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Mental Health Legal Professional needing anxiety relief for 8 hrs daily - med suggestions?

C

cbtodacb

Bluelighter
Joined
Aug 28, 2012
Messages
69
My dear friends,

I have posted a few threads already and am constantly referring to them to absorb the information from the forum members. It has been a great help. The reason for starting a new thread is to give a more clear representation of my current situation.

I am a lawyer and I work in an office with over 200 people. I constantly am forced to confer with colleagues and clients from 8 am through to 6 pm daily. This is horrible and excruciating for me considering I have a social phobia plus a serious generalized anxiety disorder.

Does anyone know of medications that will effectively kick the shit out of the social phobia and chronic anxiety and its symptoms i.e. sweating, hands shaking, stuttering when talking to people because of anxiety, horrific fear of people speaking to me so that I have to respond in an anxious stuttering mess. IMPORTANTLY, I need meds that give relief for the period of the working day, or 24/7 is possible.

Any suggestions from persons in similar situations?

Also, please note that I am extremely thankful for all help and advice provided to me on my other thread and have recorded it all in my Anxiety Journal for further consideration/research. Just though I would pop this thread in as it explains my work situation and work hours.

Kind Regards.
 
Benzo's aren't a good solution, and unless you're prone to seizures I wouldn't suggest taking it daily/all the time.
I would recommend trying an "anti-depressant" with anxiolytic properties. If you're not in the states I'd suggest Moclobemide, but if that isn't available where you live your GP/psych would probably start off with an SSRI. This is assuming you want a long-term medication. If that doesn't work, I'd suggest trying an SNRI and Mirtazapine if that doesn't work.
I'd suggest some psychotherapy to try and work out what is causing your anxiety.

Benzos will detract from your cognitive function.
Benzos have intense w/d symptoms (which have the potential to be fatal if you don't taper)

Learn about the half-life and peak plasma levels of the medication you take.
Good luck.
 
Hey, thanks for the message.
I'm on an SSRI already. Been seeing a shrink for 5 yrs. I have been on up to 60mg daily on Lexapro which is some form of record I heard. Was useless for the effects of my anxiety. I have been taking lexapro for about 5 yrs. I'm currently on 30mg.
I have tried CBT, therapy, all the jazz - to no avail.
Unfortunately, I think I have some form of chemical issue which causes my anxiety as I am an intelligent and logical man who has tried a lot of non-medical treatments.
The time has come to find something to sought this shit out once and for all! lol

I take valium in small doses sometimes.

I would be interested on hearing more about Mirtazapine? Also, what is an SNRI as opposed to an SSRI?
 
If you think you have a chemical imbalance bring it up with your GP and discuss the possible causes and your options. Was the valium prescribed or do you self medicate with it? How effective is it for you?

We can't really recommend a medication for you as we know next to nothing about your situation.

As for SNRI's this may help shed some light on them for you:

http://www.wdxcyber.com/ssri-or-snri.html said:
SSRI's Vs. SNRI's—What's The Diff?

Antidepressant drugs do their work by either increasing the production of neurotransmitters or by breaking them down. There are three major neurotransmitters that are involved in depression. These are called dopamine, norepinephrine, and serotonin. Serotonin is sometimes called 5-HT.

When the levels of one or more of these neurotransmitters dip or become unbalanced, depression or other conditions may result. The newest class of antidepressants is called selective serotonin and norepinephrine reuptake inhibitors (SNRI's). The drugs from this class used for depression are Effexor XR (venlafaxine), Cymbalta (duloxetine), and Pristiq (desvenlafaxine).

