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The "Best" Anxiolytic?

honeywhite

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Joined
Apr 5, 2012
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Someone who *is* me suffers from infrequent periods of anxiety/hysteria, sometimes brought on by overwork/things not going as I wanted (NASDAQ goes down, writers block, poor marks on Tax Law paper, etc), sometimes idiopathic. I've tried a few anxiolytics, most prescribed, three unprescribed but legal (ethanol in the form of absinthe, diethyl aether, and hydrate of chloral). What I need in an anxiolytic is this:

a) Lysis of anxiety (it's in the name of the thing!).
b) Lack of hypnotic effect (VERY important).
c) Long duration of action.
d) Not required to take daily (SSRI's, I'm looking at you!)
e) Lack of sexual side effects. I'm a man; the most important organ in my body is my, erm, joystick, and I won't have it out of commission.

The anxiolytics I have personally tried, in order of desirability, are:

a) Phenobarbitone sodium. - Disadvantage: lethal in overdosage.
b) Ethanol. - Disadvantages: possible emesis and risk of stomach-ache. Can't wander about drunk all the time.
c) Diazepam. - Disadvantage: hypnotic. Advantage: The most efficacious.
d) Pentobarbitone sodium. - Disadvantages: lethal in overdosage, difficult to obtain (the chemist doesn't always have it, hard to get from doctors), shortish-acting. Advantage: Just as efficacious as diazepam.
e) Aether. - Disadvantages: ultrashort-acting, HIGHLY INFLAMMABLE (I smoke 5 packs a day, this is not tolerable), risk of stomach-ache, SMELLS. Advantages: comes on fast, like ethanol.

===== Undesirable =====

i) Alprazolam. - Disadvantages: short-acting, hypnotic occasionally. Advantage: comes on faster than Na-phenobarb.
j) Chlordiazepoxide. - Disadvantages: inefficacious, hypnotic at effective dose. Advantage: long acting.
k) Lorazepam. - Disadvantages: ULTRASHORT-ACTING. Lasts me an hour or two. That's not what I need. Also nearly always hypnotic (not enough to put me to sleep, enough to make me tired).
l) Fluoxetine. - Disadvantage: droopy cock syndrome which persists after cessation of use; must use every day to be efficacious. Advantage: all outweighed by the DROOPY COCK SYNDROME.
m) Chloral. - Disadvantage: inefficacious, causes stomach-ache every time like clockwork.
n) Amfebutamone (Zyban). - Disadvantage: inefficacious. Advantages: Good stimulant (but that's not what I wanted it for!), reduces urge to smoke (also not why I want it!). Slight boost in mood, a bit like very toned-down Desoxyn.

At the moment I am on phenobarbitone. After being warned to keep its use to a minimum for reasons of overdosage and habit prevention, I can manage with 50 mgm. once or twice a week. It's quite gentle and doesn't put me to sleep. Has a tendency to whittle down my verbal filter in an odd way. Not like morphine/other opiates (which simply make me less critical of my own writing) - I tend slightly to overestimate how appropriate my words/actions are. I've managed to learn to walk on it properly - this was important because it used to give me ataxia (stumbling around as if I were drunk).

Still, I've heard from multiple places that it's habit-forming. My doctor doesn't appear to be overconcerned but was a bit shocked when she heard about my misadventures on it (i.e. taking 1/2 gm. or more as a single dose). The maximum human dose, apparently, is 300 mgm. and that is for refractory insomnia. Her words: "Don't you ever do that again - unless you want your problems gone in a most spectacular fashion!"

Any thoughts on a better medicine? I like how pheno lasts a long time but don't like its lethality. Valium is all right if it didn't make me so sleepy - it's allegedly safer and 100% can be reversed with flumazenil.

P.S.: While opioids have a slight, and I repeat slight, anxiolytic action, the first and foremost reason I take them is reduction of pain, so they don't figure on the list. I also remember briefly using Lyrica in my youth, but it makes my feet swell up something awful and it has oxybate-like (i.e. Xyrem) effects at the therapeutic dose (which, as I recall, was 300 mgm., taken daily). Doctor advises continuing pheno, on the basis of "let's not try to fix what's been fixed already".
 
Phenibut is very good for social anxiety.

Alprazolam or clonazepam in low doses are actually really decent just for general anxiety or panic attack relief. Not as sedating as diazepam.

