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Dr. Bob is Robert Hsiung, MD,
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Posted by Leor on February 3, 2003, at 11:35:19
In reply to Re: Buspar for anxiety » Lynnae, posted by Elizabeth on June 27, 2001, at 6:57:34
Hello Elizabeth.
Just read the old post (copied below) on psychobabble and decided that I would be most grateful for any info you might have about
natural approaches to the treatment of general anxiety disorder. Many thanks for your help. Hope
that 2003 finds you in good health and good spirits.Blessings,
Leor
> Hi there.
>
> Can you describe your anxiety symptoms in more detail, like what type of thoughts you have when you are feeling anxious, and are there any triggers? Do you feel anxious all the time, or does it come in spells or attacks?
>
> Ihe reason I'm asking these questions is that there are a few different types of anxiety and the treatments are not the same for all of thems (although there is some overlap). What you described sounds more like panic disorder than any other anxiety disorder, but obviously that's not certain. I'll go ahead and tell you about treatments for panic disorder, but just be aware that this info doesn't necessarily apply to other anxiety states like generalised anxiety disorder, posttraumatic stress, social phobia, etc.
>
> > I have taken Paxil, Zoloft, and Celexa along with Ativan and another nerve pill (I can't remember it's name).
>
> Klonopin, Xanax, Valium, Librium, Serax, Tranxene, ... ?
>
> Do you remember what dose of Ativan you were taking, by any chance? Also, were you taking it on an ad-lib (or "as needed") basis, or on a regular around-the-clock schedule (e.g., thrice daily or every 6-8 hours).
>
> > Does anyone have any experience with Buspar for anxiety?
>
> I tried BuSpar (buspirone) in the typical low dose range used for mild to moderate anxiety and antidepressant augmentation: up to 45 mg/day, I think. In this dose range, it is *not* effective for panic disorder (which might be what you have), nor (by itself) for depression. In higher doses (more like 60-90 mg/day) it is effective for depression; I'm not sure about panic disorder. (60 mg or more
>
> Unlike the benzodiazepines (what you call "nerve pills," also known as "minor tranquilisers"), BuSpar takes several weeks to work. It sometimes causes increased anxiety in the beginning. It's basically an antidepressant, like most of the other ones you mentioned (Paxil, Zoloft, Celexa). The way it works is a little different, though: instead of increasing the amount of serotonin available, buspirone imitates one of the actions of serotonin. (It's thought to be what's called a "partial agonist" at type 1a serotonin receptors.)
>
> > Also, what about Effexor XR?
>
> Like the other antidepressants, it takes several weeks to work and may make you more anxious during those first weeks. Also, if you had weight problems from the SSRIs (Paxil, etc.), then Effexor may cause weight gain for you too.
>
> SSRIs and Effexor do usually work for panic disorder, but a lot of people have a very hard time tolerating them long enough (they take several weeks to work, as I mentioned). The best appproach if increased anxiety is a problem starting out is to start out at a very low dose and increase it gradually, as tolerated. It can also help to take a benzodiazepine during the time when you are waiting for the antidepressant to work. Klonopin and Xanax are probably the most effective benzodiazepines for anxiety (especially panic anxiety).
>
> Besides benzodiazepines, some other options for panic disorder are the older antidepressants -- "tricyclics" (imipramine, nortriptyline, desipramine, clomipramine) and monoamine oxidase inhibitors (Nardil, Parnate). People who have anxiety often find these more tolerable, although the newer ADs are marketed as having fewer side effects (really, they have *different* side effects). There are also two newer, non-SSRI antidepressants -- Serzone and Remeron -- that may work for panic disorder. Non-cardioselective beta blockers (such as propranolol) can also alleviate some of the symptoms, like tremor, difficulty breathing, and palpitations.
>
> Sometimes, if a person has an abnormal EEG or if more conventional treatments (like antidepressants and benzodiazepines) don't work, anticonvulsants may be used. Depakote and Neurontin seem to work for true panic disorder as well as for some types epilepsy; Tegretol may be preferable for people who have temporal lobe epilepsy that manifests as panic-like attacks. Panic-like epilepsy is unusual, but not unheard of, and it should be considered if the usual treatments don't work. There are a few other conditions that can mimic panic disorder, such as asthma and cardiac arrhythmias, and these should be ruled out, especially if you are considering a tricyclic antidepressant or a beta blocker.