SNRI's are capable of acting on both norepinephrine and serotonin. Low levels of these two neurotransmitters are known to be a factor in depression. However, norepinephrine affects energy levels and level of alertness, while serotonin's sphere of influence is on mood. Because of this unique dual action in raising levels of both serotonin and norepinephrine, SNRI's combat more than one cause of depression.
Dual-Acting Antidepressants

In treating depression, the doctor's aim is to achieve remission in the depressed patient. The medical director of Georgia Institute of Mood and Anxiety Disorders, Dr. Jeffrey Kelsey says that all the antidepressants available on today's U.S. market are equal in their effectiveness. "However, when it comes to remission, the data shows that SNRIs, dual-acting antidepressants, will, in some patients, confer an advantage. And the tricky part is going into it; we don't know which patients will benefit from one approach to the other. SSRIs are very effective treatments but some patients are going to get more benefit from a dual-acting antidepressant," says Kelsey.

The FDA has approved Cymbalta, Effexor XR, and Pristiq for the treatment of major depressive disorder (MDD). The first two have also been approved for treating generalized anxiety disorder (GAD), a known associated condition for depression. Cymbalta is also indicated for relief from diabetic peripheral neuropathic pain, a condition secondary to nerve damage incurred by diabetes. Besides MDD and GAD, Effexor XR has been approved for the treatment of panic disorder and for treating social anxiety disorder.
Comparable Effectiveness

Cymbalta and Effexor XR have been found to have comparable rates of effectiveness. In two studies, patients were treated with 60 mg of Cymbalta daily or 150 mg of Effexor XR over a period of 6 weeks. Then patients continued to take the same drug for a further 6 weeks but with doses adjusted to a maximum of 120 mg daily for Cymbalta and 225 mg daily for Effexor XR. 75% of the Effexor XR group completed the entire 12 weeks of treatment as opposed to 65% of those taking Cymbalta. Cymbalta caused greater nausea and a small number of those in the Effexor XR group had heightened blood pressure.
Click to expand...
 
Thanks for the reply.
I am currently prescribed valium from my GP (normal doctor). He gives me 50 x 5mg tablets and says to take no more than 20mg a day. Unfortunately, 20mg a day does not cut the mustard. I need 20mg just to function up until lunch and then another 20mg to get through the remainder of the working day. I also see a shrink who prescribes valium to me in the exact same way as my normal doctor. They never give me repeats for valium, they are always one off prescriptions, which is a pain in the ass considering how much of it I go through. I have discussed Xanax but they are all shivering their boots due to the bad publicity associated with its abuse. I want to ask for some xanax or klonopin and find a doc who understands the seriousness of my condition and prescribe it to me on a regular basis.

I am also prescribed lexapro 30mg a day which is shit house for anxiety. Have been on lexapro for 5 years with no anxiety relief. I have also just started Lyrica which I am unable to report on yet because it has only been one or two days of use.

As far as my situation goes, it's a disaster. I can't function in my job. I work 8 - 6 in an office and am shaking and sweating and stuttering the whole time. It's hell.

Do you personally think the SNRI's are better for anxiety than SSRI's or simply better for depression.
 
I haven't tried SNRI's myself, but I also found that Lexapro did nothing for my anxiety.

Have you talked to your psych about the valium not being enough to get you through your day? It may come off as drug seeking behaviour by some, but if it is truly that bad and effecting your working performance then something needs to be done. Xanax is being prescribed less these days because of the abuse potential, but if they are giving you one off scripts every time they can control your use a little.
 
you could also try beta-blockers such as propranolol, they are used for stage fright and stop the physical manifestations of anxiety (trembling etc)

they also have no side-effects rlly and no addiction potential/recreational value, they are definitely a useful tool though for some people

anti-depressants never did much for my anxiety, i think you should look into stress reducing activities such as yoga&meditation and regular cardio exercise, not all problems have a pill solution
 
Thanks for the message.

Yeh I have got to the point now that I swear and vent with my psych. No more messing around pussy footing around the issues. If the valium isn't doing the job I'm going to tell him. I'm actually in the process of organising to see a new shrink. My current shrink is a great guy but he is a huge believer in therapy. He has written books on it and stuff. His main clientele are couples and young children. I would be an anomaly in his patient list. I suppose he is more a therapist for couples and children with disorders rather than a serious clinical, scientific psychiatrist. For example, while I was at work having a full scale melt down we arranged a phone call. I said I wanted to discuss medication given everything in the last 5 years hasn't worked. All he wanted to do was talk things through i.e. therapist type stuff. I've been doing this for 5 years with him to no avail so I got a bit short with him saying enough is enough, I need a medication which soughts this shit out!

