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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 8 of 8. This is the beginning of the thread.
Posted by pete on March 9, 2001, at 21:19:12
I have been suffering from the physical symptoms of anxiety for the last year brought on by 3 years of worry about misdiagnosed peripheral neuropathy and the loss of ability to walk properly. I feel incredibly anxious most days with pronounced dizzyness/lightheadedness, mild agoraphobia and panicky episodes as well as some fear of social situations. I also suffer insomnia. This is something ive never really experienced till now although ive had periods of depression all my life. My doctor doesnt really listen and keeps trying various SSRI's including Prozac, Paxil and Nefazodone(serzone) but all these make me extremely agitated and increase anxiety after only a few days use. (Serotonin overload or something). Ive read some of the posts here and looked around the web for info/help but Im still confused. I could really use some advice about all this as Im desperate to try to find some relief from my symptoms. I try to maintain a positive outlook and rationalise it away but its like something taking me over which I cant control or fix. My doc dont seem to realise that im finding it difficult to cope, I could do with some advice about anti-anxiety drugs that work. Thanks.
Posted by adams on March 9, 2001, at 21:55:35
In reply to GAD Advice badly needed, posted by pete on March 9, 2001, at 21:19:12
> I have been suffering from the physical symptoms of anxiety for the last year brought on by 3 years of worry about misdiagnosed peripheral neuropathy and the loss of ability to walk properly. I feel incredibly anxious most days with pronounced dizzyness/lightheadedness, mild agoraphobia and panicky episodes as well as some fear of social situations. I also suffer insomnia. This is something ive never really experienced till now although ive had periods of depression all my life. My doctor doesnt really listen and keeps trying various SSRI's including Prozac, Paxil and Nefazodone(serzone) but all these make me extremely agitated and increase anxiety after only a few days use. (Serotonin overload or something). Ive read some of the posts here and looked around the web for info/help but Im still confused. I could really use some advice about all this as Im desperate to try to find some relief from my symptoms. I try to maintain a positive outlook and rationalise it away but its like something taking me over which I cant control or fix. My doc dont seem to realise that im finding it difficult to cope, I could do with some advice about anti-anxiety drugs that work. Thanks.
email me pete, and we will talk
Posted by JohnL on March 10, 2001, at 5:09:32
In reply to GAD Advice badly needed, posted by pete on March 9, 2001, at 21:19:12
> I have been suffering from the physical symptoms of anxiety for the last year brought on by 3 years of worry about misdiagnosed peripheral neuropathy and the loss of ability to walk properly. I feel incredibly anxious most days with pronounced dizzyness/lightheadedness, mild agoraphobia and panicky episodes as well as some fear of social situations. I also suffer insomnia. This is something ive never really experienced till now although ive had periods of depression all my life. My doctor doesnt really listen and keeps trying various SSRI's including Prozac, Paxil and Nefazodone(serzone) but all these make me extremely agitated and increase anxiety after only a few days use. (Serotonin overload or something). Ive read some of the posts here and looked around the web for info/help but Im still confused. I could really use some advice about all this as Im desperate to try to find some relief from my symptoms. I try to maintain a positive outlook and rationalise it away but its like something taking me over which I cant control or fix. My doc dont seem to realise that im finding it difficult to cope, I could do with some advice about anti-anxiety drugs that work. Thanks.
Hi there Pete,
I think your doctor is making a very common mistake. That is, he is focusing too much on just one brain chemistry responsible for anxiety, and ignoring all the others. There are many different chemical root causes of anxiety, and he is only focusing on serotonin. Obviously that is not the correct route for you, or else you would have experienced better results by now.When a doctor sees a patient with depression, they automatically think "antidepressants". When a patient shows up with anxiety, they automatically think "serotonin antidepressants, or benzos". In my frame of thinking this is all wrong. I think they should instead be asking, "which chemistry is at fault here?" And then sample for a couple weeks each several totally different drugs to try to narrow down which chemistry needs attention. The results of each trial will provide clues as to which chemistry to focus on.
