in the same family such as Paxil (this is what my doctor wants to try me on if the Zoloft doesn't work) or should we be trying another class of drug ie an SNRI ( I have been reading a lot of good things about Effexor and especially Serzone)? I would really like to avoid TCAs and MAOIs if possible.
3. I have been reading a lot of good things about BuSpar, both as an anti-anxiety agent and anxiety accompanied by depression. My doctor indicated she does not normally prescribe this drug, as she has questions about its effectiveness. My pharmacist indicated that the SSRIs are now more commonly prescribed for chronic anxiety than is BuSpar. Any thoughts on this?
4. I have been on the Zoloft for about 5 weeks now and have moved up slowly beginning with 25 mg. I have now been on 100 mg for just under two weeks. My appetite and sleep patterns have remained good. As well, I notice that there has been a reduction in the intensity of my anxiety and I seem less demoralized and more interested in things. However, I am still experiencing elevated levels of anxiety and I still consider myself to be "in crisis". Have I given Zoloft a fair chance? Should I remain on it a bit longer, perhaps at a higher dose? (I keep reading that the most common reason for the failure of an anti-depressant is too low a dose for too short a period of time - maybe we didn't give the Prozac a fair chance either!!). I find myself worrying that I will be one of the 10 - 20 % of the people who will not respond to any of the anti-depressants.
5. In the last week, I have been experiencing a new kind of anxiety. It is not the gut-wrenching, "deep in your soul" kind of worry, but more a superficial jitteriness or nervousness that , at times, can be rather unpleasant. I normally do not experience this kind of anxiety. Is it possible this is a side effect of the Zoloft? If so, why is it appearing now after I have been on the Zoloft for a while? Why didn't it show up earlier?
6. I respond very well to Ativan and Klonopin. In particular, I find that when I take Klonopim (.75 to 1 mg), the change is almost miraculous. The symptoms of both anxiety and depression (if in fact they are symptoms of depression) literally evaporate and I feel a sense of well-being, and a real sense of hope that I will once again be free of this miserable state. I feel like my old self and really enjoy my life. However, the drug appears to poop out on me after about 1 hour. It seems to last longer if I take it with food. My doctor suggested I try Xanax, but both she and I are concerned about the increased potential for dependency with this drug. I am extremely concerned about the potential for psychological and/or physical dependency with any of the benzos and I likely do not take them nearly as often as I should. Any thoughts on this??
7. (Last question) One of the most confusing things about my situation is the fact that I can't seem to determine for sure if my problem is essentially anxiety or depression or a combination of both. Have other people experienced this confusion as well?
Thanks to all for responding. I have done lots of research into the areas of anxiety and depression and, unfortunately, I have lots of personal experience with emotional turmoil. I would be more than happy to share my experience and to offer my perspective to others on the board.
Paul
Posted by Julian on February 20, 1999, at 16:54:05
In reply to New to Board - Anxiety & Depression, posted by Paul Frank on February 20, 1999, at 10:02:38
> I was very excited indeed to find this board. Dr. Bob should be congratulated for providing a valuable and much needed service After a week of reading the posts, I decided to take the plunge and post my own story along with some questions. Responses from professionals and non professionals are welcome. I will be as brief as possible.
>
> For as long as I can remember, I have suffered from chronic anxiety. For the vast majority of my life, the anxiety has been manageable and has been more of an inconvenience than anything else. However, there have been a number of times when, following a significant crisis in my life, the anxiety has become acute. While I don't normally experience panic during these times, the acute anxiety is nevertheless quite unpleasant and at times unbearable. In the past, I have only infrequently used sedatives and 99% of the time, just tolerated the misery. Each time, the acute phase lasted between 3 and 5 months and then disappears (Thank God!!). I then return to my previous state of mild but manageable anxiety.
>
> My last such episode occurred 21 years ago. In the interim, I married, and have two wonderful kids. I built a successful career and, in general, have been reasonably content. However I have tended, without good reason, to worry a lot especially about my own and my family's health (I'm terrified of cancer!!). I have always been a worrier.
>
> Six months ago, my wife's doctor found a cyst on one of her ovaries. While we were assured it likely was not cancer, we both worried a great deal, especially me. After about four weeks of this "normal" worry, my anxiety quickly escalated and I found myself once again in the midst of an acute anxiety state. After 21 years of being free of this miserable state, it was very demoralizing to once again find myself in this personal "hell".
