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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 Melanie-00 on January 12, 2011, at 23:36:08
I'm not sure if I should be posting on this board or the 'psychology' board ...
Anyway, I've been posting here for a few weeks, mainly about my hope to find an alternative/herbal/over-the-counter therapy to help with anxiety that is impairing my ability to function and get things done and damaging the quality of my life. I would say it's a definite problem ...
So far, I haven't had a huge amount of success with medication/supplements. Taking a calcium glycinate/magnesium glycinate supplement on an as-needed basis does seem to give me a bit more of a feeling of relaxation. I don't know if it's the magnesium, the glycine, or the combo that has the effect.
I'm also taking inositol (for trichotillomania -- so far it has helped with trich but only with trich), and I recently started taking N-acetyl-cysteine (NAC) and rhodiola rosea and am still waiting to see if they do much to help. I use ambien and occasionally benadryl to help with insomnia (or waking too early). I also have about 15 clonazepam pills available from an old prescription that I can take when really desperate, but since I don't have access to a doctor at the moment, I won't be able to get a new prescription when those run out.
Anyway, I'm skeptical that benzos are really the answer for me ... since my problem is chronic and has been affecting me (to lesser or greater extents) since adolescence. It's not new, it's just that the stressors in my life have gotten particularly bad lately, and consequently, my anxiety, while often an irritating problem, has become a huge problem!
But I do think I have a pretty clear understanding of what would make it better. Like many anxiety sufferers, I suffer a lot from anticipatory anxiety. I end up avoiding situations that make me feel anxious (many related to my career -- social anxiety is secondary to this). Of course, the more I avoid what makes me anxious, the worse it gets. It's really a no-brainer. Stress --> avoidance --> anxiety --> worse stress --> increased anxiety
Needless to say, I have low self-esteem, low confidence, frequent feelings of shame and inadequacy, and don't get much enjoyment out of life. Blah! I so very much want to be a different sort of person and have my life be going differently. But when it comes to simple things that make me anxious, I freeze up. It is SO hard to overcome! I tell myself to just deal with it, face up to it, no matter how bad, but then my heart starts racing, and I feel like I can't cope, ...Probably something like CBT or acceptance therapy would really help me. But I don't have the access, life-situation or money to allow for that right now.
But maybe a support group would help? I've never been part of a support group, either online or face-to-face. If I were to be a member of a support group now, it would almost certainly have to be an online group.
So my question is:
Does anyone have any experience with online support groups for anxiety? How was your experience? Would you recommend it? And if so, where to start?Thanks!
Posted by mrtook on January 14, 2011, at 14:41:55
In reply to Online Support Group for Anxiety?, posted by Melanie-00 on January 12, 2011, at 23:36:08
I would really recommend a course of "bibliotherapy" that is go and get a well recommended book and follow through with the exercises and readings required.
I would highly recommend Feeling Good: The New Mood Therapy.
