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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 December 7, 2010, at 13:00:56
I believe that I have suffered from generalized anxiety disorder (GAD) most of my life. Of course, when the stressors in my life get worse, my anxiety also gets worse, and now is one of those times. But the anxiety never really goes away.
To make a long story short, I am feeling a bit desperate. I would really, really LOVE to find a long-term solution for my anxiety. (Right now, while I nominally have medical insurance, my insurance is in a totally different state from where I live (long story), so it is for all intents and purposes like I don't have insurance at all except for emergencies.) Given my lack of access to mainstream health care (I expect this situation to stay the same for at least a year), if I could find an alternative solution for my anxiety disorder, that would be fantastic!
In the short term, I need to get my anxiety under control. I am not functioning at all well in my work. I am avoiding things that stress me out, which is just making it worse.
I have a short history with benzos. A few years ago, during one of my attempts to get treatment for my anxiety, I was prescribed 30 klonopin pills (0.5 mg). I hesitated to take the klonopin at first due to concern about it "messing up my brain" but I was desperate then, too, so I finally did take it.
Wow! What a change! I felt so much better. I was able to have a much better outlook on my problems. It kind of felt like the calm, contented person I was meant to be had finally been revealed. But I couldn't access that person without the drug. I was taking about 1 pill a day, occasionally 2 pills. However, when I got the prescription, my doctor either failed to inform me, or I failed to understand, that it was only a stop-gap solution. So I went in and asked for another prescription, completely expecting to be able to continue long-term, since it was working so well. At this point, my doctor really put up resistance. He reluctantly prescribed me 40 more pills, but made it clear that he wouldn't prescribe any more.
Now at that point in my history, I do not think I had any addiction to the klonopin, although my doctor was already worried about addiction. For example, sometimes, I went several days at a stretch without taking any klonopin pills. And I certainly wasn't needing to take a higher and higher dose. However, I DO think that psychological dependence was already becoming a problem. I did not feel confident that I could handle the worst stresses in my life without the pills. Ironically, this made me slow down my pill intake substantially, since I was really worried about running out. I made those 40 pills last more than a year.
About a year ago, I was very low on klonopin, and even though I was hardly using it at all, I still had that psychological dependence. If I went on a trip or anywhere overnight, I always brought it with me "just in case". I was still very scared of running out. So I went back to my doctor and asked for more, but because I was afraid he would deny me, I told him I wanted it to deal with "fear of flying" (actually, that's not really a problem for me). So, I got 30 more pills.
Sorry, that was a lot of background info ...
At this point (almost a year after filling that last prescription for klonopin), I still have about 20 pills and haven't taken any for months. But still the psychological dependence continues in the sense that I frequently *think* about the option of taking it.
With my increased stress level lately, I have begun to look for alternatives. I feel that I need help getting back on track.
I read about niacinamide being like a benzo drug in its effectiveness. (For more info, please see my post under the alternative board: Niacinamide -not helping- how long to take effect? Melanie-00 12/6/10).
I'm beginning to have my doubts about niacinamide doing anything for me at all. So far, my anxiety has been worse, but this may just be because my stressors are increasing with each day that I don't get my anxiety under control. On the other hand, given the minimal research I could find on niacinamide as anxiety therapy, it really shouldn't surprise me if the whole thing turned out to be a hoax/scam.
Now, I am thinking I should try kava. It seems to be the only herbal remedy for anxiety that has any real research backing it up. (I haven't tried it yet due to concerns about liver toxicity.) But in the meantime, I am wondering if I should go on a short course of benzos (5-10 days) while I wait to see if anything more happens with the niacinamide or while I wait to order kava?
So, advice, thoughts? Thank you in advance for any comments pertaining to my dilemma regarding what to do for short-term and long-term control of my anxiety. I know the ultimate solution is to change my life so that I don't have as much stress, but I just don't see the way to do that right now.
I should also add that I do NOT use alcohol and avoid caffeine as much as possible.
I have never used/abused drugs.
I try to exercise at least 5 days a week by taking a brisk ~3 mile walk.
I have also suffered most of my life from trichotillomania (hair pulling -- in my case, I pull from my eyebrows and eyelashes). For the first time in my life, my trichotillomania seems to be under control thanks to inositol. About 2 months ago, I started taking inositol, builing up to about 17-18 grams/day, and I haven't been pulling my hair at all for several weeks. Inositol seemed to improve my mood as well for a while, but now I feel worse again. I thought that if I could get my trichotillomania under control, maybe I could do the same for my anxiety.
And finally, just to make it clear, I think my issues with klonopin have always been issues with psychological dependence (not physical addiction), if the distinction can be made. And if I start on the klonopin, I really only have those 20 pills, and no more. If I don't make the necessary changes in my life, or find some alternative therapy in the meantime, I will have no more klonopin to fall back on. This worries me.
