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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 14 of 14. This is the beginning of the thread.
Posted by saturn on June 18, 2007, at 19:57:20
I hate writing posts that are less than brief, but whatever:
After many years I'm considering a serious trial of meds primarily because due to my self-diagnosed social anxiety. I am also seriously considering sticking with the status quo.
I have been reluctant to undergo any significant med trials due to severe problems with prior trials, most significantly severe chest pain with Zoloft and stimulants independently (BTW I'm a healthy 30 y/o male and have had a completely thorough and negative cardiac workup except for an asymptomatic heart block which therefore prevents me from taking TCA's).
I have also gone through ambien withdrawal and cannot imagine a more serious benzo withdrawal.
Here's the thing: I get by, at least enough to usually fake it. I have times where I'm completely calm and content, and times where I'm rather anxious and/or depressed. *I seem to have virtually no control over these states*, though my anxiety seems to rather consistently be elevated in social situations (and depending on the context of these situations). I can occassionaly be completely calm and collected in front of many people. Many other times I'm very anxious just talking with a co-worker. Insomnia is a constant, which has been reasonably treated with Lunesta monotherapy.
I've never had a manic episode.
So here's my question: Is going down the med route more or less likely to worsen my situation over the long run? My life is decent/manageable...but the social/anticipatory anxiety is really a *serious* problem. Adding serious med side effects/withdrawals could very tip the balance *against* having a decent/manageable life.
I am terrified of chest pain and CNS depressant withdrawal, and am not fond of a merry-go-round of trials and withdrawals (who is, right?).
Self-diagnoses in order of significance are:
1. Social Phobia
2. GAD (but perhaps just an extension of SP)
3. dysthymia (possibly due to anxiety)
4. ADHD (helped with fish oil and worsened with anxiety).I have taken a beta-blocker/benzo combo on several occassions, which worked ok, but am concerned about long-term benzo-induced worsening of depression and ADHD, and tolerance withdrawal. If I go on a benzo I know I'm going on it for life, and I'm afraid of the cardiovascular side effects of MAOI's.
Fish oil seems to help modestly with ADHD and dysthymia, but any med-induced worsening of my ADHD would present significant problems. I absolutely refuse an SSRI or stimulant. Lunesta is my only psych med.
I know I want to have my cake and eat it too. But seriously, to summarize I'm rather reluctant of having a pdoc throw me on some benzo/lamicatal/Lithium or whatever combo and then in the end being worse off than I already am.
Thanks for any input.
Peace...Saturn.
Posted by Phillipa on June 18, 2007, at 20:20:20
In reply to When and/or how to treat or not treat, posted by saturn on June 18, 2007, at 19:57:20
Sounds like xanax prn might work for you. Love Phillipa
Posted by Quintal on June 18, 2007, at 22:06:42
In reply to When and/or how to treat or not treat, posted by saturn on June 18, 2007, at 19:57:20
Well I'd say if you're doing reasonably well as you are I think it's wise to stay that way, and maybe look into non-med ways (not necessarily therapy) of changing your life/attitude/outlook on life to make things more comfortable for you. In fact meds are only likely to ever serve as aids in keeping you motivated in doing these things. Relying on them to make you feel good, and keep you feeling good for the rest of your life will almost certainly lead to disappointment when you develop tolerance or the meds poop-out. I often fall into the temptation of thinking "This is good, but if only I was taking med X, it would be so much better". Sometimes I do feel good for a while on certain meds but it never lasts, and I could probably feel just as good once I got used to living without them.
So at most, maybe as Philipa suggests, a short acting benzo like Xanax or Ativan taken as required would be most helpful? I do wonder how a person who feels anxious most of the time decides when it is required though. Few people seem to be able to manage that type of benzo use because the rebound anxiety after each dose almost undoes the benefit of taking it in the first place, so you end up taking them nearly all the time or having strong cravings between doses. Still, you can only know how you personally react by trying them for yourself.
Q
Posted by Phillipa on June 18, 2007, at 22:18:07
In reply to Re: When and/or how to treat or not treat » saturn, posted by Quintal on June 18, 2007, at 22:06:42
Quintal funny when I knew absolutely nothing about benzos .5 of xanax four times a day worked very well. Never felt when they wore off as I was on a schedule. Love Phillipa
Posted by Quintal on June 18, 2007, at 22:40:04
In reply to Re: When and/or how to treat or not treat » Quintal, posted by Phillipa on June 18, 2007, at 22:18:07
Yeah, if you were taking them four times a day you wouldn't feel them wearing off. When people say 'as required' they usually mean less than once daily, sometimes twice a week or less, and in those situations you would feel the Xanax wearing off after a few hours.
Q
Posted by Phillipa on June 18, 2007, at 22:47:07
In reply to Re: When and/or how to treat or not treat » Phillipa, posted by Quintal on June 18, 2007, at 22:40:04
If that infrequent the use I don't think so as it would probably be to stop a panic attack and once it's over you wouldn't need the med so no withdrawal. At least that's the way I see it. Love Phillipa ps kind of like inderal
Posted by Quintal on June 19, 2007, at 0:09:52
In reply to Re: When and/or how to treat or not treat » Quintal, posted by Phillipa on June 18, 2007, at 22:47:07
Saturn doesn't seem to have panic attacks, rather social/general anxiety which is usually chronic and all-pervading rather than episodic like panic disorder. So how do you decide when the benzo is needed when your anxiety is more or less constant, and how do you cope with the rebound anxiety when it's wearing off? That's the problem many people with GAD/social anxiety run into when trying to use benzos p.r.n.
