Psycho-Babble Medication Thread 3795

Shown: posts 1 to 18 of 18. This is the beginning of the thread.

 

To Elizabeth!

Posted by Paul on March 18, 1999, at 20:34:20

In an earlier post, you indicated that Buspar is not effective against all types of anxiety. What types of anxiety is it good for and not good for? What type of anti-depressant would you recommend for GAD?

Thanks for your response.


Paul

 

BuSpar and other things for anxiety

Posted by Elizabeth on March 20, 1999, at 12:40:36

In reply to To Elizabeth!, posted by Paul on March 18, 1999, at 20:34:20

> In an earlier post, you indicated that Buspar is not effective against all types of anxiety. What types of anxiety is it good for and not good for? What type of anti-depressant would you recommend for GAD?

It's not effective for panic disorder. For GAD it can be great, and I've heard of a number of wonderful successes. It's gotten a bad reputation mostly because doctors have been prescribing it for panic, perhaps also because some people are dissatisfied with it because it doesn't work as fast as some other anti-anxiety drugs do. I don't know how it works for other anxiety disorders (OCD, PTSD, social phobia).

One thing is I think that sometimes (with BuSpar in particular, that is) you need to be willing to push the dose up pretty high (especially if you have depression too).

I don't think I could make a general recommendation for what to try for GAD without knowing more (hell, what am I doing making recommendations anyway? :-). BuSpar is good. SSRIs and MAOIs can be good for a lot of people as well although I don't think they've been studied specifically for GAD without depression. Tricyclics might work as well. I'd probably avoid Wellbutrin, although again, it's hard to know for sure. Sometimes what looks like GAD turns out to be depression on closer inspection, that's something to consider especially if it is very severe. There is a tendency to make the assumption that a "sedating" antidepressant will help with anxiety, but this does not always turn out to be true.

Antidepressants tend to make people more anxious at first (even BuSpar does this sometimes). Certainly people with panic attacks, and probably people with anxiety disorders who don't have panic attacks, ought to have the option of taking a benzodiazepine (like Ativan, Valium, etc.) when they need it, at least when they are first starting out on antidepressants. Some people need to take an antidepressant (I count BuSpar as an antidepressant) and a benzodiazepine every day, but I think that in the long term this is probably not necessary too often.

There are other meds you can try as well (some anticonvulsants, cardiac drugs, etc. work for some people), but these are the most common ones.

The best luck that I *personally* have had for anxiety (I have taken an awful lot of meds, I'm afraid) was with Prozac, nortriptyline (a mildly sedating tricyclic), Nardil (MAO inhibitor), Fioricet (a muscle relaxant that contains a barbiturate - used mainly for migraine), and high-dose Librium.

Good luck - write more if you'd like.

-e

 

Re: To Elizabeth!

Posted by Matt on March 28, 1999, at 6:20:51

In reply to To Elizabeth!, posted by Paul on March 18, 1999, at 20:34:20

Paul,

BuSpar sometimes is used to augment OCD treatment. Other than that, I second Elizabeth's post (btw, if you ever get contradictory info on stuff from us, take her word over mine. She knows more :)).

Remeron is very good for depression with anxiety. I know this firsthand. This probably is due to the combo of its effect on the H1 (histamine) receptor and the fact it's a strong 5HT2 antagonist, though as it usually goes with these things, no one is quite sure. The atypical antipsychotics (Risperdal, Zyprexia, Seroquel) all hit the 5HT2 receptor, and all (esp. the latter two) often are used as anxiolytics at low doses.

Serzone is said to be good for anxiety, though I'm a bit skeptical of this drug (as if that matters :) ). IME, Prozac worked wonders on my anxiety.

If you do switch from the Zoloft, I'd seriously give Remeron a look. It works very well on depression (faster than Prozac), is great on GAD, and probably works for OCD and panic (they're doing trials right now--so far all we have is lots of anecdotal evidence).

How are you doing, anyway?

