Dear Dr.and anyone!!!I recently wrote about my PDoc putting me on Neurontin and wanting me to try
Lexapro. You wrote me back now Here is what has happened. Short refresher of my problem:
I started having "DURING THE NIGHT ANXIERY ATTACKS" 14 MONTHS AGO; (WHICH WAS MANAGED, till now, BY 1 MG. LORAZ.in
PMPremenstrual syndrome
Relieving pms and on rate occas.I would take 1/4mg.in day) After learning my Husband has to have Valve Replacement surg. on his heart;Two weeks ago I started having severe DAILY ANX. 24/7 WHICH LANDED ME IN THE ER LAST WEEKEND; Next day, My Psyc. Med. Spclist. suggested Neurontin It was horrible; then they asked me to try
Lexapro on Friday(.05mg.) and it was worse! I was a basket case and fell into a deep despair. My Husband took me to see the med specialist she and Psyc. told me to stop all of the above. I stopped
prozacProzac
Prozac weekly after 9 years 4 months ago and was functioning pretty well on 1 mg. loraz. at bedtime until two weeks ago. After I was told I had
ProzacProzac
Prozac weekly Poopout I have, over the Last 4 months, they tried
PaxilPaxil
Paxil cr, Traz.,Celexa, Serenity, and SAM-e all with the same side effects of the lexapro or worse. Now they prescribed Ambien as Loraz. won't get me thru the night like it always has. (I didn't want to increase the dose more and more).Ambien is giving me 4/5hrs sleep . The First nt. 1/2 tab.no loraz. then 1 mg. lorz. at 4am I was exhausted. I wok up a mess and was a mess all day depressed/crying awful! I took meclazine 25mg. for nausea and it made me feel worse/asthma etc. Desperate for sleep last night my husband sugg. I take 1 whole Amb. tab.w/1/4mg. loraz. got 6hrs - woke up took another Ambien 1/2mg. loraz. 5hrs. sleep. Woke up groggy, wobbly, Feel weak, hungover. I did force food down today; had not eaten since Thurs. I feel undelying anxiety don't know what to do for it I am so confused and just want my life back so I can function during the day. Can Ativan start causing depression even on this "low" dose over time. Is it working against me? Can I switch over to low dose Xanax without going off Ativan would it help me more and or longer. I want to go back to Prozac next weekend; want other meds out first. Will Prozac work again???? Please tell me it will I am desperate. I never had a prob. with it but now fear it will be like all the others!! !!!
I WANT MY LIFE BACK!!!! I HAVE JOINED AN IOP GROUP 2/3 X'S WEEK; FIRST WAS FINE I LIKED IT, SECOND I WAS TOO SICK AND FELT TRAPPED BECAUSE OF THE LEXAPRO REACTION. i GO AGAIN TOMORROW. I WANT ONE ON ONE THERAPY TO GET TO THE BOTTOM OF WHAT STARTED THIS BUT I KNOW I NEED SOMETHING TO CHEMICALLY BALANCE MY BRAIN SO I CAN COPE AGAIN. PLEASE TELL ME YOU HAVE SEEN PATIENTS GO BACK TO PROZAC ETC. AND HAVE IT WORK! HAVE I BEEN OFF LONG ENOUGH 6/16 STOPPED.
Can Xanax, short term while getting back on Prozac over 4/6weeks, help me thru the transition and daily anxiety; then wean off. Will it trap me, is that too long to be on it? Or will I have to wean off Ativan too or before or what???? Would it mask the effectiveness of the Prozac? Please Help Me I am desperate. I just want to not feel anxious when I start my Prozac again. I know the mind is powerful and when I feel this way I feel helpless and think negatively.
You tried a small dose of Ativan/Ambien but ended up taking a larger dose of them. It might not be a good idea to cut down on your Ativan to 0mg or 0.5mg in the “First” and “Second” nights respectively in such unstable situations. Ativan is for both anxiety and sleep while Ambien is for sleep only. Since Ativan 1mg cannot compromise your stresses, it may not be the best time to cut it down by adding Ambien. It may be a good idea to try Ativan 1mg and Ambien 10mg for sleep. Keep this until Prozac takes effect. Worrying the effectiveness of Prozac in the future and the addictiveness of Ativan at present may only neutralize their efficacies and produce insomnia.
Don’t worry since you are in good hands.
Firstly, sleep hygiene and stimulus control change behaviors of sleep.
The following is sleep hygiene:
(1) Avoid caffeine, nicotine and other stimulants before sleep.