Posted by Lao Tzu on January 14, 2011, at 15:06:05
In reply to Online Support Group for Anxiety?, posted by Melanie-00 on January 12, 2011, at 23:36:08
I tried doing the online support for anxiety years ago, and occasionally, I browse through social anxiety forums just to see what people are talking about. It helps when you realize that so many others out there are having the same difficulties. What I search for are any therapies people are trying that are helpful. Sometimes, you get some really good ideas from other people. It could be a good start getting to know other people and supporting each other. I have always thought this a good idea, but I have always thought one-on-one counseling with a good therapist is more beneficial. I did that for 3-4 years a long time ago. It's always better one-on-one in my opinion, but it couldn't hurt to join an online support. For some people, it keeps them occupied and it may be beneficial to a certain degree. I don't think it is the best therapy, however. Anxiety disorders are complex and there are many different therapies and medications out there. I guess you have to explore all possibilities to determine what helps you. Getting a good therapist, in my opinion, would be a good starting point if you can afford it. On Anxiety support groups, everybody is looking for the same thing: relief from their symptoms and kind words to help them get through the day. Do I think it helps? It depends on the person. If your anxiety is biochemical, nutrients, herbs, or medication could help with that. I have social anxiety disorder, but I used to have the anticipatory anxiety real bad a few years ago. Now, I am on 4mg of Risperdal and 200mg of Zoloft plus a bunch of vitamins and minerals and amino acids, and my anxiety is not nearly as bothersome as it was years ago. I can cope with it better. Perhaps, if you treat the biochemical cause plus use the online support, this might help you. Like I said, it depends on the person and your diagnosis. Seeing a psychiatrist or a therapist regularly would be beneficial to some degree and medications/nutrients are a back-up if the therapy isn't sufficient. I really do understand what you are going through. I had really bad anxiety for many, many years before I was diagnosed and treated. The first thing to understand is that you have a problem and that you are making efforts to treat it. The best results I have gotten so far are with medication plus vitamins, minerals, fatty acids, and a couple of amino acids. My anxiety is primarily biochemical. I've been through the worst anxiety imaginable, but today, I do feel much better and can cope better. Like I said, if you talk with somebody regularly this will be helpful, but getting your brain working properly is essential. Hang in there, look at all your options, then go from there, you will find a way to deal with it. I did and I probably had anxiety as bad as you have it. Hang in there. You will find out what helps you and you will get better and be able to cope better:)
Lao
Posted by Lao Tzu on January 14, 2011, at 15:11:47
In reply to Re: Online Support Group for Anxiety?, posted by mrtook on January 14, 2011, at 14:41:55
I also want to say that I am not trying to advertise taking medication. In my case, it has helped, but some people don't want to go that route. For them, using a combination of nutrients, exercise, and therapy is helpful. Just wanted to let you know where I am coming from.
Lao
Posted by Lao Tzu on January 14, 2011, at 15:31:08
In reply to Re: Online Support Group for Anxiety?, posted by Lao Tzu on January 14, 2011, at 15:11:47
I know this is a little off topic, but if you need some nutrients that are anxiety-relieving if you don't want to resort to medication, and I recommend the following:
Vitamin B6, Vitamin B3 (Niacin), zinc picolinate, Kava Kava (if you're not on medication), and of course, some kind of serotonin support like tryptophan.
There are others, but I like these the best. If you need to know more about using nutrients to help your anxiety (orthomolecular medicine), there are some good websites out there and many books written on the subject.
Lao
Posted by Lao Tzu on January 14, 2011, at 15:47:39
In reply to Online Support Group for Anxiety?, posted by Melanie-00 on January 12, 2011, at 23:36:08
This is from Daniel Amen's webpage. He has a website, clinics, and has written many books on anxiety disorders and depression. Maybe this might give you a few ideas:
How Brain SPECT Imaging Can Help with Anxiety and Depression
Help determine your type of anxiety and depression to direct treatmentCan be performed after you are on treatment to see if it is working correctly
Can help see if there are other co-occurring conditions that need to be treated
Helps to decrease the pain of stigma and increase compliance
Helps families see the biological nature of anxiety and depression to better understand the illness.
Anxiety and depression are major public health problems that are reaching epidemic levels in the United States. According to the National Institutes of Health they affect 38 million Americans each year. Additionally, twice that number (75 million) will suffer from an anxiety or depressive illness during some point in their lives. The loss to our society from these illnesses is staggering in terms of individual pain, family strife, school and relationship failure, lost work productivity, and death.
Our work and the research of many others have demonstrated that anxiety and depression are brain illnesses, not the result of a weak will or character problem. Common symptoms include anxiousness, fearfulness, tension, headaches, stomach aches, panic attacks, negativity, obsession, sadness, low energy, feelings of hopelessness, helplessness and worthlessness, suicidal ideas, mood swings, sleep and appetite problems and irritability.
Having untreated anxiety or depression affects nearly every aspect of a persons life and has been associated with school underachievement, family conflict, drug abuse, legal difficulties and poor work performance. Anxiety and depression are involved with low self-esteem, chronic stress, failure and even suicide.
