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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 10 of 10. This is the beginning of the thread.
Posted by Jenna S. on December 11, 2001, at 18:15:28
My bf has anxiety and depression which seem to have resisted all attempts to treat them. The anxiety is the more unbearable of the two and he really needs to find something to alleviate it. The problem is, that he has taken everything we can think of! Can anyone think of anything else that is left to try?!
Here is the list of drugs he has already tried:
Benzos - lorazepam, diazepam, chlordiazepoxide - no help.
Tricyclics - amitriptyline, clomipramine, trimipramine, dothiepin - marginal assistance.
Antipsychotics - thioridazine, chlorpromazine, droperidol, risperidone, olanzapine, sulpiride, amisulpride, flupenthixol. These all caused increased agitation and anxiety, paradoxically. Doses of risperidone below 1mg per day lowered anxiety but not sufficiently. Increasing the dose leads to increased anxiety.
SSRIs - fluoxetine, fluvoxamine, paroxetine, citalopram - all made anxiety worse. Sertraline was neutral.
Venlafaxine - very much worsened anxiety.
Reboxetine - as for venlafaxine but worse.
Bupropion - up to 150mg per day helps a bit, more than that increases anxiety.
Mirtazapine - helps but not enough.
Mood stabilisers - carbamazepine - no effects at all.
MAOIs - moclobemide, phenelzine - moclobemide was generally neutral, phenelzine caused anxiety and dangerously high blood pressure so had to be withdrawn.
Hypnotics - temazepam, nitrazepam, zopiclone, zolpidem, chloral hydrate, various antihistamines - the benzos sedated, others did not, none reduced anxiety.Various combos of the above have been tried, which didn't really help either. Combos were generally antidepressants with benzos and /or antipsychotics, and some antidepressant augmentations, eg sertraline and mirtazapine.
Even Kava and St John's Wort have not worked, but made anxiety worse....
Help!
Jenna
Posted by Jenna S. on December 11, 2001, at 18:21:47
In reply to Anxiety - what else is left?, posted by Jenna S. on December 11, 2001, at 18:15:28
Oops, forgot a few (unsurprisingly...)
Nefazodone - neutral, caused tremor.
Trazodone - sedating but not anxiolytic.
Cyproheptadine - used to augment sertraline as a serotonin antagonist, had no effect.I think that's it....
Posted by Twain on December 11, 2001, at 19:55:39
In reply to Anxiety - what else is left?, posted by Jenna S. on December 11, 2001, at 18:15:28
Has your bf tried a beta (or is it alpha?) blocker? Think it was called inderal. It was prescribed in my case for "rage" during one of my hospital stays. Quite calming but discontinued after my heart rate went below 50 beats per minute.
Another idea is meditation, yoga or something along those lines. TM worked for me until I gave it up during my christian phase. Now I'm thinking about taking it up again. It really lowers the bp and heart rate too. Helped me with anxiety.
You might consider whether there's something environmental. Sometimes allergies or environmental sensitivities (to everything from perfume to dental fillings) can cause anxiety.
Posted by JohnX2 on December 11, 2001, at 21:20:10
In reply to Anxiety - what else is left?, posted by Jenna S. on December 11, 2001, at 18:15:28
It seems like when people are ready to
throw in the towel Lamictal is a good try. Lamictal
can be a good mood stabilizer and anti-depressant
but it leans toward stimulating. You may want to add Topamax
to it to help with anxiety. Topamax is less of an
anti-depressant, better for mood stabilization and anxiety.
Some people have recently reported novel synergy
between the two meds (like me so admitedly I'm
biased). Both are anti-convulsants.Maybe you could revist Wellbutrin somehow, but
what to do about the anxiety? Strange that the
benzos didn't help? That is so weird.This is a fringe recommendation but I guess were
at that stage of suggesting anything. What about the
supplement 5-htp and flaxseed oil for anxiety?
The 5-htp worked immediately for me. Also, are
we taking all the b-vitamins, etc?good luck.
john
> My bf has anxiety and depression which seem to have resisted all attempts to treat them. The anxiety is the more unbearable of the two and he really needs to find something to alleviate it. The problem is, that he has taken everything we can think of! Can anyone think of anything else that is left to try?!