(2) Don’t eat and drink a lot before bedtime. Don’t eat spicy or fatty foods, which can cause heartburns before sleep. No alcohol. One can take small amount of warn milk, tuna or turkey that contain L-tryptophan or complex carbohydrate like bread or cereal.
(3) A program of regular physical exercise (but not before sleep) enhances sleep.
(4) Take a hot bath or shower that relax muscles helps bring on sleep.
(5) Make sure you have a bed and pillow that are comfortable and offer orthopedic comfort.
(6) Maintain a comfortable room and body temperature during sleep. The bedroom humidity should not be too dry or too moist.
(7) Keep the sleeping environment quiet. Silence is very important. So, no TV or radio. Use double-pane windows and heavy curtains to ward off outside noise. Use earplugs if necessary.
Use the bed for sleeping only. Go to bed when sleepy. Fix a constant wake-up time. Get out of bed whenever awake for more than 15 minutes and do something else before getting back to bed. Avoid reading, watching TV, eating, worrying and other sleep-incompatible behaviors in bed and bedroom. Refrain from daytime napping. In these way, only successful sleep is re-associated with the bed, bedroom and bedtime. To rephrase, stimulus control achieves such re-association by curtailing sleep-incompatible activities in bed/bedroom and by establishing a consistent sleep-wake schedule.
Secondly, proper timing of sleep-wake behaviors and light exposure maintain the natural circadian rhythm that governs sleep. Avoid daytime sleep. Try to develop a habit of going to bed and getting up at about the same time everyday including the weekends. Keep one’s window covering closed to avoid light from the street that may disturb one’s sleep.
Thirdly, through somatic and mental relaxation training, the arousal system is calmed. Deep-breathing exercises, progressive muscle relaxation, meditation and self-hypnosis reduce both anxiety and excessive tension at bedtime. Avoid arguments and emotional talks near bedtime. Refuse violent scenes in movies or TV near bedtime. Listen to some relaxing music before sleep.
Fourthly, in order to achieve regular and correct behaviors for sleep, one’s cognition has to be changed. Understanding the rationale behind the above concepts will perpetuate the above behaviors.
Don’t fight insomnia because the anxiety and stress levels will rise and one will never sleep.
Paradoxical intention is to stop one’s fear of insomnia, e.g. one simply prepares to stay awake since one can still function the next day without sleep.
Yes, your mind can be very powerful if it can think in the right direction. Don’t allow the withdrawal symptoms of Ativan to discourage you.
Looking forwards to seeing your good news in your next post.
I recently started University A big part of my course involves presentations. I knew this before I started but still i applied. It was the first day (everyone is usually nervous arent they?) I had normal nerves but I was generally ok ( I think so This anxiety makes one confused) but it all started when the lecturer asked us to introduce ourselves to the class. He simply wanted us to give our name and just say what we did last year (education) if anything.
Well thats when it started I began to feel really self concious my heart started to speed up I felt I was going very red ( did anyone notice?) I was feeling hot and both really awake and confused. the time for me to talk was drawing closer and closer i tried to smile block it out but no, it wasn't going away, it seemed impossible to overcome, really impossible, i was scared. I remained in this state thinking about how I was going to sound I thought I ws going to cry if I opened my mouth (really) How I was going to sound was unknown to me and I felt trapped obligued to talk as everyone else did it. We it came to my turn i spoke quickly My voice very weak and I was trembling it was over well so I thought. Then the lecturer asked where I studied I answered in a similar quick broken weak emotional voice. I felt really ashamed, very scared, very confused, very trapped, the list is endless.
I have always been very sensitive I am not very socialable I see it as a catch 22 situatation ( you need a social life to have a social life) everyone else seems to drift along effortlessly while I worry about this that and everything. I wonder if I have a component missing, I was premature so I wonder maybe it is a subconcience thing that I missed out on something that helps in life. I never really to spoke to anyone about it. I feel lost really lost, I may look alright on the exterior but underneath I feel that something has taken a big chunck out of me, I am hanging by a thread.
