![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 4 to 28 of 29. Go back in thread:
Posted by Phillipa on January 11, 2007, at 20:05:57
In reply to Re: Benzo alternatives for anxiety/panic?, posted by med_empowered on January 11, 2007, at 19:50:26
chloral hydrate without alchohol. Love Phillipa
Posted by laima on January 11, 2007, at 20:47:01
In reply to Benzo alternatives for anxiety/panic?, posted by halcyondaze on January 11, 2007, at 18:16:46
I've heard a lot of murmering about inderall, but haven't tried it myself. It relaxes a person by lowering blood pressure, I understand.
Posted by laima on January 11, 2007, at 20:49:06
In reply to Re: Benzo alternatives for anxiety/panic?, posted by laima on January 11, 2007, at 20:47:01
Oh- I'm also interested in the herb skullcap, because it's supposed to relax muscles in addition to being mentally calming. It sounds like it could therefore be helpful for hyperventilation. Haven't tried it yet, though.
Posted by willyee on January 11, 2007, at 21:18:19
In reply to Re: Benzo alternatives for anxiety/panic?, posted by laima on January 11, 2007, at 20:47:01
>
> I've heard a lot of murmering about inderall, but haven't tried it myself. It relaxes a person by lowering blood pressure, I understand.Beta blockers are good secondary drugs,for actualy pyschiscal and some over ruminating thinking.
However they are not very popular for hard anxiety,i used to use lopressor,which my father gave me,a mild one,and it was to stop and body anxiety,also went well and complimented klonopin,HOWEVER i agree as monotherapy i wouldent recomend them,but i guess everything is worth a shot.
They also are not totaly safe with maois either.
Posted by Phillipa on January 11, 2007, at 21:24:08
In reply to Re: Benzo alternatives for anxiety/panic?, posted by willyee on January 11, 2007, at 21:18:19
Will don't know about safety with MAOI's but my pdoc gave me lopressor 25mg before he started me on l0mg of paxil said it would help with anxiety and I was already on xanax. And that lopressor made me so tired. Love Phillipa
Posted by laima on January 11, 2007, at 21:26:23
In reply to Re: Benzo alternatives for anxiety/panic?, posted by willyee on January 11, 2007, at 21:18:19
Oh---good point about MAOIs. I imagine then that they might really plunge the blood pressure or something. Thanks for info.
> Beta blockers are good secondary drugs,for actualy pyschiscal and some over ruminating thinking.
>
> However they are not very popular for hard anxiety,i used to use lopressor,which my father gave me,a mild one,and it was to stop and body anxiety,also went well and complimented klonopin,HOWEVER i agree as monotherapy i wouldent recomend them,but i guess everything is worth a shot.
>
> They also are not totaly safe with maois either.
Posted by Quintal on January 11, 2007, at 21:43:03
In reply to Benzo alternatives for anxiety/panic?, posted by halcyondaze on January 11, 2007, at 18:16:46
I'm in a similar place as you halcyondaze in that my doctor will no longer prescribe benzos and I'm supposed to be taking Parnate but I'm worried about it being too stimulating without a benzo. Have you tried Nardil as it's more GABAergic and has powerful anxiolytic effects?
Zyprexa is another AP that may feel 'kinder' than Seroquel and it would probably counteract the stimulating effects of Parnate nicely (it is used in combination with Prozac for the same reason).
Q
Posted by harry_in_philly on January 11, 2007, at 21:51:48
In reply to Re: Benzo alternatives for anxiety/panic? » halcyondaze, posted by Quintal on January 11, 2007, at 21:43:03
What about Thorazine, Compazine, or maybe even vistaril to treat anxiety. Perhaps Geodon?
Posted by med_empowered on January 11, 2007, at 22:39:14
In reply to Re: Benzo alternatives for anxiety/panic?, posted by med_empowered on January 11, 2007, at 19:50:26
depakote might help, but its pretty rough stuff. Vistaril helps some people, but again--rough stuff. And really over-hyped--its not that great. Picamilon, maybe?