The standard treatment for anxiety and depression are either anti-anxiety medications such as Xanax or antidepressant medications, such as Prozac or Lexapro. These medications are helpful for many people, but they also make many others much worse. Sometimes negative reactions to these medications can be extreme, such as hallucinations, violent outbursts, volatile temperaments, psychosis and suicidal behavior.
Shortly after I began the brain SPECT imaging work began in 1991, I realized that anxiety and depression were not single or simple disorders. Just as there are many different causes of chest pain, there were different brain SPECT patterns in my anxious and depressed patients. Over the subsequent 9 years, I described 7 different types of anxiety and depression that required individual treatments. One treatment did not fit everyone. The 7 different types are described below and in greater detail in my book Healing Anxiety and Depression.
Example:
Mark was a 37 year old male attorney who came to the Amen Clinic with his wife. She complained that he was rigid, worried, held grudges and tended to be a perfectionist. He was often anxious and depressed. He had tried SSRI medications but did not like the sexual side effects. His SPECT scan showed increased anterior cingulate activity and deep limbic activity. On St. Johns Wort and NeurOmega fish oil he felt calmer and happier.
Marked increased cingulate
and deep limbic activity
Types of Anxiety and Depression
Type 1. Pure Anxiety
Symptoms: Sufferers with this type feel stirred up, anxious, or nervous. They often feel uncomfortable in their own skin. They report feeling as though they could climb the walls or that they are crawling out of their skin. They are plagued by feelings of panic, fear and self-doubt, and suffer the physical feelings of anxiety as well, such as muscle tension, nail biting, headaches, abdominal pain, heart palpitations, shortness of breath, and sore muscles. It is as if they have an overload of tension and emotion. The symptoms may be a consistently disruptive presence or may come in unexpected waves. Irrational fears or phobias may also be a burden. People with pure anxiety tend to avoid anything that makes them anxious or uncomfortable, such as places or people that might trigger panic attacks or interpersonal conflict. People with this type tend to predict the worst and look to the future with fear. They may be excessively shy or startle easily, or they may freeze in emotionally charged situations.SPECT: increased activity in the basal ganglia, seen on both the concentration and baseline studies.
Supplements: multiple vitamin, NeurOmega fish oil, GABA, kava kava, valerian
Medications: Buspar, short term use of benzodiazepines
Type 2. Pure Depression
Symptoms: This type is associated with primary depressive symptoms that range from chronic mild sadness (termed dysthymia) to the devastating illness of major depression. The hallmark symptoms of pure depression include: a persistent sad or negative mood, a loss of interest in usually pleasurable activities, periods of crying, frequent feelings of guilt, helplessness, hopelessness, or worthlessness, sleep and appetite changes (too much or too little), low energy levels, suicidal thoughts or attempts, and low self-esteem.SPECT: markedly increased activity in the deep limbic area at rest and during concentration and decreased prefrontal cortex activity both at rest that improves with concentration. Deactivation of the prefrontal cortex at rest and improvement with concentration is a finding that is very commonly, but not always present.
Supplements: multiple vitamin, NeurOmega fish oil, SAMe or DL-phenylalanine
Medications: Stimulating antidepressants, such as Wellbutrin.
Type 3. Mixed Anxiety and Depression
Symptoms: Sufferers of this type have a combination of both pure anxiety symptoms and pure depressive symptoms.SPECT: Excessive activity in the brains basal ganglia and deep limbic system. One type may predominate at any point in time, but both symptom clusters are present on a regular basis.
