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Misc Desperate for your advice on meds for debilitating anxiety

Yeh I hear weight can be a killer with some of these drugs. Howcome you hose mirtazapine over other SSRI's? Did SSRI's not work?
I have heard of people being on xanax for like 6 or 7 years daily, howcome they can do it? It is so tempting because of the positive effects and relief from the horror of SAD and GAD.

They can do it because there is a doctor that is willing to keep prescribing them their daily dose of xanax. It doesn't mean they are not addicted. They would probably be at high risk of seizures if they stopped suddenly after taking it for so long.

I know it is tempting to use benzos everyday. Were it not for the lessons I have learnt through addiction, I would too. I, like you, am also Australian and know how much of a pain in the arse it can be to get a supply of benzos from doctors. But take it from me, using benzos everyday will quickly catch up too you. For a professional (as both of us are) we need to be able to keep a clear head and a focused wit. Sadly, benzos aren't the best for this particularly as tolerance rises quickly and so can your doses leaving you unfocused and with a flimsy memory.

To answer your first question. This is my 2nd episode of serious depression. The anxiety I have is kind of always with me since my first episode in 2010, but it peaks during depressive episodes. Anyway, first antidepressant I tried in 2010 was effexor. I couldn't tolerate that and had to discontinue it after 3 days when it gave me really bad suicidal thoughts. A few months passed and I tried zoloft and it was somewhat effective for depression but made no difference with anxiety. It had a shitload of side effects though such as insomnia, weight gain and no sex drive.

The 2nd episode happened after a bad break up. I was flung into severe depression and couldn't sleep. I went to the doctor and asked for an antidepressant that would help me sleep. He recommended mirtazapine, but warned of the weight gain. I was really hesitant about it too, as I am well built and muscular but put on weight easily as it is. Within a week, I was lifted out of suicidal depression. Within a month, I was back to being high functioning. Now I actually have moments of happiness (something I haven't felt in almost a year). So yeah, things are getting better. But I still get pretty anxious sometimes. Not to the debilitating level as previously, but still enough to distress me. I can also sleep properly now. Before that I couldn't sleep without like 4 stilnox and I was constantly exhausted.

I do take valium maybe 3 times a week. I try to have two or three days break, and try not to use more than 10mg. This is already pushing it pretty close to the line with addiction for me. However, it does make me feel more normal and actually be able to enjoy things rather than worrying excessively about something. It also a pain in the arse going back to the doctor to get it as they give me the third degree each time about it's addictiveness and side effects.

Ha anyway this was a bit of a ramble.

The tldr version would be 1) benzos are effective but are not an everyday option as addiction and withdrawal is absolutely terrible, 2) mirtzapine is really effective for me for depression but not so much with anxiety. the weight gain is the only side effect I have had.
 
By the way, check out this thread in Australian Drug Discussion:

http://www.bluelight.ru/vb/threads/611040-The-Benzodiazepine-Thread-v-IV

It's Australian centric and has plenty of good advice from people who are familiar with benzo prescribing practice is Australia. It's good for info on whether you are interesting in medical or recreational use. BTW, AusDD is a great group of friendly and knowledgable people. We'd be happy to have you around.:D
 
Thanks for the info guys.
First of all, as a serious sufferer of anxiety it concerns me to hear people talking about abusing drugs like lyrica to get 'high'. If word get out that this is so then they will stop prescribing them as much and people like me get screwed because we can't get our hands on them for our genuine needs. If you are going to hit it up hard for recreational use, keep it on the down low so word doesn't get out and doctors stop prescribing it to people who need it to survive, people like me.

Interestingly enough, while it would seem recreational doses would be counterintuitive to anxiety control, my own experience is that a recreational dose once every 3-4 days is actually better at controlling panic anxiety while daily doses with occasional breaks are better are better at controlling Generalized anxiety. Recreational doses seem to be effective for at least two days, while therapeutic doses must be taken two to three times per day. If you take 900mg at six AM you will still feel fairly strong effects 24 hours later with an afterglow still more potent than the effects of a 150mg dose lasting for a couple more days. This is only way I could see Lyrica being used to prevent panic.
 
Lyrica is ineffective for true panic disorder as it just doesnt work fast enough to control panic attacks but it is very effective for GAD.
In answer to an above posters question, i believe pregabalin increases the availible amount of GABA which lowers levels of glutamate and hence noradrenaline.
Benzos works by modulating the opening of GABA a subreceptors and in so doing release available GABA.
Benzos by themselves are fairly safe as theres a 'ceiling dose' effect because they can only release what GABA is already present. When you take pregabalin with a benzo, you raise that ceiling dose by making extra GABA available with the pregabalin.
OP, ive tried most of the ssri's for my severe anxiety and they were ineffective or had terrible side effects, like hallucinations and hypermania.
Mirtazapine was the saviour for me as it enabled me to get control of insomnia which lowered my anxiety.
Within two weeks mirtazapine had stopped my daily panic attacks and pregabalin helps control my GAD.
I also get good anxiety relief from my opiates (especially when used with the pregabalin) which im prescribed for chronic pain.
Im not condoning use of opiates for this purpose as it could end badly but i thought id point out the unexpected side benefit.
I would avoid everyday use of benzos for anxiety, while they seem like miracle pills at first, the addiction they bring will push your anxiety through the roof.
Im afraid the only true way you can effectively treatment your anxiety is through learning to control it. Medications are there to help you do that but there is no longterm miracle pill, just shorterm crutches and lots of hard work.