Matt

 

Re: BuSpar and other things for anxiety

Posted by Terry on March 31, 1999, at 16:12:50

In reply to BuSpar and other things for anxiety, posted by Elizabeth on March 20, 1999, at 12:40:36

I though SSRIs were appropriate for panic? And what about Klonopin? both are approved for that indication, as I understand. I would not use benzodiazepines as a first-choice for long-term treatment of panic disorder because of tolerance/dependency issues. Terry

> > In an earlier post, you indicated that Buspar is not effective against all types of anxiety. What types of anxiety is it good for and not good for? What type of anti-depressant would you recommend for GAD?
>
> It's not effective for panic disorder. For GAD it can be great, and I've heard of a number of wonderful successes. It's gotten a bad reputation mostly because doctors have been prescribing it for panic, perhaps also because some people are dissatisfied with it because it doesn't work as fast as some other anti-anxiety drugs do. I don't know how it works for other anxiety disorders (OCD, PTSD, social phobia).
>
> One thing is I think that sometimes (with BuSpar in particular, that is) you need to be willing to push the dose up pretty high (especially if you have depression too).
>
> I don't think I could make a general recommendation for what to try for GAD without knowing more (hell, what am I doing making recommendations anyway? :-). BuSpar is good. SSRIs and MAOIs can be good for a lot of people as well although I don't think they've been studied specifically for GAD without depression. Tricyclics might work as well. I'd probably avoid Wellbutrin, although again, it's hard to know for sure. Sometimes what looks like GAD turns out to be depression on closer inspection, that's something to consider especially if it is very severe. There is a tendency to make the assumption that a "sedating" antidepressant will help with anxiety, but this does not always turn out to be true.
>
> Antidepressants tend to make people more anxious at first (even BuSpar does this sometimes). Certainly people with panic attacks, and probably people with anxiety disorders who don't have panic attacks, ought to have the option of taking a benzodiazepine (like Ativan, Valium, etc.) when they need it, at least when they are first starting out on antidepressants. Some people need to take an antidepressant (I count BuSpar as an antidepressant) and a benzodiazepine every day, but I think that in the long term this is probably not necessary too often.
>
> There are other meds you can try as well (some anticonvulsants, cardiac drugs, etc. work for some people), but these are the most common ones.
>
> The best luck that I *personally* have had for anxiety (I have taken an awful lot of meds, I'm afraid) was with Prozac, nortriptyline (a mildly sedating tricyclic), Nardil (MAO inhibitor), Fioricet (a muscle relaxant that contains a barbiturate - used mainly for migraine), and high-dose Librium.
>
> Good luck - write more if you'd like.
>
> -e

 

Re: BuSpar and other things for anxiety

Posted by Matt on April 1, 1999, at 1:08:13

In reply to Re: BuSpar and other things for anxiety, posted by Terry on March 31, 1999, at 16:12:50

> I though SSRIs were appropriate for panic?

They are, generally.

And what about Klonopin?

Used by many, many people for pd.

both are approved for that indication, as I understand. I would not use benzodiazepines as a first-choice for long-term treatment of panic disorder because of tolerance/dependency issues. Terry

This is a complicated issue. Some people wonder what the problem is with being dependent on a drug so long as you're not abusing the drug, you need to take the drug to control the pd, and it looks to be safe for long-term use (as are benzos, most would say). In this last regard, we know much more about the consequences of benzo use over the long term than we have SSRI use over the long term, simply in virtue of the fact that benzos have been around for a long time.

It certainly is the case that when the term "dependency" is used, red flags go up, but I think that there are real questions here as to how much weight the prospect of drug dependency should be given in drug selection.

Matt

> > > In an earlier post, you indicated that Buspar is not effective against all types of anxiety. What types of anxiety is it good for and not good for? What type of anti-depressant would you recommend for GAD?
> >
> > It's not effective for panic disorder. For GAD it can be great, and I've heard of a number of wonderful successes. It's gotten a bad reputation mostly because doctors have been prescribing it for panic, perhaps also because some people are dissatisfied with it because it doesn't work as fast as some other anti-anxiety drugs do. I don't know how it works for other anxiety disorders (OCD, PTSD, social phobia).
> >
> > One thing is I think that sometimes (with BuSpar in particular, that is) you need to be willing to push the dose up pretty high (especially if you have depression too).
> >
> > I don't think I could make a general recommendation for what to try for GAD without knowing more (hell, what am I doing making recommendations anyway? :-). BuSpar is good. SSRIs and MAOIs can be good for a lot of people as well although I don't think they've been studied specifically for GAD without depression. Tricyclics might work as well. I'd probably avoid Wellbutrin, although again, it's hard to know for sure. Sometimes what looks like GAD turns out to be depression on closer inspection, that's something to consider especially if it is very severe. There is a tendency to make the assumption that a "sedating" antidepressant will help with anxiety, but this does not always turn out to be true.
> >
> > Antidepressants tend to make people more anxious at first (even BuSpar does this sometimes). Certainly people with panic attacks, and probably people with anxiety disorders who don't have panic attacks, ought to have the option of taking a benzodiazepine (like Ativan, Valium, etc.) when they need it, at least when they are first starting out on antidepressants. Some people need to take an antidepressant (I count BuSpar as an antidepressant) and a benzodiazepine every day, but I think that in the long term this is probably not necessary too often.
> >
> > There are other meds you can try as well (some anticonvulsants, cardiac drugs, etc. work for some people), but these are the most common ones.
> >
> > The best luck that I *personally* have had for anxiety (I have taken an awful lot of meds, I'm afraid) was with Prozac, nortriptyline (a mildly sedating tricyclic), Nardil (MAO inhibitor), Fioricet (a muscle relaxant that contains a barbiturate - used mainly for migraine), and high-dose Librium.
> >
> > Good luck - write more if you'd like.
> >
> > -e

