Need help prescribing right medication for anxiety.

[danglesmcgee]

Although I would also caution against obtaining benzos via any other means aside from an understanding doctor, anyone who is suggesting antidepressants or -- even worse -- antipsychotics, for whatever reason, is misguided.

If you have legitimate anxiety/panic issues (which it sounds like you do), no SSRI is going to bring you the relief a benzo will. I'm sorry, it just won't. As far as the antipsychotics go (i.e. Seroquel), they carry just as many risks and side effects as benzos do, albeit slightly different ones. Antipsychotics are extremely powerful drugs, and no one who doesn't ABSOLUTELY need them should ever take them -- period. I learned this after being prescribed Zyprexa and later Seroquel in my early 20's, and the withdrawal from the latter was fucking horrific. (Use the search function for 'seroquel withdrawal)

Suggesting antipsychotics as a replacement for benzos is flat out irresponsible.

I would suggest doing your best to find an understanding doctor willing to try at least one of the weaker benzos (Lorazepam). No one can tell you you're going to go down a disastrous path with benzos, only you can know that. That being said, obtaining them on your own is still a bad idea.

I have withdrawn from benzos in the past, and yes, it is everything you've been warned about and worse. However, I do have a benzo script now, and have for the past three years, and have not become physically dependent again. And while I don't condone abusing them, I myself do, but the fact that I cannot just obtain them at will staves off physical dependence. I do okay cycling the benzos, kratom etc... which brings me back to, simply: No one can tell you how you'll handle them, only you know.

FTR, my experience with gabapentin is that it is practically useless, and in higher doses extremely uncomfortable. I do have a younger brother who was opioid-dependent for about a decade and it works really, really well for him.

I have no experience with Lyrica, although I have tried a few times to get it from my doctor for depression/anxiety off-label (she won't do it).

Phenibut is hardly without its own risk of dependence and withdrawal, as I and many others here can attest (again, use the search function).

Sorry for going on so long...

i disagree. You can generalize every person. I know of 300 patients who have responded very very well to vanlefaxine or desvanlefaxine. its a very effective drug so long as its taken most importantly - consistantly and for AT least 12 months in order to fully get its therapeutic effects. seroquel is mostly intolerable due to its unintended side effects. however some people exploit it at lower dosages to get its sleeping effect. I think its generally excepted that CBT in combination with medication is the most effective treatment for chronic anxiety. CBT is a powerful process, you learn to re-program your thinking process and thus can eliminate the worst of it by actually facing the problem.

 

[d1nach]

Ive been on effexor for years for multiple suicide attempts depression and and anxiety with lithium went from being on icu for days or weeks for the year suicide attempt to none in years.

 

[danglesmcgee]

Ive been on effexor for years for multiple suicide attempts depression and and anxiety with lithium went from being on icu for days or weeks for the year suicide attempt to none in years.

^case in point. problem with ssri or snri is 9 times out of 10 the GP doesnt have time nor the knowledge to discuss the proper way to take these medications. for example they feel nausea so bad they just stop.
Your gut has more serotonin then your entire brain, so say you eat a rotten piece of meat - your gut releases ALOT of serotonin, + vanlefaxine = nausea, headache. solution - take it at AM with food. symptoms may then dissapear

 

[Keif' Richards]

The reason I recommended Gabapentinoids is because, I feel, they are a logical next step up from total sobriety. Substances along the lines and potencies of the Benzodiazepines and Opioids are more or less, "magic bullets" when dealing with anxiety or with the latter, both anxiety and depression. For someone with a problem as innate and terrible as chronic anxiety/depression, having an outlet that can remove a problem so severe, with such ease, can be dangerous.

There will no doubt be an introductory or honeymoon phase where Benzodiazepines will work wonders for you. You'll probably interprety being initialized upon them as a "life changing moment". The issue is that they don't last indefinitely. A further issue is that they become useless much more quickly when they are used in even vaguely reckless fashions. The same issue that drives you to pick up a potentially life-crippling habit in the first place is going to make it much more difficult to control or cease your use in the future, once you are both physically and emotionally dependent upon them.

Gabapentinoids can produce a severe withdrawal syndrome as well, but judging by my own experience and those experiences of my peers, it's most often of a lower intensity than Benzodiazepine withdrawal. Sedative/Hypnotic withdrawal cripples both your mental and physical capabilities. By most accounts, Gabapentinoids tend to not be quite so serious, although these experiences are all relative.

At any rate, if you're looking for something with true therapeutic benefit on a long-term basis, you'd be doing yourself a favor by working your way up step-wise to the more powerful anixolytics/antidepressants. Using very powerful substances can "ruin you" for the use of less-potent, similarly-acting substances. I've watched you for a little while Fermonos and I'm not talking in broadly generic terms here. I feel like I know a little bit about you and none of this is coming from out of left field.

 

[Ozle]

What exactly are you looking for? Something you can take punctually in certain situations/when needed (with a fast onset and relatively short duration of effects), or something suited to daily/regular use (with a longer onset time but effects that persist through the day)?

 

[LoveSexDreamz]

For me, 2g phenibut twice weekly combined with 4g green kratom 5x a week helps tremendously. My only true help comes with clonazepam, but gabapentin also helps occasionally.

 

[truenamebrand]

The combination of a ssri with a second generation antipsychotic does have evidence behind its use in treatment resistant anxiety disorder.