>
> After 2 ½ months of this, I finally went to my doctor who felt that some of my symptoms (sleep disturbance, poor appetite and weight loss, lack of interest in things) indicated major depression. I was not convinced, as, in my opinion, most if not all the symptoms of depression can be attributed to chronic, acute anxiety. Nevertheless, she prescribed Prozac 20 mg, and indicated that if it worked, it would help with both the anxiety and depression. I remained on it just short of 4 weeks (no dose increase) and found that the appetite and sleep problems improved, but the anxiety and other "psychic" symptoms did not. She decided this drug was not working for me and started me on Zoloft.
>
> Here are my questions;
>
> 1. Have people found that the SSRI's are effective against chronic anxiety with or without depressive symptoms? If so, which SSRI's have people found to be most effective with the latter problem?
>
> 2. If one or two SSRIs are unsuccessful, does it make sense to go to another drug in the same family such as Paxil (this is what my doctor wants to try me on if the Zoloft doesn't work) or should we be trying another class of drug ie an SNRI ( I have been reading a lot of good things about Effexor and especially Serzone)? I would really like to avoid TCAs and MAOIs if possible.
>
> 3. I have been reading a lot of good things about BuSpar, both as an anti-anxiety agent and anxiety accompanied by depression. My doctor indicated she does not normally prescribe this drug, as she has questions about its effectiveness. My pharmacist indicated that the SSRIs are now more commonly prescribed for chronic anxiety than is BuSpar. Any thoughts on this?
>
> 4. I have been on the Zoloft for about 5 weeks now and have moved up slowly beginning with 25 mg. I have now been on 100 mg for just under two weeks. My appetite and sleep patterns have remained good. As well, I notice that there has been a reduction in the intensity of my anxiety and I seem less demoralized and more interested in things. However, I am still experiencing elevated levels of anxiety and I still consider myself to be "in crisis". Have I given Zoloft a fair chance? Should I remain on it a bit longer, perhaps at a higher dose? (I keep reading that the most common reason for the failure of an anti-depressant is too low a dose for too short a period of time - maybe we didn't give the Prozac a fair chance either!!). I find myself worrying that I will be one of the 10 - 20 % of the people who will not respond to any of the anti-depressants.
>
> 5. In the last week, I have been experiencing a new kind of anxiety. It is not the gut-wrenching, "deep in your soul" kind of worry, but more a superficial jitteriness or nervousness that , at times, can be rather unpleasant. I normally do not experience this kind of anxiety. Is it possible this is a side effect of the Zoloft? If so, why is it appearing now after I have been on the Zoloft for a while? Why didn't it show up earlier?
>
> 6. I respond very well to Ativan and Klonopin. In particular, I find that when I take Klonopim (.75 to 1 mg), the change is almost miraculous. The symptoms of both anxiety and depression (if in fact they are symptoms of depression) literally evaporate and I feel a sense of well-being, and a real sense of hope that I will once again be free of this miserable state. I feel like my old self and really enjoy my life. However, the drug appears to poop out on me after about 1 hour. It seems to last longer if I take it with food. My doctor suggested I try Xanax, but both she and I are concerned about the increased potential for dependency with this drug. I am extremely concerned about the potential for psychological and/or physical dependency with any of the benzos and I likely do not take them nearly as often as I should. Any thoughts on this??
>
> 7. (Last question) One of the most confusing things about my situation is the fact that I can't seem to determine for sure if my problem is essentially anxiety or depression or a combination of both. Have other people experienced this confusion as well?
>
> Thanks to all for responding. I have done lots of research into the areas of anxiety and depression and, unfortunately, I have lots of personal experience with emotional turmoil. I would be more than happy to share my experience and to offer my perspective to others on the board.
>
>
> PaulDear Paul,
A major symptom of depression is Anxiety. I have found that all SSRI,s cause more anxiety for those who tend to have that problem. I too have that problem. I found that Remron and Serzone are the best antidepresents for this problem.
With Remron you tend to gain weight. Serzone takes longer to work but has no weight problems.
Ask your MD. If she is not familiar with these meds it might be time to change MDs.
Julian
Posted by Matt on February 25, 1999, at 2:46:56
In reply to New to Board - Anxiety & Depression, posted by Paul Frank on February 20, 1999, at 10:02:38
2. If one or two SSRIs are unsuccessful, does it make sense to go to another drug in the same family
such as Paxil (this is what my doctor wants to try me on if the Zoloft doesn't work) or should we be
trying another class of drug ie an SNRI ( I have been reading a lot of good things about Effexor and
especially Serzone)? I would really like to avoid TCAs and MAOIs if possible.TCAs have been given a bad rap, I think. They have their place, and are many quite effective on depression and anxiety. So I would't rule out TCAs totally. But I'd probably not look to them as first-line drugs, either.