 

Re: question for Matt

Posted by mila on April 1, 1999, at 19:43:34

In reply to Re: BuSpar and other things for anxiety, posted by Matt on April 1, 1999, at 1:08:13

Dear Matt,

you seem to be well versed on meds and since I've no such person to get advice from (my current doctor seems to be anti-medication!!), I thought I'd ask for your input.

I've been on prozac, paxil, celexa, effexor, wellbutrin, xanax, lorazepam, lithium, zyprexa and risperdal. All except for risperdal have been unhelpful. I suffer from anxietty and depression. The risperdal prevents my anxiety from getting to a point where I scream and writhe on the floor. So with it I am just anxious to the point where I experience extreme restlessness and inability to concentrate on anything. It's better then screaming and writhing.

I'm at a loss(and so is my doctor) as to how to help my self any further. Do you have any suggestions?

 

Re: question for Matt

Posted by Matt on April 1, 1999, at 22:10:44

In reply to Re: question for Matt, posted by mila on April 1, 1999, at 19:43:34

Wow, you've been on more meds than I have. You've had adequate trials on all these meds, I take it? Why did you discontinue the Risperdal? (I personally won't take it long term because it has a much stronger effect on the basal ganglia than does the other newer antipsychotics, and this increases the possibility of TD. I too found it helpful, though.)

Has your doctor indicated that there is any element of psychosis associated with your depression?

Have you tried Seroquel? It's another atypical antipsychotic. It's excellent on anxiety, and it has even less of an effect on the basal ganglia than does Zyprexia.

I also note that you haven't tried any tricyclics. You might give something like nortriptyline a shot. Nor does it look like you've tried adding pindolol to any of the SSRIs. That might be something to think about. (See psych. tips for info on this.) I think that Remeron is a terrific drug for anxiety and depression. It has shown much promise even in treatment-resistant depression such as your depression.

So the benzodiazepines like lorazepam and xanax were totally unhelpful on your anxiety? I found Klonopin, another benzo. to be very helpful for my anxiety. Its advantage is that it's much longer lasting than the two above. I'm guessing that if you found lorazepam and xanax ineffective, it's because you didn't take enough of them. It took a while for me to figure out how much Klonopin I needed to alleviate my own anxiety. For long term treatment, xanax probably isn't the best solution, anyway, because of how short acting it is (it's harder to stop and there is breakthrough anxiety with it.)

Anyway, I guess the upshot of all this is that I'd discuss Klonopin, Remeron, Seroquel and perhaps a tricyclic with your doc. (though not necessarily all together). Don't be afraid to take the amount of K you need to deal with your anxiety; for me it was 2mg. Remeron causes less sedation and weight gain at higher doses than it does at 15mg. Seroquel at 25-50 mg is quite helpful with anxiety, and more can be used if there are elements of psychosis with your depression.

Anyway, those are just some thoughts--I'm no doctor or anything, for sure. Good luck with things, though.

Matt

 

Re: question for Matt

Posted by mila on April 2, 1999, at 9:08:54

In reply to Re: question for Matt, posted by Matt on April 1, 1999, at 22:10:44

i'm still on the risperdal but i want to stop because of the side effects -weight gain, acne, cognitive imapairment.
>
> Has your doctor indicated that there is any element of psychosis associated with your depression?
no. my doctor does not seem to say much at all to me except that I should make myself more motivated to live a normal life. I have no insurance so I'm going to borrow money from my parents and find a new (good) doctor.