P.s Mirtazapine is a tetra-cyclic antidepressant, closely related to the old school tri-cyclics but alot safer for longterm high dose use as mirtazapine doesnt have the cardio-toxic effects of the tri-cyclics. Studies have shown mirtazapine to be as effective for anxiety and depression as tri-cyclics and almost as effective as ssri's but without the severe side effects.
Doctors will be alot more likely to prescribe mirtazapine (rather then benzos like xanax) because its non-addictive and isnt considered to have abuse potential.
 
Lyrica is the one for GAD, I know others have mentioned it but I will also to further endorse it's effectiveness.

300mg twice a day is the max dose a doc will write the script for you though, but it is very effective and long lasting. But do not suddenly stop taking it, it is one that if you in the future wanted to stop, you would have to taper it slowly. It is quite a nasty W/D so even tapering is quite intense.
 
Mirtazapine was the saviour for me as it enabled me to get control of insomnia which lowered my anxiety.
Within two weeks mirtazapine had stopped my daily panic attacks and pregabalin helps control my GAD.
I also get good anxiety relief from my opiates (especially when used with the pregabalin) which im prescribed for chronic pain.
Im not condoning use of opiates for this purpose as it could end badly but i thought id point out the unexpected side benefit.
I would avoid everyday use of benzos for anxiety, while they seem like miracle pills at first, the addiction they bring will push your anxiety through the roof.
Im afraid the only true way you can effectively treatment your anxiety is through learning to control it. Medications are there to help you do that but there is no longterm miracle pill, just shorterm crutches and lots of hard work.

P.s Mirtazapine is a tetra-cyclic antidepressant, closely related to the old school tri-cyclics but alot safer for longterm high dose use as mirtazapine doesnt have the cardio-toxic effects of the tri-cyclics. Studies have shown mirtazapine to be as effective for anxiety and depression as tri-cyclics and almost as effective as ssri's but without the severe side effects.
Doctors will be alot more likely to prescribe mirtazapine (rather then benzos like xanax) because its non-addictive and isnt considered to have abuse potential.

I have to put in my vote for Mirtazapine as well. It is just a wonderful medication! It pulled me out of a very dark depression recently and has also been a wonderful anxiety treatment, especially when combined with the Pregabalin.

Just today I began taking Desvenlafaxine (Pristiq) as an adjunct to the Mirtazapine. This combination is known as "California Rocket Fuel" and seems to be a remedy for even the most severe of depressions. These two substances potentiate the antidepressant effects of each other a great deal as Mirtazapine is a Serotonin Specific and Noradrenergic Antidepressant and Desvenlafaxine is a Serotonin Norepinephrine Reuptake Inhibitor. Basically, the Mirtazapine causes a significant increase in the production of 5HT and NE while Desvenlafaxine prevents their reuptake.

It is, of course, too early to tell, but if I feel even half as good as I did today this combo is a winner. For some reason I respond to most antidepressants from the first dose, though their effects often change over time. I felt so calm yet stimulated today. Very smooth effect!
 
Have you tried Hydroxyzine (Generic for Atarax), or any beta-blockers like propanolol (which are great for physical symptom alleviation of tension/anxiety)
 
Have you tried Hydroxyzine (Generic for Atarax), or any beta-blockers like propanolol (which are great for physical symptom alleviation of tension/anxiety)

I could recommend trying these too. Especially propranolol has been a huge help for many who suffer from debilitating anxiety and panic attacks. When I went through benzo withdrawal, I wouln't have managed without propranolol. Usually for anxiety and panic, the dose of propranolol is 20-40 mg. I've gone as high as 3 x 40 mg a day when I had my worst WD (which consisted of debilitating fear and anxiety).

Lyrica is very effective, but tolerance to it builds rapidly. So only for some weeks or months was it effective for me. I started with 75 mg but it wasn't long until I was on the maximum dose you can be prescribed, 600 mg a day (not 300 mg as some other mentioned). And not long after that you have such tolerance to it that it doesn't help anymore. And then it is somewhat addictive, but not like benzo's.

