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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 9 to 33 of 33. Go back in thread:
Posted by Christ_empowered on August 3, 2011, at 18:44:13
In reply to Re: Any other recommendations for Anxiety? » displaced9, posted by floatingbridge on August 3, 2011, at 18:09:37
I take 3 500mgs capsules of Vitacost brand niacinamide 2x daily. Today I'm trying 6 grams (6 caps, 2x daily). Feeling a little tranquilized, but otherwise fine.
I also take Jarrow Formulas Taurine. They come in 1,000mgs capsules. They're on perma-sale at www.vitacost.com and elsewhere. I take 3 capsules 2x daily, for a total of 6 grams.
When I started, I jumped right into the full doses of each. If you wanted to, you could try it more gradually, like taking 500mgs niacinamide plus 1 gram taurine 2x daily, and then work up as needed. 3 grams niacinamide was/is pretty standard for orthomolecular treatment of anxiety disorders. Larger amounts were/are sometimes used for schizophrenia and other more severe disorders.
I saw on vitacost.com that there's a relatively inexpensive niacinamide that comes in 1500mgs time release capsules. That might be worth trying. When I have to reorder I may just order that stuff.
Posted by jono_in_adelaide on August 3, 2011, at 19:46:15
In reply to Any other recommendations for Anxiety?, posted by displaced9 on August 3, 2011, at 14:41:06
Mirtzepine 30mg at bedtime would be worth a try, risperidone 1mg at bedtime would also be well worth trying.
Posted by displaced9 on August 3, 2011, at 19:49:05
In reply to Re: Any other recommendations for Anxiety?, posted by jono_in_adelaide on August 3, 2011, at 19:46:15
Mirtazapine is remeron right ? If so I tried that before and Gaines 5 lbs in a week. I couldn't stop eating
Does risperdone cause weight gain ?
Posted by Phillipa on August 3, 2011, at 19:53:22
In reply to Re: Any other recommendations for Anxiety?, posted by displaced9 on August 3, 2011, at 19:49:05
I think not sure the atypicals do cause weightgain. As for luvox sold as fluvoximine not to be mistaken for generic prozac. Similar spelling. Phillipa
Posted by jono_in_adelaide on August 3, 2011, at 19:53:45
In reply to Re: Any other recommendations for Anxiety?, posted by displaced9 on August 3, 2011, at 19:49:05
Risperidone can cause weight gain in the doses used for psychosis, but in the 1mg dose used for anxiety and depression, it hasnt caused any for me, infact I have managed to lose a fair swag of weight while taking it.
By taking 1mg risperidone at bedtime, you will likely get SOME releif of your anxiety, and thus be able to reduce your reliance on Klonopin, such that you wont be tolorant to it, and when you do need it, it will realy work
Taking the 1mg of Risperidone has enabled me to cut my Xanax from 1mg three times a day to 1mg twice a dat on most days, thus I have 1mg up my sleeve to take if I am having a particularly bad day.
Posted by jono_in_adelaide on August 3, 2011, at 20:02:36
In reply to Re: Any other recommendations for Anxiety?, posted by jono_in_adelaide on August 3, 2011, at 19:53:45
"A comparison of low-dose risperidone to paroxetine in the treatment of panic attacks: a randomized, single-blind study.
Prosser JM, Yard S, Steele A, Cohen LJ, Galynker II.
SourceThe Department of Psychiatry and Behavioral Sciences, Beth Israel Medical Center, Albert Einstein College of Medicine, New York, NY 10003, USA. jprosser@chpnet.orgAbstract
BACKGROUND: Because a large proportion of patients with panic attacks receiving approved pharmacotherapy do not respond or respond poorly to medication, it is important to identify additional therapeutic strategies for the management of panic symptoms. This article describes a randomized, rater-blind study comparing low-dose risperidone to standard-of-care paroxetine for the treatment of panic attacks.METHODS: Fifty six subjects with a history of panic attacks were randomized to receive either risperidone or paroxetine. The subjects were then followed for eight weeks. Outcome measures included the Panic Disorder Severity Scale (PDSS), the Hamilton Anxiety Scale (Ham-A), the Hamilton Depression Rating Scale (Ham-D), the Sheehan Panic Anxiety Scale-Patient (SPAS-P), and the Clinical Global Impression scale (CGI).