For someone with a condition like me (severe severe anxiety), therapy is analogous to asking someone with a severely broken leg to talk their way out of their condition and symptoms. The talking don't do anything! Medical intervention is needed to heal the leg. Talking is just a waste of time. No matter how hard they try to 'therapy' their way out of their condition, the fact remains, their leg is broken and they are in pain and cannot walk. This is where I am at with 'therapy' with my anxiety. I have something wrong in my brain which causes this stuff and medication is needed.

Sorry for the venting guys, just wanted to get it out :(

Have you guys experienced different doctors/shrinks having different approaches - some more effective than others?
 
Mmm. If the valium isn't working for anxiety, that's really a problem. I'd ask to be trialed on benzos which are more selectively anxiolytic, such as lorazepam and clonazepam.

As has been mentioned previously, propanalol is a good bet to control the physical symptoms of anxiety. It's non-addictive and really very safe. It can be taken concomitantly with your other meds and shouldn't interact with them. It could make you a little tired, so that's something to keep in mind.

Good luck.
 
I should place a small caveat on my last post. The valium works but not in the doses they recommend I take. My doctor and shrink say not to take more than 20mg a day but I need at least 40mg to 50mg daily to make function free from the horror of anxiety. So I should say that valium does work but I my doctor and shrink do not recommend I take the dose that actually deals with my crippling condition.

I will definitely take note of lorazepam (Ativan) and clonazepam (Klonopin) and record them in my anxiety treatment diary.

Is it normal to need to 40mg + valium per day to function or is this an abnormal/ineffective response to valium? Or is it common to need such high doses to function?

Many thanks.
 
Honestly, no. 40mg isn't really considered a high daily dose for severe anxiety. Of course, you want to keep your doses as low as possible, but no that wouldn't be considered an unreasonable dose. If that's what you need to function normally and with a better quality of life, that's what you need. The thing is, there may be other benzos that could be more effective and/or work in lower doses, so I really would look into being trialed on other drugs.

For the shaking hands, increased heart rate, palpitations and other physical symptoms of anxiety, truly, give the beta-blockers a try. You may get more effect, and actually be able to take lower doses of your valium or other benzos.

There are other anxiolytics, such as buspar and sediel, that may be worth a try. Even lemon balm, or other nervine herbs, may be of use to you.

I hope you can get the anxiety and social phobia under control! I've suffered from severe anxiety myself before, and know what hell it turns your life into.
 
Yeh severe anxiety is like having your balls in a vice everyday, it's so horrible. Makes you dread being within 50 meters of another human being.
I will consult with my doctor about all these suggestions and see what he recommends.
IMHO though, most shrinks I have been to, and doctors for that matter, do not have a clue about the effective treatment of severe anxiety disorders such as mine. They simply say, 'oh well mate, let's get you on an SSRI'. From my experience, SSRI's, Lexapro in my experience, are useless for bringing freedom to a patient such as me.
Oh well, many thanks people. I really appreciate it. i will give an update once I see my doc/shrink again. I know that all this information will one day help another person suffering the hell of chronic anxiety while they see everyone else fluttering around anxiety free like butterflies on a sunny spring day. Meanwhile, the anxious cower in dark caves, unable to share in the beauty of the sweet summer day that is life.
 
You mentioned going to see a new psych, have you asked your current one if they can recommend one that specializes in anxiety disorders? They are out there and it makes a massive difference in both treatment and results.
 
Hello Rabbit,
No I haven't mentioned it to my current shrink. I was afraid he would be offended because I have been with him for over 5 years now. I was also afraid he would simply think I am moving to someone else to get stronger meds, as if I were some type of junkie, which obviously isn't the case. I have a serious condition that is why I am always discussing medication with him. I was afraid he would put some type of black mark next to my name on some secret shrink register which says I am a drug seeker or something. OR maybe it's just my anxiety and he would not care at all :/

Given your advice, I will most certainly ask him if he knows anyone who specialises in anxiety disorders. Are there any members of this site from the Brisbane region in QLD Australia. It would be great to get some type of referral to someone who has given others great results and treatment.
 