The right strain of cannabis can also be highly effective but the downside is obviously you might not function too well stoned and the wrong strain can make it worse.
 
Alprazolam or clonazepam in low doses are actually really decent just for general anxiety or panic attack relief. Not as sedating as diazepam.

Agree. Lyrica is underrated too for anxiety imo. I use methadone and bromazepam and my SEVERE social anxiety is nearly gone.
 
Bromazepam is very rarely found in the UK. Can't speak for Canada.

@Pill2Chill: Lyrica is effective too and commonly prescribed for anxiety in the UK too but for me I find it's very intoxicating. I can keep a much straighter head on a low dose of benzos than I can on pregabalin. That stuff has me acting like a drunk.
 
Bromazepam is very rarely found in the UK. Can't speak for Canada.

@Pill2Chill: Lyrica is effective too and commonly prescribed for anxiety in the UK too but for me I find it's very intoxicating. I can keep a much straighter head on a low dose of benzos than I can on pregabalin. That stuff has me acting like a drunk.

Funny, for me it's like I drank a cupful of Xyrem (sodium gammahydroxybutyrate - if I spelled it wrong, I'm sorry). It fuzzes up my vision, or makes me see stars - but on the upside it's quite euphoric! I'd only take it to go dancing though or something; it's not my kind of nerve tonic (neither Lyrica nor Xyrem). I think out of the available options, barbiturates really are the best solution (not tuinal though, that stuff gives me a hangover!)

I got two tablets of Lexaurin (i.e. bromazepam) from my doctor and used it today, promising that I hadn't taken my usual phenobarbitone (truthfully). Somewhat effective and doesn't have the side effects I mentioned, but really, really doesn't hold a candle to good old pheno/pento. It's odd because the benzodiazepines are a newer class of drug but don't turn the trick as well; pheno, as far as I can recall, came out the year the Titanic went down, and nembutal is just a bit younger. How's that possible---that modern drugs are less fit for purpose than their predecessors?

Similarly analgesics. The most effective analgesic for me is buprenorphine. Everything that's come out since then (Vioxx?, Celebrex?, etc) doesn't come close for pain without inflammation. Pethidine is neurotoxic. Paracetamol destroys the liver (especially in those APAP/narcotic combos). Plain, simple diamorphine is also a good one and it is well over a century old! (Thanks go to the people at Bayer Farbenfabrik - their research is much appreciated!) It's something that's always puzzled me. If you take too much pethidine, you risk a death from seizure and of course brain damage. If you chronically use high doses of Celebrex? or Toradol?, say goodbye to your kidneys. Yet plain, simple diamorphine (Heroin?) is non-toxic to the organs, and is controlled simply because it causes pleasure; people buy it off the street, where it's been adulterated to the extent that it's more cut than active ingredient, and the cut rots their arms from the inside. Plus the motivation to commit crimes to acquire it. It's this damned puritanism I can't stand. Cocaine, diamorphine, and cannabis were all freely available in 1905 or so, and the crime rate then was NOTHING like the one now. People didn't die of overdosage either!

NOTE: I'm not suggesting that buprenorphine or nembutal is always the better choice; for pain involving fever, paracetamol is obviously the gold standard, using bupe or diamorphine for mild pain is overkill, and there's a lot of leeway because medicine is as much art as science. Similarly, some people might hate nembutal and love valium. My preferences in medication are of course my own, for my conditions and my body. Still, some of the "classic" drugs are underrated for their use. My doc's experience using pheno for anxiety was zero before I came along; I was the one holding her hand through it rather than the other way around.
 
I've had phenobarbital but didn't rate it on its own. Very subtle yet significantly more dangerous than the more modern benzodiazepines.

Haven't tried any other barbiturates simply because they're so rare. I'm sure the more potent ones are more effective then phenobarb but also much easier to OD on. Nembutal in particular is literally famous as a suicide drug and that reputation is not unearned. It's actually what Dignitas uses for assisted suicide.

Diamorphine is going off on a tangent a bit, it technically is anxiolytic but it's very much overkill for that purpose! It's still used in the UK as a painkiller although only in hospitals and only in severe cases. Usually it's given to old people who are about to die so they can have some comfort in their last days. The NHS used to do outpatient scripts too but this has pretty much stopped now because of diversion.

But if we're talking about old drugs, don't forget simple morphine is the gold standard classic opiate and is still widely used all over the world. In the UK you often get it prescribed in liquid form under the brand name Oramorph in a dosage of 10mg/5ml.