RESULTS: All subjects demonstrated a reduction in both the frequency and severity of panic attacks regardless of treatment received. Statistically significant improvements in rating scale scores for both groups were identified for the PDSS, the Ham-A, the Ham-D, and the CGI. There was no difference between treatment groups in the improvement in scores on the measures PDSS, Ham-A, Ham-D, and CGI. Post hoc tests suggest that subjects receiving risperidone may have a quicker clinical response than subjects receiving paroxetine.
CONCLUSION: We can identify no difference in the efficacy of paroxetine and low-dose risperidone in the treatment of panic attacks. Low-dose risperidone appears to be tolerated equally well as paroxetine. Low-dose risperidone may be an effective treatment for anxiety disorders in which panic attacks are a significant component."
Posted by floatingbridge on August 3, 2011, at 20:40:12
In reply to Re: Any other recommendations for Anxiety?, posted by jono_in_adelaide on August 3, 2011, at 20:02:36
Do you have an idea what is considered low dose?
Thanks, Jono
> "A comparison of low-dose risperidone to paroxetine in the
treatment of panic attacks: a randomized, single-blind study.
> Prosser JM, Yard S, Steele A, Cohen LJ, Galynker II.
> SourceThe Department of Psychiatry and Behavioral Sciences, Beth Israel Medical Center, Albert Einstein College of Medicine, New York, NY 10003, USA. jprosser@chpnet.org
>
> Abstract
> BACKGROUND: Because a large proportion of patients with panic attacks receiving approved pharmacotherapy do not respond or respond poorly to medication, it is important to identify additional therapeutic strategies for the management of panic symptoms. This article describes a randomized, rater-blind study comparing low-dose risperidone to standard-of-care paroxetine for the treatment of panic attacks.
>
> METHODS: Fifty six subjects with a history of panic attacks were randomized to receive either risperidone or paroxetine. The subjects were then followed for eight weeks. Outcome measures included the Panic Disorder Severity Scale (PDSS), the Hamilton Anxiety Scale (Ham-A), the Hamilton Depression Rating Scale (Ham-D), the Sheehan Panic Anxiety Scale-Patient (SPAS-P), and the Clinical Global Impression scale (CGI).
>
> RESULTS: All subjects demonstrated a reduction in both the frequency and severity of panic attacks regardless of treatment received. Statistically significant improvements in rating scale scores for both groups were identified for the PDSS, the Ham-A, the Ham-D, and the CGI. There was no difference between treatment groups in the improvement in scores on the measures PDSS, Ham-A, Ham-D, and CGI. Post hoc tests suggest that subjects receiving risperidone may have a quicker clinical response than subjects receiving paroxetine.
>
> CONCLUSION: We can identify no difference in the efficacy of paroxetine and low-dose risperidone in the treatment of panic attacks. Low-dose risperidone appears to be tolerated equally well as paroxetine. Low-dose risperidone may be an effective treatment for anxiety disorders in which panic attacks are a significant component."
>
>
Posted by jono_in_adelaide on August 3, 2011, at 22:18:46
In reply to Re: Any other recommendations for Anxiety?, posted by floatingbridge on August 3, 2011, at 20:40:12
I'd say 1-1.5mg per day would be considered low dose, but I stand to be corrected.
Posted by jono_in_adelaide on August 3, 2011, at 22:26:00
In reply to Re: Any other recommendations for Anxiety?, posted by floatingbridge on August 3, 2011, at 20:40:12
I have had no side effects from 1mg risperidone at night, except for a bit of drowsiness during the first 2 days.
