Panic attacks / anxiety issues

[Btodd]

Just wanting to hear from people who suffer / have suffered from this. I've always been a fairly anxious person, but recently had 3 panic attacks in a few weeks time (out of nowhere), and have been having random anxiety symptoms since then. I'm 38 years old.

I've been reading as much as I can on the net, but one thing that stands out about my panic attacks is that they lasted for hours (4-6). The last one was the worst, which ended up in a visit to the emergency room after hours of trembling, tingling sensations all over my body (especially my legs), weak legs that felt like Jell-O, feeling like I was going to pass out, two separate violent puking episodes, hot/cold flashes, sweaty palms, hyperventilating / shallow breathing, and just general terror. I've never felt so helpless in my life. The ER gave me some Ativan, which finally ended it and allowed me to go to sleep.

It's been weeks since I've had an actual full-on attack, but I do still have many symptoms on occasion, mainly the tingling and weak legs, and a shallow, very nervous feeling in my chest. I exercise regularly, and have always had trouble sleeping.

I better spill some beans: I have been a daily marijuana smoker for many years, not saying I'm proud of it, but I do know that some people who do so abusively end up developing panic attacks. The first attack was while high, the second was after waking up in the middle of the night after being high, and the third (and worst) was a week after quitting smoking altogether. I haven't touched it in a month now, but I'm still having problems.

I visited my regular doctor, and wore a halter monitor for 48 hours to check my heart. Everything was fine. He prescribed me some Alprazolam (.5mg Xanax), which I've been taking, but only at night (when the symptoms are the worst) when I know I'm not going to get any sleep. I've avoided taking them two days in a row, and usually make it 3 days.

I saw a Psychiatrist recently, who advised me not to drink any alcohol (I'd been having 2-3 beers on some nights since quitting smoking), definitely not to smoke (I'm not), and to try to reduce my Xanax usage to 3-4 times total over the next month. At that point, we're going to re-evaluate the situation, and if there hasn't been significant improvement, I may go on an anti-depressant or Klonopin.

Over the weekend, I had a bout of dizziness with some minor trembling and feeling very weak. I took a Xanax for the first time in 5 days (the longest I've gone since getting the prescription), and a little over an hour later, I felt great. I am afraid of the addiction factor, but it's nice to know that the drug is so effective when things seem like they're going to get out of control. It really works, but I know it's not a solution. I obviously have an addictive personality, so it concerns me.

I just wanted to hear from others who have experienced this, how they dealt / deal with it, and if any of you ended up getting through it completely. Thanks, and sorry for the extremely long post.

[Jeff Corey]

Just my opinion, but while there are a few established medical types here, this may not be the place to get free help for something that is bothering you. And look at what happened with that chimpanzee in Connecticut when he was given Xanax, which is clearly a palindrome.

[Btodd]

I understand, but this isn't about 'medical' advice as much as personal advice. I'm leaving the medical side up to the professional. I hesitated to give the full background (pot) because it can quickly descend into stereotypes and jokes, but I think most people here won't go that route, and if someone else went through it in the same manner, it's entirely relevant.

Having spoken to a few people I know that have dealt with it, it helps hearing just how they did it, both in an advice context, and as a source of comfort.

[Gate2501]

You sound a LOT like me. I have been having severe anxiety my entire life (I am 29). I have also worn a halter monitor due to my palpitations which are probably largely anxiety related. The palpitations were benign, but I am glad I checked.

I smoked MJ constantly and drank 12-16 beers a night(or the equivalent in vodka) for many years. The alcohol took my symptoms away. I tried many other different techniques, some of them quite dysfunctional(look at my arm in my avatar, the rest of my body is worse). I refuse to take medication, because zoloft and friends never seem to work, and I know that I am an addict(not an AA'er), and I don't even want something like Xanax within 50 yards of me.

To be honest, nothing works better for me than running a sink full of cold water, sitting down on my toilet in the dark with my MP3 player, and wetting an ice cold rag to wipe my face/back of my neck with. I haven't gotten over it at all, but I have learned to live with it, and no long drink gobs of alcohol or hack myself up. I don't expect it to ever go away. I still enjoy my life quite a bit, more than most people I would say.

[KellyG]

I'm sorry to hear your symptoms are so severe, Btodd. I get them from time to time in physically or emotionally stressful situations. For me, just taking it easy and deep breathing helps. Sometimes I consume a depressant or two. I was prescribed medication once but found that I just needed to change my environment, not take medication.

Good luck!

[bpesta22]

About 5 years ago I started getting some intense panic attacks. Perhaps not as bad as you describe but some had me on the floor feeling like for sure I was dying.

Anyway, I went on some SSRIs and havent had them in years. I do remember that ativan was awesome for stopping one (chew it or put it under your tongue for faster impact).

Whether the SSRIs work, or I recovered, or it's a placebo effect, I don't know, but I'd rather take paxil and ativan then have the attacks.

Be careful though, you need to make a decision, as the ativan is addicting (not in the I crave it for a good buzz kinda way, but in the I need it to function normal kinda way). So too are the SSRIs, plus they have bizarre side effects, at least for me, and take some adjusting too (and if you do start em, don't go cold turkey to get off em!).

So, you need to do a cost benefits analysis-- is it worth depending on meds to help (perhaps for the very long term) or do you think you can maybe resolve these without going on the meds.

Caffeine may have been a trigger for me too-- not sure.

Good luck (being on meds is not the end of the world, but I would resort to it only after trying other things).

[Dancing David]

Hi,

I come from a family with high levels of anxiety and substance abuse/dependence issues.

I was always hypersensitive, easily overwhelmed with emotions and prone to anxiety. Symptoms became a problem in sixth grade, tried to commit suicide at 13 and 14 (fortunately no access to lethal means). Symptoms continued and worsened, very disturbed sleep, frequent panic and anxiety, continuing depression.

In college I became addicted to LSD, used marijuana regularly and alcohol only occasionally.

During this time I was also acquainted with= the techniques of Cognitive-Behavioral therapy.

LSD provided some symptom relief (on a longer frame than the intoxication) but increased the panic and sleep disturbance. I stopped after three years and continued with daily MJ use, due to other issues I also started heavy caffeine consumption and became dependant upon pseudo ephedrine (seasonally).

The use of CBT techniques helped to cope with my symptoms, depression, anxiety and obsessive compulsive disorder. And I began to develop healthier life choices as well, I began to remove myself from destructive relationships, moderate the MJ and avoid the pseudo ephedrine. I also got separated and divorced and entered individual and group therapy for five years.

My symptoms remained constant, disturbed sleep, anxiety, depression and obsessive-compulsive. However my lifestyle choices and coping skills improved, I made some progress and continued treading water.

At age 39 I decided I had had enough and saw a psychiatrist, who due to my use of LSD and response to St. John's Wort prescribed Zoloft. My symptoms responded well, I could sleep through the night, I stopped waking up at 3 am in the spring, my obsessions went away, over time my depression came and went, and I still had issues with irritability big time. My marijuana use tapered and stopped, I eventually got treatment for sleep apnea, my caffeine use reduced drastically.

After 11 years my symptoms seem to be in remission, the highest dose of Zoloft I took was 150mg HS, I am now on 50 mg, and hope to taper and stop in two months. My symptoms are not present or transient. I don't use MJ except at parties, I drinking very little coffee. I wear my CPAP whenever I sleep.

I credit the use of CBT, lifestyle choices and medication all together for my recovery.

[Dancing David]

About 5 years ago I started getting some intense panic attacks. Perhaps not as bad as you describe but some had me on the floor feeling like for sure I was dying.

Anyway, I went on some SSRIs and havent had them in years. I do remember that ativan was awesome for stopping one (chew it or put it under your tongue for faster impact).

Whether the SSRIs work, or I recovered, or it's a placebo effect, I don't know, but I'd rather take paxil and ativan then have the attacks.

Be careful though, you need to make a decision, as the ativan is addicting (not in the I crave it for a good buzz kinda way, but in the I need it to function normal kinda way). So too are the SSRIs, plus they have bizarre side effects, at least for me, and take some adjusting too (and if you do start em, don't go cold turkey to get off em!).

