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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 8 of 8. This is the beginning of the thread.
Posted by Haightguy on July 7, 2008, at 14:39:29
I have extreme morning anxiety, and sometimes I think I can't bear it. As soon as I wake up it hits me hard. I have taken Lyrica and Neurontin and they help but they make me sleepy. Anyone have any ideas what might help better for this. I take Klononpin, but I can't take it in the morning, as it induces sleep. I have a very hard time dealing with this anxiety. I take Klonopin in the evening and it helps.
Thanks,
Posted by bleep on July 7, 2008, at 17:59:20
In reply to Extreme morning anxity, posted by Haightguy on July 7, 2008, at 14:39:29
You can try Ativan (generic name Lorazepam). I take a really low .5 mg dose. It's a lot cleaner feel than Klonopin or Xanax and I actually WANT to do stuff that normally would freak me out (i.e. the park of Chuck E. Cheese w/my kids). It kicks in really fast, too. They are tiny and I dissolve them in my mouth b/c they don't taste bad and they kick in superfast.
Or for round the clock relief you can try an SSRI but that will take awhile to kick in and things may feel a little worse till it does. I had great success with Celexa (Generic Citalopram) for 2 yrs.
Posted by bleauberry on July 7, 2008, at 20:05:25
In reply to Extreme morning anxity, posted by Haightguy on July 7, 2008, at 14:39:29
I have theses exact symptoms. They've been with me about 3 years, and even when I was on zyprexa they were strong symptoms. I have found a few things that stop them dead in their tracks in about 3 days.
8mg milnacipran 3 times per day (25mg capsule customized into 3 homemade capsules)
5mg cymbalta once a day morning (about 50 of the enteric coated beads spread on applesauce)
2.5mg hyrodcortisone
All of these things have something in common...they interrupt the feedback loops that have gone wild in the norepinephrine/cortisol circuitry.
My doctor made a diagnosis of this condition with me by doing an adrenal stress index test, which is a saliva cortisol test taken 4 times in a day. It showed below normal cortisol noon, creeping up toward normal 4pm, slightly above normal 10pm, off the charts high 5am. I mean seriously so high it was literally almost off the top of the graph paper, equivalent of being as high as a skycraper above where it should be. That's the waking anxiety. It is excessive cortisol/adrenaline stuff. In my case anyway, and I am pretty sure most others who experience it.
The meds I mentioned will actually worsen it the first couple days. But when the feedback loops realize something has changed and kick in, the morning anxiety shuts down rather fast.
St Johns Wort actually helped too, just not quite as powerful and not nearly as fast.
I am sensitive to meds, so maybe someone else would need higher doses than I took. The doses I took are way below therapeutic doses for what they were intended.
Klonopin in the evening, as with you, helped me too, except for the terrible depression it gave me. Klonopin worked not through the feedback loops, but by basically shutting everything down, including the haywire adrenaline stuff. I much prefer a low dose norepinephrine or cortisol med, since they more directly interrupt the real problem.
> I have extreme morning anxiety, and sometimes I think I can't bear it. As soon as I wake up it hits me hard. I have taken Lyrica and Neurontin and they help but they make me sleepy. Anyone have any ideas what might help better for this. I take Klononpin, but I can't take it in the morning, as it induces sleep. I have a very hard time dealing with this anxiety. I take Klonopin in the evening and it helps.
> Thanks,
Posted by bleauberry on July 7, 2008, at 20:47:31
In reply to Extreme morning anxity, posted by Haightguy on July 7, 2008, at 14:39:29
I forgot about the blood sugar connection possibility. I discovered by accident once that if I had a glass of orange juice, a glass of milk, or a spoonful of peanut butter at about 2am or 3am the morning anxiety was greatly diminished or nonexistent. I took blood sugar readings in mornings before that, as well as routine fasting lab tests, and glucose was fine. But it felt like hypoglycemia anyway. And somehow the snacks with some modest amounts of natural sugar content worked pretty good. I couldn't begin to explain how or why they worked. Something in the blood sugar circuits, or maybe they triggered the response of circulating tryptophan to enter the brain and make serotonin, or what. I don't know.
It's probably worthy of an experiment to see. The problem was that I went to bed around 9pm-10pm, so I had to wake at 2am-3am for the quick snack or drink and then go back to bed. Not exactly something I could do routinely day after day forever. If you think about it though, the body is fasting for 8 hours when you sleep. That's a long time with no food.
Just something to ponder. Since my morning anxiety seemed to calm down considerably after I ate something, I couldn't help but wonder.