I think the exciting thing isnt that it works about as well as paroxetine, but that it works as well through a different mechanism, so the two can be taken together for a double whamey effect, and that there is no tolorance or dependence as there is with benzos
Posted by floatingbridge on August 3, 2011, at 22:30:03
In reply to Re: Any other recommendations for Anxiety?, posted by jono_in_adelaide on August 3, 2011, at 22:26:00
> I have had no side effects from 1mg risperidone at night, except for a bit of drowsiness during the first 2 days.
>
> I think the exciting thing isnt that it works about as well as paroxetine, but that it works as well through a different mechanism, so the two can be taken together for a double whamey effect, and that there is no tolorance or dependence as there is with benzosJono, I'm not familiar with the other medication paroxetine. You have taken the risperdal and it helps with sleep and throughout the next day? I was reading the wiki entry and trying to understand how risperdal was so different.
Thanks for getting back to me with dosage.
Posted by displaced9 on August 3, 2011, at 22:34:33
In reply to Re: Any other recommendations for Anxiety?, posted by jono_in_adelaide on August 3, 2011, at 22:26:00
Just curious.. are you male or female? and age?
Paroxetine in the past caused sexual issues for me. I am 29 yo male.
But the 1mg risperidone added to current regimen (possibly replacing one of the drugs) sounds like it could work..
Posted by utopizen on August 4, 2011, at 0:31:27
In reply to Re: Any other recommendations for Anxiety?, posted by displaced9 on August 3, 2011, at 22:34:33
have you tried Neurontin? It's a great alternative to Klonopin... no absurd withdrawal if you lose it and your doc feels like taking a week's vacation, claim it was 4 days to excuse the lack of a backup, and...
yeah. anyhow, Neurontin is very, very, very soothing.
It feels like it envelopes the soul.
Posted by jono_in_adelaide on August 4, 2011, at 0:34:25
In reply to Re: Any other recommendations for Anxiety?, posted by floatingbridge on August 3, 2011, at 22:30:03
paroxetine is paxil/aropax/seroxat, an SSRI antidepressant.
Posted by jono_in_adelaide on August 4, 2011, at 0:37:16
In reply to Re: Any other recommendations for Anxiety?, posted by utopizen on August 4, 2011, at 0:31:27
Me: male, 39, Australia
I found adding 1mg risperidone at night to my other meds made a big difference in how I felt
Posted by displaced9 on August 4, 2011, at 6:06:37
In reply to Re: Any other recommendations for Anxiety?, posted by utopizen on August 4, 2011, at 0:31:27
He mentioned Neurontin last time. What dosage do you take ?
Would I take it in lieu of buspar ?
Thanks !
Posted by Shes_InItForTheMoney on August 4, 2011, at 16:19:48
In reply to niacinamide, taurine, posted by Christ_empowered on August 3, 2011, at 18:44:13
I felt absolutely horrible on niacinamide, regardless of brand and dose. This stuff also can cause massive increases in blood sugar. I would have these horrible scarry dreams, and feel like absolute crap, and my mood would be horrible. I became very grumpy, aggressive. A number of other people I have met found they are the same way when taking it.
So, I guess, YMMV, be careful, etc.
Jay
> I take 3 500mgs capsules of Vitacost brand niacinamide 2x daily. Today I'm trying 6 grams (6 caps, 2x daily). Feeling a little tranquilized, but otherwise fine.
>
> I also take Jarrow Formulas Taurine. They come in 1,000mgs capsules. They're on perma-sale at www.vitacost.com and elsewhere. I take 3 capsules 2x daily, for a total of 6 grams.
>
> When I started, I jumped right into the full doses of each. If you wanted to, you could try it more gradually, like taking 500mgs niacinamide plus 1 gram taurine 2x daily, and then work up as needed. 3 grams niacinamide was/is pretty standard for orthomolecular treatment of anxiety disorders. Larger amounts were/are sometimes used for schizophrenia and other more severe disorders.
>
> I saw on vitacost.com that there's a relatively inexpensive niacinamide that comes in 1500mgs time release capsules. That might be worth trying. When I have to reorder I may just order that stuff.