As I mentioned, I'd try Celexa, Remeron, and Effexor (and probably a TCA) before trying Serzone.
3. I have been reading a lot of good things about BuSpar, both as an anti-anxiety agent and anxiety
accompanied by depression. My doctor indicated she does not normally prescribe this drug, as she has
questions about its effectiveness. My pharmacist indicated that the SSRIs are now more commonly
prescribed for chronic anxiety than is BuSpar. Any thoughts on this?This is probably correct. BuSpar is another BMS product. Read about it via their slick advertising, you'll form one opinion. Talk to those who have taken it, and you'll probably form another. It certainly has helped some, and some people a great deal. But, as one p-doc put it, "All BuSpar has ever done for my patients is made them dizzy."
Seriously, Paul, I'd add Klonopin (or if that doesn't work, perhaps Ativan), as much as you need (I mean, don't take 15mg or anything, but if it takes 2 or even 3 mg for relief, why not take it? Quite often with benzos the dose it takes to initially control the anxiety is much greater than the dose needed to stay anxiety-free. So, you might try going up as far as you need to with the K, staying at that dose for 4-6 anxiety-free weeks, and then taper down to a lower dose. Hopefully the Zoloft will be working well by then.
I and many others to whom I've talked have strong prefs for the brand-name Klonopin. I've not heard this sort of thought expressed with respect to the other benzos. Brand name K is almost the same price as generic K.
On your benzo fears, try expressing them on alt.support.anxiety-panic and see what sort of answers you get there. Most people there have pd, though some have GAD. Most are on benzos and a) know lots about them and b) have good things to say about the whole dependency issue.
Best,
Matt
Posted by anonymous on February 26, 1999, at 22:20:59
In reply to Re: New to Board - Anxiety & Depression, posted by Matt on February 25, 1999, at 2:46:56
>
>
> 2. If one or two SSRIs are unsuccessful, does it make sense to go to another drug in the same family
> such as Paxil (this is what my doctor wants to try me on if the Zoloft doesn't work) or should we be
> trying another class of drug ie an SNRI ( I have been reading a lot of good things about Effexor and
> especially Serzone)? I would really like to avoid TCAs and MAOIs if possible.
>
> TCAs have been given a bad rap, I think. They have their place, and are many quite effective on depression and anxiety. So I would't rule out TCAs totally. But I'd probably not look to them as first-line drugs, either.
>
> As I mentioned, I'd try Celexa, Remeron, and Effexor (and probably a TCA) before trying Serzone.
>
> 3. I have been reading a lot of good things about BuSpar, both as an anti-anxiety agent and anxiety
> accompanied by depression. My doctor indicated she does not normally prescribe this drug, as she has
> questions about its effectiveness. My pharmacist indicated that the SSRIs are now more commonly
> prescribed for chronic anxiety than is BuSpar. Any thoughts on this?
>
> This is probably correct. BuSpar is another BMS product. Read about it via their slick advertising, you'll form one opinion. Talk to those who have taken it, and you'll probably form another. It certainly has helped some, and some people a great deal. But, as one p-doc put it, "All BuSpar has ever done for my patients is made them dizzy."
>
> Seriously, Paul, I'd add Klonopin (or if that doesn't work, perhaps Ativan), as much as you need (I mean, don't take 15mg or anything, but if it takes 2 or even 3 mg for relief, why not take it? Quite often with benzos the dose it takes to initially control the anxiety is much greater than the dose needed to stay anxiety-free. So, you might try going up as far as you need to with the K, staying at that dose for 4-6 anxiety-free weeks, and then taper down to a lower dose. Hopefully the Zoloft will be working well by then.
>
> I and many others to whom I've talked have strong prefs for the brand-name Klonopin. I've not heard this sort of thought expressed with respect to the other benzos. Brand name K is almost the same price as generic K.
>
> On your benzo fears, try expressing them on alt.support.anxiety-panic and see what sort of answers you get there. Most people there have pd, though some have GAD. Most are on benzos and a) know lots about them and b) have good things to say about the whole dependency issue.
>
> Best,
>
> Matt
Your doctor may be right about Paxil. It is indicated for anxious depression. But many people find Zoloft needs to be at about 150mg. Hope that helps.
This is the end of the thread.
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