So, you need to do a cost benefits analysis-- is it worth depending on meds to help (perhaps for the very long term) or do you think you can maybe resolve these without going on the meds.

Caffeine may have been a trigger for me too-- not sure.

Good luck (being on meds is not the end of the world, but I would resort to it only after trying other things).

Yes both Ativan and Xanax have high addiction profiles, they should be monitored carefully. Valium on a steady dose is much safer.

However I am not sure SSRIs are addictive, any more than insulin is. They need to be monitored and adjusted however and have some very strange side effects. As do the SNRIs and TCAs.

Caffeine and lifestyle are definite contenders. Work and life stress are always contenders as well.

NOTE to ALL: I am not a doctor, nor do I play one on TV, people should work with doctors that they trust, they should be informed consumers, avoid any sort of ‘miracle cures’ and ‘special’ treatments. Avoid all professionals who won’t answer questions, establish treatment plans and don’t set clear objective goals. Talk therapy should be brief goal focused and time limited. You must read and be educated to be an informed consumer.

I was a case manger in mental health for ten years and a crisis counselor.

[Cainkane1]

Just wanting to hear from people who suffer / have suffered from this. I've always been a fairly anxious person, but recently had 3 panic attacks in a few weeks time (out of nowhere), and have been having random anxiety symptoms since then. I'm 38 years old.

I've been reading as much as I can on the net, but one thing that stands out about my panic attacks is that they lasted for hours (4-6). The last one was the worst, which ended up in a visit to the emergency room after hours of trembling, tingling sensations all over my body (especially my legs), weak legs that felt like Jell-O, feeling like I was going to pass out, two separate violent puking episodes, hot/cold flashes, sweaty palms, hyperventilating / shallow breathing, and just general terror. I've never felt so helpless in my life. The ER gave me some Ativan, which finally ended it and allowed me to go to sleep.

It's been weeks since I've had an actual full-on attack, but I do still have many symptoms on occasion, mainly the tingling and weak legs, and a shallow, very nervous feeling in my chest. I exercise regularly, and have always had trouble sleeping.

I better spill some beans: I have been a daily marijuana smoker for many years, not saying I'm proud of it, but I do know that some people who do so abusively end up developing panic attacks. The first attack was while high, the second was after waking up in the middle of the night after being high, and the third (and worst) was a week after quitting smoking altogether. I haven't touched it in a month now, but I'm still having problems.

I visited my regular doctor, and wore a halter monitor for 48 hours to check my heart. Everything was fine. He prescribed me some Alprazolam (.5mg Xanax), which I've been taking, but only at night (when the symptoms are the worst) when I know I'm not going to get any sleep. I've avoided taking them two days in a row, and usually make it 3 days.

I saw a Psychiatrist recently, who advised me not to drink any alcohol (I'd been having 2-3 beers on some nights since quitting smoking), definitely not to smoke (I'm not), and to try to reduce my Xanax usage to 3-4 times total over the next month. At that point, we're going to re-evaluate the situation, and if there hasn't been significant improvement, I may go on an anti-depressant or Klonopin.

Over the weekend, I had a bout of dizziness with some minor trembling and feeling very weak. I took a Xanax for the first time in 5 days (the longest I've gone since getting the prescription), and a little over an hour later, I felt great. I am afraid of the addiction factor, but it's nice to know that the drug is so effective when things seem like they're going to get out of control. It really works, but I know it's not a solution. I obviously have an addictive personality, so it concerns me.

I just wanted to hear from others who have experienced this, how they dealt / deal with it, and if any of you ended up getting through it completely. Thanks, and sorry for the extremely long post.
I have the same problem. I take trazadone for my chronic insomnia. Pot smoking causes me to have severe panic attacks and I haven't done that in over thirty years. Alcohol aggravates the symptoms. However you can avoid taking these drugs and still have these attacks. You'll probably have to take medication the rest of your life for this unfortunant condition. Good luck.

[Ivor the Engineer]

<snip>

You'll probably have to take medication the rest of your life for this unfortunant condition.

<snip>

Why do you think that?

[Ysidro]

First, I want to say way to go for actually seeing professionals for this. Too many people try to deal with it themselves and end up self-medicating. So, as one anxiety sufferer to another let me say "woot".

Me, I'm currently on an SSRI but I have a form of depression as well. I was taking neurontin with it, but don't do that any longer. I also had a .5 mg dose of Atavan to take "as needed" but I'm not currently taking that either (looks like I don't get addicted easily. Yay for me!) I also don't drink (personal choice; hate the taste) and don't do any recreational drugs (also personal choice). Also cut my caffeine intake to almost nothing. Every once in awhile I have something with caffeine in it, but not too often. That probably helps a lot.

I deal with it by doing what you're doing: working with professionals and paying attention to my body's signals. Keep on that and take things one day at a time when you need to. Keep the docs in the loop.

Keep your friends and family appraised where necessary too. Let them know you have attacks and let them know if you need to disappear for awhile because of one. It'll be awkward at first, but it's better than disappearing without warning.

[Btodd]

Thank you for the replies so far, people. I woke up at 2:00 am after falling asleep about 12:20, with tingly sensations all over my body. Practiced yogic breathing exercises and got calmed back down, but still couldn't fall asleep. Then the tingling started right back up from nowhere, and at 4:00 am, I took a .5mg Xanax just so I could get 2 hours more sleep (it takes an hour to take effect), and woke up at 7:00. I'm getting ready to go to work, but I'm worried about what's gonna happen when the Xanax wears off and my lack of sleep kicks in, which always seems to make the next day hellish.

I'm calling the Doctor today, to see if I should get on Zoloft or Klonopin for the time being, hoping he will call it in if he agrees. I can't miss work, which is what happens if I don't get sleep, and the problem gets worse. I stopped using caffeine months ago, and did yoga last night until I felt great. Still didn't stop me from waking up with anxiety.

This sucks. I really don't want to be on constant meds, but right now I don't know what else to do.

[Cainkane1]

Why do you think that?
Personal experience. I'm 62 and I've had problems all my life.

[DaN K. StAnLeY]

I was having panic attacks about 3 years ago. I couldn't figure out why they started but once I went to the doctor to get checked out and got a clean bill of health, it gave me relief that I was going to be okay. I'm not sure why you are having panic attacks, but I don't think the pot is the cause. You might think it is causing the attack, but how many times have you smoked before and been just fine?

I think something is up with you mentally. Are you affraid of death? This was my problem. I had an irrational and impending feeling of doom and I figured since I hadn't been to the doctor in a while, I was bound to have some disease (I've been a hypo since my buddy died of cancer when I was a kid). What snapped me out of it was realizing that I was being a big "snatch" and didn't realize how good I had it. My Nigerian neighbor reminded me that there are African babies born with AIDS and people that have to walk 2 miles twice a day to get water. Heck, I dunno what I'd do without AC.

My main point is that if you are physically healthy (Doc clean bill of health), then you should just relax and quit smoking for a while until your life is in a place you want it to be (get a job, go back to school, accomplish something to make yourself proud). Life is too short to be scared about death all the time. One thing to remember also is that if you die from pot, you'd be famous for being the first dude ever to take a fatal riff bro, heh, heh. Knarly!!

[Baby Nemesis]

In answer to the OP:

Though some drugs can bring anxiety symptoms on, they can sometimes be made worse because people get anxious about the anxiety symptoms they're having so they're fuelled. That might happen especially if they've had bad experiences like being scared they were dying before. Feeling calmer about having panic attacks can alleviate the symptoms. (At least, that's the kind of thing we were told to tell people on the anxiety help-line I worked on.) :D

Part one of this article might give you an explanation of things you might find worthwhile. (http://www.broadcaster.org.uk/section1/scenarios/agoraphobia.html) Some of it's about medical things that can mimic anxiety symptoms, and some is about what actually happens in the body to cause the symptoms when a panic attack comes on. Knowing what's actually causing the sensations they're having can stop some people worrying about them so much.

