Antianxiety meds

[Naven]

Hey guys, I think I've always had somewhat of a hypervigilant personality, but lately it's starting to turn into full-blown paranoia I think. Add to that a healthy plate of social anxiety and I'm a wreck.



My sleep sucks because my mind is going 100mph about "what about this, what about that", I tried to get in the hot tub to relax last night and found that I was more freaked about thinking I saw flashlight light and people were coming to get me.



I'm not falling off the deep edge, but I think I'm hitting up against paranoia to the point where it's impactiing my life. I'm leaving for a trip soon and I think that's making things worse.



So, I called my doc and have an appointment - I'm thinking I'll get a script for something, but I'm wondering if you guys that have tried a number of benzos, etc. could give me some ideas about which ones were effective, which ones might do the job for the social anxiety, etc. I've heard Klonopin for SA is good, but I don't know if that would be a general anxiety thing too?



Anyhow, thanks for any thoughts or ideas. The lowest side-effect one would be my choice, obviously.

[so_money]

Sorry to hear about your issues. I can totally relate to the anxiety, irrational fears, and disturbed sleep. I have been diagnosed with GAD and have been prescribed multiple drugs over the years. The bad thing with benzos is this: You WILL build up a tolerance. Especially if you are taking them multiple times a day. I have gone through this with Xanax and Klonopin. Coming off of them is a bitch too. I currently keep Klonopin on hand for the really bad nights of insomnia, as it doesn't leave me feeling like utter crap the following day, like Trazadone does.



SSRI's were miserable experiences for me but seem to work for some as far as reducing the anxiety. However, I do not have the paranoia that you seem to struggle with. You might want to talk to your doctor about "anti-psychotic" drugs as a more logical choice. Don't let the "anti-psychotic" tag frighten you. It doesn't mean your a psycho if you take them. Research drugs like Seroquel, which should help slow down the racing thoughts and help you sleep. Also, there have been a lot of doctors who have found that anti-epileptic drugs such as Neurontin and Gabapentin have done wonders for symptoms like yours.



I must add that the MOST important thing is to get THERAPY. Talk this stuff out to a professional. The mind is a powerful thing. Drugs aren't always the "quick fix" we would like for them to be. Best of luck to you. You'll overcome this.

[ATB]

Whilst I dont want to suggest for a second that you shouldn't seek medical advice, or ignore drug options which may be the best ones for you....



Under methylation of the brain, omega 3 deficiency, and other irregulatities cant be so easily corrected by a pharmaceutical compound, so it makes sense to be truly 'chemically correct' and feed the brain right first, then see what you need to do. I cant see it as right that a pharmaceutical agent should be chosen preferentially and at the expense of a good diet and nutritional work up.



They should be compatible as far as I know.



Some early nutritional studies indicated that vitamin B therapy was very effective in treating schizophrenia.



Others indicate O3 imbalances and deficiences, and under methylation.



Omega 3 correction has stabilised that 'other' psychosis, bi-polar (not suggesting that you have one, but I tend to feel that if a treatment works at that end, its demonstrated efficacy at the other). Some B Vitamin did the same if I recall (cant remember which). For various reasons, many researchers regard bi-polar and schitzophrenia as related, so again, I tend to think of these conditions as sharing underlying problems.



I would seriously consider looking at your wider heath, and correcting fatty acid, phospholipid and vitamin issues.



Do you have other conditions, that you may regard as being problems with the bowel/digestion, tiredness, possible infections etc?



Could you describe your diet also?



I will only offer views that I have read from various Dr's and individuals, I have no expertise in this particular area, but it might be of interest to you.



All the best.

[Naven]

Thanks to both of you for your thoughts and ideas.



I'm a normally healthy 37 year old with no history of any type of disease. I work out regularly, eat very well, and supplement well, including fish oils, among others.



Recently, my wife has been going through a malaise that I can only describe as candida/IBS/CFS and probably a few more maladies thrown in. She's been to just about every doctor in the state and then some, has tried so many different treatments for so many different "diseases", and yet she's still not cured (although she's feeling much better). Her symptoms were depression, super-high intolerance for carbs, bipolar-like manias, alternating constipation/diarrhea, etc., etc. She's lately tried a series of antibiotics/antifungals that seems to be helping, but that's pretty much the end of a 7 year journey that's seen everything from very bizarre alternative treatments to mainline western medicine, and everything in between.



I bring this up because along the way I've learned a whole lot about nutrition and have tried to adapt what I have learned about nutrition to my own lifestyle, for the better.



I have been working for about 3 or 4 years in psychotherapy as well, and am currently working through stuff with hypnotherapy, as well as continuing with psychotherapy.



So far, in the years that I've working through the anxiety, etc. I have resisted any meds, besides things like trying 5HTP, kava kava, B vitamins, SAMe, and other OTC things, all of which worked to one degree or another, but never really got me to where I felt I was getting much better. Since we're leaving on a pretty big trip, I thought it was time I try something a little more drastic to see if I could combat it enough to get through the trip and enjoy myself.