With that in mind, it would be safe at this point to assume that increasing serotonin chemistry is not going to cure your anxiety. The cause is somewhere else. What are other causes? Low GABA, treated with a benzo like Xanax, Klonopin, Valium, etc. Excess dopamine, treated with antipsychotic. Chemical instability, treated with Lithium. Electrical instability, treated with Tegretol or Depakote. Excess noradrenaline, treated with an antihypertensive drug.
One doctor I know keeps records of which medications worked completely with his anxiety patients. It is amazing to see that all drugs worked, though each patient responded to a different one, depending of course on which chemistry was at fault with the particular patient.
You might tell your doctor firmly that you want to try drugs from other classes. Remind him you've already beaten the serotonin thing to death. Specifically I think your best bets will be in the benzo class and the antipsychotic class. Statistics are in your favor with those. You might also need to hunt for a more cooperative open minded doctor who is more interested in getting you well rather than stroking his own ego.
John
Posted by ChrisK on March 10, 2001, at 5:13:16
In reply to GAD Advice badly needed, posted by pete on March 9, 2001, at 21:19:12
I assume that either you or your doctor won't get involved in the benzo's since you didn't mention trying them. They (Klonopin, Xanax, ATivan, etc.) are the first line of defense against GAD. Klonopin worked very well for me.
If those aren't for you I would suggest Zyprexa or the recently relesed Ziprasidone. The latter is supposed to have very good anti-anxiety effects along with Ad effects.
I would still try a benzo first. They are the best thing for anxiety.
Posted by pete on March 13, 2001, at 18:02:01
In reply to Re: GAD Advice badly needed, posted by ChrisK on March 10, 2001, at 5:13:16
Thanks for the advice guys. I appreciate the fact that someone replied to my post so quick. sorry I didn’t get back sooner but I didn’t have access to a computer for a while.
I agree that I may need to look around for a more sympathetic GP (Doctor here in UK) as he doesn’t like proscribing Benzodiazepines as well as not listening when I go see him because Im desperate. The thing is Im definitely suffering mild depression but its the bouts of debilitating anxiety that are unbearable, Each AD Ive tried including Lofepramine (tricyclic) seems to make me extremely agitated very soon after starting medication. Ive read that this can happen with some AD's but the reaction I get is intense. What id like is to find a med that reduces the panic and anxiety without the initial agitation and that doesn’t dope me up all day.
I was proscribed Prozac a couple years ago for depression and was agitated less initially but that was before the anxiety attacks, post disability. Im not sure that if i took this again it would work as the side effects are a pain.
Any advice is appreciated especially if anyone else has had any similar experiences, Thanks again.
Posted by ChrisK on March 14, 2001, at 5:24:01
In reply to Re: GAD Advice badly needed, posted by pete on March 13, 2001, at 18:02:01
Pete,
I would seriously consider Zyprexa (Olanzapine?) as a good option for you. It can be seedating for a week or two but you kind of grow out of that. I've never heard of anyone say that it causes more anxiety. It has good AD qualities also and there have been recent studies that suggest that it forms a very strong combination with SSRI's that go beyond just mono-therapy.
I take it with a TCA and have been able to give up Klonopin because my GAD has been so greatly reduced. If you try it you will probably notice a difference within a week to 10 days. It's worth a trial if you aren't going to try a Benzo.
Chris
Posted by Joy on March 15, 2001, at 20:21:37
In reply to Re: GAD Advice badly needed, posted by pete on March 13, 2001, at 18:02:01
I would suggest possibly adding Buspar to Prozac. That combo works well for a lot of people with GAD. 40 mg Prozac takes care of my anxiety[don't need Buspar], and generic Xanax at night 30 minutes before bedtime. Good luck.