Posted by blueberry1 on January 12, 2007, at 6:32:59
In reply to Benzo alternatives for anxiety/panic?, posted by halcyondaze on January 11, 2007, at 18:16:46
I don't think it makes any sense at all to pay someone to create a traumatic experience on top of your existing problems. The doctor sounds more mentally ill than the rest of us here. Is he being paid to be a babysitter or a doctor? Sounds to me like he is looking out for his malpractice insurance more than he is looking out for your state of mind.
Suggestions:
Taurine. 500mg 1 to 3 times per day, some people have used up to 3000mg a day. It is a calming natural amino acid available at the health food store or the drug store. I found it helped my mood too. It has other bodily benefits and brain benefits.
The herb skullcap. It is kind of subtle but worked good for me. It seemed to work a little bit the first day I tried it, no big deal, but the next day was unusually calm. I read somewhere that it has been used to help people wean off opiates, so it does have some respectable power. It is supposedly good for insomnia but wasn't all that powerful to me. It's overall calming was significant.
I hate to suggest antipsychotics. Hate it. But if, and only if, that is where you want to go, then zyprexa. Keep the dose at 2.5mg twice a day or 5mg once a day or less.
Get another doctor! One that will give you what you need/want. One that will provide a service to the paying customer! You don't need to pay someone that much to be a professional babysitter. If you want a benzo, you should be able to get one. After all, who the paying customer? If the store/service/catalog/whatever doesn't deliver what you pay for, then why shop there? I don't know, maybe it's just me, but I do not pay someone my hard earned money for them to tell me what I can and cannot do.
Picamilon was mentioned. I tried it and got opposite results. It wired me. Same thing with theanine.
Parnate itself may be part of the problem. I am not familiar with it, but many people here have said it is stimulating. Nardil is generally considered more calming and relaxing, probably because it affects GABA.
For something you can try right now without any hesitation and real cheap, taurine.
Posted by laima on January 12, 2007, at 8:18:07
In reply to Re: Benzo alternatives for anxiety/panic? » halcyondaze, posted by blueberry1 on January 12, 2007, at 6:32:59
Yes, zyprexa can help with accute anxiety. Not the nicest drug in my personal experience and opinion, mostly due to sluggishness and appetite increase, but alright for short term. It can do some of what it does in a really short time- like an hour even. I didn't experience any withdrawals from my brief trials of low doses.
Posted by med_empowered on January 12, 2007, at 12:42:09
In reply to Re: Benzo alternatives for anxiety/panic?, posted by laima on January 12, 2007, at 8:18:07
your doc is not caring for you appropriately. Past abuse or no, adequately supervised benzo rx's are appropriate for your situation. My advice: ditch him/her. Start over. Don't mention your drug addiction, don't refer them to anyone who would give evidence of it. Just give yourself a clean slate.
I know this sounds tricky and manipulative but...situations like this make me furious. I think you would do much better with a doc who doesn't mistreat people just b/c they have a history of substance abuse. I also don't think that a history of substance abuse=relapse. So...please; find yourself a different doctor, one who will help you out.
Good luck.
Posted by laima on January 12, 2007, at 13:57:33
In reply to ditch your doc, posted by med_empowered on January 12, 2007, at 12:42:09
I saw your post where you mentioned what happened, and I completely agree with medempowered here now. Common decency seems to indicate some assistance with such an 'unusual' and traumatic episode.
Posted by yxibow on January 12, 2007, at 14:38:14
In reply to ditch your doc, posted by med_empowered on January 12, 2007, at 12:42:09
> your doc is not caring for you appropriately. Past abuse or no, adequately supervised benzo rx's are appropriate for your situation. My advice: ditch him/her. Start over. Don't mention your drug addiction, don't refer them to anyone who would give evidence of it. Just give yourself a clean slate.
>
> I know this sounds tricky and manipulative but...situations like this make me furious. I think you would do much better with a doc who doesn't mistreat people just b/c they have a history of substance abuse. I also don't think that a history of substance abuse=relapse. So...please; find yourself a different doctor, one who will help you out.
>
> Good luck.Common decency is true. However, nobody on here knows the doctor-patient relationship, the patient that is speaking about, and all the psychiatrist's notes.
Telling someone to ditch their doctor is a reckless statement. Rephrasing it might be a better way. Because you don't know why the doctor chooses to do the things he or she does and there may be a medically valid though on the face perverse reason. I've seen too many of these generalizations and I don't think they're helpful.