Lucky coincidence, I'm from Brisbane myself =D

IMO you're better off explaining to your current shrink that you appreciate all they've done for you, but you feel that your needs aren't being met. Tell them that you're looking for a 2nd opinion on your case and would like to see someone that specializes in anxiety if possible. After 5 years, with a good shrink, you should have made some significant progress in narrowing down what works for you (rather than just a string of things that don't work). Be honest with them. They'll be able to give you a better recommendation than I can.

I don't think I read it, but are you seeing a psychologist or a psychiatrist?
 
Haha how fantastic, your in the Bris Vegas too!
I've been seeing the real deal mate, psychiatrist.
I saw psychologists on 3 or 4 occasions but it was useless. I'm sure it is good for people with small issues who need counselling but for a serious, chronic condition such as mine (which is near madness yet still functioning somehow) psychologists are useless. They told me to picture bubbles and pop them in my head and gave me breathing techniques. All useless. I tried really hard at it too. Hired books out on CBT, I did the lot, all to no avail. Once again though, I'm sure it is effective for some people.

Do you see a shrink in Brissie? Has your shrink helped you with your condition? Have you made major positive gains with him/her?
 
I have seen a psychologist in the past but found, like you, that Lexapro and Valium just weren't working for me. I chose to stop seeing anyone and just deal with it. I found that mindfulness (click) helped during this time, but it's not a viable long-term solution for me.

I start seeing a psychiatrist on Friday, who was recommended as a great with anxiety/agoraphobia cases, and I will be starting CBT with them. Hopefully I get some results this time, because I'm not looking to just be medicated.
 
Mate I wish you all the best and I hope it work out for you with that shrink. I'll be interested to hear how it goes so that I can consider whether it is something I should pursue.
Mate just out of interest, what is your med regime currently and what were your symptoms pre meds? If not medicated now, what did you find to be the most effective med regime?
Kind Regards.
 
Thanks man.

At the moment I'm med free (but I do use a large number of drugs still). I never found a med regime that worked, but I was also going through a lot of different meds to fix an insomnia issue at the same time, so who knows what was doing what really :\ Symptoms pre-meds started as a general aversion to going anywhere with 20+ people or leaving my room if strangers were in the house. My mother put it down to being a lazy teen and never did anything when contacted by my school counselor. It slowly got worse, from nervousness even being with friends up to the point I was having panic attacks while in the city from being overwhelmed by the amount of people. This led to me never leaving the house and a deep depression so I decided it was time to get help.

Moving to Melbourne helped quite a bit, but when I moved back to Brisbane the anxiety came back just as bad. So it's time to try to do something about it again.

I wish you luck with finding another shrink that can help you. Having to bounce from one to the next again and again can be grueling, but finding the right one will make a noticeable difference :)
 
As someone that has dealt with very severe anxiety as a kid and overcome most of it (so much so that I would now classify it as mild) I actually side with your shrink on the therapy/mind retraining bias. I don't think of anxiety as a "chemical imbalance" as much as a nature of over-sensitivity that some of us are born with. The problem is that we want a magic bullet and there is none. All drugs--especially the benzos that treat it so effectively at first--end up making the condition worse, create a higher and higher tolerance and, most insidious, are a hellish addiction to conquer. The therapies that you have already tried and those that have been recommended--CBT and mindfulness, etc are effective but they are a lifelong practice and the benefits are not easily seen in the short run. Internalizing the concepts and integrating them so that the thinking becomes stronger than the anxious thinking itself is a slow process but ultimately the most freeing. All any drug can do is to separate you temporarily from the feelings of fear. Deep psychological retraining could be seen as digging a weed out by the root instead of just endlessly mowing the top off.
 
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