>
> I hope this helps. Don't get discouraged: there are lots of different approaches to anxiety, as you can see; you just have to keep trying stuff until you find what works for you. (If you're interested, I can also tell you about a few different non-medical approaches. These tend to be less reliable, in my opinion, but they are often very helpful, especially if used with medication.)
>
> -elizabeth
Posted by Tina P on February 3, 2003, at 12:30:07
In reply to Re: any sexual side effects?, posted by Elaine on January 15, 2001, at 12:32:11
Hey, Elaine, I'm in the same boat as you are with the lack of desire. I just switched from Paxil to Effexor XL and I'm waiting to feel some changes. Did you find yourself a bit emotional during that transition period? Any weight issues?
Posted by Dysfunk on February 3, 2003, at 16:42:48
In reply to Re: withdrawal, posted by banom on February 2, 2003, at 5:09:54
I guess they don't want to scare us or make us psychosomatics by telling us the potential withdrawal effects. Only side-effect I heard about from my Dr. on this was possible high blood pressure. That was the least of my worries!
Posted by khead on February 4, 2003, at 9:21:16
In reply to Re: withdrawal, posted by Dysfunk on February 3, 2003, at 16:42:48
Well in my case my BP spiked from my "high-normal"
of ~130/90 to 180/105. Felt better, but was getting ready for a stoke. Had to get off the stuff.> I guess they don't want to scare us or make us psychosomatics by telling us the potential withdrawal effects. Only side-effect I heard about from my Dr. on this was possible high blood pressure. That was the least of my worries!
Posted by Lynnads on February 4, 2003, at 10:17:23
In reply to Re: withdrawal, posted by Maisy on February 3, 2003, at 5:04:37
GOING ON THREE WEEKS, WITHDRAWAL EFFECTS STILL GOING STRONG!!!!! THIS IS DRIVING ME NUTS!! I don't think I would ever go back on this drug unless I planned to stay on it life-long.
I am experiencing three weeks straight of constant vertigo/dizziness, brain freezes, and an utter feeling of an unpleasant high. When I move my eyes, I hear a WHOOSH sound in my head. If I move my body, it sounds like someone is throwing magazines at the floor. I don't feel safe driving and I keep waiting for this to go away but it just seems to continue to progress. I did taper my medication, which only seemed to prolong the effects withdrawal. If anyone does have to get off Effexor, follow the explanation Maisy gave. I think I would have followed a more gradual approach to tapering if I knew it was going to be anything like this. This is just miserable.
Posted by KayC on February 4, 2003, at 11:07:56
In reply to Anyone had success on Effexor XR? , posted by jp on October 24, 1999, at 14:59:14
I've been on it for about 2 months (75mg). I'm getting off too because I too can't deal with the fatigue and the inconsistent feelings. No one day is the same (tiredness one day, headache the next, feeling blue the third, energetic in the morning, lethargic in the evening or vice versa etc...)
I posted a few weeks ago about how much better I felt and I do feel better. However I still need to be on an AD. I don't go to see my psychaitrist until 2/27 but I've had all I can take. On 1/29 I began taking a capsule every other day.
On the second day the withdrawal always hits. By 7:00 a.m. I am lightheaded and lethargic. I get really bad muscle pains in my back (upper and lower). I feel weird and disoriented. Every night is a crazy dream. Always being chased and running away.
Good luck to everyone on Effexor. I don't believe it's for me. I just can't deal. I just want to get off it. I worry about what it's doing to my nervous system and my brain. Since I've been on Effexor I only pee about twice a day. My skin is so dry and itchy, it's flaking off. I use Vaseline after I shower and by morning my skin is dry. But the thing that bothers me the most is my inability to focus. Mentally, I'm just not there on this drug (eye sight getting worse too). Just too many things. I wrote a list of all the adverse reactions I've had and a list of all the good things the drug has done for me. The adverse reaction list was 3x as long as the good. I'll keep posting. Good luck to those who persevere.