Supplements: multiple vitamin, NeurOmega fish oil, SAMe or DL-phenylalanine plus GABA or valerian
Medications: Antidepressants with anti-anxiety qualities, such as desipramine
Type 4. Overfocused Anxiety and Depression
Symptoms: Trouble shifting attention and tend to get locked into negative thoughts or behaviors. When this is combined with excessive basal ganglia activity people get stuck on anxious thoughts. When it is combined with excessive deep limbic activity people get stuck on negative, depressing thoughts. Many people get stuck on both anxiety provoking and depressive thoughts. Obsessive-compulsive disorder (stuck on negative thoughts or actions), phobias (stuck on a fear), eating disorders (stuck on negative eating behavior), and post traumatic stress disorder (PTSD, stuck on a past traumatic event) fit into this type. This type is also associated with people who worry, tend to hold grudges, and have problems with oppositional or argumentative behavior. We have also noticed that this type tends to occur more frequently in children or grandchildren of alcoholics.SPECT: increased anterior cingulate gyrus activity and increased basal ganglia and/or deep limbic activity at rest and during concentration.
Supplements: multiple vitamin, NeurOmega fish oil, 5HTP, L-tryptophan or St. Johns Wort
Medications: SSRI antidepressants
Type 5. Temporal Lobe Anxiety and Depression
Symptoms: This type results from too much or too little activity in the brains temporal lobes, in addition to too much activity in the basal ganglia and/or deep limbic system. The temporal lobes are very important to memory, moods, and emotions. When there are problems in this part of the brain people struggle with temper outbursts, memory problems, mood instability, visual or auditory illusions, and dark, frightening or evil thoughts. People with this type tend misinterpret comments as negative when they are not, have trouble reading social situations, and appear to have mild paranoia. They may also have episodes of panic or fear for no specific reason, experience frequent periods of déjà vu, and be preoccupied with religious thoughts. People with this type may exhibit aggressive behaviors toward others or themselves. There may be a family history of these problems or they can be triggered by a brain injury.SPECT: increased or decreased activity in the temporal lobes and increased basal ganglia and/or deep limbic activity at rest and during concentration. When the temporal lobes become less active with concentration often people struggle with learning problems. When they are less active on the left side there is a tendency toward reading problems and irritability, when they are less active on the right side there is a tendency to have trouble reading social situations. It is possible to have decreased activity on both sides.
Supplements: multiple vitamin, NeurOmega fish oil, GABA or taurine for irritability, or Brain Vitale or NeuroMemory for memory issues.
Medications: Antiseizure medications
Type 6. Cyclic Anxiety and Depression
Symptoms: Results from too much activity in the brains basal ganglia and/or deep limbic system. These hot areas in the brain act like emotional seizures as the emotional centers hijack the brain for periods of time. Like typical seizures, patients have little or no control over these episodes. Cyclic disorders, such as bipolar disorder, cyclothymia, and premenstrual tension syndrome, along with panic attacks, fit in this category, because they are episodic and unpredictable. The hallmark of this type is its cyclic nature.SPECT: Not surprisingly, SPECT scan findings vary with the phase of the illness, or point in the patients cycle. For example, when someone is in a manic phase of a bipolar illness there is focal increased deep limbic activity and patchy increased uptake (multiple focal hot spots) throughout the brain; when this same person is in a depressed state there is increased focal deep limbic activity but it is often associated with overall decreased activity (no patchy increased uptake). Similarly, a woman with premenstrual tension syndrome may show only increased focal deep limbic activity during the unaffected time of her cycle, but show increased focal deep limbic activity, decreased prefrontal cortex and increased anterior cingulate activity during the worst time of her cycle. Like the other types, Cyclic Anxiety/Depression is a spectrum disorder, which means that one can have a very mild form or a very severe form, or anything in between. One may have mild PMS, or a mild cyclic mood disorder, or the problems can be so severe as to be life threatening. Cyclic Anxiety/Depression must be closely and skillfully monitored especially at critical times in the course of the disorder, for instance, when medications are first started because antidepressants may trigger mania, at hormonal transition times, when a patient is experiencing additional intense stressors, and in the case of a medically fragile individual. If the problem interferes with your life, you need professional treatment.
