Just throwing this out there, not trying to stir up anything if someone takes an anti psychotic for anxiety. If you do and it works.... great. But I take lorazepam occassionally, but am to the point where I need something daily. I understand the risks with benzos and my family doctor suggested a switch to Klonopin for daily use. I have seen some psychiatrists who freak out on the idea of daily benzo use, and suggest a small dose of an anti-psychotic instead. Now I only have a basic understanding of psychoactive meds, but to me this seems ridiculous and more risky than taking a benzo. I pretty much said the same thing to one of the psychs and she had a long pause, and said "well, that is a big area of controversy in psychiatry" Anyhow, I'm still somewhat open to the idea even though it doesn't sound so appealing. I asked how they worked and she explained how they block certain dopamine receptors and calm over active activity and certain areas of the brain etc...I have done a little research on some of the anti psychotics and the side effects seem pretty scary. I also found many sites stating that they are only approved and indicated for severe bipolar mania and psychotic episodes. I just am confused as to how they can help with anxiety since I didn't really get a straightforward answer from any professional relating dopamine to anxiety and the theory behind it all. I know now one here knows this for sure. But maybe someone has been through this themselves and has some first hand knowledge/experience or other information to share. Thanks!
You are seeing a psychiatrist, and that is GREAT! Therapy is wonderful!
I actually recommend seeing a psychiatrist and taking a AntiDepressant. Don't just do the antidepressant if you can do both.
Basically, the benzos, should only be used when needed, and your psych is right, they can be VERY addictive... even if you don't have an addictive personality, they can become physically addictive. So only take them here and there if really needed.
I tried to beat my anxiety by myself and by seeing a psych, and I just couldnt do it. I was going WAY DOWN into a downward spiral. I had to get a little extra help.
My Dr. put me on Lexapro, 5mg, very low dose... the next day, my mind got out of that negative thinking process, and I didnt feel as hopeless!
I don't have very many side effects at all. And the side effects tend to leave after a few weeks.
My anxiety is actually lifting a lot. And seeing a psych while I'm taking this I think is really going to help me take control. Then when I feel I can do this on my own, I'll just wean myself off the Lexapro. =)
Don't be scared to try something if you are feeling that bad.
Always talk to your Dr. first to see what he thinks. =)
I found your post very interesting and I just wonder whether you reside in the US. Well I reside in Australia and I have found that anti-psychotics are being used to treat anxiety.
I was seeing a therapist and was shocked to hear her preach so calmly that anti-psychotics are given to people with anxiety and the manner in which it was said was that it was totally safe.
The trend apparently for anxiety apparently is to treat it with a SSRI and if no success there, then Zyprexa and Seroquel is given . The older anti-depressants are no longer given as they have cardiac consequences, but I guess the mental doctors think it is okay to stuff up your brain completely.
I told my doctor about this and he thought my psychologist and the profession has gone a bit crazy. The funny thing is that these mental doctors and their little helper psychologist take a very dim view on benzos and yet benzos if taken cautiously is okay . Just read the posts in this forum , many survive.
I think there is just a conspiracy, there just aren't enough psychotics or bipolar people out there so the drug companies need to expand their market and of course who are the guinea pigs, patients of psychiatrists.
I once had a chat with a mental health worker and she said the department was so strapped for cash and was hugely funded by the pharma companies and these drugs were often prescribed to patients who just had anxiety. Zyprexa is known to cause diabetes, who wants that anyway.
I get really angry with the whole mental health professionals, I really don't know how they can sleep at night after prescribing such dangerous medications. When one sees a mental health professional , usually the person is so vulnerable and a lot of trust is placed with the worker and it is sad that this trust is being abused by the psychiatrist and psychologist with the drug companies calling the shots. Really there should be more control over dispensation of these drugs and the whole profession.
Anyway, my advice is just try one of the SSRI's if you have to.
As with any psychoactive compound, one must assess the risk-to-benefit ratio. The modern atypical antipsychotics actually are no better or safer than their 1950's Phenothiazine counterparts that they've largely replaced (which are/were known as "typical" antipsychotics).