Posted by carsan01 on February 4, 2003, at 11:15:07
In reply to Re: withdrawal » Maisy, posted by Lynnads on February 4, 2003, at 10:17:23
Hi Everyone,
I am on Effexor XR(it at least..i am coming off)to control Hotflashes from a shot called Lupron Depot....today is day 2 trying to get off Effexor XR.....i feel like i need some sleep. As i sit here at work, all i can think about is my comfy bed at home! I did not have any side effects at all yesterday which was my first full day....woke up without any headaches, life seemed great. But today that's not the case...my body hurts, concentration is very hard to keep, my head and eyes just can't seem to focus properly. I hope that it doesn't last long, but my heart tells me that's it's gonna last longer. I have to say though some of the emails that have been posted in the past are scary.....if i had known what i know now....i would never have started Effexor Xr....your mood definitely improves but the side effects can be terrible. I wish my doctor had gone over this medication thoroughly..i am mad at myself that i didn't ask the questions. Education can be a huge part of the problem!! Well hopefully i will feel better soon, i have too.
Have a wonderful day all :) Carsan
Posted by Tina P on February 4, 2003, at 22:52:53
In reply to Anyone had success on Effexor XR? , posted by jp on October 24, 1999, at 14:59:14
Anyone want to coment on the dry, itchy skin condition? Anyone experience acne from this drug? How about a comparison to Paxil? I'm in the transition period now from Paxil to Effexor, and The dry itchy skin has me losing sleep!
Posted by DSA on February 4, 2003, at 22:58:27
In reply to Re: withdrawal, posted by maggie on April 13, 2000, at 14:32:34
Your observations, feelings of electricity or shocks during withdrawal, are very interesting. I'd noticed the same symptoms during withdrawal from a long-term and ultimately self-destructive attempt to self-medicate using dextromethorphan (dissociative, not recommended). I found that sudden lateral eye movements would accentuate the feelings; sudden head movements not as much.
At any rate, I'm brand new to Effexor, having survived the gauntlet of (primarily) SSRIs since 1994. Prozac @ 20MG was the first, and it worked incredibly well for about two years. I frankly couldn't believe that something so right could actually lose efficacy, but have found myself trying to fill the void left by its failure more desperately over the ensuing six years. Celexa, Buspar, Zoloft, Depakote, higher doses, self-medication -- nothing has worked.
Effexor is another attempt to find my way back to that pinnacle of my life, the first time since puberty I'd seen blue sky.
Thanks for contributing your experiences.
Posted by Scot_lass2003 on February 5, 2003, at 0:18:24
In reply to Re: Anyone had success on Effexor XR? , posted by Tina P on February 4, 2003, at 22:52:53
> Anyone want to coment on the dry, itchy skin condition? Anyone experience acne from this drug? How about a comparison to Paxil? I'm in the transition period now from Paxil to Effexor, and The dry itchy skin has me losing sleep!
I also switched from Paxil to effexor, mostly because I couldn't sleep on Paxil. I have some acne and dryness so I just use lots of moisturiser. I also live in a very cold dry climate which doesn't help. However not great skin is better than no sleep!!!! Good luck.
Posted by astrowill on February 5, 2003, at 1:32:48
In reply to Alcohol???, posted by jb07 on February 1, 2003, at 18:48:08
Effexor made me want to drink, smoke, and eat lots of candy. I started smoking in November, right around the time I changed my dose. It was as if I hated the way "normal" felt so I used cigarettes and alcohol to take a break from myself. Also I used to drive to the store at like 10:30 at night to get a bag of candy, which I would eat continuously until it was finished. It was almost scary. Last week I quit taking my Effexor altogether and, along with the awful withdrawal, I quit smoking. No longer do I want cigs and even when I have one it has no effect at all. That's how I ended up here.
Posted by anais on February 5, 2003, at 17:34:13
In reply to Monthly Positive Update, posted by h20surfer1 on January 9, 2003, at 20:17:50
I've been tapering the effexor, it feels like I've had the flu sans nausea for weeks. Yesterday I slept 18 hours, to avoid constant migraines. Took my first 20mg prozac today, am hoping for a reprieve. Although paxil and prozac are related, and paxil didn't work, I'm hoping prozac will. Is anyone doing the same thing? How does prozac compare, and is there a message board for it? After reading these posts, reeling from 3 months of inadequate dosage (insurance ran out), I decided that this drug is just too dangerous for me. The whole "revving up" process seems to indicate how powerful and foreign this thing is for the human body. Oh well. I hope this prozac works. Please let me know if you had/are having positive experiences with prozac.