Joy
> Thanks for the advice guys. I appreciate the fact that someone replied to my post so quick. sorry I didn’t get back sooner but I didn’t have access to a computer for a while.
> I agree that I may need to look around for a more sympathetic GP (Doctor here in UK) as he doesn’t like proscribing Benzodiazepines as well as not listening when I go see him because Im desperate. The thing is Im definitely suffering mild depression but its the bouts of debilitating anxiety that are unbearable, Each AD Ive tried including Lofepramine (tricyclic) seems to make me extremely agitated very soon after starting medication. Ive read that this can happen with some AD's but the reaction I get is intense. What id like is to find a med that reduces the panic and anxiety without the initial agitation and that doesn’t dope me up all day.
> I was proscribed Prozac a couple years ago for depression and was agitated less initially but that was before the anxiety attacks, post disability. Im not sure that if i took this again it would work as the side effects are a pain.
> Any advice is appreciated especially if anyone else has had any similar experiences, Thanks again.
Posted by Mr. Scott on March 17, 2001, at 16:43:48
In reply to Re: GAD Advice badly needed, posted by JohnL on March 10, 2001, at 5:09:32
> > I have been suffering from the physical symptoms of anxiety for the last year brought on by 3 years of worry about misdiagnosed peripheral neuropathy and the loss of ability to walk properly. I feel incredibly anxious most days with pronounced dizzyness/lightheadedness, mild agoraphobia and panicky episodes as well as some fear of social situations. I also suffer insomnia. This is something ive never really experienced till now although ive had periods of depression all my life. My doctor doesnt really listen and keeps trying various SSRI's including Prozac, Paxil and Nefazodone(serzone) but all these make me extremely agitated and increase anxiety after only a few days use. (Serotonin overload or something). Ive read some of the posts here and looked around the web for info/help but Im still confused. I could really use some advice about all this as Im desperate to try to find some relief from my symptoms. I try to maintain a positive outlook and rationalise it away but its like something taking me over which I cant control or fix. My doc dont seem to realise that im finding it difficult to cope, I could do with some advice about anti-anxiety drugs that work. Thanks.
>
> Hi there Pete,
> I think your doctor is making a very common mistake. That is, he is focusing too much on just one brain chemistry responsible for anxiety, and ignoring all the others. There are many different chemical root causes of anxiety, and he is only focusing on serotonin. Obviously that is not the correct route for you, or else you would have experienced better results by now.
>
> When a doctor sees a patient with depression, they automatically think "antidepressants". When a patient shows up with anxiety, they automatically think "serotonin antidepressants, or benzos". In my frame of thinking this is all wrong. I think they should instead be asking, "which chemistry is at fault here?" And then sample for a couple weeks each several totally different drugs to try to narrow down which chemistry needs attention. The results of each trial will provide clues as to which chemistry to focus on.
>
> With that in mind, it would be safe at this point to assume that increasing serotonin chemistry is not going to cure your anxiety. The cause is somewhere else. What are other causes? Low GABA, treated with a benzo like Xanax, Klonopin, Valium, etc. Excess dopamine, treated with antipsychotic. Chemical instability, treated with Lithium. Electrical instability, treated with Tegretol or Depakote. Excess noradrenaline, treated with an antihypertensive drug.
>
> One doctor I know keeps records of which medications worked completely with his anxiety patients. It is amazing to see that all drugs worked, though each patient responded to a different one, depending of course on which chemistry was at fault with the particular patient.
>
> You might tell your doctor firmly that you want to try drugs from other classes. Remind him you've already beaten the serotonin thing to death. Specifically I think your best bets will be in the benzo class and the antipsychotic class. Statistics are in your favor with those. You might also need to hunt for a more cooperative open minded doctor who is more interested in getting you well rather than stroking his own ego.
> JohnHave you tried Neurontin (Gabapentin) for GAD? I have heard of success but have no personal experience yet.
This is the end of the thread.
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