[bpesta22]

Btodd-- just one stranger's opinion but it sounds to me like the misery you're going through is far worse than any common side effects of SSRIs

[Baby Nemesis]

Btodd-- just one stranger's opinion but it sounds to me like the misery you're going through is far worse than any common side effects of SSRIs

It was pot he thought caused it.

It would be difficult to tell whether or not in his own situation there's more to it or not, since some of the effects of some drugs can be severe; but one tragic thing is that some people, including children, are Only given medication, or cognitive behavioural therapy to help them change their thoughts about their symptoms to more rational ones, when what they need far more than anything else is a change in their life circumstances.

Worth thinking about.

[Btodd]

Responding to several posts:

I don't think pot 'caused' it. My best guess (and it's only a guess) is that I've been self-medicating for years, which I already knew to some degree (at least as far as the sleep problems are concerned). Whatever was under the surface is now coming out, and I don't yet know what it is. Pot is definitely a trigger, but I doubt it's really the cause. I smoked it so much because of my general personality, it was a natural fit, and solved some of my problems. Plus, I really enjoyed it.

Which is not to say that as soon as I feel better, I think it's OK to start smoking again. I don't know how that will turn out, and I'm not making any promises to myself or anyone else, although I doubt that after years of abuse that I can suddenly be responsible. As silly as it sounds, it will be difficult as I start to feel like my old self again. There's somewhat of a loss of identity, because that's what I did when enjoying music, books, movies, and many other things. God, I sound like a heroin addict. :D

Anyway, after last night's episode, I got a prescription for an anti-depressant today (Celexa). I'm getting ready to read up on it before starting; I want to know what I'm getting into. The worst part is that they told me it will take at least 2 weeks, and as many as 6 for some people, before it takes effect.

In the meantime, I have to try to avoid taking the Xanax as much as I can, but still get enough sleep to function. Getting ready to go work out, but damn I'm exhausted.

[SRW]

When I was about your age I had about 10 attacks over two years, I have smoked pot but gave it up when I turned 18 and I only drink occasionally. To this day I do not know why they started or why they stopped. But for at least 5 years I would not leave the house with out a Xanax in my pocket. I think the ritual of sticking the pill back in the bottle at the end of the day may have helped more than anything else. I would suggest you get a full physical and find out if there is not something else going on.

[luchog]

This sucks. I really don't want to be on constant meds, but right now I don't know what else to do.
Unfortunately, some conditions are chronic, and so far there isn't any other reliable option. Personally, I don't have a problem with it, aside from the long-term side effects. There's too much cultural stigma surrounding medication for chronic disorders, and the best thing to do is simply ignore it; since the anxiety over being "stuck on medication for the rest of your life" can contribute to exacerbation of the condition.

Aside from potential side effects, it's no different from being stuck in a wheelchair, taking insulin, or wearing glasses or a pacemaker for the rest of your life.

As for what else you can do, oftentime lifestyle changes can help. Increase the amount of exercise, a change of scenery, etc. Also, anxiety is often co-morbid with a number of other disorders, many of which are masked by the more obvious anxiety, and particularly by long-term self-medication. You may want to discuss the possibility of another undiagnosed disorder with your therapist.

[luchog]

I don't think pot 'caused' it. My best guess (and it's only a guess) is that I've been self-medicating for years, which I already knew to some degree (at least as far as the sleep problems are concerned). Whatever was under the surface is now coming out, and I don't yet know what it is. Pot is definitely a trigger, but I doubt it's really the cause. I smoked it so much because of my general personality, it was a natural fit, and solved some of my problems. Plus, I really enjoyed it.
There is strong evidence that delta-9-tetrahydrocannabinol can cause anxiety responses in high doses. In the crude form, the effects are mitigated by the presence of another cannabinoid, cannbidiol; and the degree to which anxiety effects occur is regulated by the ratio of THC to CBD. (Interesting, CBD is also showing some promise in treating some forms of schizophrenia.)

[rlr]

There is strong evidence that delta-9-tetrahydrocannabinol can cause anxiety responses in high doses. In the crude form, the effects are mitigated by the presence of another cannabinoid, cannbidiol; and the degree to which anxiety effects occur is regulated by the ratio of THC to CBD. (Interesting, CBD is also showing some promise in treating some forms of schizophrenia.)

Instead of just waving your hand and asserting "there is strong evidence", give citations. Cite it or it's not true.

[Starthinker]

I had never had a panic attack until last year (and I'm old). I'd start on a thought and that thought would run away and next thing I know I'm curled up on the floor shaking like a scared puppy. I can still feel them coming on but one thing I've tried (that I read on a site somewhere) was to distract myself as soon as I feel one coming on. Open Solitaire and play to win, start counting the periods in a book, calculate the volume of your wall unit, anything that can take up the majority of your conscious brain power. I was eating Xanax like Smarties, and taking Valium and vodka on the side and they didn't help as much as distractions did. You really have to force yourself. Feel an attack coming on? Jump on the internet and learn everything you can about how a VCR works. Out in public? Force yourself to find the nearest 3 ATMs. Anything to focus your brain on something. Something other than what's causing the attack.

It wasn't really easy at first, but I think I've got it down and have avoided many attacks this way.

[Eos of the Eons]

Pot probably didn't cause it, but your body will get worn down by the self medication, since pot is not free of damaging side effects. Have to go, but will post more later.

[TriskettheKid]

I, too, suffer from something similar.

I got my first one back when I was 18. I had my last one when I was 21. I've come close in the 4 years since then, but I've managed to stave them off.

In my case, it appears to have been a mix of low-blood sugar and panic attack. Meaning, those caused by low blood sugar were harder to control. I could also give myself an attack when my blood sugar was fine.

In any event, I refused meds. Everything I did was strictly, well, therapy based, I guess you could say. I learned to recognize what caused them, and how they affected me. I learned to read my mood so that I can tell whether one is brewing.

I had a doctor (now retired) who had been in the USAF. He told me stories about pilots that had had similar attacks while flying, and what could be done to prevent one if you feel it coming on.

Breathe. If I feel one coming on (rare now, as I've gotten pretty good at keeping my mindset in a place where they aren't really prone to happen), I take a few deep breathes pushing from my stomach (as if you were singing), counting between each one. By the time I hit 30 it's pretty much over, and I've avoided a full-on attack.

[Vic Vega]

If you are only seeing a Psychiatrist, you are not being treated completely. You also need to see a Psychologist. Treatment with meds and also talk therapy will give you a better chance of getting past this.

And you can get past this. I had panic attacks for two years when I was a junior and senior in college. I haven't had one since I was 22. I'm 40 now.

[TriskettheKid]

If you are only seeing a Psychiatrist, you are not being treated completely. You also need to see a Psychologist. Treatment with meds and also talk therapy will give you a better chance of getting past this.

And you can get past this. I had panic attacks for two years when I was a junior and senior in college. I haven't had one since I was 22. I'm 40 now.

Haven't seen a Psychiatrist since I ended ADD meds (completely different issue).

It was a Cognitive Therapist. Actual student of Dr. Beck, if I recall correctly.

[Dancing David]

Haven't seen a Psychiatrist since I ended ADD meds (completely different issue).

It was a Cognitive Therapist. Actual student of Dr. Beck, if I recall correctly.

Super Cool!

:cool:

[TriskettheKid]

Super Cool!

:cool:

He really was amazing. And he loved Coca-Cola. So much so that he had a stock of cold glass bottles of Coke. It was completely unrelated to any therapy going on, but it was always nice to have.

[theMark]

Treatment with meds and also talk therapy will give you a better chance of getting past this.

And you can get past this. I had panic attacks for two years when I was a junior and senior in college. I haven't had one since I was 22. I'm 40 now.

