Mental Health Other Alternatives to Benzos for Acute Symptomatic Relief of General Anxiety Disorder

[Rybee]

Hi All,

Diagnosed with GAD ~3 years ago. Given up with SSRIs/SNRIs/Tricyclics/Pregabalin/Gabapentin etc... and want to try alternatives to Benzodiazepines as I think they've largely lost their efficacy now. I'm px'd Diazepam which I do use when needed, and will be seeing my Psych for review in 2 weeks time but want to research some alternatives before I see him. He's quite open to new suggestions and medications used 'off label'. I would like to avoid daily medication, and would prefer to use medications pro re nata - such as how Benzodiazepines should really be used.

I don't know much about Barbituates, as they seem to have largely been replaced with Benzo's which are seen as a little bit safer. I've actually had a fair level of success with Beta-blockers (Propranolol & Atenolol), but they only control the physiological symptoms of anxiety such as trembling, sweating, reduced pulse etc... but they do little to actually help relax me.

As said, he's always open to new suggestions so I'd like to be as prepared as possible before we next meet to discuss alternatives, that either he or I suggest. My sleep is fine at the moment so that's good. I doubt it'd make much difference but for the sake of possible drug interactions, I currently take 3x10mg Oxycodone throughout the day for 2x herniated spinal discs - of which he's aware of.

Any suggestions would really help - I also think I'm going to give CBT another go.

 

[HB Pencil]

CBT really helped me with GAD so would absolutely recommend. Have never used anything other than citalopram but feel in the long-term medication isn't the answer anyway for GAD.
There is a benzo called pyrazolam which is really good for anxiety with essentially no sedation but again it's no long term answer.

A couple things you can do which may help:

Start a diary and note how you feel and highlight what situations you find the most tough. I have found it helps to vent into a book cos then you can just draw a line under it and try to move on.
If you have any 'crazy' anxiety thoughts, just take a step back and try and find the humour in it. Again a diary is good because you can read it back and rationalise how little sense it makes even though at the time is was horrible.
Lastly, when you feel symptoms look out into the world and study it in detail, colour of leaves, cars going by, doesn't really matter. This can help take you out of your inner mind where the GAD lives.

Do you have any specific triggers for your anxiety?

 

[PriestTheyCalledHim]

I've heard meditation can help.

 

[AlphaMethylPhenyl]

Meditation, exercise, and centering yourself when you have an attack can always help/

 

[Rybee]

Thanks - I do try meditation and it definitely does help. However, I do find it quite hard. My mind often drifts and I lose focus quite easily. Though I think that's normal for a beginner and it's actually quite a hard art to master. I find the 'guided' meditation clips on youtube really help as it helps guide you as to what you're doing.

 

[AlphaMethylPhenyl]

Have you considered SSRIs or Gabapentin?

 

[Acanthus]

Kava kava. Getting some more today. Works well and allows you to keep a clear head. Meditation I find usually only works with low/medium anxiety. Ie: you're not going to sit down and start meditating during a panic attack.

 

[flyhighk]

Etifoxine seems to work for me. It reduces anxiety but doesn't sedate me like benzos do.

But as always, use drugs only when really necessary.

 

[Rybee]

Have you considered SSRIs or Gabapentin?

Yes I have (Citalopram and Fluoxetine as well as Venlafaxine and Duloxetine) - I hate SSRI/SNRIs.

& Yes I've also tried Gabapentin and Pregabalin, both made me very slow cognitively and I just couldn't cope even on small doses. Hence why I'm after something

Etifoxine seems to work for me. It reduces anxiety but doesn't sedate me like benzos do.

But as always, use drugs only when really necessary.

Honestly, I've never heard of that. I'll have a read up on it - thanks, appreciate the suggestion.

 

[neversickanymore]

Have you given at least thirty minutes of an aerobic exercise five time a week a try?

If not I would recommend this greatly.