I have had a few panic attacks since that have stemed from the first one The constant analysing and thinking about the anxiety creates more anxiety i find. I recently went to the campus councelor something I never thought i would ever have to do ( well underneath maybe i did) she talked to me about breathing techniques something that is ok when in a calm environment but i dont think it helps during a panic attack ( not even winning the lottery during a panic attack could help) we have talked over various things related to anxiety but now that I have researched and talked about the anxiety I feel that it is in controll of me it is out there and as long as i even think about it , it will always be there. Last week I was feeling realy anxious all day and at night it is worse, i feel realy anxious my mind is really confused I had thoughts of sliping into a madness without controll over my feelings, this was scary, I ask my self if all this thrapy, talk and research is really help the more i look up websites the more I feel I have a more anxieties i begin to add them subconciously to my list........ I am very sorry If anyone who feels depressed of worried after reading this. I am still hopeful, there is always hope
Never go for quick fixes that have no lasting power, e.g. cigarettes, alcohol, food-binging, illicit drugs…
MINDFUL MEDITATION is to focus on calming and becoming aware of one’s body in the act of hyper-responding to stress/anxiety with the aim of catching and interrupting the over-reaction. Just take a few deep breathes and settle down for mindful meditation whenever feeling anxious. Other forms of meditation use other means to bring on moments of quiet contemplation, but all are designed to have the body focused. The most important thing is to become aware of the body when stressed.
RELAXATION RESPONSE is to sit or recline comfortably. Close the eyes. Relax the muscles. Breathe in slowly and deeply. Feel the abdomen rise. Exhale slowly and deeply. Focus on the breathing. Silently repeat the word “anker” while exhaling; it helps to clear the mind. If thoughts intrude, allow them to come and go but not to stay. Return to focus on the breathing.
CLEANSING BREATH is to take a huge breathe in. Hold it for about three seconds. Then let it out very slowly, blowing out all the tension.
RELAXING POSTURES is to sit. Relax the shoulders. Drop the arms by the sides. Rest the hands, palms up, on top of the thighs. Extend the legs. Allow the feet to fall gently. Drop the jaw. Close the eyes and breathe deeply for two minutes.
PASSIVE STRETCHES is to let gravity to relax the muscles. Start with the neck. Let the head fall forward to the right. Breathe in and out normally. With every breath out, allow the head to fall more. Do the same for shoulders, arms, and back.
IMAGERY is to find a comfortable posture and close the eyes. Imagine the most relaxed place one have ever been. Well all have a place like this and can call it to mind anywhere, anytime. It may be a lake, mountain, cottage at the beach…
TENSE AND RELAX is to curl the toes against the soles as hard as one can for 15 seconds, then relax them. Progressively tense and relax the muscles of your legs, back, shoulders, neck, face, arms, hands….
Drill on these relaxation techniques to desensitize yourself to stress/anxiety.
The cause of you anxiety state is the “starting of university(involving presentations)” in a personality trait that is “very sensitive and not very sociable.”
You had “never really spoken to anyone about such problem except your campus counselor.”
You anxiety is not amenable to simple “counseling” and “breathing techniques.”
I would suggest formal interview with a psychotherapist who is specialized in CBT and insight psychotherapist. If you are not afraid of being stigmatized I would advise you to see a psychiatrist for a formal diagnosis.
Please refer to the link for social anxiety: http://pub154.ezboard.com/fsocialanxietysupportfrm45.showMessage?topicID=695.topic
Kindest regards
As anxiety can escalate very quickly and can occur in a wide variety of circumstances, the AIM of relaxation exercises is to achieve relaxation quickly (20 seconds) not just sitting, but in any situation.
When a person is anxious, the reaction can be subdivided into 4 components-(1) physiological (pounding heart,..), (2) emotional (nervous,..), (3) behavioral (avoid, escape,..), (4) cognitive (“I am collapsing”,..). In short, physiological change, followed by negative thought, which increase the physiological reaction, produce a vicious cycle. The RATIONALE behind relaxation exercises is to focus on the physiological response and learn how to control it.
Keep a RECORD of anxiety episodes in order to quickly spot the earliest signs of anxiety. The record includes the situation wherein the anxiety occurred, its intensity (0-10), and the earliest signs noticed. Monitor the earliest signs of anxiety throughout the relaxation training.
PROGRESSIVE MUSCLE RELAXATION is to sit in a comfortable chair. Close the eyes. Clench the fists, feel the tension in the fists and forearms, relax the hands, feel the relaxation in the hands and the forearms. Bend the elbow and tense the biceps, keeping the hands relaxed…. Straighten the arms and contract the triceps…. Wrinkle the forehead by raising the eyebrows… Bring the eyebrows together (as in a frown)… Screw up the muscles around the eyes…. Tense the jaw by biting the teeth.. Press the tongue hard and flat against the roof of the mouth… tighten the lips… Press the chin on the chest… Hunch the shoulders up towards the ears…breathe calmly and regularly with the stomach… Take a deep breath, fill the lungs, hold the breath for a few seconds then passively exhale… Tense the stomach muscles…. Pull in the stomach… Arch the lower back away from the chair… Tense the buttocks and calves by pressing the heels to the floor… Tense the calves by pressing the feet and toes downwards… Tense the shins by bending the feet and toes upwards… Keep a record of the time taken to relax and the amount of relaxation attained (0-10).
