Question about meds.

[stressedintx]

Hello all,

This is my first post on this forum and I have a few questions about meds.  I have been dealing with GAD for years and have just recently decided to get medical help for it.  I have been to see my doctor several times and he has tried several different medications which have not worked very well.  Here is what we have done so far:

1.  50mg Zoloft (Did not do anything)
2.  100mg Zoloft (Did not do anything)
3.  75mg Effexor (Did not do anything)
4.  150mg Effexor (Did not do anything)
5.  150mg Effexor and 300mg Wellbutrin XL (Wellburtin cause me to sweat like a pig)
6.  225mg of Effexor.  (Seems to do a little)

The 225mg of Effexor seems to help me concentrate more during the day at work.  However, I am still very stressed out several evenings a week.  It is to the point where I am not in a mood to talk to my wife and normal household noise makes me very irritable.

I recently took a couple of Valiums which were prescribed by my dentist before dental procedures.  They seem to drastically reduce my stress level.  Does anyone here use some type of benzos in addition to the other medications for GAD?

[ocdengineer]

I take Xanax (2mg) per day.  It works great for me and I also had issues with antidepressants, but beware they are dependency forming, so if you decide to go there plan on committing yourself to it for awhile.  If you decide you want to stop you need to take your time getting off of the drug no matter what the doctor says.  It may take months, but it is better than ending up having seizures due to lack of GABA in your brain.  They are great drugs, but they must be manged by you and your doctor correctly otherwise you could end up taking too much and then quitting and dealing with withdrawl.  I did a lot of research on the drugs before I took them and a lot of the info you find on the i-net is negative, but there are some good books and papers out there that actually consider benzos to be (argueably) the most effective treatment for anxiety disorders hands down.  It is the street value and misuse of these drugs that give them a bad rap.  It is worth discussing with your doctor either way.

Read this article about Xanax.  It is a really quick overview of how the drugs work and how to use them and wean off them.

http://lexington-on-line.com/naf_xanax.html

Take care,
OE

[stressedintx]

OC,

Thanks for the information   I forgot to mention that since the antidepressants are not helping my doctor also has me on 10mg of Ambien as needed.  When I first decided to seek help with my anxiety I told my doctor not to give me anything that can be abused.  I don’t drink or use illicit drugs and did not want to risk becoming dependent of the benzos.  This route is just not working for me.  After doing some research, I am becoming open to using something like Valium or Xanax under the close supervision of my doc.  The rest of the meds just are not helping.  I have been using the same doctor for 15 years and we trust each other.  He knows that I will follow his directions and I know he will do what is in my best medical interest. Again, thanks for the info.

[ocdengineer]

Glad to help.  I would definitely try to stop taking the Ambien though.  It is probably doing little for you other than giving you one more drug to worry about!

Take care,
OE

[itsmeesindee]

Stressed,

I have tried many different anti anxiety meds over many years and have finally found a combination that works for me.  I had a similar problem to you I think.  When I would take antidepressants like Prozac, Paxil, Lexapro, etc.  I would feel irritable, depressed and just blah.  I always thought this was weird but I never really described it properly to my Doc until recently.  My doc increased my Zolft to 100 mg and added 50 mg of Seraquel (a mood stabilizer), boy what a difference.  Not only is 95% of my anxiety and hypocondra gone but I actually feel happy and normal for the first time in a very very very long time.  I know they are currently doing more research into treating anxiety with mood stabilizers and I do know it really works well for me.

Anyway hang in there and really be detailed when you speak with you doc.

Cin

[King]

Yes AstraZeneca plan to launch Seroquel for MDD and GAD in the future.

Plus there are other drugs 3-4 years away (NK1's, CRFs, M2/M3's, TRIs - all new classes), it will be a different drug landscape by then.

Why did you get Ambien anyway? If its sleep then TCAs are good for sedation and treating anxiety and depression.

You dont want to be on a benzo long term if you can avoid it, I see them as a last resort. They are fire extinguishers when whats needed is fire prevention.

[gloomy]

Thats a very good way of describing benzos King.  I guess thats one of the reasons they are only supposed to be used on a short term basis. 

I mean with the best will in the world, good diet, positive lifestyle changes and exercise, if benzos are being used over long periods of time then the benefits from self perceived positive day to day alterations are surely a placebo.  Really its the benzo thats extinguishing the fire, notihng else, otherwise one might be able to establish positive life changes while initially coping with the benzo and then stop using it, and the mind would be healed?

[King]

I think its possible that whilst the fire is being extinguished all the time, i.e. the fire is always there, the person doesnt use other ways of managing the condition long-term that exclude the drug - ie. a complete non-drug long term solution.

Clearly some people may need life-long treatment if the imbalance is permanent (although how do we know if its permanent?). But I suspect for the majority of people that the long-term answers to achieving balance, or fire prevention, can lie outside drugs - or in other words the fire extinguishers in this case.

After all, humans weren't born or designed to take or need drugs, the body is designed to balance itself but modern lifestyles and environment are constantly creating fires (if we let them).

[gloomy]

I agree totally, this is the exact reason, I am now weaning off lexapro, I hope that I have created enough coping strategies to live without medication.  I believe in meds in the short term to give a much needed step up on the ladder.  Which I believe I have now had.  Then we must face the problem head on with the cognitive behavioural therapies we have learned.  I can face the rest of my life hiding behind meds, like you said there is no concrete evidence that anyone has a genuine long term chemical imbalance that requires meds for a lifetime.  Some use alcohol as a coping mechanism, whereas benzos can be seen in exactly the same vein apart from the fact they dont have the obvious health implications.  The exact same can be said of SSRI's too.