In fact I actually use easily available codeine as an anxiolytic sometimes since we're on the topic of opiates. It's not something I'd encourage others to do, but for me at least it works very well and helps me take tolerance breaks from benzos.
 
Kratom it's a stimulant also but anxiolytic, may be good for your schoolwork and long hours...but OP did u say u smoked 5 paks of cigs a day? How is that even possible logistically?
 
low dose valium was always the kindest to me.

From December 2013 to June 2016 I used 5-10mg just about every night for insomnia. At that point I stopped using it because I wanted to make sure I wasn't hooked. I started using 2mg pills (AFAIK the smallest there is) PRN about a year ago and they work just fine for me. Then again, I often use them at night when the hypnotic effect is welcome. FWIW I have had an Rx for diazepam from the start, so I have a large degree of experience with all doses (up to ~80mg). I find a bit of a ceiling effect past 30mg. Anything more seems to be wasteful IMO. Maybe it's just my individual physiology.
 
Anxiolytic benzos are great. Even though Diazepam has the longest half life, it is the weakest imo. Clonazepam 2mg are good, but Alprazolam 2mg are definitely the most effetctive I think. I have never tried Bromazepam though.
 
I have a script for gabapentin 1200mg 3x/day. Works decent.

I don't like benzos very much because people can tell I'm fucked and as soon as they wear off the anxiety is worse than it was to start with.

Dissociatives completely kill all anxiety for me but not suitable for day to day use.
 
MDMA is a damn good one...I've straight up nodded out and want to sleep iving it...takes away heroin WD also
 
Honeywhite I'm in the same boat as you but I do NOT recommend Bromazepan. A quick search showed this:

Bromazepam is similar in side effects to other benzodiazepines. The most common side effects reported are drowsiness, sedation, ataxia, memory impairment, and dizziness.[7] Impairments to memory functions are common with bromazepam and include a reduced working memory and reduced ability to process environmental information.[8][9][10] A 1975 experiment on healthy, male college students exploring the effects of four different drugs on learning capacity observed that taking bromazepam alone at 6 mg 3 times daily for 2 weeks impaired learning capacities significantly. In combination with alcohol, impairments in learning capacity became even more pronounced.[11] Various studies report impaired memory, visual information processing and sensory data and impaired psychomotor performance;[12][13][14] deterioration of cognition including attention capacity and impaired co-ordinative skills;[15][16] impaired reactive and attention performance, which can impair driving skills;[17] drowsiness and decrease in libido.[18][19] Unsteadiness after taking bromazepam is, however, less pronounced than other benzodiazepines such as lorazepam.[20]

Yeah... no fucking thanks.

Phenibut looks more promising but most of the information is in Russian. Is there a single anxiolytic that doesn't have retard-inducing effects or give you a limp dick? DOesn't seem so.
 
^^^ What you cited is true for all benzodiazepines. The most efficacious class of drug for pervasive anxiety. If there were anything better--and beta blockers definitely aren't--it would be in market circulation by now.
 
I suffer from anxiety for many years,been prescribed diazepam,oxazepam,bromazepam,alprazolam and promethazine for this condition.Out of benzos alprazolam and bromazepam are probably best choices BUT i accidentally found out that modafinil - low dose does wonders for my anxiety,i am much more confident, talkative, social and less shy while on modafinil and absolutely not brainfogged and memorydeath like when i am on benzos. So modafinil is my best anxiety cure and its effects lasts even when i skip a day or even more. Another great medication for anxiety is tramadol but this one is seriously addictive and tramadol withdrawal is not worth it, it was worse than my alprazolam wd..so i can not recommend it but i absolutely recommend low dose modafinil for anxiety, its not like amphetamines so it doesnt make u tense so much, it just make u feel better, alive and less anxious. I have a feeling that modafinil also made some long lasting - maybe permanent changes to my brain and personality. It made me somehow more prosocial and socialy confident even if i dont take it and by this mechanism it enables you to participate in anxiogenic activities so u can raise your anxiety tolerance, its like psychological or social-behavioral therapy.
 
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What works best for me is a low dose of a dissociative. PCP and friends get bad rep, but they're actually good anti-depressants. One big advantage is that NMDA antagonists don't have physical withdrawals (as opposed to the infamous benzos and opis, which are both great antidepressants, but also have horrific withdrawal symptoms).
 
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