Anecdotal, of course, but that just about fits me to a T, too.
First one came out of nowhere, I hyperventilated and just collapsed when I left a theater. No medical problems. After that, "afraid of being afraid" took over to the point where I couldn't enter e.g. underground parking.
I spent about half a year in panic limbo, barely leaving the house, unable to go anywhere on foot (driving in a car anywhere was no problem - getting out at the destination was).
What followed was talk therapy in combination with taking TCA's (there was no SSRI then) over the course of several years. My GP pointed me to autogenic training Wikipedia (http://en.wikipedia.org/wiki/Autogenic_training) which I've found to be extremely helpful. Though I don't practice much any more, I can still trigger the "calm-down" reflex pretty easily. YMMV.

Those were the days before the internet - I started at the local library to read just about anything about panic disorder that I could get my hands on, and according to the then state of research it's a) common (1 in 10, as some authors claim), b) follows certain patterns, c) can be "unlearned". So I started to "get out" of the fear spiral. Walking on foot into an underground parking lot all by myself, after a year of barely leaving the house, was hell - but I knew I'd get the stomach pain and racing heartbeat etc. and that it would pass, given enough exposure over time. It worked out. Took me several years, but today I'm off any medication and life is good.
Of course each one needs to find their own way. Talk to your GP, talk to a psychiatrist/psychologist, don't be afraid to voice your concerns to your doctors if you feel they're no help. There are ways to beat this. There are always ways.

[Agular]

[/URL]Some of it's about medical things that can mimic anxiety symptoms, and some is about what actually happens in the body to cause the symptoms when a panic attack comes on. Knowing what's actually causing the sensations they're having can stop some people worrying about them so much.

That's right on. I was having anxiety attacks for about 9 months. The doctor prescribed valium, but nothing helped until I found a book called "Hope and Help for Your Nerves" by Dr. Claire Weekes. [URL]http://www.amazon.com/Hope-Help-Your-Nerves-Signet/dp/0451167228/ref=sr_1_1?ie=UTF8&s=books&qid=1239920831&sr=8-1 (http://www.broadcaster.org.uk/section1/scenarios/agoraphobia.html)

That's not to say that it will work for you, but it certainly helped me. I haven't had a panic attack in decades.

Basically her method is:

Facing
Accepting
Floating
Letting time pass

Instead of:

Running away, not facing
Fighting, not accepting
Arresting and listening in, not floating past
Being impatient with time, not letting time pass

She describes the fear-adrenaline-fear cycle and how once you first feel the attack coming on your adrenaline starts flowing because of the fear of another panic attack, causing even worse symptoms.

An excerpt from the book:

"Fear causes an additional outpouring of adrenaline, so that a heart already stirred to palpitations becomes further excited, beats even more quickly, and the attack lasts longer. The sufferer may panic, thinking he is about to die. His hands sweat, his face burns, his fingers tingle with pin and needles while he waits for he knows not what.

The attack eventually stops - it always does - and all may be well for a while. However, having had one frightening experience, he dreads another and for days remains tense and anxious, from time to time feeling his pulse.
If the palpitations do not return he settles down, loses himself in his work and forgets the incident. If, however, he has a second attack, he really is concerned.

Not only is he afraid of palpitating, but he is also in a state of tension, wondering what further alarming experience may yet be in store for him. It is not long before tension, releasing more and more adrenaline, makes his stomach churn, his hands sweat, and his heart constantly beat quickly. He becomes even more afraid, and still more adrenaline is released. In other words, he becomes caught in the fear-adrenaline-fear cycle."

Reading that book is how I beat it without drugs. As always, your mileage may vary.

[Eos of the Eons]

Taking meds to give your poor brain a chance to heal from the stress and panic attacks and get weaned off of anything used previously to self medicate (pot, alcohol, etc.) is just fine. However, you also need to find out what triggers those attacks for you and find out what works to help you personally to minimize it. I get panick atacks less frequently now that I take good care of myself in several ways: eat properly, exercise regulary, no abuse of any kind (including not getting enough sleep and no drugs or alchohol not prescribed).

I had to take meds for several years to overcome depression and anxiety. Your brain is like any part of your body. You bang it against a wall constantly, and the over time the damage will get cumulatively worse. You have to stop whatever is causing your brain to be banging against a figurative wall. You also need to give it a break. Meds were a break for me, I could concentrate on the other therapy I was getting to discover what else I needed to change in my life and learn to deal with stressful situations better. I couldn't handle much without going into a panic, since I had too much on my plate, too much to deal with. I also needed some healthy relationships. I needed a break from my life, but I had to change it to give myself some breaks. I'm being deliberately vague since I don't know all that you have to deal with in your life.

I finally got some group therapy too, and that helped give me more of what I needed to feel more comfortable in social situations. I wasn't as much of a wreck on the outside as I was on the inside, so relaxed a little and stopped being so hard on myself. I literally thought I was the weirdest person ever, but others assured I just needed to relax and stop worrying so much, since nobody really cares that much about my perceptions. That helped, to hear from others.

I also relax more and worry less in general. The breathing is a great idea, as someone else already described how to do it. Belly breathing, is what I was told it was called. It helps to calm the body and brain so that your brain can stop being banged against that wall. I rolled my eyes at first, I didn't need to breathe, I needed a coma to escape into! Well, breathing is easier to do than a coma. I take a deep breath every time I walk through a doorway and deep breathe when I'm driving.

What do you need? You have to find out what your issues specifically and then experiment to see what helps you. Is there a kind of exercise you like? I like to jog and dance. Others like to bike ride.

I also get overwhelmed by things more easily than other people. Crowds I can only handle for an hour or two, depending on the crowd. Fast moving noisy crowds are less tolerable than quiet sitting crowds. I tire quickly if there is too much noise and too many people. I will go into a bathroom to give myself a break, or some other quiet place.

Panic is a signal you're getting too much, like too much stress, too much stimulation, just too much. The less you take care of yourself, the less you can stand of anything, and the worse your panic attacks will be.

At least that is what it is like for me. I've accepted that I'm different, and give myself a break whenever I can to wind down. Then I'm pumped to handle whatever else is going on that day. Take care of yourself.

[Eos of the Eons]

I found a book by Elain N. Aaron very helpful. http://www.hsperson.com/
It didn't all apply to me, but made sense, a lot of sense. And it has some great advice and insights too, like what is in Agular's post as well.

[Dancing David]

I used to like the Anxiety and Phobia Workbook, but I haven't looked at it in a long time.

http://www.amazon.com/exec/obidos/ASIN/1572244135/bookstorenow57-20

And then Feeling Good:

http://www.feelinggood.com/

[Ysidro]

And then Feeling Good:

http://www.feelinggood.com/

Don't let the pop-psych still name turn you off. Feeling Good is a serious work for sufferers of various mental problems (like me!). It gets updated fairly often. I'm not even sure which edition they're into now.

[Eos of the Eons]

I have a very old edition of "feeling good". It has the old title "feeling good feels great". It was recommended by my therapist at the time, and I did my homework assignments in it. Some of the seemed silly, but looking at yourself in the mirror and thinking or saying something nice to yourself is not so silly when you find out other people do it all the time, and that's not arrogance, but a healthy self esteem, huh.

[Dancing David]

Well, there is the self esteem but there are also some great CBT work sheets in there.

[Tricky]

This thread has some discussion on it as well. (http://forums.randi.org/showthread.php?p=4558843&highlight=panic#post4558843)

My post from that thread.

Sounds very much like my worst panic attacks, especially the derealisation. It is almost an out-of-body experience. And your heart is racing so hard, you are sure you are having a heart attack. I've had panic attacks since I was about 25. Twice I've even called an ambulance. The attacks come and go, but they never really go away, or at least, they haven't for me.

However, talking to a professional can help. The worst thing about panic attacks is that they feed on themselves. Once you start to have one, you panic you even more. For me, I can usually deal with them by finding a calm place and zoning out. It's something like meditation. I've tried taking medicine and some works better than others. Beta blockers are extremely helpful for controlling the racing heartbeat. (Good for blood pressure too.) But I got rid of most of the mind-altering things they tried on me. The side effects were worse than the panic attacks. I have a prescription for Xanex and I take one when I get really really going. Basically, it puts me to sleep. The stuff's addictive though, so I only take one if there is no other way. A prescription of twelve lasts me a couple of years.