Given my history of benzo dependence, my doctor will not prescribe benzodiazepines to me, even though I have been having panic attacks (hyperventilating) and am having severe anxiety to the point where I don't want to go outside.
I took 25 mg Seroquel but it just made me tired and MORE anxious because I felt like my reflexes were not up to par.
How long have you been on the Seroquel ? Have you tried a similar very minor dosage of Zyprexa, say a split with a sharp splitter of a 2.5mg pill ? It doesn't carry the same antihistaminic effects quite as much and the weight gain issues are small at 1.25mg. I'm not sure of its interactions with Parnate but I imagine similar.
Is there anything short-acting that can help panic like this that is not a benzo? I am also on Parnate, so some choices are limited.
You can try .1 to .2mg of Clonidine (alpha blocker) per day -- though you must remember to take it consistently otherwise you will have rebound high blood pressure.Propranolol, a beta blocker, as suggested also is used to cover the effects but not the root cause of things.
If you do desire -personally- to find a different doctor, that is a different thing, but I dont like the "ditch the doctor" generalizations, it goes against the grain of casual medical advice that we give on here. Nonetheless I am sympathetic to your cause, don't get me wrong.
Neurontin, if you haven't taken it before, works in the short term fairly well, in the long term, it is more of an adjunctive. Lyrica, which is similar, is more effective but has more side effects -- again, I don't know the interaction with Parnate for the two, although Neurontin by itself is fairly harmless.
-- tidings
Jay
Posted by laima on January 12, 2007, at 15:23:57
In reply to Re: ditch your doc -- a comment to generalizations » med_empowered, posted by yxibow on January 12, 2007, at 14:38:14
Yxibow, I would agree with you 100%, were it not for the fact halcyondaze reported on another thread that she was just very recently attacked. Trust me, that's traumatic! I wonder, does her doctor comprehend what a big deal that is? This is a tough situation, a little merky.
Posted by blueberry1 on January 12, 2007, at 16:42:24
In reply to ditch your doc, posted by med_empowered on January 12, 2007, at 12:42:09
Patient/doctor relationship is very important. Whether that exists in this case I don't know. Only the patient and doctor know. I get the sense the doctor is underplaying a role as healer and overplaying a role as babysitter...either from true desire to avoid benzo relapse hidden motives or to protect oneself from malpractice (though if suicide were the result of non-treatment, malpractice would be a lot worse).
What are the risks of a former benzo abuser returning to benzos? Relapse. This can be controlled with therapeutic dosing, limited dosing, and monitoring.
What are the risks of not treating this kind of anxiety/panic appropriately and aggressively? Suicide. Emergency room. Withdrawn from life. Numerous other life traumas.
The doctor seems to have taken it lightly. That doesn't seem like a good relationship to me. Especially when you consider who is paying who. I mean, if you get right down to the basics, it isn't about relationships, it is about paying for a service, and the service you are paying for is healing.
I don't know the whole story so I could be wrong. I would make one last vigilant effort to beg and plead for what I want, make some genuine promises and offer strategies not to fall into abuse, and if that failed I do not think I could ever walk in that doctor's office again. I probably wouldn't even pay him for that visit. Let it show up on my credit report, I could care less. I aint payin someone to treat me bad.
Posted by UgottaHaveHope on January 12, 2007, at 17:02:26
In reply to Benzo alternatives for anxiety/panic?, posted by halcyondaze on January 11, 2007, at 18:16:46
You can take up to 400mg of Seroquel safely.
Maybe try some Benadryl to calm you down.
Maybe go to a nutritional store, and buy some GABA.
I hate that you are in this situation, especially on Friday when the most soon you would be able to get help would be Monday.
Hoping and praying for you, Michael
Posted by laima on January 12, 2007, at 17:42:47
In reply to Re: » halcyondaze, posted by UgottaHaveHope on January 12, 2007, at 17:02:26
I almost wonder if it would make sense to go to an emergency room and explain the situation, to ask for benzo? I did that when my klonopin taper started too abruptly, was met with a stressor, and resulted in a holiday-eve hyperventilation attack. The hospital gave me enough of a shorter acting benzo to get me over the hump, even though I explained my situation and that the goal was to taper off. Surely, most people would comprehend that this is an extrordinary situation. Then re-assess the relationship with primary psychiatrist?