>
> Here is the list of drugs he has already tried:
> Benzos - lorazepam, diazepam, chlordiazepoxide - no help.
> Tricyclics - amitriptyline, clomipramine, trimipramine, dothiepin - marginal assistance.
> Antipsychotics - thioridazine, chlorpromazine, droperidol, risperidone, olanzapine, sulpiride, amisulpride, flupenthixol. These all caused increased agitation and anxiety, paradoxically. Doses of risperidone below 1mg per day lowered anxiety but not sufficiently. Increasing the dose leads to increased anxiety.
> SSRIs - fluoxetine, fluvoxamine, paroxetine, citalopram - all made anxiety worse. Sertraline was neutral.
> Venlafaxine - very much worsened anxiety.
> Reboxetine - as for venlafaxine but worse.
> Bupropion - up to 150mg per day helps a bit, more than that increases anxiety.
> Mirtazapine - helps but not enough.
> Mood stabilisers - carbamazepine - no effects at all.
> MAOIs - moclobemide, phenelzine - moclobemide was generally neutral, phenelzine caused anxiety and dangerously high blood pressure so had to be withdrawn.
> Hypnotics - temazepam, nitrazepam, zopiclone, zolpidem, chloral hydrate, various antihistamines - the benzos sedated, others did not, none reduced anxiety.
>
> Various combos of the above have been tried, which didn't really help either. Combos were generally antidepressants with benzos and /or antipsychotics, and some antidepressant augmentations, eg sertraline and mirtazapine.
>
> Even Kava and St John's Wort have not worked, but made anxiety worse....
>
> Help!
>
> Jenna
Posted by JohnX2 on December 11, 2001, at 21:26:26
In reply to Re: Anxiety - what else is left? » Jenna S., posted by JohnX2 on December 11, 2001, at 21:20:10
oh. To the Wellbutrin you could also try the
anti-convulsant Neurontin or Topamax. Neurontin has the
longer track record of being used as an
adjunctive medication for anxiety. Another
possible choice is the newer anti-convulsant Gabitril
(tiagabine).
>
> It seems like when people are ready to
> throw in the towel Lamictal is a good try. Lamictal
> can be a good mood stabilizer and anti-depressant
> but it leans toward stimulating. You may want to add Topamax
> to it to help with anxiety. Topamax is less of an
> anti-depressant, better for mood stabilization and anxiety.
> Some people have recently reported novel synergy
> between the two meds (like me so admitedly I'm
> biased). Both are anti-convulsants.
>
> Maybe you could revist Wellbutrin somehow, but
> what to do about the anxiety? Strange that the
> benzos didn't help? That is so weird.
>
> This is a fringe recommendation but I guess were
> at that stage of suggesting anything. What about the
> supplement 5-htp and flaxseed oil for anxiety?
> The 5-htp worked immediately for me. Also, are
> we taking all the b-vitamins, etc?
>
> good luck.
> john
>
>
> > My bf has anxiety and depression which seem to have resisted all attempts to treat them. The anxiety is the more unbearable of the two and he really needs to find something to alleviate it. The problem is, that he has taken everything we can think of! Can anyone think of anything else that is left to try?!
> >
> > Here is the list of drugs he has already tried:
> > Benzos - lorazepam, diazepam, chlordiazepoxide - no help.
> > Tricyclics - amitriptyline, clomipramine, trimipramine, dothiepin - marginal assistance.
> > Antipsychotics - thioridazine, chlorpromazine, droperidol, risperidone, olanzapine, sulpiride, amisulpride, flupenthixol. These all caused increased agitation and anxiety, paradoxically. Doses of risperidone below 1mg per day lowered anxiety but not sufficiently. Increasing the dose leads to increased anxiety.
> > SSRIs - fluoxetine, fluvoxamine, paroxetine, citalopram - all made anxiety worse. Sertraline was neutral.
> > Venlafaxine - very much worsened anxiety.
> > Reboxetine - as for venlafaxine but worse.
> > Bupropion - up to 150mg per day helps a bit, more than that increases anxiety.