Also, let your friends, loved ones and co-workers (especially your boss) know about your problem, otherwise they won't understand why you had to leave in the middle of an important meeting or conversation.

Panic attacks are a real pain in the arse, but as conditions go, there are much worse ones. Knowing what they are and knowing that they aren't going to kill you is a very important step toward being able to deal with them. Your doctor can help. A lot.

[Btodd]

A little update: I started taking Celexa (an anti-depressant used to treat anxiety too) a few weeks ago, and from about 4 days into it, the daily anxiety symptoms have disappeared entirely. I feel like myself again, and it's great.

Thanks to all who gave advice, much appreciated.

[Baby Nemesis]

That's good.

It's still worth researching ways of calming anxiety symptoms that don't involve drugs though, so you'll know that if you relapse, you can deal with them as soon as they arise, rather than having to wait till you can see a doctor who can prescribe you something.

[luchog]

Instead of just waving your hand and asserting "there is strong evidence", give citations. Cite it or it's not true.

There's an entire thread full of them on the board. Just search for cannabidiol and it should be right there.

[Travis]

I've been having panic attacks for about 6 years now. I get one about every third day. I can get through them now by recognizing them for what they are and knowing that eventually they'll pass.

Personally I'm not really taking anything for them at the moment (I don't smoke pot or drink alcohol either). My doctor doesn't like prescribing strong things like Valium so I've never gotten anything stronger than Xanax which I keep a bottle of around but rarely need to get through them now. Which is good since I have to pay for whatever medication I get and most benzo's are pricey.

[Dancing David]

Personal opinion, I am not a doctor:

Xanax for limited PRN is sort of okay, but it has a very high addictive profile. There are reasons that a daily dose of Valium is safer.

That is just an aside and based upon the tolerance for the soporific effect of Valium.

This is just an aside with no other intent or meaning than information.

[Travis]

I honestly can't figure out why people would use Xanax recreationally. It just makes me very sleepy on the rare occasions that I use it.

[Dancing David]

Some people enjoy that, which is a mystery.

As someone who has sleep apnea and allergies, i hate being drowsy, unless I am going to sleep.

[Btodd]

I don't know about recreational use, but when I was having multiple anxiety symptoms that I couldn't relieve with relaxation techniques, Xanax wiped them out completely. It didn't make me sleepy, it just ended all of the symptoms entirely and left me feeling totally relaxed. I can easily see how it can be addicting, because it was miraculous at the time.

[parky76]

go here, they can help you.

DEPRESSION CENTRAL - Depression Forums - A Depression & Mental Health Community Support Group (http://www.depressionforums.org/forums/DEPRESSION-CENTRAL-f12.html)

[Limbo]

Just wanting to hear from people who suffer / have suffered from this. I've always been a fairly anxious person, but recently had 3 panic attacks in a few weeks time (out of nowhere), and have been having random anxiety symptoms since then. I'm 38 years old.

I've been reading as much as I can on the net, but one thing that stands out about my panic attacks is that they lasted for hours (4-6). The last one was the worst, which ended up in a visit to the emergency room after hours of trembling, tingling sensations all over my body (especially my legs), weak legs that felt like Jell-O, feeling like I was going to pass out, two separate violent puking episodes, hot/cold flashes, sweaty palms, hyperventilating / shallow breathing, and just general terror. I've never felt so helpless in my life. The ER gave me some Ativan, which finally ended it and allowed me to go to sleep.

It's been weeks since I've had an actual full-on attack, but I do still have many symptoms on occasion, mainly the tingling and weak legs, and a shallow, very nervous feeling in my chest. I exercise regularly, and have always had trouble sleeping.

I better spill some beans: I have been a daily marijuana smoker for many years, not saying I'm proud of it, but I do know that some people who do so abusively end up developing panic attacks. The first attack was while high, the second was after waking up in the middle of the night after being high, and the third (and worst) was a week after quitting smoking altogether. I haven't touched it in a month now, but I'm still having problems.

I visited my regular doctor, and wore a halter monitor for 48 hours to check my heart. Everything was fine. He prescribed me some Alprazolam (.5mg Xanax), which I've been taking, but only at night (when the symptoms are the worst) when I know I'm not going to get any sleep. I've avoided taking them two days in a row, and usually make it 3 days.

I saw a Psychiatrist recently, who advised me not to drink any alcohol (I'd been having 2-3 beers on some nights since quitting smoking), definitely not to smoke (I'm not), and to try to reduce my Xanax usage to 3-4 times total over the next month. At that point, we're going to re-evaluate the situation, and if there hasn't been significant improvement, I may go on an anti-depressant or Klonopin.

Over the weekend, I had a bout of dizziness with some minor trembling and feeling very weak. I took a Xanax for the first time in 5 days (the longest I've gone since getting the prescription), and a little over an hour later, I felt great. I am afraid of the addiction factor, but it's nice to know that the drug is so effective when things seem like they're going to get out of control. It really works, but I know it's not a solution. I obviously have an addictive personality, so it concerns me.

I just wanted to hear from others who have experienced this, how they dealt / deal with it, and if any of you ended up getting through it completely. Thanks, and sorry for the extremely long post.


Try meditation.

Best Ways to Ease Anxiety Disorders
Meditation and Other Relaxation Techniques Work Equally Well Against Anxiety (http://www.webmd.com/anxiety-panic/guide/20061101/best-ways-to-ease-anxiety-disorders)

http://www.mayoclinic.com/health/meditation/HQ01070

[Undesired Walrus]

This flu outbreak isn't going to be helpful to people such as me, who suffer from panic attacks.

I'm sure I'll start to believe that I have this flu some time soon.

[Vic Vega]

I'm sure I'll start to believe that I have this flu some time soon.

Uhhhh..... Did I just hear you cough?










:p

[Zeuzzz]

Xanax for limited PRN is sort of okay, but it has a very high addictive profile. There are reasons that a daily dose of Valium is safer.


Alprazolam is very useful for short term aleiviation. Trouble is, its the benzo that most people can find euphoric and so relaxing it can be very habit forming. As you said, diazepam is much less risky, and far less addictive (primarily due its MUCH longer half life).

If there is a sudden bout of anxiety coming on (panic attack) and you cant wait the 15-30 minutes for the pill to be absorbed in your stomach you can crush it up and insufflate it, though most benzo's are not very water soluble making absorption by the mucous membrane not very efficient, but this does work for quick (1-5 minute) relief. The main effects will come on from the drip down the back of your nose into your stomach over a longer period, though some will be instantly absorbed for the quick relief. Tamazepam is one of the most water soluble, and the most efficient for quick relief via insufflation.

Also CNS depressants help too (ethanol, GHB, gamma-Butyrolactone) and also opiates (but you DEFINATELY dont want get into a habit of using opiates)

Also Beta blockers like Propranolol are very useful in stopping an escalation of panic type symptoms (stabalizes your BPM) and are very handy to have before you are going to enter a situation that you know is going to produce anxiety (my doc prescribes it to my friend when he does public speeches, or else he turns into a sweaty quivering mess)

As someone who has had his fair share of anxiety issues when the after effects of various stimulants have subsided (Methylenedioxypyrovalerone and ritalin (Methylphenidate) are the worst), I would say the following are the best methods:

1) Clear your mind and force yourself to stop thinking and relax. Not always possible, granted.
2) Talk to someone about how your feeling so they can re-assure you.
3) watch TV (or just stare blankly at it) and keep your mind distracted.
4) If heart rate is increasing try breathing slowly and very lightly, and even breathing lightly into a plastic bag can help avoid inhalation of excess oxygen (stops hyperventilation and further excalation of heart rate). Hyperventilation can lead to lightheadedness (even fainting) and severe cramping and tingling of your muscles.
5) Play a musical instrument (sounds odd, but its amazingly efficient at distracting you)
6) Walk around, if your legs feel weak again (due to primarily to the adrenaline from the anxiety) a couple of minutes of walking usually stabilizes them and will convince you that they are okay (whereas just trying for a few seconds and then giving up can make it far worse)

Best Long term solution: Get some cognitive behaviour therapy (CBT) to get to the root cause of what produces the anxiety and treat it for good.