How can the mind ever heal if we constantly feed it chemicals, it will never learn to cope alone.

[King]

Quite. And I dont think this is off-topic because this all relates to the philosophy of taking meds. Stressedintx, please note we're talking about the long-term picture here in terms of non-drugs. Clearly as Gloomy says sometimes we just need that peg onto the ladder of recovery that drugs give us.

Regarding imbalances, we are of course talking about imbalances relating to mood disorders. The brain self-regulates levels of the 6 key neurotransmitters in the absence of trauma or stressors. Otherwise we get into an off-topic discussion about structural anomalies in the brain that through chemical imbalance (e.g. too much dopamine) can lead to other non-mood disorder spectrum conditions such as schizophrenia, schizo-affective disorder, etc. But again, its strange why this only really manifests itself in humans - and in adulthood mainly. I attended a lecture a long while back entitled "Is schizophrenia the cost humans pay for language". Fascinating stuff. But it is true that the brain is a marvellously adaptive organ - most drugs cant even get to the brain because of its defence mechanisms.

Anyway back to drugs - perhaps the summary of this is treat the fire now whilst its raging with benzo's if you feel you need them (please discuss this with your doctor), and restore the balance with the Effexor 225mg, then perhaps in 6 months you can come off (slowly) and having learnt other coping and management strategies during this time you'll hopefully be able to pursue a non-drug route to controlling your anxiety after that.

All the best

[stressedintx]

My doc changed the meds again.  He wants me we stop taking the Effexor over a 2 week period and then start on Cymbalta (60mg/day).  What's the scoop on Cymbalta?

[King]

Cymbalta works like Effexor, is thought to be slightly stronger and is one of the newer antidepressants.

You might notice some side effects to start with but these should wear off.

[ocdengineer]

When I first decided to seek help with my anxiety I told my doctor not to give me anything that can be abused.  I don’t drink or use illicit drugs and did not want to risk becoming dependent of the benzos.  This route is just not working for me.  After doing some research, I am becoming open to using something like Valium or Xanax under the close supervision of my doc.  The rest of the meds just are not helping.  I have been using the same doctor for 15 years and we trust each other.  He knows that I will follow his directions and I know he will do what is in my best medical interest. Again, thanks for the info.

You will find that in most cases you will take less than prescribed.  I was prescribed 1.5 mg to start per day of Xanax, but I only took .75 mg per day for a month, then I moved up to 1 and then eventually 1.5 and finally 2 mg per day because the doctor was ramping me up to an effective dose.  I have been at this dose for well over 6 months with no need to change, however, my prescription is for 3 mg per day, so I always have extra.  LOL.  It is part of the anxious mind to not take more than needed.  If you don't have an addictive personality then you probably won't have much of a problem with benzos, but there will be dependency.  I can almost guarantee that, so when and if you decide to stop taking meds you need to seriously take your time weaning off of the medication.  If you take your time the withdrawl should be minimal to non-existent.  The quicker you wean off the worse the withdrawl. 

In any case, this is a discussion I assume you have already had with your doctor and Cymbalta was probably the recommended change.  Give that some time and see where you are at in a couple of weeks and if you are still not feeling better, then consider the benzos.  They have worked wonders for me and many others.

Take care,
OE

[stressedintx]

Okay, I have been taking the Cymbalta for a couple of weeks now.  I just makes me feel weird and more stressed out.  In the evenings I get so stressed out that I can’t carry on conservation.  I get so wound up emotionally that I stay by myself until the evening’s dose of Ambien takes the edge off.  How low should I continue the Cymbalta before asking for a change?

[ocdengineer]

I would thing a month as a general rule but all of these drugs have a lightly different time to max effectiveness.  Give it a little more time and see if you start feeling better, if not then maybe it is time to have another talk with your doctor.  Are you seeing an anxiety disorder specialist or your GP?  If it is just a GP then you may want to consider finding and anxiety disorder specialist.

Good luck,
OE

[stressedintx]

OC,

I am seeing my primary care doc.  He change from cymbalta to prozac today.  I guess I will see how this one works.  If I don't get better soon I will be looking up a specialist.

[jcp]

All I want is an SSRI that doesn't make me gain weight or ruin my sex life!  Sorry if thats too much information but it seems there is nothing like that!

[crs]

Your medication history looks alot like mine. The antidepressants did not work for me either. They actually made me feel more anxious. I tried 4 different antidepressants and now I take Xanax .25mg  3x a day and .50mg to sleep. I feel great. For the first time in years my anxiety is better. I can go out to the store drive or whatever...It'a a miracle drug. Just start out with the lowest dosage possible because they can make you tired. I know about the addiction, but if you are suffering and nothing else really works then perhaps you are like me and  thousands of other people who need this med. Until they come up with a better Med for anxiety thats not addicting this is the one for me.
Good luck.

[anxiousinfla]

jcp

I haven't found one yet. Let us all know if you do.

[ocdengineer]

It would be nice if there was a medication out there that didn't cause dependency, but that may be a pipe dream.  Who knows.  Anyway, in the meantime, Xanax works for me.

Later,
OE

[apple]

If it works for you and you need to take it long term...does it really matter if you are also dependant?  My opinion anyhow.         You can always wean off very slowely if you need to.

[ocdengineer]

Agreed.  I am much happier having made the decision to take medication.  I would not change that decision for the world!  You make a good point Apple and a lot of times people are more fearful of the meds than the anxiety, so they avoid meds.  For me, it took almost 10 years before I decided I needed to finally take medication.  I used alcohol as a medication for a long time and watched my life slowly slipping out of my control.  Finally, I decided that I needed help and found a great doctor and have been on meds since.  It was a godsend honestly.

Take care,
OE