>
>
>
>
>
>
Posted by Phillipa on August 4, 2011, at 19:26:12
In reply to Re: niacinamide, taurine » Christ_empowered, posted by Shes_InItForTheMoney on August 4, 2011, at 16:19:48
Jay knew it was you as who else comes up with these long names to post with. How is life for you? Phillipa
Posted by bleauberry on August 4, 2011, at 19:59:17
In reply to Any other recommendations for Anxiety?, posted by displaced9 on August 3, 2011, at 14:41:06
My opinion would be to try several adaptogens one at a time. Since you are already into the supplement/herb approach, that's a good move. It doesn't make the journey any easier, but at least the possibility of actually beating this thing becomes more attainable. Botanical medicines have some power.
I am not a good judge of herbs since I react so strangely to most substances. But I have tried all the adaptogens. My favorite has been Rhodiola, second favorite Cordyceps, third Ashwaganda. In your case, I would probably be looking at either of the last two. Rhodiola can be stimulating and dosing is tricky. Ashwaganda I think had the most anti-anxiety for me. One that seems to be the best in books is Siberien Ginseng (Eleuthero). It has to be in tincture form, high doses, long time, and it just never felt good to me. But it is one of the best.
The reason I zeroed in on the adaptogens is because to me this whole thing looks like it is in the adrenal/adrenaline/cortisol circuitry. Those herbs do good of balancing whatever is out of whack. If you think about it, all that anxiety stuff you feel feels kind of like too much adrenaline, right?
A friend of mine started taking Source Naturals brand Resveratrol made from Japanese Knotweed not grapes just for general brain and heart health, but within days noticed he felt calmer, sharper, and less trembling. That's not what the substance is known for, but if one is aware of all the mechanisms this substance does, it is not a surprise.
My best help has been Lemon Balm. I found the pills useless, the tea mildly helpful, but the tincture works. I just put a full dropper under my tongue and in 20 minutes I'm fine. It's one of my emergency friends. I also take the Source Naturals resveratrol, except I take it as part of a Lyme protocol. It is somewhat calming to the nervous system, as a side benefit to everything else it does.
Buspar can cause anxiety, ya know. That's one of the side effects that causes people to drop out of a trial. Actually any of the meds you are taking can. So you might want to see if you can identify which one might be doing it, if that is indeed a part of the picture.
Posted by torrid on August 4, 2011, at 23:00:36
In reply to Any other recommendations for Anxiety?, posted by displaced9 on August 3, 2011, at 14:41:06
My very server anxiety is under control. I'd split the credit between vitimins, medication and discovering the root of my emotional problems in therapy. I'm on the same meds as you, cymbalta 60mg, busbar 10mg x3, welbutrin 100mg, I also take concerta. I take NAC, SAMe, folic acid, selenium, vit C, D3, high potency multi, niacin and omega mood fish oil. I'd say therapy was the key for me. My therapist has helped me in a VERY SHORT amount of time shown me that there is a false belief at the root every time I have anxiety. The solution has been so easy, I just choise to change my beliefs. For example, I have a family court matter pending and when ever I woorked on my legal papers I would shake uncontrolably and get so overwelmed that I couldn't get a thing done, now I found a way to turn the anxiety off, I simply say to my self there is nothing to be afraid of and the anxiety gos away. I started by my changed my thoughts, every time I looked at my legal papers I stopped saying oh my good I can't do it, instead saying those papers can't hurt me and I can do it. I began just by changing the chatter of worry in my head to a more rational dialoge. It's called rational emotive therapy and it is working for me.
Posted by Phillipa on August 5, 2011, at 0:03:38
In reply to Re: Any other recommendations for Anxiety? » displaced9, posted by torrid on August 4, 2011, at 23:00:36
Wonderful I need to do this also. But can you take sammee with cymbalta? I didn't know you could. Phillipa
Posted by torrid on August 5, 2011, at 0:19:21
In reply to Re: Any other recommendations for Anxiety? » torrid, posted by Phillipa on August 5, 2011, at 0:03:38
There is risk of mania for bipolar's and of course risk of seritonin syndrome with SAMe. My doc isn't worried about it. SAMe works for some and not of others. For me it works in a couple hours, The very first day I took it in 3 hours I was out of depression for that day. I take it on bad days or days I need to function better. For me it's dose dependant and tolerance builds up fast. SAMe increases seritonin, AD's inhibit uptake so it makes sense to me to put them. together.