Supplements: multiple vitamin, NeurOmega fish oil, GABA or taurine
Medications: Antiseizure medications or Lithium for bipolar disorder, full spectrum lights for Seasonal Affective Disorder
Type 7. Lights Are Low Anxiety and Depression
Symptoms: This type results from too little activity in the brains prefrontal cortex, in addition to excessive activity in the basal ganglia and/or deep limbic system. The prefrontal cortex acts as the brains supervisor. It helps with executive functions, such as attention span, forethought, impulse control, organization, motivation, and planning. When the prefrontal cortex is underactive people complain of being inattentive, distracted, bored, off task, and impulsive. This type may also be the result of some form of toxic exposure, brain infection, such as chronic fatigue syndrome, near drowning accident, or other insults to the brain.SPECT: decreased activity in the prefrontal cortex at rest and during concentration along with increased basal ganglia and/or deep limbic activity. Sometimes overall decreased activity.
Supplements: multiple vitamin, NeuroEPA fish oil, L-tyrosine or DL-phenylalanine
Medications: Wellbutrin, Provigil, stimulant medications (such as Adderall, Concerta, Ritalin, or Dexedrine)
Knowing your type is essential to getting the right help for yourself.
Lao
Posted by Melanie-00 on January 14, 2011, at 18:48:54
In reply to Re: Online Support Group for Anxiety?, posted by mrtook on January 14, 2011, at 14:41:55
Thanks! I'll try to find a copy of this book.
What in particular makes you recommend this one? Just curious ...
Thanks for giving me a direction to pursue!
Posted by Melanie-00 on January 14, 2011, at 19:30:36
In reply to Re: Online Support Group for Anxiety?, posted by Lao Tzu on January 14, 2011, at 15:06:05
Thank you for your kind words and expressions of support. What you say makes a lot of sense--that is, that people online are all mostly looking for the same thing, so finding what everyone is looking for is going to be a lot harder than just being part of the crowd. I definitely agree that it wouldn't be like a one-on-one therapeutic relationship or even a face-to-face group. It would be useful for getting new ideas of what might work, like you say, and the occasional kind word (and the knowledge that we are not alone ...), but that's not really what I'm after when I think of a "support group". I do like Mtook's book suggestion, and I think I will start another thread asking for bibliotherapy suggestions.
I would love to find a good therapist, as you recommend, but I can't afford it right now. I think probably cognitive behavioral therapy would really help me. I don't know if my anxiety is biochemical or not. Maybe part of it is biochemical, but I think I've also learned some extremely bad "coping" mechanisms that are hard to unlearn. Also, my brief foray with benzos did not help me. The benzos certainly reduced my anxiety symptoms by a lot and did so very quickly, but it was almost as if I then had too little anxiety -- they made me a bit passive. Worse than that, I quickly developed the feeling/attitude that if I were going to be able deal with anything that really made me anxious, I had to take a benzo first. I don't take benzos (much) anymore (although I have a few left from an old prescription) and yet I still have that feeling of "needing" them. I know it's irrational, but knowing that doesn't help much. I'm always glad to have a few benzos on hand in case of "emergency". I'm certainly not physically addicted, as I almost never take a benzo, and when I do, I take a very small dose, but I did develop a psychological dependency.
That said, I'm definitely not opposed to medication, if they are the right ones.
The more I think about it, though, the more I feel that the medication I take should help me with my self-esteem, energy, and self-empowerment issues first, rather than simply mask my anxiety. I think if I felt more empowered, energized, and confident, I could cope better with stressors. In that case, I think anxiety would never get so out of control because I would be dealing with stressors in a much more expedient and forthright fashion.So I'm glad, in a way, that Rhodiola rosea has been among the first herbs I've tried to help with anxiety, since it has a reputation for helping overall mood, boosting positive outlook on life, and boosting energy. Unfortunately, so far, I cannot say if it's making a difference for me or not. However, at the start I was using one brand that I had heard was good by looking up reviews on the internet. It didn't seem to help, so I recently switched to Ameriden brand, which is a brand that is recommended by the authors of The Rhodiola Revolution and which has been around for a while. Maybe this brand will be more effective for me. Over the last day or two, I have felt a slight lift in my mood, but this could be just a random shift, or due to any number of factors. I've also been taking NAC for a few weeks, and this may be starting to kick in, too. Who knows? At least the herbs/supplements I am taking are few, so if something does seem to help, it shouldn't be too hard to narrow in on which one it is.