Posted by jb07 on February 5, 2003, at 18:58:04
In reply to Re: Alcohol???, posted by astrowill on February 5, 2003, at 1:32:48
I hear you.....alcohol has become an escape from the everyday numbness I fell on effexor. Inside I feel empty. I look forward to end of the day and having a few drinks. I take my pill @ night prior to bed....does any one think changing my dose to the morning might help in changing things up???
Help... this crazy cycle has to stop!!
Posted by Tina P on February 5, 2003, at 19:34:55
In reply to Re: Alcohol???, posted by jb07 on February 5, 2003, at 18:58:04
Hey,jb07, my doc told me that alcohol basically enhances the effect of the drug, so it's likely that you just need a larger dose. And of course, no alcohol. Good luck.
Posted by jb07 on February 5, 2003, at 19:39:02
In reply to Re: Alcohol???, posted by Tina P on February 5, 2003, at 19:34:55
Thank you tina, that makes total sense!! What about taking my pill early morning instead of bedtime???
I am so confused about this!!!
Posted by Thorn on February 5, 2003, at 21:16:29
In reply to Re: Anyone had success on Effexor XR? , posted by Cindy W on April 11, 2000, at 21:36:26
I was on serzone for @ 2 years before I saw a comercial on t.v relating the information including a class a law suit involving serzone.. my doctore put me on effexor @ ayear ago and I find it to be beneficial, I am still depressed but what do you expect a miracle? Effexor helps me get through the day providing a little gumption so to speak.. I have some initiative now and am much more productive,functioning with less emotional instability. I feel it is important to comment on the withdrawl affect of any and all seretonin level inhibitors-look out because it is not easy I gradually lowered my dose to 75 mg twice a week and just when I thought I could do it.. 3 days into it I was manic. Good Luck to all and remember You gotta do what you gotta do tomake it through.
Posted by DSA on February 5, 2003, at 22:39:05
In reply to effexor withdrawal/prozac, posted by anais on February 5, 2003, at 17:34:13
> <edit> The whole "revving up" process seems to indicate how powerful and foreign this thing is for the human body. Oh well. I hope this prozac works. Please let me know if you had/are having positive experiences with prozac. <
I'm traveling the opposite direction, going from Prozac 40MG to Effexor 150MG. I think you're right, Effexor seems to be a different beast, certainly different from what I've experienced before. Time will tell.
In response to your query, I wanted to say that, while it lasted, Prozac was a miracle worker for me. It was effective in my case for about two years, the best two of my life. Unfortunately, it or I seemed to lose the thread after two years, and I haven't found a suitable replacement since. I was drawn to Effexor based largely on their online advertising, which seemed to describe exactly what I'd experienced with Prozac (offering Effexor as a replacement, of course).
If Prozac is going to work for you, my wish is that you know it soon. (I'd say that you WILL know it very soon, but I've been amazed at the diverse reactions expressed on this site, and I've become reluctant to assert my own reactions other than as anecdotes -- I realize now that no one is affected in quite the same manner by these meds. So, the anecdote: I knew within hours of my first dose that Prozac held greater promise for my condition than anything I'd experienced before. It still took weeks to become fully effective, but the promise saw me through.)
I hope you meet success. I would simply caution that, if it works, you should still prepare for another transition in the indeterminate future. Best wishes.
Posted by anais on February 6, 2003, at 0:19:36
In reply to Anyone had success on Effexor XR? , posted by jp on October 24, 1999, at 14:59:14
I'm in the midst of withdrawal and it is so horrid. I don't know what to do. I can't live this way. I switched over to prozac (today was day 1) and...nothing. All I can feel is flu, headaches, dark moods. Once in college I made the mistake of partying all night, doing many lines of speed, mixed with 1/2 bottle of vodka (I am a 120lb girl); I compare that detox to the one I am undergoing now. Except this is lasting longer...
Posted by John Doe on February 6, 2003, at 1:48:17
In reply to Re: withdrawal, posted by khead on February 4, 2003, at 9:21:16
I am now going on my 2nd day without Effexor XR. I had been on 75 mg, then I went to 37.5 for a week and as soon as I dropped my dosage I began experiencing all of the horrible withdrawal effects that have been posted. How long have the withdrawal effects lasted for most people before they finally go away? I am considering going back on the drug just to mitigate the withdrawal.
Posted by astrowill on February 6, 2003, at 5:12:47
In reply to Re: Alcohol???, posted by jb07 on February 5, 2003, at 19:39:02
I used to take 150mg and then I switched to 75mg twice a day. Ask your doc.