Exercise and Brain Neurotransmission
Neurobiology of Exercise
Exercise 4 Health, Mental Health, and Addiction vs. I worked all that out

Anxiety indicates a problem that needs to be addressed. It uncomfortable to get you attention and unpleasant to motivate you to seek and address the issue. Its an emotion just like pain is an emotion, just pain is location specific. So as pain screams stop what ever you are doing and address the location where the pain is coming from. Anxiety say im going to make you feal real uncomfortable until you figure out or change something. Once you figure out what you need to address and address it the anxiety goes away. They tell you its caused from a chemical imbalance in the brain.. it is but the brain has created the chemical imbalance to make you feal uncomfortable so you know there is something you need to take care of. This is why CBT is probably your best bet to find real lasting relief.

 

[Rybee]

Thanks for the response nsa, I'll give them a read when I've got the time.

Appreciate it.

 

[aq.]

They tell you its caused from a chemical imbalance in the brain.. it is but the brain has created the chemical imbalance to make you feal uncomfortable so you know there is something you need to take care of. This is why CBT is probably your best bet to find real lasting relief.

This.
I agree with NSA 100%. My anxiety used to be horrible before i started CBT. I still have anxiety, don't get me wrong, it's something i am going to have to cope with my whole life, but CBT makes dealing with my anxiety and stress a little more bearable. you just have to allow it the time to work. don't give up right away if it is not giving you the desired results after just a few sessions, and make sure you find the right therapist.

 

[herbavore]

CBT and mindfulness. They have many overlaps and they complement each other beautifully. Learning to rationally deconstruct anxiety so that you can let it come and then let it go is a very empowered way to live.

 

[421]

This answer is politically incorrect and possibly against the principles of harm reduction but... cigarettes.

Meditation certainly works but it's painful and takes a lot of time, not always practical (needs to be used preventively). I prefer prayer.

 

[Hear Me Roar]

Barbiturates aren't the answer and I'd hope your Doctor like most would be wise to steer clear to prescribe you them. They come with larger risks than other medications and in some cases can become lethal. Plus they come with a lot of nasty side effects.

Benzodiazepines as I'm sure you've been told aren't long term medications and after a while lose their efficiency yet leaves the patient dependant on them. They can Experience withdrawal symptoms when coming off them which can cause rebound anxiety. Like most sedating medication, they don't directly deal with the underlying problem, just mask it. Though as I said, I'm sure you've had this drummed into you many a time.

I fully understand how beta-blockers alone like propofol, even though regulating your heart rate do little for the feelings induced by anxiety.

You say you've tried varying SSRis, SNRis, TCAs and the rest. Have you tried any of the medications in the Phenothiazine class like Chlorpromazine? Or any anti-psychotics in general. A lot of the classic anti psychotics like Chlorpormazine, have anti-anxiety properties and some unlike SSRis and the like won't raise your anxiety temporarily while you wait for them to take effect and have been less known to cause the numbing effect SRRis are commonly known for. There is also Mirtazapine and similar which are NaSSA anti-depressants, which have anti-anxiety properties. In reality there are hundreds of medications which could potentially help with your anxiety prescribed on or off label, though for some medication isn't the answer. I guess it's up to you whether you carry on searching through to find one which helps, or you go down other avenues.

If it helps at all, it may be worth searching the different classes of anti-depressants, anti-anxiety and anti-psychotic medications and noting down a few to take to your Psychiatrist. Or even do a simple search of medications which can be used off-label for anxiety. Even some anti-histamines have sedating/anti-anxiety properties. Your Psychiatrist will be better suited to advise you which would be beneficial and which wouldn't. Just be aware some medications which are used in America aren't prescribed in the UK and from my knowledge, some are more loosely prescribed over there. I've been in a similar situation your in and found it helpful to be part of my health care as I can see you are doing.


Healthy eating, exercise and work have been shown to help with anxiety. Cutting out stimulants like nicotine and caffeine also help. Sleep also plays a large factor in anxiety. Though sometimes it does feel like a dead end road.

There are varying therapies which will help you deal with anxiety as well, CBT, DBT(usually group therapy) and a couple of newer therapies which encompasses a lot of the techniques from some of the older therapies. A newer one is called Schema therapy, which I'm currently being referred for.

It may take some time, but it's a case of just working with your Health Care professionals to find what works best for you.

Hope some of this may have helped.