PS One more thing about klonopin is that in the past it has been great for helping me fall back asleep. I frequently suffer from insomnia. I fall asleep fine, but I wake several hours before I am full rested. I could take half an ambien (sleeping pill), but by that point in the night, sometimes the half-ambien just makes me groggy, or it makes me sleep longer than I really need to. In the past, I have found that klonopin helps me to get those last couple of hours of much needed sleep.
Thanks for your help!
Posted by Phillipa on December 7, 2010, at 13:29:13
In reply to Help! Short-term + long-term solution for anxiety, posted by Melanie-00 on December 7, 2010, at 13:00:56
Personally I don't find that odd that you would fear running out of them as it's worked for you and in an emergency it's there. So why not try a lower dose and bet it works. Then since it sounds a bit like OCD try luvox it's sedating and also is for OCD. Just my thoughts. Phillipa
Posted by mrtook on December 7, 2010, at 14:24:51
In reply to Help! Short-term + long-term solution for anxiety, posted by Melanie-00 on December 7, 2010, at 13:00:56
Melanie,
Your story sounds similar to mine. I think we are both on the OCD-GAD spectrum. At times my mood will be definitively one or the other.
I take lexapro as a long term "solution" I still get break through anxiety, but either the lexapro or skills I have learned through therapy seem to make it manageable.
Special note---the first week on lexapro was pretty bad. I experienced some start up anxiety. I think it is pretty common.
Posted by Melanie-00 on December 7, 2010, at 14:41:28
In reply to Re: Help! Short-term + long-term solution for anxiety, posted by mrtook on December 7, 2010, at 14:24:51
So interesting you should mention lexapro. Actually, my only other experience with psychotropic drugs is with lexapro.
On one of my other unsuccessful attempts to get my anxiety under control via modern biomedicine(this was a while before I tried the klonopin), I was prescribed a very low dose of lexapro. Unfortunately, at that time, I had just switched insurance companies. As a result, I didn't realize that my my appointments with the psychiatrist who was prescribing the lexapro were not being covered. Before I knew it, I had racked up some very large medical bills, which I could not afford as a student. So, I abruptly stopped seeing the psychiatrist. I did stay on the lexapro for a while (at least a month or two, maybe even three months ... I don't exactly remember), but I found that it wasn't doing anything for me and was possibly making me feel even a little bit worse. So I stopped taking it. (And by the time I stopped, I couldn't consult with the psychiatrist because I was far too overwhelmed to deal with insurance issues.) I did start to feel better once I was off of the lexapro, but in retrospect, I wish I had given it more of a chance. I was on a VERY low dose, and I probably needed a higher dose -- maybe? I dunno ... Anyway, perhaps some day I can try the lexapro (or something similar) again, but my access to any prescription meds is very limited right now, since my doctor (& insurance coverage) are located on the other side of the country. My life is a bit of a complicated mess, and the best thing would be to finish up the project I am involved in so I can move on, but this is going to take at least another year. Anyway, even if my doctor were near by, I wouldn't put great faith in him. He means well, but he's not the best (nor the worst). But doctors just don't usually have the time to really help you when your case is not cut & dry. If I had a really excellent doctor, I might feel otherwise.
Posted by Melanie-00 on December 7, 2010, at 14:44:40
In reply to Re: Help! Short-term + long-term solution for anxiety » Melanie-00, posted by Phillipa on December 7, 2010, at 13:29:13
Thank you, Phillipa. You are right. I think I do have some elements of OCD. (Trichotillomania is definitely part of the OCD spectrum.) I'll keep the drug you mentioned in mind. Maybe some day I can try it. And you're right about the low dose. Although a full klonopin pill is best, I still get some relief from just a quarter or half a pill.
Posted by mrtook on December 8, 2010, at 14:08:28
In reply to Re: Help! Short-term + long-term solution for anxiety » mrtook, posted by Melanie-00 on December 7, 2010, at 14:41:28
I wish I could be more helpful, but the only things I can say are....
1.) A general practitioner would probably be able to prescribe an SSRI for you. I know Lexapro is approved for GAD so they should have no problem with that. In addition there are other SSRI's that are off patent and much cheaper then Lexapro.
2.) I started with 10 mg Lexapro over 5 years ago. It work great for almost 4 years. Coinciding with a change in job it didn't work as well and I upped it to 20mg with Deplin. I have still been a little lumpy since then, but managing.
3.) An over-the-counter supplement with a similar action as SSRI's is St. John's Wort. I have never taken it so I can't say anything good or bad about it.