I think people get too caught up in labels

The Antidepressants ssris when used daily upregulate the expression of growth factors in parts of the brain that can be shown to downregulated in rats by exposing them to chronic unpredictable stress.

Additionally, second generation antipsychotics can increase the improvement of people with anxiety disorders who dont fully respond to a ssri alone

Second generation antipsychotics at low doses
-antagonize histamine receptor which can reduce the physical effects of anxiety lack of appetite , flushing, vomiting , ect
-increasing the ssris effects on seritonin receptor subtypes 5ht1a and 5ht2ac
-reducing the number of weeks before remission vs a ssri alone
-antagonizing alpha adrenic adrenic receptors

I think another important factor here is receptor affinity just because a drug at maybe 5-10x the dose might blunt dopamine functioning doesnt mean that at fractions of that dose itll have the same theraputic effects and negatives

Here's the thing, if the goal is to avoid dependence and/or withdrawal from a substance, I simply don't buy into the notion that antidepressants and antipsychotics are a good alternative to benzodiazepines. Simply because they're not recreational (which benzos really even aren't) does not mean, IMO at least, they're somehow a better or even safer alternative. The fact of the matter is, not EVERY person who takes benzos will become dependent on them, despite addiction history. As I said, I have been dependent on them in the past, and currently get 60 clonazepam a month without that happening again.

I've yet to hear a good explanation as to why being on drugs where the idea is specifically to become dependent (otherwise it simply will not work) should automatically be preferred to sporadic use of a drug that MAY cause dependence. This whole mentality is ass backwards to me.

Yes, benzo withdrawal is bad. Benzo withdrawal can also be avoided. Antidepressant and antipsychotic withdrawal can be almost as bad, and if they're to work properly, withdrawal of some sort CANNOT be avoided. If someone does not have debilitating depression or psychotic symptoms, and anxiety is the primary issue at hand, I don't think anyone should be recommending the latter drugs under any circumstances.

As I advised this young lady from the outset, it is best to find an understanding doctor if benzos are sought. A doctor or anyone else who is excluding benzos by default is doing her a disservice.

EDIT: I wanted to quote both yours and danglesmcgee's posts, but don't know how on mobile. That response was in regards to both your post and his.

 

[benzolonely]

If you are searching for benzodiazepines for relief from anxiety/panic symptoms. IF you are manic/panic, I would suggest xanax xr, or less than 1mg xanax taken throughout the day.
If you have a general feeling of uneasiness, feeling on edge or you're under the impression that there is some sort of impending doom, I would recommend Klonopin- however- there is no therapeutic need for the dosage to surpass 2mg daily. If you feel that <1mg is not helping, maybe xanax xr would be more efficient.
If you have difficulty with social situations or freak out during social events, Ativan would be my proposed anxiolytic, though, I am not very familiar with this Benzo.

 

[Darksidesam]

Someone with truly crippling anxiety self-medicating with Benzodiazepines is almost always a recipe for disaster. They're very effective medications and work wonders when used as prescribed, but you can't treat them like a true solution to your problem.

anyone with anxiety wishing to self medicate with benzos read this

 

[d1nach]

Depence rather than sporatic use is important for people with chronic mental illness that does not respond to talk therapy and is not caused by day to day stress of life.

I think we need to be careful because while i do agree antipyschotics are often abused by doctors and insurance companies as a easy way to sedate problematic patients.

However, when you have someone with severe schizophrenia, manic depressive disorder, extreme phobias , panic , and or depression sometimes they are important

Im not suggesting someone take a ssri with some seroquel or abilify for depression from loosing a job or anxiety over a stessful dysfunctional family rather than solving the issue

I am talking about people who are so ocd they are scrubbing their hands to the point of they are blistering their hands, or so depressed they are regulary admitted for slicing up their body and suicide attempts.

Antipsychotics are like nitroglycerin just because it might be a deadly highly reactive explosive or extremely harmful to almost everyone that doesnt mean it doesnt have a essential critical role in the treatment of certain ill people

 

[GizmodiGirl]

Before going down the road of self-medication with Benzodiazepines, have you ever tried using Gabapentinoids for your issues? This class of drugs would include Gabapentin (Neurontin), Pregabalin (Lyrica) and Phenibut (OTC), among some others that are starting to appear on the grey-market. They work really well as anxiolytics for some and carry a relatively low risk of dependence/addiction when compared to the Benzodiazepines as a class. That's not to say that they are non-addictive or will not produce dependence, but like I said, relatively speaking, they are much safer for this purpose.

Someone with truly crippling anxiety self-medicating with Benzodiazepines is almost always a recipe for disaster. They're very effective medications and work wonders when used as prescribed, but you can't treat them like a true solution to your problem.

I was just reading on this site last night some threads on this Phenibut. It caught my attention because I am having difficulty with sleeping right now. However, what I was reading is this stuff can be very strong and seems to hit you late, like hours after taking it? Anyway, I am currently looking at a site that sells this stuff, but its really confusing. They have Phenibut HCL and then Phenibut F.A.A and then one that just says Phenibut. They have this in powder like crystals, and then sell it in capsules. What the heck is the difference in these things? Anyone, not meaning to take away from the OP's original post but it seems based on what is posted on here that this might be better than taking prescription medication?