Anxiety meds

[Thrashley]

I have been diagnosed with anxiety by more than one doctor. I have had prescriptions for Xanax in the past. Now, I cannot find a doctor who will give them to me. I know all about people abusing them, etc. That is not why I need them. They work for my panic attacks. They work fast and they calm me down. I take them as needed. My question is should I go to a regular medical doctor or a pyschiatrist? Any advice would help! Thanks!

[suzi-q]

Do you have a general practitioner that you have been seeing for a while?  I know that if you just go to a doctor for only one visit, who does not know your history, they will not prescribe controlled substances.  A pyschiatrist would probably prescribe it quicker, but, never on a first visit...it is a shame, but they have to do that because there are people who "doctor hop" to feed their bad habits...if you don't mind my asking, why won't your other doctor prescribe it?

[Thrashley]

My psychiatrist wont give them to me because I have a history of alcohol abuse. HISTORY. I am 37 years old, I know what I need and I know what works for me. My regular doctor, same thing. I was told that the younger doctors wont give it because of the potential of abuse. They are scared, etc. I know all this. What I dont get is why do they keep making Xanax if people who really need them cant get them? I thought about ordering online, but I dont want to get into trouble. I really just want to start all over and get a new doctor.

[suzi-q]

I would say that is your best bet....start with a new doctor and don't say ANYTHING about the alcohol...It is a shame that we need to lie...especially to a therapist, but you have to do what you need to do. Go to a psychiatrist and tell him your symptoms...don't even say you were ever on Xanax...just give the symptoms and see what happens..Maybe if not xanax then another benzo.  Have you heard of a pharmacologist?  It is like a psychiatrist who believes in treating with medication...that could be a good start.  I don't want to sound like a drug pusher or a partner in crime...I am taking you at your word that you do not have an addiction problem....best to you.

[Thrashley]

Thanks! I will check into that. I am a wired mess. I am going to Las Vegas in 3 weeks and then I am going to Switzerland in September. I HATE to fly. I have never been out of the country either. It is all for work, which is another issue. Thanks for your help!

[RCA7591]

What form of anxiety were you diagnosed with? Generalized, Panic Disorder, etc? Do you get panic attacks, and if yes, what is the frequency of the attacks?

If you have Generalized Anxiety Disorder (GAD), or infrequent panic attacks (a few per week), a PRN drug such as Xanax would be a good choice. You can take this drug "as needed", but shouldn't take it every day.

If you suffer from recurring panic attacks often (Panic Disorder), a longer acting drug such as Klonopin is more useful long term. Klonopin, unlike Xanax, may be taken every day, twice daily.

At any rate, I would recomend seeing an older Psychiatrist who is well versed with the anxiety disorders, and who would be willing (based on their findings), to prescribe the drug you need, and in the amount you need to supress your symptoms.
The "quality of life" needs to be factored in. If Xanax gives you a better quality of life, it should not be withheld.

Past alcohol abuse is not an excuse to withhold valuable therapy, IMHO. Many people have abused alcohol in an attempt to mask their anxiety disorders. Most of those people will continue to abuse alcohol without treatment of the underlying anxiety disorder. Cessation of alcohol is important, however, once Xanax (or Klonopin) therapy is initiated.

If you are displeased with your current Psychiatrist, you should seek out a second opinion. Surely, there is more than one shrink in your area. If your current Psychiatrist refused Xanax, what was his/her alternative treatment method for you?

-Ryan

[Thrashley]

I was GAD, I believe. It has been years. I was prescribed xanax, but they had me taking so many of them I hated it. I was a zombie all day long. I quit taking it altogether. Mind you, I was on TennCare then (I live in Nashville). I have better insurance now, but cant find a doctor "brave" enough to give it to me.
I have infrequent panic attacks. It scares the **** out of me. My heart feels like it will beat right out of my chest. It skips beats and stuff. It feels all jumpy. That makes everything else worse. I break out into a cold sweat, face will flush and my back will spasm and I shake. I hate it.  
I have been on anti depressants for many years. They also diagnosed me with clinical depression. My current psych who wont give me the xanax gave me Risperdal. I am not psychotic. I am a nervous wreck. She switched my beloved Zoloft to Lexapro. I didnt like the Lexapro, so I went back to Zoloft. I take 200 mg a day. I cannot be without it. I have tried every anti depressant they make, Zoloft works best for me, but it does nothing for panic attacks.

[fyulaba]

Thrashey,

The reason why the doctor gave you Risperdal is because alot of anxiety disorders carry psychotic-related features (paranoia, etc...) I had a doctor prescribe me both Abilify (for Schizophrenia) and Depekote (or Paranoia, Depression). Neither of those worked for me. Here is what I would suggest...

Make an appointment with your psychiatrist. Tell him that you have been previously diagnosed with GAD and have been taking Xanax for your anxiety. Let him/her know that your are actively seeking treatment for your anxiety and are willing to go to therapy. Whatever you do, do not mention that your anxiety has increased since you have been without Xanax. Because Xanax is addictive alot of Psychiatrists and Pain Management Specialists will conclude that your lack of Xanax is the CAUSE of your anxiety.

In any event, you may want to try Ativan (lorazepam .5 or 1MG tab). They work pretty well in combination with a good anti-anxiety/depressant medication like Well-Butrin (bupoprion). Let me know if you have any more questions, or need help! ***@****

thanks,
jason

[RCA7591]

Risperdal, Zyprexa, Seroquel, Abilify, Geodon - are all atypical antipsychotics. All are useless in anxiety states. All carry the risk of severe side effects, including permanent movement disorders of the Parkinson type.

Depakote, Depakene, Carbamazapine, Diphenylhydantoin - are epilepsy drugs. Some are used off-label for bi-polar disorder. NONE of them are effective in anxiety states. Like the atypicals, the risk of serious adverse effects is great (in the case of these drugs, hematologic disorders).

Off-label use of these drugs is common, but they have absolutely no proven efficacy in true anxiety states. In the vast majority of cases, they will *increase* anxiety.

The same can be said for the SSRI class of drugs. Their original target was depression. Lately, they have been advertised for anxiety/panic disorders, pushed by their manufacturers upon doctors. For the anxiety sufferer, these drugs are largely worthless.

There are only three classes of drugs that have long proved their efficacy in anxiety states. Those three are the Benzodiazepines, the Tricyclics, and the Carbamates. Two other classes that were commonly used are now banned.

Benzodiazepines:

-Alprazolam (Xanax, Niravam), PRN
-Alprazolam (Xanax-XR), Maintenance of GAD
-Chlordiazepoxide HCL (Librium, Libritabs), Maintenance
-Clorazepate Dipotassium (Tranxene, Tranxene SR), PRN
-Clonazepam (Klonopin, Rivotril), Maintenance
-Diazepam (Valium), Maintenance
-Lorazepam (Ativan), PRN
-Oxazepam (Serax), PRN

Tricyclics:

-Amitriptyline (Elavil)
-Nortriptyline
-Doxepin (Sinequan)

Carbamates:

-Meprobamate (Miltown, Equanil, Meprotabs, Meprospan)

"Infrequent" panic attacks is the key word here. The best treatment for infrequent attacks is a Benzodiazepine with a fast onset of action, and a short half-life. Niravam or Xanax is the best.

ATIVAN (Lorazepam), once widely prescribed in the late 70's through the 80's, is now falling out of favor, largely replaced by Alprazolam. Alprazolam has two benefits over Lorazepam. (1) Shorter half-life, and (2) Rapid onset of action. It does not accumulate in your system, making it the ideal PRN drug.

Ativan.....has no specific effect on panic.

-Ryan