Benzo's, well, hardly anyone disagrees that they are the undisputed kings of anxiolysis and sleep (I don't count barbs because they aren't really used anymore). For me they are so effective that I don't need any other meds for anxiety anymore. The last 15 years I've tried so many different meds, the list is huge, but only benzo's (and Lyrica for a short time) truly help. The big problem with them is that they are so effective you soon start thinking there is no other way in the world to get rid of your anxiety than taking benzo's. The addiction risk you probably know enough about already.

SSRI's and SNRI's can be a huge hit or miss. Some have made my anxiety horribly much worse, some have maybe helped a little. Mirtazapine is quite good, I've always quite liked it. Mainly in small doses, more than 15 mg can be too much (too much adrenergic action). If not else, it's great for sleep.
 
Got a prescription for propanolol today. Doc told me to take 40mg in evening and 40mg at night. Is this an alright dose?
Also, does anyone know if I should stay away from coca cola or other caffeinated soft drinks because of anxiety or does it make no big difference?
 
I could recommend trying these too. Especially propranolol has been a huge help for many who suffer from debilitating anxiety and panic attacks. When I went through benzo withdrawal, I wouln't have managed without propranolol. Usually for anxiety and panic, the dose of propranolol is 20-40 mg. I've gone as high as 3 x 40 mg a day when I had my worst WD (which consisted of debilitating fear and anxiety).

Lyrica is very effective, but tolerance to it builds rapidly. So only for some weeks or months was it effective for me. I started with 75 mg but it wasn't long until I was on the maximum dose you can be prescribed, 600 mg a day (not 300 mg as some other mentioned). And not long after that you have such tolerance to it that it doesn't help anymore. And then it is somewhat addictive, but not like benzo's.

Benzo's, well, hardly anyone disagrees that they are the undisputed kings of anxiolysis and sleep (I don't count barbs because they aren't really used anymore). For me they are so effective that I don't need any other meds for anxiety anymore. The last 15 years I've tried so many different meds, the list is huge, but only benzo's (and Lyrica for a short time) truly help. The big problem with them is that they are so effective you soon start thinking there is no other way in the world to get rid of your anxiety than taking benzo's. The addiction risk you probably know enough about already.

SSRI's and SNRI's can be a huge hit or miss. Some have made my anxiety horribly much worse, some have maybe helped a little. Mirtazapine is quite good, I've always quite liked it. Mainly in small doses, more than 15 mg can be too much (too much adrenergic action). If not else, it's great for sleep.

Was your doc happy to keep prescribing you benzos though?
 
No decent doctor would just stop a benzo script if youve been on them for a longtime, its too distressing for the patient and borders on being unethical.
Whats more likely is that if they find other meds that work then they will wean you from the benzos gradually.
I was prescribed mirtazapine, pregabalin and zopiclone at the same time, doctor wasnt overly happy bout that many sedatives because of my opiate prescription as well but i wasnt happy to come off the zopiclone at that time.
 
Was your doc happy to keep prescribing you benzos though?

Well, I went to quite a few doctors/psychiatrists through the years but since I had been using them (addicted) for some time they didn't have much choice, because they knew what would follow if I'd go cold turkey. They just can't say no (well, one actually did) really, since I was doing fairly well in life on benzos anyway and they know WD is quite serious business. At some point I think also the doctors realized that it was hopeless just trying new meds all the time when there was a class of drugs that did the job.
 
Youve also got to remember that it wont be the doctors aim to completely flatten any anxiety you have.
Some level of anxiety is normal, the meds are just to take the edge off and make it managable.
It could be helpful if you could make some life changes to remove or lessen stress factors, even if its just for a little while, to give yourself some breathing room.
Meds alone wont be enough to effectively treat anxiety, lifestyle, diet and exercise also have to be addressed.
 
I had severe, full scale, extreme anxiety while playing professional sport,; so much so that I was going to elope to an isolated area by myself. I trained everyday to a level most people will never imagine. I also ate healthily to the utmost. For severe cases such as mine 'lifestyle' changes are a moot point.
I will say though, your suggestion should definitely be considered and put into practice by those who have not yet tried exercising and the like. I'm sure it is of some benefit to some people.
 
Got a prescription for propanolol today. Doc told me to take 40mg in evening and 40mg at night. Is this an alright dose?
Also, does anyone know if I should stay away from coca cola or other caffeinated soft drinks because of anxiety or does it make no big difference?

40 mg twice a day is a strong but quite good dose. I've even taken propranolol 3 x 40 mg a day. Propranolol will pretty much nullify the stimulating effect of caffaine though, since propranolol will keep your heart rate and blood pressure quite low (and steady). But generally caffeine is anxiogenic and should be avoided when you're anxious.
 
I played professionally for 5 years. For 3 years I was medicated and for 2 years I was not. I was taking Zoloft (SSRI) when I was medicated. I have found SSRI's to be completely useless for my level of anxiety. Hope this helps.

@Cyanoide
So would I be alright to drink coffee on Propranolol.
 
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