Posted by Phillipa on January 12, 2007, at 18:39:05
In reply to Re:, posted by laima on January 12, 2007, at 17:42:47
I was thinking the same thing and most ER's will send a Social Worker down to see you and they can give you a list of pdocs and therapists and of course a script for your horrible anxiety. Love phillipa
Posted by halcyondaze on January 12, 2007, at 18:44:27
In reply to Re:, posted by laima on January 12, 2007, at 17:42:47
Thank you to everyone who responded.
My aunt gave me some of her Xanax, and I have been able to take less than 1 mg each day (which, considering my "history," is kind of amazing). I take 0.5 mg when I leave for work and then 0.5 when I am coming home. It is amazing how much it helps. I am not afraid to go outside when I take it and I am experiencing ZERO euphoria, just relief from anxiety.
I am afraid that I am going to abuse it, which is why I wish my doctor could be on board and give me something milder like Klonopin, even just enough pills for the week (I see her every week; she's my therapist as well as my psychopharmacologist). That's why I can't just "ditch her" - we have a three year therapy relationship and she's helped me in SO many ways.
I think the biggest issue is that, two weeks ago, I relapsed on drugs. I took 45 mg Xanax and the next day ended up injecting heroin, overdosing and nearly dying, and ending up in the ER. So I understand her reservations. And she's requiring me to do an outpatient substance abuse program so I can't take unprescribed Xanax for much longer. I don't really know what to do.
I was considering switching from Parnate to a SSRI - Zoloft worked for me very well (for depression) and maybe it would help the panic attacks too.
Posted by yxibow on January 12, 2007, at 19:04:24
In reply to Re: ditch your doc -- a comment to generalizations » yxibow, posted by laima on January 12, 2007, at 15:23:57
>
> Yxibow, I would agree with you 100%, were it not for the fact halcyondaze reported on another thread that she was just very recently attacked. Trust me, that's traumatic! I wonder, does her doctor comprehend what a big deal that is? This is a tough situation, a little merky.
>
> http://www.dr-bob.org/babble/20070107/msgs/721440.htmlI understand -- and believe me that makes it a very tough situation, between a traumatic situation but also a revelation of past drug abuse. Giving advice leaves you stuck in between because you want to be sympathetic but you don't want to lead someone down the path of self-revelation of IV drug use again, and you have to take someone at their face value and trust that what is told is all truthful. And I'm not saying it isn't.
Your option of going to the ER would probably be one, considering you were very recently attacked. I can't vouch for your insurance -- if you don't have good coverage a typical bill could run up in the several hundreds at least for a visit, but if it is necessary, then do so. They may even do a psychiatric evaluation and possibly give you some pointers in the community to social workers who might know someone who is more compatible to your situation if you choose so.
The other, I can't comment as a good or bad thing -- it does violate federal law to give prescriptions to someone else and thus I cannot advise that it is a good or bad thing on here because I cannot advise you to break the law no matter the situation. I.e. I broke the law once speeding to get a companion in the car closer to a hospital due to some neurological issue and flagged down the trooper who was about to stop me who gave me a wet noodle that I passed a phone booth.
As for other things, Drugs.com makes no negative comment on the interaction between Kava and Parnate and for a -short- term use of it, it poses no liver issue if you don't have liver damage to begin with. Just don't mix it up too much with Xanax, that would be bad. The Liquid Caps from GAIA I believe or whatever are fairly potent. This steps somewhat into the realm of alternate health although it is considered prescription I believe in some European countries.
GABA by itself will not cross the blood-brain barrier in any regards and is a waste of money -- only Neurontin and Lyrica, which are analogues and have the ability to cross that barrier. Picamilon, which I have never seen OTC alone, its usually combined with odd herbs, will to an extent, but I wouldn't trust its safety necessarily. I can't recommend it one way or the other.
-- tidings and best wishesJay
Posted by blueberry1 on January 12, 2007, at 19:45:39
In reply to Thank you everyone, posted by halcyondaze on January 12, 2007, at 18:44:27
With a fuller story of what's going on here, I would like to take back my thoughts and comments on my previous posts in this thread. I jumped to conclusions without knowing the whole story.