Q
Posted by Racer on June 19, 2007, at 15:31:03
In reply to When and/or how to treat or not treat, posted by saturn on June 18, 2007, at 19:57:20
If you're mostly OK, but could be better -- that is, if you're able to function adequately -- there are probably better interventions than meds.
I'm always in favor of therapy, but that's my bias. You could also try anything that helps you reduce your anxiety: meditation, yoga, biofeedback, self-help programs like that in "Mind Over Mood," reminding yourself that the person/people you're interacting with may be feeling just as anxious as you are, or other things I'm not thinking of right now. Therapy, in this case, would probably be some sort of short-term, goal oriented thing. Even some sort of coaching -- a job coach might be able to help.
For some people, the answer is "fake it 'til you make it" -- if you pretend to be confident often enough and successfully enough, you find yourself becoming more confident. It's just another form of behavior training: you pretend to be confident, you get a more positive outcome, which makes it easier next time to pretend to be confident, which reinforces the positive outcome...
Good luck, whatever you decide to do.
Posted by saturn on June 19, 2007, at 18:13:02
In reply to Re: When and/or how to treat or not treat » saturn, posted by Phillipa on June 18, 2007, at 20:20:20
> Sounds like xanax prn might work for you. Love Phillipa
Hi Phillipa I do use a benzo a few times a year and it works well.
Peace...Saturn
Posted by saturn on June 19, 2007, at 18:26:15
In reply to Re: When and/or how to treat or not treat » Phillipa, posted by Quintal on June 19, 2007, at 0:09:52
>>> Saturn doesn't seem to have panic attacks, rather social/general anxiety which is usually chronic and all-pervading rather than episodic like panic disorder.
Yup--although certain social situations are much worse than others. Sometimes just the anticipation of interacting with people makes me anxious even upon waking. It can last all day. Other times I'm pretty cool for most of the day. Most days are a mix of both.
The one constant I have is knowing that the anxiety will abate, usually within hours, though I wish it weren't there at all. I'd do much better in my career and with women if I could usually be as calm as I am in the evening alone.>>>So how do you decide when the benzo is needed when your anxiety is more or less constant, and how do you cope with the rebound anxiety when it's wearing off? That's the problem many people with GAD/social anxiety run into when trying to use benzos p.r.n.
Exactly, which is why I say that if I were to go on a benzo I know it would be permanently.
Thanks for your input Quintal...I really appreciate it...Saturn.
>
Posted by saturn on June 19, 2007, at 18:52:07
In reply to I agree with Quintal » saturn, posted by Racer on June 19, 2007, at 15:31:03
Thanks so much Racer for the insight and book link. I'm think I'm partial to starting meditation.
Since an SSRI and MAOI are out of the question, I will continue to only use a benzo a few times a year for really big occassions. And I also need the lunesta to sleep.
Though unconventional, for several reasons Tenex is the only med I'm seriously considering at this point. Not Tenex plus six other meds--- though I mean no disrespect to those on polypharmacy. It is reassuring to know that benzos are always an option, though one I personally choose to reserve as an absolute last line.
Either way I realize the importance of behavioral tools. I would just be grateful for even a litte help from a pharmacologic angle, though I realize I can manage without it. If I give the Tenex a shot, whatever the outcome I'm going to proceed knowing that the bulk of the work is going to have to come from me. And the acceptance that I can survive with uncomfortable feelings...I won't let them conquer me.
Thanks so much for your input, it's greatly appreciated. Peace...Saturn
Posted by Phillipa on June 19, 2007, at 19:59:22
In reply to Re: When and/or how to treat or not treat » Phillipa, posted by Quintal on June 19, 2007, at 0:09:52
Xanax at the same dose worked wonderfully for me for years no rebound at all ever that was when I was working and extremely busy nusing, managing a home, and three kids too. Love Phillipa
Posted by Phillipa on June 19, 2007, at 20:12:10
In reply to Re: When and/or how to treat or not treat » Phillipa, posted by Quintal on June 18, 2007, at 22:40:04
Quintal but if all you required was a few times a week you wouldn't notice it as I'm sure it would be a low dose and once involved in acitivites you usually forget about it. My youngest Daughter took it for a while and stopped it she was going through a job change when things settled down and she was comfortable she didn't require it anymore. Love Phillipa ps our favorite topic
Posted by Racer on June 22, 2007, at 12:15:32
In reply to Re: I agree with Quintal » Racer, posted by saturn on June 19, 2007, at 18:52:07
You're welcome.
I'm not familiar with Tenex, so I can't comment on that. I did think of the drug which was a miracle for me with anxiety -- propranalol. It's a beta blocker, and the first time I took it I felt so damn good -- I'd never realized just how bad my anxiety was, how tense I was all the time, how tiring it was to be that tense, how generally lousy that level of anxiety left me feeling. It can be taken prn, so you wouldn't necessarily end up taking it forever. I don't remember any sort of dip when it was wearing off. (Which doesn't mean there wasn't any. It's much more likely that I wasn't aware of changes associated with its wearing off.) It might be worth a shot...
Good luck, whatever you decide on.
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