What exactly does psychosis entail?
thanks for the tips

 

Re: question for Matt

Posted by Matt on April 2, 1999, at 23:05:46

In reply to Re: question for Matt, posted by mila on April 2, 1999, at 9:08:54

> i'm still on the risperdal but i want to stop because of the side effects -weight gain, acne, cognitive imapairment.
> >
> > Has your doctor indicated that there is any element of psychosis associated with your depression?
> no. my doctor does not seem to say much at all to me except that I should make myself more motivated to live a normal life. I have no insurance so I'm going to borrow money from my parents and find a new (good) doctor.
>
> What exactly does psychosis entail?
> thanks for the tips

Elements commonly associated with schizophrenia--

Good luck,

Matt

 

Re: BuSpar and other things for anxiety

Posted by Elizabeth on April 5, 1999, at 23:20:09

In reply to Re: BuSpar and other things for anxiety, posted by Terry on March 31, 1999, at 16:12:50

>I though SSRIs were appropriate for panic?

They are, absolutely.

And what about Klonopin? both are
approved for that indication, as I understand.

>I would not use benzodiazepines as a
>first-choice for long-term treatment of panic
>disorder because of tolerance/dependency
>issues.

One would think so, but actually there are two things that make me think differently:

1. It turns out that people don't develop tolerance to the antipanic effects of benzos - just to the sedation.
2. People who have PD tend to be hypersensitive to side effects. Since the main side effects of benzos are usually sedation (wears off after a while) and cognitive impairment (different for different people, and doesn't bother some people depending on their profession), this makes them a good alternative if antidepressants aren't tolerated. (Overall I'd still consider an antidepressant the first choice.)

Also, Paul asked about an antidepressant for GAD (not PD) - Klonopin isn't an antidepressant (some people even complain of increased depression from it).

-e

 

Re: question for Matt

Posted by Elizabeth on April 5, 1999, at 23:55:07

In reply to Re: question for Matt, posted by mila on April 1, 1999, at 19:43:34

(Jumping in)

Mila,

Adding to and concurring with what Matt says:

Seroquel might be worthwhile to try (start at 25mg b.i.d., increase until you plateau). I've never heard of acne from Risperdal; weight gain is an unfortunate side effect of all the current antipsychotic drugs, although I've heard some people say that it is less with Seroquel.

There's also, of course, high-dose BuSpar, since I notice that wasn't on your list. "High-dose" meaning at least 90mg (as tolerated).

BTW, you don't have to be floridly "psychotic" in the traditional sense (hallucinations, delusions, bizarre behavior and speech, etc.) to benefit from antipsychotics. In particular, there are "negative" symptoms (i.e., symptoms indicating a lack of something "normal" rather than the presence of something "abnormal"). This is from DSM-IV, describing the not-officially-recognized category "simple deteriorative disorder" which consists mainly of negative symptoms:

"... Emotional responses become blunted, shallow, flat, and empty. Speech becomes impoverished of words and meanings. There is a definite change in `personality,' with a marked loss of interpersonal rapport. Close relationships lose warmth and mutuality, social interaction generally becomes awkward, and isolation and withdrawal result. Initiative gives way to apathy, and ambition to avolition. Loss of interest extends to the daily details of self-care. ..."

(Sounds a lot like (some kinds of) depression.)

Nortriptyline and desipramine are both good tricyclics to start with.

I'm not sure that adding pindolol is worthwhile if you've had no response whatsoever to three SSRIs (it might be good if you could only get a partial response to the SSRIs, though).

Remeron is definitely worth trying, although you should be warned that a lot of people say it increases their appetites. Serzone is another one that you didn't mention, and it generally *doesn't* cause weight gain. Some people feel that it doesn't work as often as other ADs do, but I've also heard of it working where several other things had failed. Both Serzone and Remeron share a pharmacologic property (blockade of type 2 serotonin receptors) with the atypical antipsychotics.

I do think it's true that one benzo may help even if another one doesn't - they're not interchangeable. OTOH, I'm not sure it's going to be especially useful for you to try another one if you tried adequate doses of two of them already. Usually, you should notice at least something good happening from smaller doses, though.

It might help to know your specific symptoms, since "depression" and "anxiety" could mean a number of things.

I'm glad to hear you're planning on finding a better doctor. It doesn't sound as if your present one has been very helpful.

-elizabeth

 

Re: question for elizabeth

Posted by mila on April 6, 1999, at 15:44:23

In reply to Re: question for Matt, posted by Elizabeth on April 5, 1999, at 23:55:07

elizabeth,

I'am at a loss as to what to do. i fell horrible. i feel like crying and screaming bt nothig comes out. I have no income because I can't hold down a job and so i have no health insurance. The community center doctor I went to is more hurtful then helpful(and he's the only free doctor available). I don't even know if i will be able to affor medications. Any suggestions on what course of action i should take?