Moving on...
I'm glad xanax is working. If you ask for just one week's worth of pills at a time, that might work. My doctor once said that he would call the pharmacy and have them give me just one day's worth at a time. Obviously an inconvenience. But a good way to keep from abusing.
> Thank you to everyone who responded.
>
> My aunt gave me some of her Xanax, and I have been able to take less than 1 mg each day (which, considering my "history," is kind of amazing). I take 0.5 mg when I leave for work and then 0.5 when I am coming home. It is amazing how much it helps. I am not afraid to go outside when I take it and I am experiencing ZERO euphoria, just relief from anxiety.
>
> I am afraid that I am going to abuse it, which is why I wish my doctor could be on board and give me something milder like Klonopin, even just enough pills for the week (I see her every week; she's my therapist as well as my psychopharmacologist). That's why I can't just "ditch her" - we have a three year therapy relationship and she's helped me in SO many ways.
>
> I think the biggest issue is that, two weeks ago, I relapsed on drugs. I took 45 mg Xanax and the next day ended up injecting heroin, overdosing and nearly dying, and ending up in the ER. So I understand her reservations. And she's requiring me to do an outpatient substance abuse program so I can't take unprescribed Xanax for much longer. I don't really know what to do.
>
> I was considering switching from Parnate to a SSRI - Zoloft worked for me very well (for depression) and maybe it would help the panic attacks too.
Posted by laima on January 12, 2007, at 22:23:53
In reply to Retract My Comments Please, posted by blueberry1 on January 12, 2007, at 19:45:39
It sounds like you have an overall good situation with your doctor-
and that's very valuable and very worth maintaining. I'm sorry about your current circumstances.
Posted by halcyondaze on January 13, 2007, at 15:44:34
In reply to Re: Retract My Comments Please, posted by laima on January 12, 2007, at 22:23:53
It is nice to receive support from you all; I posted in a different forum, with people who have seen me through my substance abuse history, and the responses were markedly different and quite unempathic.
I have actually been holding onto the medication myself and have had no desire to abuse it; I am aware that if I abuse it, it will stop working for the actual panic. This happened when I detoxed from high dose unprescribed Xanax, which I was using to counter the effects of high dose unprescribed Adderall and I seemed to develop an anxiety disorder, whereas I had never before had baseline anxiety. THAT was managable, but these panic attacks are not.
I am using some graded exposure techniques and am happy to say that today I did not need to take any Xanax at all. Yesterday I took .5 mg total. Considering I detoxed off of 16 mg of Xanax per day, I understand everyone's reservations; however, my reasons before for taking it were quite different and it was never my primary substance of choice, just an adjunct to amphetamines or heroin.
However, I have also abused Parnate, as I have mentioned here, and now take it at a fixed dose, more or less, without abuse. Same for Ambien. Sometimes I need to ask my doctor to hold onto my pills for me because I recognize that I do not want her to decide that I cannot responsibly take these medications when I feel as though I need them, and the same is true now of the Xanax.
I'm seeing her Tues and will bring up some of the suggestions that were brought up here. I am very interested in Kava and Taurine and other herbal medications. I am afraid of Zyprexa because I have a history of anorexia and the weight gain terrifies me. I will also see if I can perhaps switch to Klonopin or another less abusable benzo for a short period of time until I can manage the anxiety without meds.
FINAL QUESTION: Has anyone found any kind of longer-acting medication (i.e. SSRIs) to be effective for anxiety or panic? The only drugs that have ever worked for my depression have been Zoloft and Parnate and I am reluctant to switch back because of side effects and because Zoloft was never as effective as Parnate for depression but Parnate is not very effective for my anxiety.
Posted by Quintal on January 13, 2007, at 19:34:53
In reply to Re: Retract My Comments Please, posted by halcyondaze on January 13, 2007, at 15:44:34
Have you tried Nardil? It is considered the anxiolytic MAOI because one of its metaboloites increases GABA throughout the brain which helps with panic and anxiety. It is supposedly less abusable than Parnate.
Q
Go forward in 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.