Posted by Phillipa on August 5, 2011, at 20:28:21
In reply to Re: Any other recommendations for Anxiety? » Phillipa, posted by torrid on August 5, 2011, at 0:19:21
Thanks for explaining that to me. I didn't understand the mechanism of samme Phillipa
Posted by morgan miller on August 7, 2011, at 15:30:17
In reply to Any other recommendations for Anxiety?, posted by displaced9 on August 3, 2011, at 14:41:06
Did you try lowering the lexapro dose? I have to believe that with a more paleo diet and regular intense exercise, the weight issues you experienced may have gone away. Whatever medication you are on, you probably should be going paleo/primal and exercising regularly followed by a thorough meditative stretch(especially given the manifestations you experience in the muscle).
How about Zoloft or Prozac? Ever tried those?
I found both Cymbalta and Wellbutrin to worsen axiety, but that's just me. Maybe try to go a little lower with one or both to see if you can maintain most of the relief you are experiencing as far as dysthymia is concerned? You may get some relief from axiety through lowering doses, just taking a shot in the dark.
If I were you, I would try doubling the daily dose of magnesium and see what happens. I think magnesium glycinate would be a good choice. The Peter Gilham product is good, but at least for me, it irritated my gut. You will also save money with magnesium glycinate.
Have you ever tried Taurine? What about New Chapter supercritical Holy Basil? I know holy basil is in Perfect Calm, but it is not going to be nearly as potent as their CO2 extract in the softgel form. My friend at work chews on them just enough to get some of the oil out and lets in set in her mouth around her cheeks and under her toungue. She says she feels the effects within 5 or 10 minutes. That's just her though. I feel the effects too, but have not tried her method yet. You may feel nothing, guess you never know till you try.
Buspar did not turn out to be the medication for anxiety they had hoped for.
Hmm, I wonder if you would respond well to the new antidepressant out there, Viibryd(Valdoxan).
I know I mentioned this before, but I think it's very important that you exercise regularly, and try to reach a point where you can do it intensely for a 15 to 20 minute period 3 times a week, and always follow exercise with a meditative stretch, breathing properly throughout(proper breathing is also important to reap the benfits of exercise).
Morgan
Posted by morgan miller on August 7, 2011, at 15:38:46
In reply to Any other recommendations for Anxiety?, posted by displaced9 on August 3, 2011, at 14:41:06
Tough it out and never take benzos, at least hardly ever. I truly believe they make anxiety less manageable in the long run. You can do this.
Don't even bother with atypical antipsychotics. These drugs du jor are likely to cause more harm than good down the road for all those people are prescribed them unnecessarily before all other options are exhausted. It's all about capitalism bro. These people don't usually truly care about your future.
I know things really suck right now, but I believe you can mostly resolve your issues through an integrative approach and hopefully the right amount of support. Therapy is a must(especially group therapy). Diet and exercise are a must. Friends and family are a must. Pleasurable activities are a must. And the right medications and supplements are a must.
Posted by morgan miller on August 7, 2011, at 15:44:57
In reply to Re: Any other recommendations for Anxiety?, posted by bleauberry on August 4, 2011, at 19:59:17
BB has some good recommendations for supplements.
Was fish oil mentioned? A total of 600 to 800 mg of combined EPA and DHA should be fine. You don't want to go much higher than this as high doses of marine omega 3s may suppress HPA axis function-something many of us do not need.
I would add Astragalus(1:5 tincture at the weakest) and Holy Basil(New Chapter supercricial extract is a must if you try holy basil, otherwise, your chances of benefitting from it will be greatly reduced).
I would also add in each herb/supplement one at a time to try to see if you can guage what effect or lack of effect is occurring.
This is the end of the thread.
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