Posted by Tina P on February 6, 2003, at 8:46:20
In reply to Re: Alcohol???, posted by Tina P on February 5, 2003, at 19:34:55
Well, to be honest, I just recently switched to Effexor XL from Paxil, so my knowledge about the drug is still somewhat limited. I'm not too sure about how the dosage affects people according to the time of day it is taken. However, you may have something there. I'd ask my doctor if I were you. It just may help you a great deal!
Posted by Tina P on February 6, 2003, at 8:50:59
In reply to Re: effexor withdrawal/prozac, posted by DSA on February 5, 2003, at 22:39:05
Just keep in mind we are all on these drugs for depression when you consider the nature of our comments!
Posted by kimm on February 6, 2003, at 23:49:08
In reply to getting a little worried here...., posted by tlang on January 29, 2003, at 22:58:53
> I truly hope the messages posted here only a small percentage of the people on Effexor. I start my first dose tomorrow and am almost terrified before I even take it.
>
>
not everyone has bad effects on this. I loved it, but it made me feel sleepy all day and sweat a lot. I switched to wellbutrin and am doing well. did your dr. start you out on a small dose? have you taken it yet? i felt that it helped turn off the noise. is this the first drug your trying? sometimes you have to try more than one to get the best results. just don't give up before you give it a chance.
Posted by DSA on February 7, 2003, at 0:18:19
In reply to a dangerous, dangerous drug, posted by anais on February 6, 2003, at 0:19:36
This may be meager help, but are you using augmentation therapies? (If you've already posted about this, my apologies.) The info passed on in the thread including http://www.dr-bob.org/babble/20030204/msgs/139700.html is hopeful, specifically, the journal article at www.psychiatrist.com/supplenet/v62s18/v62s1802.pdf.
Folate (methylfolate, aka folic acid) has shown some promise, at dosages over 500mcg/day, in conjunction with fluoxetine. Folic acid is readily available in most health food stores or supermarket health sections, and it's not too expensive. Men seem to be less responsive to this as an adjunct. However, folic acid is on the 'Suggested' augmentation list (as opposed to 'Clear', 'Anecdotal' or 'Disputed' lists).
SAMe (S-Adenosyl-Methionine) is generally available in the same locations as folic acid, but is much more expensive. It also has been tested in conjunction with fluoxetine (Prozac), although it is on the 'Anecdotal' rather than 'Suggested' list at this point.
Omega-3 fatty acids are mentioned, but no clear strategy is proposed. My personal inclination is to go with the supplements as, in this case particularly, there's little harm in trying. (You'd be hard pressed to 'overdo it'.) Omega-3 in the form of fish oil capsules can be found at reasonable prices if you shop around. Salmon and similar fish in the diet is also an option. 8^)
NADH (B-nicotinamide adenine dinucleotide) has shown promise, but is expensive and isn't yet easy to find in some locations.
Please believe me, I'm not belittling your suffering. I remember very clearly what it was like for me, in my case with BuSpar. In the throes, it's difficult to do anything for yourself to mitigate the suffering. Hopefully you can find your way to the key elements you need to get on through to the other side.
Posted by supersleepy on February 7, 2003, at 8:24:52
In reply to getting a little worried here...., posted by tlang on January 29, 2003, at 22:58:53
Dear Pannette--I was put on Effexor while I was experiencing panic attacks and generalized anxiety, on top of a long history of mild to moderate depression. I knew NOTHING about the drug, but I was too quivery a mess to ask or demur. It has been amazingly helpful. I experienced some unpleasant side-effects at 37.5/day for about 4 or 5 days (but the panic symptoms subsided in about 48 hours!). These included serious dry mouth, profound sleepiness about 1/2 hour after dosing, a little dizziness. These were all gone completely in about a week, and did not come back when I ramped up to 75/day. That was about six months ago. I've stayed at the same dose, and have felt mostly fine. My friends and family think it's done me a world of good, and I know I have a much more positive outlook than I've had in years. Recently, the sleepiness has returned, but it is general throughout the day, and I've been having some weird-ass dreams. I knew nothing about the difficulties of going off the drug, until I started reading this message board. Still, I think it's been extremely worthwhile, and I can only hope that I won't have too much trouble when and if I decide to discontinue.
It's not for everyone, to be sure, but if it works for you, you'll really appreciate it.
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