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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 12 of 12. This is the beginning of the thread.
Posted by lrc on October 11, 2001, at 13:51:43
After the recent world events, my anxiety attacks are back. I was on Paxil for over a year and won't go back to that med. I really don't want to do the SSRI thing if I can avoid it but is there anything that works for anxiety besides an SSRI? After my experience with withdrawal in getting off of Paxil, I would like to even try something that has been on the market for at least 10 years. Any suggestions? Thanks, lrc
Posted by JohnX on October 11, 2001, at 15:46:39
In reply to Which med for anxiety, posted by lrc on October 11, 2001, at 13:51:43
> After the recent world events, my anxiety attacks are back. I was on Paxil for over a year and won't go back to that med. I really don't want to do the SSRI thing if I can avoid it but is there anything that works for anxiety besides an SSRI? After my experience with withdrawal in getting off of Paxil, I would like to even try something that has been on the market for at least 10 years. Any suggestions? Thanks, lrc
A couple routes to go:
1) benzos: Klonopin being the gold standard.
problem: addiction.2) other anti-depressant.I wouldn't let your
experience on Paxil taint the possibility
of doing well on another med.St. John's Wort. By the "Kira" brand
(highest quality control).
Give it at least six weeks. It recommends
900 mg/day, but I have found going up to
1800 mg/day is needed for severe problems.
Almost no side effects for most people.If you are looking for low side effects
I have found Manerix (moclobomide) to be
almost side effect free. Even on the PDR
the only statistically significant side effect
was a *reduction* in headaches. Unfortunately
you would need to import this from another
country as it is not in the US for business
reasons (its off patent, and doctors are panicky
about MAOIs, although this one is safe).
It may help if your problem is mild but, the
success rate is probably not quite as good a
SSRIS (hey can't get something for nuttin).Other SSRI's
- Zoloft,Celexa
Other:
- Effexor.Again, you can test run another anti-depressant
for 2 weeks and if you just can't stand it, then
punt it and try something else (unless you are
in screaming pain/anxiety/depression then you may
want to give the AD more time and cope with the
side effects).I'm sure a lot of other people would have
suggestions.-john
Posted by Rakken on October 11, 2001, at 16:03:27
In reply to Re: Which med for anxiety » lrc, posted by JohnX on October 11, 2001, at 15:46:39
You could try a low dose of an anti-psychotic (risperidone). You could also try Neurontin or Buspirone. Buspirone is an anti-anxiety med and isn't addictive like a benzo or a barbiturate. It does take time to start working though like a SSRI. But it is another route which should be effective. Most likely moreso than the SSRI's.
Posted by JohnX on October 11, 2001, at 16:31:46
In reply to Re: Which med for anxiety, posted by Rakken on October 11, 2001, at 16:03:27
> You could try a low dose of an anti-psychotic (risperidone). You could also try Neurontin or Buspirone. Buspirone is an anti-anxiety med and isn't addictive like a benzo or a barbiturate. It does take time to start working though like a SSRI. But it is another route which should be effective. Most likely moreso than the SSRI's.
Congrtualations Rakken you read my mind after
I made my post and beat me to the punch.
I had a brain fart and forgot to mention
buspar as an obvious 1st choice. I also
was thinking about Neurontin and low dose
zyprexa or other meds in that category.-john
Posted by Cam W. on October 11, 2001, at 16:34:25
In reply to Re: Which med for anxiety » lrc, posted by JohnX on October 11, 2001, at 15:46:39
John - In regards to Manerix™ (moclobemide), when I was researching side effects to make a chart for the pdocs (that didn't just include mainly start-up side effects for SSRIs), I found several older European studies showing higher rates of side effects for the Manerix. The rates were still lower than those of the SSRIs (approx. 8% - 10%), but still significantly higher than the 4% - 5% reported in North American studies.
Like you, I have seen a couple of successes using Manerix in anxiety disorders, but more respond to SSRIs (if they can get through the initial 2 - 4 week increase in anxiety caused by these agents). - Cam
Posted by paxvox on October 11, 2001, at 16:50:26
In reply to Which med for anxiety, posted by lrc on October 11, 2001, at 13:51:43
You could run a short therapy with a benzo like Xanax or tranzene or Klonopin. Since you mentioned your situation seems the result of a tempory problem, you could use the short anti-anxiety effects of the benzo for a few weeks. If you continue much more than that, you will more than likely develop some tolerance that will require titration of dosage rather than just stopping at once.