RELEASE-ONLY is to relax from the top of the head to the tip of the toes in the same way as PROGRESSIVE MUSCLE RELAXATION, omitting tension. In this way the time taken (5 min.) is reduced.
CUE-CONTROLLED RELAXATION is to tell oneself to “inhale” at inhalation and “relax” in exhalation. The cycle can be repeated to attain deeper relaxation. This serves to attain relaxation in RELEASE-ONLY but the time taken (2 min.) for relaxation is further reduced.
DIFFERENTIAL-RELAXATION is to close the eyes and relax. Open the eyes while keeping the rest of the body relaxed. Look around without moving the head…. Look around, moving eyes and head… Lifting one arm… Lifting one leg… This serve to attain relaxation in CUE-CONTROLLED RELAXATION while engaging in everyday activities. The muscles not involved in such activities remained relaxed. The time required is 1 min.
RAPID RELAXATION serves to practice relaxation more than 20 times a day using a series of cues (watch, telephone,…) to remind one to relax. A small piece of colored tape can be stick to the cues. Take 2 deep breaths, relaxing in slow exhalation. Scan the body for tension and try to relax as much as possible. Relaxation can be achieved in 20 min.
APPLICATION TRAINING is to practice applying the learnt relaxation skills in anxiety-provoking situations. Start with the least anxiety-producing situation for 10 min. first. Then lengthen the duration. Then try more difficult situations. Remember practice make perfect and a stitch in time saves nine (intervention at the earliest sign of anxiety).
This is the standard relaxation exercise for anxiety management in CBT.
From you description I don’t think it can be explained by “normal anxiety.” The reason is that you have gone through a lot of suffering including the first episode of social embarrassment and further “panic attacks” for which you required help from your campus counselor. By the way, it is a good idea for you to go to your doctor to exclude organic causes, say thyrotoxicosis… I did not say you must have social anxiety, which depends on the exact nature of your “panic attacks” and whether the whole picture fits the DSM IV criteria and the final interview with a psychiatrist.
The reason why consulting a psychiatrist is essential is that you can obtain the formulation of the causes of your anxiety state… differential diagnosis including social anxiety, panic attack, general anxiety, agarophobia, specific phobia, PTSD and OCD that constitute anxiety state… and other mental causes.. and organic causes of anxiety symptoms… formulation of the diagnosis into 5 axes: clinical condition/s are under Axis I, personality elements and defense mechanism Axis II, physical condition/s Axis III, psychosocial and environmental problems Axis IV, highest level of functioning recently Axis V. This is what I mean by full formulation.
Yes, Cognitive –behavioral therapy is your answer. CBT is the best psychotherapy for anxiety because it has shown very promising results in scientific studies. You are right that cognitive therapy changes thought patterns. It does so by identifying irrational thoughts (“people definitely will notice that I am anxious and I shall be so shameful.”), challenging their validity objectively (“How can they possibly see that I am in fear as they are absorb in their own business?”, “Even if they did notice, they will not think nasty thing about me.”) and produce more realistic rational thoughts (“They cannot see I am nervous that is sort of normal anxiety.”)and perform experiments to prove validity of the rational thoughts (“I pretend that am anxious by shaking my hands see if they notice.”) and finally replace the autonomic negative thoughts with realistic thinking (“They did not notice my shaky hands”, “My anxiety will always pass very quickly”, “Normal anxiety will help me to do things right.”). Actually, this is not pure cognitive therapy since experiments are incorporated in the cognitive process. Experiments are behavioral, so are exposures and avoidance prevention and relaxation exercises. Therefore, cognitive and behavioral are inseparable, hence Cognitive-behavioral therapy. Sometimes it is very difficult to spot the automatic negative thoughts because nobody will admit that one has irrational beliefs due to they defense mechanisms. And at times, the automatic negative thoughts will the form of very brief visual image (seeing oneself shamefully red, sweating and trembling.)
Sorry for the misunderstanding caused.
Best regards