Disclaimer: I am not a doctor. This is just opinion.

[Undesired Walrus]

Uhhhh..... Did I just hear you cough?










:p

Been swallowing all day to see if I have a sore throught. Nothing... yet.

[Travis]

I used to go for walks and that usually helped me distract myself.

Generally trying to get my mind off the panic attack is how I learned to get through them with no medication.

[Zeuzzz]

Theres a brilliant site my mum recommended when I had a chat her work the other day, http://www.livinglifetothefull.com/

"Living Life to the Full
...helping you to help yourself"

Its basically an online form of CBT. Its no substitute for the real thing with a person, for sure, but she's recently approved it as a valid tool for the mental health charity MIND in the UK, and its proving very sucessful for a lot of their patients who are too anxious even to see a therapist.

[Dancing David]

Alprazolam is very useful for short term aleiviation. Trouble is, its the benzo that most people can find euphoric and so relaxing it can be very habit forming. As you said, diazepam is much less risky, and far less addictive (primarily due its MUCH longer half life).

If there is a sudden bout of anxiety coming on (panic attack) and you cant wait the 15-30 minutes for the pill to be absorbed in your stomach you can crush it up and insufflate it, though most benzo's are not very water soluble making absorption by the mucous membrane not very efficient, but this does work for quick (1-5 minute) relief. The main effects will come on from the drip down the back of your nose into your stomach over a longer period, though some will be instantly absorbed for the quick relief. Tamazepam is one of the most water soluble, and the most efficient for quick relief via insufflation.

Also CNS depressants help too (ethanol, GHB, gamma-Butyrolactone) and also opiates (but you DEFINATELY dont want get into a habit of using opiates)

Oh WOW, any citations for that?

Alcohol and anxiety, I want some data!


:)

[Kiosk]

A little update: I started taking Celexa (an anti-depressant used to treat anxiety too) a few weeks ago, and from about 4 days into it, the daily anxiety symptoms have disappeared entirely. I feel like myself again, and it's great.

Very glad to hear it.

But... since SSRIs take several weeks to make the changes to your brain chemistry that they're supposed to make, the fact that you felt better after four days strongly suggests the placebo effect at work. Not knocking that at all. In fact it's a good thing, because it suggests that your problem can be tackled without meds at some point.

So enjoy the effects of the Celexa, but try to get off it as soon as you feel able (and do it slowly - never cold turkey). Meds can work, but the longer you stay on them the harder it can be to get off, and if you stay on for years and years like I did, coming off can - CAN - be a nightmare that defies description. Your mileage might vary, of course, but it's not worth taking a chance, especially as it's always better to be off meds than on them, if at all possible. Don't put yourself at unnecessary risk, but as soon as you're properly stable, start thinking about how you're going to tackle this long term. It may be that the break from anxiety will allow you to re-organise your mind, and you can carry on fine when you come off meds. Or maybe you'll need to look into therapy, etc. But I'd advise you to think of the peace you're experiencing now as the first (giant) step on the road to recovery, rather than the final destination. That's not trying to burst your bubble, not at all. Just offering my own advice, based on my own experience.

I am not a doctor, etc.

EDIT: Also, since you responded so fast to the Celexa, keep an eye open for any signs of hypomania. Excessive energy (beyond what you'd expect from an upturn in mood), feelings of extreme euphoria, racing thoughts, and especially sudden rages or uncharacteristic irritability. You'll probably be alright, but I'm just bringing this up as your doctor should be doing a follow-up to check for all this, and they often don't. Very fast response to SSRIs can occasionally be a prelude to hypomania, so it's just worth keeping an eye open for this, because if it happens it might feel good, but it won't be doing you any good.

And as balance, I should say again - congratulations on being anxiety free. Like everyone else, you deserve it.

[SkeptiChick]

Very glad to hear it.

But... since SSRIs take several weeks to make the changes to your brain chemistry that they're supposed to make, the fact that you felt better after four days strongly suggests the placebo effect at work. Not knocking that at all. In fact it's a good thing, because it suggests that your problem can be tackled without meds at some point.Were you to read the information on Celexa, you'd know that Celexa advertises improvement in condition within 1 to 4 weeks instead of the typical 4-8 weeks of other SSRI's. 4 days isn't totally abnormal, given those numbers.

[Kiosk]

Were you to read the information on Celexa, you'd know that Celexa advertises improvement in condition within 1 to 4 weeks instead of the typical 4-8 weeks of other SSRI's. 4 days isn't totally abnormal, given those numbers.

Fine. But near-complete recovery in 4 days is unusual enough to invite comment and suggestion. As opposed to bold statements of fact, which I avoided, quite consciously.

[Robster, FCD]

With SSRIs, because everybody's receptors are going to be a bit different due to genetic diversity in the population, some drugs work for some people and not for others. Lexapro makes me climb the walls, but celexa is very nice. I use xanax only as needed, and the last time was probably weeks ago.

Depression and anxiety probably cost me an extra year in grad school, and once I got treatment, I was done in no time.

I will probably be able to move off of them this year, and see if my brain chemistry has been reset. We'll have to see.

I am a doctor, but not the right kind. :D

[Dancing David]

Very glad to hear it.

But... since SSRIs take several weeks to make the changes to your brain chemistry that they're supposed to make, the fact that you felt better after four days strongly suggests the placebo effect at work. Not knocking that at all. In fact it's a good thing, because it suggests that your problem can be tackled without meds at some point.

No, it can have effects on the first day, I was one of those. I responded to Zoloft the first day. It ws not a placebo effect.

Not to derail, but there is no placebo effect.

So enjoy the effects of the Celexa, but try to get off it as soon as you feel able (and do it slowly - never cold turkey). Meds can work, but the longer you stay on them the harder it can be to get off, and if you stay on for years and years like I did, coming off can - CAN - be a nightmare that defies description. Your mileage might vary, of course, but it's not worth taking a chance, especially as it's always better to be off meds than on them, if at all possible. Don't put yourself at unnecessary risk, but as soon as you're properly stable, start thinking about how you're going to tackle this long term. It may be that the break from anxiety will allow you to re-organise your mind, and you can carry on fine when you come off meds. Or maybe you'll need to look into therapy, etc. But I'd advise you to think of the peace you're experiencing now as the first (giant) step on the road to recovery, rather than the final destination. That's not trying to burst your bubble, not at all. Just offering my own advice, based on my own experience.

I am not a doctor, etc.

EDIT: Also, since you responded so fast to the Celexa, keep an eye open for any signs of hypomania. Excessive energy (beyond what you'd expect from an upturn in mood), feelings of extreme euphoria, racing thoughts, and especially sudden rages or uncharacteristic irritability. You'll probably be alright, but I'm just bringing this up as your doctor should be doing a follow-up to check for all this, and they often don't. Very fast response to SSRIs can occasionally be a prelude to hypomania, so it's just worth keeping an eye open for this, because if it happens it might feel good, but it won't be doing you any good.

And as balance, I should say again - congratulations on being anxiety free. Like everyone else, you deserve it.

[Dancing David]

Were you to read the information on Celexa, you'd know that Celexa advertises improvement in condition within 1 to 4 weeks instead of the typical 4-8 weeks of other SSRI's. 4 days isn't totally abnormal, given those numbers.

I think it might be an SNRI.

[Kiosk]

No, it can have effects on the first day, I was one of those. I responded to Zoloft the first day. It ws not a placebo effect.

I responded to Zoloft the first day too (or rather, to a significant dosage increase). I felt like I'd done a line of cocaine. Hypomania, as it turned out - lovely for a little while, not so much in the long term.

Not to derail, but there is no placebo effect.

That seems an odd statement. The OP may not be experiencing placebo effect, but I'm not sure why you'd say there is no placebo effect with antidepressants. I'm prepared to be proven wrong here, but I was under the impression that studies suggest otherwise.

I think it might be an SNRI.

Celexa? No, it's citalopram, an SSRI.