So there you have it. Thanks for any ideas. For what it's worth, I'm able at this point to hold down a decent job, keep a loving wife around, and have a few good friends. So things aren't all bad, just not quite where I'd like them to be.

[Logos]

Sounds similar to my general mental state only my paranoia is rather mild. Although I can remember times in my past when I was just about that paranoid.



My advice would be to ask the doc about a month supply of low dose extended release Xanax (with no refills). That should keep you from getting addicted, and put you in a mental state that will allow more proactive solutions.



I wholeheartedly second the psychotherapy suggestion that someone mentioned earlier. When I was in a very bad place in my mental health, I was able to make leaps and bounds in my mental state with just about five sessions from an excellent psychotherapist.



Also, this is obvious, but cut out all caffine, ephedrine, yohimbine etc...

Taper down if necessary, but don't use them again until you have reached a stable mental state because they will only make it worse in the long run.



There are a lot of anxiety reducing supplements out there worth looking into, but I think ATB is probably on the right track of first making sure that there are no underlying health problemns at the root of all this.





EDIT: I wrote this before reading your last post... oh well

[Naven]

Thanks Logos, that's good stuff. I'm off to the doc today and will investigate...

[noos]

Logos, which technique used your psychotherapist used, if you know?.

[noos]

own common sense= oxymoron ;-)

[Naven]

Update, I saw the doc today, told him what was going on.



He gave me a script for Ativan, 1mg. I got 20 of them.



I took one to see if I had any reaction to it. Didn't seem to help the anxiety much, I seem a little more relaxed after an hour or so but that's about it.



I'm 220lbs, maybe I need more than 1mg? Or is Ativan just a really mild anti-anxiety drug?

[Benson]

How is your diet? IMHO hypoglycemia is often an overlooked trigger for panic/anxiety issues.

[WannaFulfill]

[quote name='Benson' date='Sep 13 2005, 05:04 PM']How is your diet? IMHO hypoglycemia is often an overlooked trigger for panic/anxiety issues.

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yes this is very true, nice

[darius]

I had a friend let me try some Klonopin (Clonazepam) and I was pretty impressed. I tried it out today. Absolutely no recreational value which is fine by me, but it completely knocked out my social anxiety. I broke up the 2mg pill into 4 pieces and ate the slightly biggest piece (maybe like .6 or .7 mg) about an hour and a half before work. There was this moment where I should have gotten really stressed out and anxious where I did something wrong and this customer was insanely pissed, invloved the management and all, but I was so fucking care free it was beautiful. Didn't even break a sweat, when usually I might have felt all jacked up inside with stress eating me away.

[Naven]

My diet is very clean, no other indicators of hypoglycemia, but I'lll keep an eye out.



Is Klonopin addictive like the other benzos?

[Logos]

[quote name='noos' date='Sep 13 2005, 03:55 PM']Logos, which technique used your psychotherapist used, if you know?.

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CBT I think. Although I think the reason why I was able to make such fast progress is just because I'm naturally very good with making connections and seeing patterns. Fortunately the therapist was skilled enough to notice this, and mostly just guided and challenged me along.

[Benson]

[quote name='jeff k' date='Sep 14 2005, 12:35 AM']My diet is very clean, no other indicators of hypoglycemia, but I'lll keep an eye out.



Is Klonopin addictive like the other benzos?

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Something you may want to look into is Magnolia bark extract. The active, honokiol, is a fairly potent anxiolytic without the dependence and other undesireable side effects associated with benzos.





J Pharm Pharmacol. 1999 Jan;51(1):97-103.

Honokiol, a putative anxiolytic agent extracted from magnolia bark, has no diazepam-like side-effects in mice.



Kuribara H, Stavinoha WB, Maruyama Y.



Use of the elevated plus-maze experiment and activity and traction tests in mice have revealed that seven daily treatments with 0.2 mg kg(-1) and higher doses of honokiol, a neolignane derivative extracted from Magnolia bark, had an anxiolytic effect without change in motor activity or muscle tone. Diazepam, 1 mg kg(-1), had the same anxiolytic potential as 0.2 mg kg(-1) honokiol but induced muscle relaxation. The aim of this study was to determine whether honokiol had diazepam-like side-effects. Mice treated with 1-10 mg kg(-1) diazepam, but not those treated with 0.1-2 mg kg(-1) honokiol, for 12 days showed withdrawal symptoms characterized by hyperactivity and running-fit when they were challenge-administered intraperitoneal flumazenil (10 mg kg(-1)) 24 h after the last treatment with diazepam. Oral diazepam (0.5-2 mg kg(-1), 10 min before) dose-dependently prolonged hexobarbital (100 mg kg(-1), i.p.)-induced sleeping, disrupted learning and memory, and inhibited (+)-bicuculline (40 mg kg(-1), i.p.)-induced death. Honokiol (0.2-20 mg kg(-1), p.o., 3 h before) had no such effects. The prolongation by diazepam (1 mg kg(-1)) of hexobarbital-induced sleeping was not modified by honokiol (0.2-20 mg kg(-1)). These results suggest that honokiol is less likely than diazepam to induce physical dependence, central depression and amnesia at doses eliciting the anxiolytic effect. It is also considered that honokiol might have no therapeutic effect in the treatment of convulsion.