Unlike the Pheothiazines (eg, Thorazine) which target D2 (dopamine) receptors exclusively, the modern atypical antipsychotics (eg, Abilify) exhibit high affinity for D2, D3, 5HT1 and 5HT2 receptors, and moderate affinity for D4, 5-HT2(c), 5-HT7, alpha(1)-adrenergic, and histamine(1) receptors.
Of the receptors cited, only 5-HT1 has been associated with anxiety (and that is anxiety that recurs secondary to a depressive affect). The others have no bearing on anxiety states, and are more attributable to a "chemical lobotomy"
Any drug that antagonizes (or that acts as a partial agonist) on Dopamine receptor sites has the potential to induce the following:
(A) Neuroleptic Malignant Syndrome: Characterized by hyperpyrexia, muscle rigidity, altered mental status, and autonomic instability (eg, irregular pulse/blood pressure, tachycardia, diaphoresis, cardiac arrhythmia). This must be recognized and treated immediately, as it usually ends fatally.
(C) Persistent Tardive Dyskinesia: A permanent movement disorder.
Those three are the hallmark adverse consequences of atypical/typical antipsychotics.
However, the atypicals carry additional adverse effects. More receptors are targeted than with the typicals (in this case, D3, D4, alpha-adrenergic, and histamine 1):
(D) Cerebrovascular Adverse Events (a nice way of saying stoke)
(E) Induction of Hyperglycemia and Diabetes Mellitus
(F) Orthostatic Hypotension (a drop in blood pressure of greater than 20/10 mmHg upon standing). This may result in fainting upon standing.
(G) Seizure: The atypicals decrease the seizure threshold
(H) Adverse Cardiac Effects (or disturbance of cardiac conduction)
Those are the risks. In the case of anxiety/panic/phobic neuroses or another comparable anxiety-related disorder, do the benefits outweigh the risks? No, as there simply are no benefits. The atypicals are not indicated for the treatment of anxiety states for a good reason...they are not effective.
So, why prescribe them? They are "non-habit forming", unlike the Benzodiazepines. That's actually not true (any psychoactive compund will induce some degree of dependence). Bottom line - The physician is unwilling to prescribe a safer agent (eg, Benzodiazepine) due to the risk of liability surrounding dependency. Here, the patient comes second. Quality of life is not factored into the equation, and the physican receives a generous "kickback" from the giant pharma corporations. The atypicals are very expensive drugs that are currently on-patent. The traditional agents are largely off-patent, are available in generic form, and generate no significant revenue.
Chronic antipsychotic treatment should be reserved for patients who suffer from a chronic illness that:
(A) Is known to respond to antipsychotic drugs, and
(B) For whom alternative, equally effective, but potentially less harmful treatments are not available or appropriate.
Otherwise, they should only be used in the smallest effective dosage, and for short-term use only to minimize serious consequences (some, of which, if they develop, are non-reversible). This is not my opinion, mind you, but rather the prescribing guidelines for such drugs.
I concur with your family physican about implementing Klonopin as a long-term maintenance option. Refer to part "B" above. Klonopin would fall under the category of a "less harmful treatment". Klonopin is certainly available, and it is certainly appropriate. Unfortunately, some physicians' compromise their patient's quality of life, or expose them to unnecessary risks. If such is the case with your physican, you should ideally secure a second opinion - one who has your best interests at heart and not his/hers.
I found that at times, yes it is great to see a therapist but remember that they are working for you . The moment they cross boundaries and suggest ideas that you don't think you would like to pursue, that is the time to stop therapy and spend the money on yourself doing something nice for yourself.
I feel that once you start seeing a psychiatrist, who knows you might be convinced to innocently try one of these anti-psychotics. Down the track , couldn't it be possible that if the psychiatrist and therapist got into trouble for prescribing it, they could simply amend their notes and say that you had a psychotic episode. I might sound paranoid, but honestly, don't trust that profession too much. The profession is overrated and they are creating patients and disorders when there really should be none. Of course there are a few good ones but as I said, they are as good as until they stop working for your best interest.
Well................I was going to say EXACTLY what crystalblue said, but she beat me to it!
(That's a joke, folks!)
But I WAS going to say that I thought your PCP had the best idea with the Klonopin and I'm impressed with myself that crystalblue thinks the same.
Let us know how you're doing, OK?
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