 

Re: question for elizabeth

Posted by Elizabeth on April 6, 1999, at 16:59:35

In reply to Re: question for elizabeth, posted by mila on April 6, 1999, at 15:44:23

Mila,

If you're in the U.S., have you considered applying for Medicaid? I have friends who are on it - it's not a big deal. I don't know how you go about it, but I think someone here probably would know.

Is the doctor at the community center a psychiatrist? Internists and other doctors can prescribe psych drugs as well, so that might be an alternative.

 

To mila re: anxiety

Posted by Alex on May 4, 1999, at 9:52:27

In reply to Re: question for Matt, posted by mila on April 1, 1999, at 19:43:34

> Dear Matt,
>
> you seem to be well versed on meds and since I've no such person to get advice from (my current doctor seems to be anti-medication!!), I thought I'd ask for your input.
>
> I've been on prozac, paxil, celexa, effexor, wellbutrin, xanax, lorazepam, lithium, zyprexa and risperdal. All except for risperdal have been unhelpful. I suffer from anxietty and depression. The risperdal prevents my anxiety from getting to a point where I scream and writhe on the floor. So with it I am just anxious to the point where I experience extreme restlessness and inability to concentrate on anything. It's better then screaming and writhing.
>
> I'm at a loss(and so is my doctor) as to how to help my self any further. Do you have any suggestions?
>

mila,

Just a thought. Is it a possibility that you have Adult Attention Deficit Disorder? How did you do in grade school? Did you and do you have trouble focusing without lots of intrusive thoughts? You might ask your physician or a licensed clinical social worker if this could be the basis for your anxiety. The theraputic approach is often significantly different from those used for panic and/or anxiety disorders.

- Alex

 

Re: To All

Posted by Rebecca on May 10, 1999, at 19:03:37

In reply to To Elizabeth!, posted by Paul on March 18, 1999, at 20:34:20

>

All of you people got to pull yourself up.
There is much hope for everyone in the future and
the truth is that no matter what your goal may be,
you will acheive it as long as you strive to the
best of all your ability.

Best to all of you in the future,
your truly
Becca.


In an earlier post, you indicated that Buspar is not effective against all types of anxiety. What types of anxiety is it good for and not good for? What type of anti-depressant would you recommend for GAD?
>
> Thanks for your response.
>
>
> Paul

 

Mila, try Medicaid

Posted by Jim Hardy on May 19, 1999, at 2:21:43

In reply to Re: question for elizabeth, posted by mila on April 6, 1999, at 15:44:23

> elizabeth,
>
> I'am at a loss as to what to do. i fell horrible. i feel like crying and screaming bt nothig comes out. I have no income because I can't hold down a job and so i have no health insurance. The community center doctor I went to is more hurtful then helpful(and he's the only free doctor available). I don't even know if i will be able to affor medications. Any suggestions on what course of action i should take?

As Elizabeth mentions, try Medicaid. I know they pay for meds and I know people who are on it. I know some of the qualifications are that you can't have more than $2,000 in the bank or an income of over $700 a month, but you are allowed to have a car and house, and other people can make in-kind payments to you to help you in support; for example, they might not be able to give you cash to buy gas if it put you over the $700/month limit but could let you use their gasoline credit card, for instance, if they paid the card's bills. It can get a little complicated, knowing all the details, but if you're income is low you shouldn't have trouble qualifying, and it's definitely something you should check out. I see my psychologist again on Thursday and can ask him if he knows any more of the details of the program if you'd like. I just met someone yesterday who is taking clozaril, at a cost of about $13,000 a year, and Medicaid is picking up the entire tab. Good luck. -- Jim

 

Re: Mila, try Medicaid

Posted by mila on May 20, 1999, at 15:43:02

In reply to Mila, try Medicaid, posted by Jim Hardy on May 19, 1999, at 2:21:43

Dear Jim,

thanks very much for the advice.
I think I will try it.

mila

 

Re: BuSpar and other things for anxiety

Posted by Ellen Brodie on May 28, 1999, at 5:55:02

In reply to BuSpar and other things for anxiety, posted by Elizabeth on March 20, 1999, at 12:40:36

> >I have just been diagnosed with general anxiety disorder on top of bipolar. Klopopin seems to really help me. I was on Buspar for a while. I did not like the side effects of the buspar. I was dizzy, almost euphoric. and it toook a long time to kick in. also, it did not last very long, It only relieved my anxiety for about four months. You might want to talk to your doc about Klonopin. It has really helped me. good Luck. Ellen Brodie


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