[Zeuzzz]

Oh WOW, any citations for that?

Alcohol and anxiety, I want some data!


Could proabably find some, but its self evident really. Most people that drink loads do so to become more confident and less anxious around people, lowering their inhibitions. I dont think that docs would prescribe it for anxiety though due to the hangover and its various detrimental effects on body, especially the liver and memory.

So its just a short term solution, I'm not suggesting someone becomes a daily alcohol addict to cure anxiety, thats for sure. Alchohol withdrawals are awful, I dread to think of going through delirium tremens.

[Zeuzzz]

Also, there are a few natural alternatives that have been proven to work for anxiety. But, as ever, they have not been tested as much as the synthetics.

Check here: Nervine Herbs for Treating Anxiety (http://www.hawaii.edu/hivandaids/Nervine_Herbs_for_Treating_Anxiety.pdf) ALTERNATIVE & COMPLEMENTARY THERAPIES—DECEMBER 2004

Ones I know work are:

Kava-Kava (very efficient, but doesn't taste nice)
Passionflower (the passiflora incarnatia strain in particular) [warning: Some strains are a mild MAOI]
Valerian Root (more for sleep, but also helps with anxiety)

This table gives a summary:

http://forums.randi.org/imagehosting/2220149f76f99cc5cf.jpg

Some are based on very precarious grounds (as with all alternative medications), but the above publication gives some references in the footnotes from more reputable journals. I would stick to them.

For example: Passionflower in the treatment of generalized anxiety: a pilot double-blind randomized controlled trial with oxazepam. (http://jerrycott.com/user/passionanxiety.pdf) J Clin Pharm Ther. 2001 Oct;26(5):363-7.

OBJECTIVE: Passionflower (Passiflora incarnata) is a folk remedy for anxiety. A double-blind randomized trial compared the efficacy of Passiflora incarnata extract with oxazepam in the treatment of generalized anxiety disorder. METHODS: The study was performed on 36 out-patients diagnosed with GAD using DSM IV criteria. Patients were allocated in a random fashion: 18 to the Passiflora extract 45 drops/day plus placebo tablet group, and 18 to oxazepam 30 mg/day plus placebo drops for a 4-week trial. RESULTS: Passiflora extract and oxazepam were effective in the treatment of generalized anxiety disorder. No significant difference was observed between the two protocols at the end of trial. Oxazepam showed a rapid onset of action. On the other hand, significantly more problems relating to impairment of job performance were encountered with subjects on oxazepam. CONCLUSION: The results suggest that Passiflora extract is an effective drug for the management of generalized anxiety disorder, and the low incidence of impairment of job performance with Passiflora extract compared to oxazepam is an advantage. A large-scale trial is justified.

[SkeptiChick]

I think it might be an SNRI.
No, it is an SSRI.

[Dancing David]

I responded to Zoloft the first day too (or rather, to a significant dosage increase). I felt like I'd done a line of cocaine. Hypomania, as it turned out - lovely for a little while, not so much in the long term.



That seems an odd statement. The OP may not be experiencing placebo effect, but I'm not sure why you'd say there is no placebo effect with antidepressants. I'm prepared to be proven wrong here, but I was under the impression that studies suggest otherwise.

Because they don't usually compare sham treatment to no treatment with a third control group. So without that third control group there is no way of knowing if there is a placebo effect.




Celexa? No, it's citalopram, an SSRI.

I just looked and you are right.

[Dancing David]

No, it is an SSRI.


I thought wrong.

[Dancing David]

Could proabably find some, but its self evident really. Most people that drink loads do so to become more confident and less anxious around people, lowering their inhibitions. I dont think that docs would prescribe it for anxiety though due to the hangover and its various detrimental effects on body, especially the liver and memory.

So its just a short term solution, I'm not suggesting someone becomes a daily alcohol addict to cure anxiety, thats for sure. Alchohol withdrawals are awful, I dread to think of going through delirium tremens.

That does not mean alcohol helps with anxiety Zeuzzz. :)

That means alcohol is used to self medicate, it does not mean it improves anxiety. :)

[Robster, FCD]

Be very careful with "naturals." They aren't tested or labeled for safety or efficacy, and there is no way to determine if you have the right dose. Also, some, such as St Johns Wort not only don't work any better than placebo, but they can interfere with other drugs, causing them to be metabolized faster. You know those warning labels that say don't consume grapefruit with this drug? They mean it, for the exact same reason.

[luchog]

Kava-Kava (very efficient, but doesn't taste nice)
Passionflower (the passiflora incarnatia strain in particular) [warning: Some strains are a mild MAOI]
Valerian Root (more for slee
Be very careful with "naturals." They aren't tested or labeled for safety or efficacy, and there is no way to determine if you have the right dose. Also, some, such as St Johns Wort not only don't work any better than placebo, but they can interfere with other drugs


Or a big fat placebo! It's all the same crap!

[Robster, FCD]

Zeuzzz, your attitude seems to that anybody who is less informed than you on supplements deserves what they get. This is why we need regulation to ensure the purity, efficacy and safety of supplements.

Pharmaceuticals have to meet this mark. Food had to meet this mark. Supplements don't. They are neither drug nor food, and the FDA has great difficulty forcing a recall of any supplement no matter how much harm it has caused.

It isn't a matter of synthetic vs natural, as more than half of prescription drugs are derived from or based on natural compounds. But they have to be demonstrated to work, be safe, and packaged in a pure form. Supplements don't. If a compound really worked, it would be sold by pharma. If not, it gets relegated to the supplement industry.

Any claim that pharma is trying to hold back or silence the supplement industry should immediately be suspect. Big pharma has bought up a fair segment of the supplement industry, and for good reason. It makes a hell of a lot of money, about 1/10th of what big pharma pulls in.

[Robster, FCD]

This is not about general supplements. I was being sarcastic (Mental note: Stop being sarcastic on this forum Zeuzzz, people dont get it) when I said "Natural Vs Synthetic, round one. FIGHT!", that was a joke. I hate people that take sides on this debate; there is no side to take! Simply labelling something as natural and something as synthetic and trying to say one is better than the other based on this is just a plain silly thing to do. The clinical studies and evidence do the talking. Not whether its natural or synthetic.

Then try adding "sarcasm" "/sarcasm" tags. Go back and read what I wrote. Natural vs synthetic are not useful descriptors, but regulated pharma vs unregulated supplements are.

This is about one particularly well researched suppliment used by millions of people and used daily by tribes for millennia.

Is it as well studied as real drugs? Seriously? Does the supplement industry have a post marketing study wing that we are unaware of? No. They don't.

True. But some supplements and drugs have been studied in such depth now that they have been proven efficacious, even though (largely unreasonable) suspicion still remains about their dangers and pharma are reluctant to use them and replace the current medications if a more sucessful natural alternative is found.

There is no such thing as alternative medicine. There is medicine with evidence and then there are things that don't work well enough to be worthwhile. If something really worked, it would be examined, tested, refined and sold. It sounds like kava has some strong supporters, but not support. If it inhibits or activates the wrong pathways, acting as an MAOI, when other extant drugs are available that do not do this, the risk of drug interference makes kava not worth pursuing. Taxol is a great anticancer drug. It is also a naturally occurring compound. Makes loads of money. Your claim falls apart.

Not true. Pharma, at the end of the day, are businesses with profits and cash revenue at their core, like every other business. Hows about a bit of business skeptisism every now again? This is a skeptics forum. Take a trip to the business section of this forum, its quite interesting.

Nice unwarranted self importance there. :nope: If a compound won't make or can't be made to make money, either because of drug interactions, safety issues, etc, it won't be pursued. Kava doesn't do what it should for a wide enough population if there are MAOI interactions.

True. A lot of the supplements are pure crap. Some are outright dangerous. Some are very efficient. Kava being one.

Yes, and many do nothing at all but take money from your pocket. The industry needs oversight.

1/10th? What exactly makes up the majority of this 1/10th?

And yes, pharma are interested in making a "hell of a lot of money" like you said. Its a business, and a business is a business, and competition to a business is still competition to a business.