4.) I have had good results with Cognitive Behavioral Therapy. There are lots of good books on this, you don't have to shell out the big bucks for a therapist.
5.) There are several people on this board who would disagree with taking an SSRI....My thought is I wish I had given CBT therapy a good shot before I started medication.
Best Of Luck to You!
Posted by Guy on December 8, 2010, at 19:33:39
In reply to Help! Short-term + long-term solution for anxiety, posted by Melanie-00 on December 7, 2010, at 13:00:56
Beware of kava as long-term use can damage your liver. I hesitate to recommend any med as I have had bad experiences with so many. However, since you have suffered for so long, you might want to try a low dose of Zyprexa (2.5 mg max) to help you with sleep and obsessive thoughts. Luvox may be a good one to try first as withdrawal from Zyprexa leads to INCREDIBLE rebound insomnia. On the other hand, some people can take clonazepam for years with good results. You might be one of those people, but then again you might not. Good luck in finding a solution.
Posted by Melanie-00 on December 8, 2010, at 20:25:36
In reply to Re: Help! Short-term + long-term solution for anxiety, posted by Guy on December 8, 2010, at 19:33:39
Thanks for the warning about kava. I've been collecting all the research articles, trying to assess the risk-benefit ratio for myself. On the whole, most everyone who's studies kava has found a good benefit-risk ratio. That being said, if I did take it, I would never go beyond the recommended dose and time-frame. A recent article in American Family Physician Journal (Saeed et al. 2007, with follow-up letter to the editor in 2008) says that for those seaking an alternative remedy for anxiety, kava at doses no greater than 300 mg/day and for no longer than 24 weeks are okay. It also says that use of WS1490 standardized kava extract is recommended. However, this particular formulation may no longer be on the market. I'm not totally sure, as I haven't quite got that far in my investigations.
Posted by Melanie-00 on December 8, 2010, at 20:40:12
In reply to Re: Help! Short-term + long-term solution for anxiety, posted by mrtook on December 8, 2010, at 14:08:28
Thanks for all your suggestions. RE: cognitive behavioral therapy. I've read a bit about this, but embarking on a cognitive behavioral therapy course of action without the help of an actual therapist seems like it would have a high probability in resulting in another reason to feel bad about myself. I don't think change like this is easy, and thus, to try to do it with only the guidance of books and without any human support would seem to have a very high chance of failure (and incomplete success). I might just be left mentally castigating myself for yet another inadequacy and my "bad" behavior. I mean it's a great idea, and I do believe that one can learn a lot from books, but to seriously pursue this option (CBT), I really think a therapist would help. But, you're right, I can't put out the big bucks for that right now.
I know exercise works up to a point, and I already do get exercise. But I am thinking more is indicated. We may invest in an exercycle of some sort since it is cold, wintery, and rural where I live and not always that easy to get outside for exercise (esp if anxiety strikes after dark). My husband has been reading up about how anxiety is basically a lot like the fight-or-flight response a person would have if faced by a threatening lion. In such a case, you would run like mad. So his theory is that every time I feel anxious, I should get my heart rate up as if I were running away from that "lion". Get the lion off of my tail ... Doesn't seem totally outrageous to me, as suggestions go! Alongside a proven herbal remedy like kava. Maybe these two things could be the short-term solution.
Posted by Melanie-00 on December 12, 2010, at 22:11:56
In reply to Re: Help! Short-term + long-term solution for anxiety » mrtook, posted by Melanie-00 on December 8, 2010, at 20:40:12
I have decided not to try kava just now. The risks seem to be minimal, nevertheless, I don't want to add the worry of severe liver damage to my list of anxieties. I've done substantial research over the past few days looking for clinical trials and other experimental-based evidence concerning herbs/supplements to help with anxiety. I sure wish there was more research on this topic! There is really very little research overall, and so much of it is of limited usefulness. Kava has the most support, but the (more minimal) research on Rhodiola rodea is also intriguing. I ordered some MIND BODY & SPIRIT by Verde Botanica brand and will be trying it soon. When I look through the archives for other threads here mentioning rhodiola, it looks like people's experience with this herb have been mixed. But often, the rhodiola was being combined with other medications (esp other prescription medications). I won't be combining rhodiola with any prescription meds because that is really not an option for me. I will continue with the inositol and add in the Rhodiola and see how that works. Oh, I pray it helps! There is also a very recent study on chamomile (Chamomile extract standardized to 1.2 % Apigenin). Maybe I will try that, too. Anyway, this is the wrong board to be talking about these things. I should be doing this on the Alternative board, since none of these is a standard prescription med for anxiety. Maybe I will start a new thread there (over on the Alternative Board). Thanks to everyone who took the time to post their thoughts. Best wishes.
This is the end of the thread.
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