Posted by chiron on July 7, 2008, at 22:25:00
In reply to Re: Extreme morning anxity » Haightguy, posted by bleep on July 7, 2008, at 17:59:20
I had the EXTREME morning anxiety. I had anxiety the rest of the day, but it was much worse in the morning. I would wake up @ 5:30 every morning no matter when I went to bed.
Bleuberry, your post was interesting. I never thought about the norephinephrine connection.My psych dr. didn't say anything about cortisol, but when I was getting a blood test by a regular dr. I marked to test cortisol. But it was in the normal range (and it was a morning test).
It has definitely decreased since then. I take xanax, celexa, & lamictal. But actually, what seemed to help me the most was taking birth control to stabilize my messed up hormones. I guess progesterone has a calming effect. It's such a complicated feedback loop.
Sorry about your anxiety, it sucks!
Funny story though (but not at the time) - I ended up in the hospital w/ this anxiety & depression. Because ect had helped, I had a couple (but I was freaking out because of my anxiety). Anyway, I guess when I was recovering from the anesthesia, I sat up with my eyes wide open, then went back down. The dr. said they had never had seen that before & asked what was going on with my nerves. I don't know, you tell me!
Posted by nomadjones on July 8, 2008, at 13:34:49
In reply to Re: Extreme morning anxity » Haightguy, posted by bleauberry on July 7, 2008, at 20:05:25
I agree with bleauberry that there might be something going on with high cortisol early in the morning. I wake up at 4 or 5 in the morning with extreme anxiety. I take xanax or klonopin to get a few more hours sleep (probably not the best solution), but the anxiety still sometimes breaks through. Mind you, this is after taking 3mg lunesta when I go to bed (4.5mg worked better, but insurance won't cover it).
Lately, I've been looking at the high cortisol possibility and been taking some supplements before bed that seem to damp down the cortisol (although it doesn't solve the problem, I sleep a little better and can get back to bed a little faster/longer): Extended release Vitamin C, baby aspirin, and phosphatidylserine (not cheap).
I should probably get the cortisol test and make sure that's part of what's going on and get scripts accordingly.
Any suggestions are welcome
Good luck, Nomad
Posted by Bob on July 9, 2008, at 0:42:53
In reply to Re: Extreme morning anxity » Haightguy, posted by bleauberry on July 7, 2008, at 20:05:25
> I have theses exact symptoms. They've been with me about 3 years, and even when I was on zyprexa they were strong symptoms. I have found a few things that stop them dead in their tracks in about 3 days.
>
> 8mg milnacipran 3 times per day (25mg capsule customized into 3 homemade capsules)
>
> 5mg cymbalta once a day morning (about 50 of the enteric coated beads spread on applesauce)
>
> 2.5mg hyrodcortisone
>
> All of these things have something in common...they interrupt the feedback loops that have gone wild in the norepinephrine/cortisol circuitry.
>
> My doctor made a diagnosis of this condition with me by doing an adrenal stress index test, which is a saliva cortisol test taken 4 times in a day. It showed below normal cortisol noon, creeping up toward normal 4pm, slightly above normal 10pm, off the charts high 5am. I mean seriously so high it was literally almost off the top of the graph paper, equivalent of being as high as a skycraper above where it should be. That's the waking anxiety. It is excessive cortisol/adrenaline stuff. In my case anyway, and I am pretty sure most others who experience it.
>
> The meds I mentioned will actually worsen it the first couple days. But when the feedback loops realize something has changed and kick in, the morning anxiety shuts down rather fast.
>
> St Johns Wort actually helped too, just not quite as powerful and not nearly as fast.
>
> I am sensitive to meds, so maybe someone else would need higher doses than I took. The doses I took are way below therapeutic doses for what they were intended.
>
> Klonopin in the evening, as with you, helped me too, except for the terrible depression it gave me. Klonopin worked not through the feedback loops, but by basically shutting everything down, including the haywire adrenaline stuff. I much prefer a low dose norepinephrine or cortisol med, since they more directly interrupt the real problem.
>
> > I have extreme morning anxiety, and sometimes I think I can't bear it. As soon as I wake up it hits me hard. I have taken Lyrica and Neurontin and they help but they make me sleepy. Anyone have any ideas what might help better for this. I take Klononpin, but I can't take it in the morning, as it induces sleep. I have a very hard time dealing with this anxiety. I take Klonopin in the evening and it helps.
> > Thanks,
>
>
Milnacipran is not available right now in the US, correct?
Posted by bleauberry on July 9, 2008, at 18:46:18
In reply to Re: Extreme morning anxity » bleauberry, posted by Bob on July 9, 2008, at 0:42:53
>
> Milnacipran is not available right now in the US, correct?From a local pharmacy? No. From your mailbox? Yes. Legal? For a 90 day personal supply per shipment from overseas, yes.
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