Big supplements take in something like 12 billion a year. IIRC, that is about one tenth of what Big pharma does. I have that info at work, so you will have to excuse my lack of exact figures. Big supplement is a big business, and big pharma recognizes this, and has bought up a fair amount of it. They can sell people junk with no need for real supporting evidence, or the costs associated with R&D.

Selling unregulated snake oil, with no evidence of efficacy, purity or safety is not good competition. If the supplement industry had to play by the same rules and treat its customers with the same respect, it would be real competition. Big supplements doesn't want this. They don't want to play by the same rules because it would cut into their profit margins. Besides, isn't an appeal to ancient knowledge just as good as a phase 3 clinical double blind trial performed at multiple centers?

[Zeuzzz]

Kava's Efficacy as an Anxiolotic (split from "Panic attacks") (http://forums.randi.org/showthread.php?t=141696)

Continue there.

[Zeuzzz]

But yeah, anxiety. Real bitch eh?

My vote still goes for CBT for long term treatment of the causes of the anxiety. Drugs should be for short term allieviation only.

[Iconoclast08]

But yeah, anxiety. Real bitch eh?

My vote still goes for CBT for long term treatment ...

Yes, CBT is the best non-drug intervention for this. And with the way managed care is going, evidence-based treatments (EBTs for short) are more likely to yield some (but not nearly enough) insurance reimbursement, which is better than none.

I'd recommend reading Craske and Barlow's Mastery of Your Anxiety and Panic: Therapist Guide (Treatments That Work series) and the accompanying workbook to get sound details of some of the basic concepts that can be used in treatment (NOT a substitution for professional advice and intervention, though!). Written by some of the top CBT experts in the world and very easy to understand. Simple, useful concepts for tough problems.

... treatment of the causes of the anxiety. Drugs should be for short term allieviation only.

Most CBT practitioners actually aren't as concerned about "causes" per se. The focus is on the distress and life interference in the here and now (although precipitating events are certainly taken into account in assessment protocols). A stubborn myth floating around in self-help circles and psychodynamic cadres is "you have to treat the cause or the symptoms always come back in a different form [symptom substitution]," for which there really isn't much good empirical evidence.

[Dancing David]

But yeah, anxiety. Real bitch eh?

My vote still goes for CBT for long term treatment of the causes of the anxiety. Drugs should be for short term allieviation only.

Sorry Zeuzzz, CBT can only be effective in some cases with medical attention and treatment. As has been stated before studies show that a combination of both CBT and medication is the most effective.

Anecdotally, CBT provided coping skills to deal with OCD and depression, but it did not reduce the severity or occurance of panic attacks in me. It took medication, CBT and major life style changes to make that effect.

CBT alone never reduced my symptoms of OCD and panic attacks.

[Dancing David]

Most CBT practitioners actually aren't as concerned about "causes" per se. The focus is on the distress and life interference in the here and now (although precipitating events are certainly taken into account in assessment protocols). A stubborn myth floating around in self-help circles and psychodynamic cadres is "you have to treat the cause or the symptoms always come back in a different form [symptom substitution]," for which there really isn't much good empirical evidence.

Thank you, yes it is a pervasive component of neo-Freudianism that creeps around. Behaviorism really bothers some people becaus eit says 'causes are relevant but if we treat the current interactions improvement occurs'

Self help can often retruamatize and make things worse.

[Robster, FCD]

I'm a big fan of a mixed approach of CBT (real CBT, not self help woo) + drugs. My doc is thanked in my dissertation.

[Iconoclast08]

...Anecdotally, CBT provided coping skills to deal with OCD and depression, but it did not reduce the severity or occurance of panic attacks in me. It took medication, CBT and major life style changes to make that effect. CBT alone never reduced my symptoms of OCD and panic attacks.

DD-

It would be great to see more individual-focused studies (single-n designs) taking into account those lifestyle changes you mentioned, which I think are a crucial but neglected source of genuine change. Are you familiar with any by any chance? I haven't seen many studies successfully accounting for those important extraneous sources of variability. Would be fascinating to see how they varied with treatment outcomes.

I'm sorry in advance if this is nosing too much into your personal life, Dancing David, but do you mind sharing what kinds of lifestyle changes helped you the most?

My hat goes off to you for struggling with those difficulties in your life. Lately, I have found myself feeling greater and greater admiration for those people who persistently struggle with these problems and are able to change their lives for the better using these evidence-based approaches. It takes a lot of courage, focus, and perseverance.

[Iconoclast08]

I'm a big fan of a mixed approach of CBT (real CBT, not self help woo) + drugs. My doc is thanked in my dissertation.

I posted this in an earlier thread, but I thought I'd briefly reiterate some of the nuances here for consideration. I would recommend some caution in the notion that medication plus CBT is superior to either meds or CBT alone for any given disorder. The more research that has been done in recent years, the more we are learning that it really depends on the type of pathology at hand. While "two are better than one" holds for many studies pertaining to clinical depression and bipolar disorder, it has been either empirically checked or shown to be too gross an oversimplification in many studies examining other disorders (despite med adherence):

See Beitman et al's (2003) Integrating Psychotherapy and Pharmacotherapy text for a nice summary of these results and relevant references:

1. Sleep impairment (Morin et al., 1999): meds + CBT combo actually detracted from efficacy of Tx.
2. Panic disorder: no consistent evidence that benzos + CBT have an additive effect.
3. Bulimia: CBT confers stronger Tx response than meds alone regardless of whether or not CBT is combined with meds (CBT alone vs. med combo doesn't matter)
4. Schizophrenia: failure to show consistent and stable stronger Tx effects with med + therapy combos (meds have a clearer beneficial impact) although psychosocial interventions and arguably cognitive remediation have their place.
5. OCD: mixed results for combo Tx; exposure/response prevention seems most powerful OCD Tx available currently.

So while findings are mixed, "two better than one" is not altogether accurate for every disorder.

[Dancing David]

DD-

It would be great to see more individual-focused studies (single-n designs) taking into account those lifestyle changes you mentioned, which I think are a crucial but neglected source of genuine change. Are you familiar with any by any chance? I haven't seen many studies successfully accounting for those important extraneous sources of variability. Would be fascinating to see how they varied with treatment outcomes.

I'm sorry in advance if this is nosing too much into your personal life, Dancing David, but do you mind sharing what kinds of lifestyle changes helped you the most?

My hat goes off to you for struggling with those difficulties in your life. Lately, I have found myself feeling greater and greater admiration for those people who persistently struggle with these problems and are able to change their lives for the better using these evidence-based approaches. It takes a lot of courage, focus, and perseverance.

It is an area of research but tends to belong to the social network people and the quality of life areas.

I first had depression for sure when I was eight, tried to commit suicide twice before I was 14, had major depression recurrent and OCD by the time I was 17, became a mixed drug addict with a history of destructive relationships.

I became a mental health worker at the age of 32, learned a lot about coping skills and life style at that point. I started to treat my allergies, which was important to reducing caffeine and pseudophedrine use, which was very harmful. Got into group and individual counseling/therapy. And two years later started a separation and divorce, I had already stopped my primary addiction but still had abuse issues that bordered on dependence. Curtailed those substance and behavioral dependencies. At that point my OCD was sort of the tame monster, I had it bounded on the compulsions but the obsessions were a problem. Had another destructive relationships started on medication, was single for 17 months, got into a better relationship. Symptoms now in remission and on a very low dose, about to try quitting in 6 weeks.

Lifestyle changes are multiple:
-physical health: allergies and sleep apnea: treating those helps a lot.
-family issues: shame based philosophy, needed to change that for sure
-destructive relationships: it if good to be involved with people who like you and don't tear you down
-reduce caffeine and get a regular sleep cycle
-avoid destructive sexual relationships
-avoid any serotonergic hallucinogens (primary addiction)
-avoid sudaphed
-engage in regular exercise
-avoid people who are mean to me and shame me
-avoid codependency

That is the laundry list. Feel free to ask more.
-limit intake of videogames and substances of abuse