Thanks again for all your comments.
Posted by mrtook on January 14, 2011, at 21:22:55
In reply to Re: Online Support Group for Anxiety? » mrtook, posted by Melanie-00 on January 14, 2011, at 18:48:54
This book is very highly recommended from lots of sources....even dr. bob's readers voted it as one of their most recommended (http://www.dr-bob.org/babble/psycho/
). It is the book that brought CBT to the masses. It has been in print for >20 years.
I was first suggested this book by my therapist when I first went to see him 6 years ago. (My brother was also recommended this book by his therapist...anxiety definitely runs in families.) I read it then, and I reread it whenever I have spikes in anxiety. Basically it lays out what CBT is and how to practice it yourself. Even if you did go see a therapist to do CBT with them, most of the work of CBT will be done by you as homework.Bibliotherapy using this book has been clinically shown to be effective.
One note, this particular book focuses on Depression, but the ideas pretty much carry over to anxiety without difficulty. I think he did a version that focused more on anxiety but I have not read it so i can't recommend it, but I am sure it is fine.
One other thought, you keep mentioning not wanting to go see a doctor because of cost. I obviously don't know your situation, but it is not insanely expensive to see a psychiatrist. Some of the SSRI's are generic now to so they wouldn't cost a ton more then the supplements you are taking. I know an SSRI has helped me (lexapro...not generic yet), and it meets what you are looking for in that it doesn't mask the anxiety. Another avenue might be to try St. John's Wort as it has a similar function to SSRI's.
Sorry for the ramble. Best of luck. You are obviously very intelligent and striving to get better. You will.
Posted by Lao Tzu on January 15, 2011, at 12:10:13
In reply to Re: Online Support Group for Anxiety?, posted by mrtook on January 14, 2011, at 21:22:55
I know EXACTLY what you are saying about the benzos. I was a benzo junkie for years. I loved Ativan, I mean loved how it made me feel so calm and in a way, more confident. Unfortunately, I made the mistake of using it everyday for two years, and then it started to lose effectiveness and my anxiety returned. It was a learning experience for me, and though I still have the odd feeling that I'd like an Ativan, I realize I don't need that drug anymore because actually it started making the depression worse after a year or so. But you're right, you do become psychologically dependent on it and I don't really like that feeling. You tend to use the benzos as a crutch and that is not a healthy coping mechanism. It was a remarkable drug for awhile, but now I realize it's not as remarkable as I thought it was.
Bibliotherapy sounds like a good idea. I have read books that helped change the way I viewed my anxiety, but if it is biochemical, then you need to address your nutrition. My coping skills are basically, to run away from a situation if it is too anxiety-provoking. I learned that was the way to do it instead of facing it. The fact is, facing it will actually help you cope with the anxiety. So I can't say I do it right all the time either. All it is is fear and we have the ability to inflate it or diminish it. Some people fight it with everything they've got. Other people run away from it because it is a basic instinct. If it involves neurotransmission in the brain, it could be a deficit of neurotransmitters or possibly too much dopamine and norepinephrine. Serotonin is very important in regulating anxiety, but I discovered that it wasn't just a matter of increasing serotonin, but stablizing my dopamine which is why I take the Risperdal in addition to the Zoloft. So if it is a dopamine problem, then medication is the way to go. There could also be problems with GABA and glutamate. Who knows for sure? Scientists are still working on the pathology of anxiety disorders. In years to come we will understand it better.
I do recommend any of Daniel Amen's books. They are easy to read and they get to the point of the matter. I caution not to self-diagnose with the books. A psychiatrist should do that, but the books will give you a nice overview of what causes anxiety in most people. I have one of his books, 'Change your brain, Change your life,' but I think he has written some updated books on the subject. I like his books because he is an actual medical doctor not just a psychologist.
Lao
This is the end of the thread.
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