J Pharm Pharmacol. 2000 Aug;52(8):1017-22.

Does dihydrohonokiol, a potent anxiolytic compound, result in the development of benzodiazepine-like side effects?



Kuribara H, Kishi E, Maruyama Y.



The aims of this study were to assess whether dihydrohonokiol, 3'-(2-propenyl)-5-propyl-(1,1'-biphenyl)-2,4'-diol (DHH-, a potent anxiolytic compound, developed benzodiazepine-like side effects. A 1 mg kg(-1) dose of diazepam, almost equivalent to the minimum dose for the anxiolytic effect, disrupted the traction performance, potentiated hexobarbital-induced sleeping and impaired learning and memory performance. DHH-B, even at a dose of 1 mg kg(-1) (i.e. five times higher than the minimum dose for significant anxiolytic effect) neither developed diazepam-like side effects nor enhanced the side effects of diazepam. Rather, the potentiation by diazepam of hexobarbital-induced sleeping was reduced by 1 mg kg(-1) DHH-B. Furthermore, mice treated with 10 daily administrations of 1 and 5 mg kg(-1) diazepam, but not 0.2-5 mg kg(-1) DHH-B, showed precipitated withdrawal symptoms characterized by hyper-reactivity, tremor and tail-flick reaction when they were challenged with flumazenil (10 mg kg(-1) i.p.). These results suggest that, unlike the benzodiazepine anxiolytic diazepam, DHH-B is less likely to induce motor dysfunction, central depression, amnesia or physical dependence at the effective dose required for the anxiolytic effect.



Pharmacol Biochem Behav. 2000 Nov;67(3):597-601.

Comparative assessment of the anxiolytic-like activities of honokiol and derivatives.



Kuribara H, Kishi E, Kimura M, Weintraub ST, Maruyama Y.



Honokiol has previously been shown to be an effective anxiolytic-like agent in mice when administered for 7 days at 0.2 mg/kg/day prior to evaluation in an elevated plus-maze, while 20 mg/kg is required for efficacy as a single oral dose. The aim of this study was to find analogs of honokiol that are more effective for acute administration. Among the eight analogs evaluated, one partially reduced derivative of honokiol [3'-(2-propenyl)-5-propyl-(1,1'-biphenyl)-2,4'-diol] exhibited significant anxiolytic-like activity at 0.04 mg/kg. Following oral administration of 1 mg/kg of this analog, anxiolytic-like activity was clearly evident at 1 h, peaked at 3 h, and remained significant for longer than 4 h after treatment. Combined administration of the derivative with diazepam led to enhanced anxiolytic-like efficacy. Moreover, as with diazepam, the anxiolytic-like effect of the analog was reduced by flumazenil. In contrast, bicuculline, a GABA(A) antagonist, had no effect on the activity of the derivative. Taken together, these results suggest that this analog of honokiol acts at the benzodiazepine recognition site of the GABA(A)-benzodiazepine receptor complex.

[muidumees]

[quote name='jeff k' date='Sep 13 2005, 08:35 PM']My diet is very clean, no other indicators of hypoglycemia, but I'lll keep an eye out.



Is Klonopin addictive like the other benzos?

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they say that klonopin is the worst one.

[liorrh]

i second the diet reccomendations.

I also suggest to look at your activities.

CBT is a great help, as is hypnosis I believe.



last but not least, I found the follwoing helpfull:

tianeptine

Sam-e

inositol

fish oil.

[Naven]

Benson, thanks, those are some very intriguing studies.



My diet is clean, I currently supplement with many things that should help (multis, EFAs, fish oils, 5htp, kava, etc.), and have used SAMe in the past. This seems to be more of an acute case of anxiety for me, or a flareup due to an upcoming situation, rather than a constant feeling, although I would like to push through the social anxiety part. For that, I've been working for a number of years with a psychotherapist (doing CBT), and just recently started hypnotherapy as well.



Thanks guys for the ideas, I'm off to read more about magnolia bark

[Naven]

Searching more on the Magnolia stuff, it seems Relora is the common form of this, anyone have any experience with Relora?

[darius]

Klonopin is addictive and tolerance builds fast I hear. It's active for really long, I think somewhere up to 40 hours so it shouldn't really be taken everyday. Maybe a couple times a week. Anyways, I just took the remaining that I had left today before college to see how it works out as I usually get in social binds. It was about 1.3-1.4mg.



This magnolia bark seems very interesting.. I need to research it as well.