> > Mirtazapine - helps but not enough.
> > Mood stabilisers - carbamazepine - no effects at all.
> > MAOIs - moclobemide, phenelzine - moclobemide was generally neutral, phenelzine caused anxiety and dangerously high blood pressure so had to be withdrawn.
> > Hypnotics - temazepam, nitrazepam, zopiclone, zolpidem, chloral hydrate, various antihistamines - the benzos sedated, others did not, none reduced anxiety.
> >
> > Various combos of the above have been tried, which didn't really help either. Combos were generally antidepressants with benzos and /or antipsychotics, and some antidepressant augmentations, eg sertraline and mirtazapine.
> >
> > Even Kava and St John's Wort have not worked, but made anxiety worse....
> >
> > Help!
> >
> > Jenna
Posted by gheld on December 12, 2001, at 8:26:24
In reply to Re: Anxiety - what else is left?, posted by JohnX2 on December 11, 2001, at 21:26:26
I didn't notice Buspar on your list of medications he's tried.
I also didn't notice therapy with anyone, particularly a psychiatrist specializing in panic/anxiety.
Having taken all those medications, he must have either taken each of them for a brief period, perhaps to brief to become effective, or taken them in some combination that leaves one wondering which is doing what.
Sounds like some therapy is needed here.
Posted by 3 Beer Effect on December 12, 2001, at 17:46:59
In reply to Anxiety - what else is left?, posted by Jenna S. on December 11, 2001, at 18:15:28
Caffeine is a major cause of both anxiety & panic attacks.
Posted by Joy on December 12, 2001, at 21:43:27
In reply to Re: Anxiety - what else is left?, posted by Jenna S. on December 11, 2001, at 18:21:47
The benzo left out is the best for panic: Xanax generic alprazolam
Joy
Oops, forgot a few (unsurprisingly...)
>
> Nefazodone - neutral, caused tremor.
> Trazodone - sedating but not anxiolytic.
> Cyproheptadine - used to augment sertraline as a serotonin antagonist, had no effect.
>
> I think that's it....
Posted by verne on December 13, 2001, at 0:20:59
In reply to Anxiety - what else is left?, posted by Jenna S. on December 11, 2001, at 18:15:28
A previous post recommending cutting out caffeine is right on. Add nicotine to that - another popular alkaloid.
Every time I've been in the hospital (psych ward) most of the patients were nicotine and caffeine addicts. In the morning, instead of birds singing, we would hear all the smokers hacking and coughing away. Then we would all find the nearest caffeine source to counteract the meds.
Documentaries on one mental illness after another show the afflicted with a cigarette in one hand and a cup of coffee in the other. They're taking a dozen different meds and I'm wondering what would happen if they gave up the 2 in their hand.
still hooked on caffeine and trying to quit.
Posted by Jenna S. on December 13, 2001, at 17:06:08
In reply to Re: Anxiety - what else is left?, posted by JohnX2 on December 11, 2001, at 21:26:26
Thanks to everyone for replying, you have given us some useful new ideas. He took Dr Bob's sub-syndromal epilepsy quiz and came out at 73, so we think the mood stabilisers would be the next best thing to try. He saw his pdoc this morning, who has agreed to screen him for epilepsy and is OK about trying a mood stabiliser, I think lamotrigine was the one he had in mind. Pdoc wants to consult his boss before going ahead so we haven't got the prescription yet.
Xanax would be worth a shot but I don't think we'd be able to get it, because of all this political correctness regarding benzos. It's very annoying. They seem to have it in for Xanax in particular, I don't know why. I think it isn't even offered on the NHS. He's already tried beta blockers (I knew we'd forget something off the list).
Coffee, cigarettes and other environmental things are also going on the 'what else to try' list. He has one cup of coffee per day, but it's fairly strong. He won't want to give it up though, he loves his coffee!
I think he also asked about therapy today as well. It was suggested to him a while ago and he wasn't too keen, but after talking to me about some of his worries I think he has changed his mind and says he might find it helpful. He's had quite a bit of therapy before but I get the impression he found it hard to open up to the therapist at that time. I hope it will be different this time.
Jenna
This is the end of the thread.
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