PAX
Posted by Alan on October 11, 2001, at 23:46:53
In reply to Re: Which med for anxiety » lrc, posted by paxvox on October 11, 2001, at 16:50:26
> You could run a short therapy with a benzo like Xanax or tranzene or Klonopin. Since you mentioned your situation seems the result of a tempory problem, you could use the short anti-anxiety effects of the benzo for a few weeks. If you continue much more than that, you will more than likely develop some tolerance that will require titration of dosage rather than just stopping at once.
>
>
> PAXYeah, what is it with this fear of BZD's as anxiolytics? I've never understood what the problem is? Tapering dosages is turning out to be the order of the day for ssri's and all other meds as it turns out anyway. There's 40 years of study to support the short AND long term treatment of BZD therapy. Even the World Health Organization after reviewing the long term studies of short and long term therapy consider them safe.
This whole ssri thing to treat anxiety seems to me to be iffy at best.
The neurontin and other antiepileptics may work too but if you get into low dosages of neuroleptics then risk of TD significantly increases.
Alan
Posted by tina on October 12, 2001, at 13:35:54
In reply to Re: Which med for anxiety » JohnX, posted by Cam W. on October 11, 2001, at 16:34:25
Manerix is the only med I've ever taken that gave me no side effects and worked perfectly for my anxiety disorder. But then again, I'm an idiosyncratic responder.
> John - In regards to Manerix™ (moclobemide), when I was researching side effects to make a chart for the pdocs (that didn't just include mainly start-up side effects for SSRIs), I found several older European studies showing higher rates of side effects for the Manerix. The rates were still lower than those of the SSRIs (approx. 8% - 10%), but still significantly higher than the 4% - 5% reported in North American studies.
>
> Like you, I have seen a couple of successes using Manerix in anxiety disorders, but more respond to SSRIs (if they can get through the initial 2 - 4 week increase in anxiety caused by these agents). - Cam
Posted by paxvox on October 13, 2001, at 16:02:54
In reply to Re: Which med for anxiety » paxvox, posted by Alan on October 11, 2001, at 23:46:53
i don't know if you have read any of my other posts, Alan, but I have been a major proponent of benzos. Gee wilikers, they WORK! It's better than letting people self-medicate with alcohol or other drugs. BUT.... we can't have a bunch of people running around actually being able to function while on benzos. This is the same logic that keeps more effective pain management from being used in terminal illness cases (though I will admit, that is improving with Octycontin and the other time-release opiates...too bad THESE are getting maligned by a few people misusing them to get a buzz).What to do , what to do.
PAX
on the soap box
Posted by lrc on October 14, 2001, at 15:30:29
In reply to Re: Which med for anxiety, posted by Rakken on October 11, 2001, at 16:03:27
> You could try a low dose of an anti-psychotic (risperidone). You could also try Neurontin or Buspirone. Buspirone is an anti-anxiety med and isn't addictive like a benzo or a barbiturate. It does take time to start working though like a SSRI. But it is another route which should be effective. Most likely moreso than the SSRI's.
I've had my eye on Buspar ever since I started to withdrawal from Paxil for "just in case". I've read previous posts here and some say good and others hate it? How do you know what to do. Can you take BuSpar for a long period of time? I assumed my anxiey/panic attacks were caused from a health "scare" before but now they are back. Maybe I'm just going to be an anxious person from now on. Who knows! I don't mind being long time "friends" with a med but I don't want to jump around on different meds and I would like one that works. I guess that's what we all want though. Thanks to all that answered my previous post and this one too. lrc
Posted by Waterlily on October 14, 2001, at 16:21:13
In reply to Which med for anxiety, posted by lrc on October 11, 2001, at 13:51:43
You might want to try imipramine. I've been on it for almost a year for generalized anxiety and I do think that it has worked to an extent. To what extent I don't really know since I started cognitive therapy soon afterward. It's worth a try though.
Posted by madeleine on October 15, 2001, at 16:29:35
In reply to Which med for anxiety, posted by lrc on October 11, 2001, at 13:51:43
lrc-
I have had success with a low dose of Klonopin (.5 mg 3 times per day) for treating anxiety. Actually, I had no idea how much anxiety I was living with on a daily basis until I started taking Klonopin and it went away. Amazing. Previously I had been taking Ativan on an as needed basis for anxiety attacks, but that was less effective overall--first of all, I still had the anxiety attacks, and secondly, although Ativan relieved the symptoms fairly quickly (within 20 minutes--usually I fell asleep) four hours later the anxiety returned.
I have been taking Klonopin for at least a year now and have found no need to increase the dosage. All I can really say is, it works for me.
Best of luck to you--
madeleine
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