Welcome to the Mood Disorders Forum. Questions in this forum are being answered by Peter Forster, MD and topics covered are anxiety, bipolar, depression, panic disorder, post traumatic stress disorder and stress.
Hello Doctor, what would be the best way to combat free-floating anxiety? Im a 29 year-old man and about half the time I feel as I have drank 10 cups of coffee. I don't have panic attacks (I have had them in the past so I know what they feel like), but just overwhelming anxiety that lasts for days on end. Im not anxious about anything really, it just feels as my body is revved up, esp in the mornings. Its really effecting my work and social life. I usually avoid going out with friends, traveling and doing all the things I used to enjoy because I feel like im being tortured from the inside. This started after stopping drinking 14 months ago.
Suicidal thoughts are creeping in, I don't want to die as I have (had) a great life, but I cannot stand this anxiety (yes I have told my psychiatrist). I have seen a psychiatrist recently, who was really no help, I cannot tolerate SSRIs (tried prozac, lexapro, celexa and zoloft), but can tolerate and take the SNRI Effexor XR, but only at 37.5mg, I cannot go up. Would an TCA be helpful for this type of anxiety? Buspar didnt work for me. Also, I have had many medical checks, full blood work, MRIs of the brain ect--all normal. I cant really pin this anxiety down on any thoughts, the only thought that sometimes bothers me is the fear im developing schizophrenia. My new psychiatrist said its not an issue and she sees no signs of schizophrenia at all--hope I can find a solution to this anxiety.
I am curious about what happened with BuSpar? How long did you take it, and at what dose?
Also you didn't mention anything about your mood other than that suicidal thoughts are creeping in, I am interested because subtle "bipolarity" can be one reason that SSRI's and SNRI's are not tolerated at therapeutic doses. In those cases the medications can cause a sense of excessive and uncomfortable activation.
Hope all those questions aren't too overwhelming.
By the way, I agree with Jaquta that in terms of non-medication steps, active approaches are more likely to be useful than relaxation approaches - for instance, something called progressive muscle relaxation - which begins with tension in a muscle and then relaxation - or yoga or even martial arts.
Hello, thank you for your reply. I took the Buspar for one month at 5mg/day, it made me feel kinda spacey. I was wondering about bipolar as well and talked to my psychiatrist about it, but she says there is no sign of bipolar disorder. My sister is mildly bipolar (successful, without any medication), and my mother says she doesn't see it in me. My mood is usually stable, I never really ever lose my temper, go on mass spending sprees, feel im on the top of the world ect. Most of my friends and co-workers describe me as a calm and patient person, and I have had perfect attendance at work for several years. However, I forgot to mention, I do take lamictal 25mg and neurontin 600mg (for nerve pain due to bulging cervical discs) and they helps depression more than anything but do nothing for anxiety.
I did try exercise, but once my heart rate goes up, it stays up for several hours afterwards, its quite annoying.
Also, the reason I cannot tolerate ssri's is because they make me emotionally numb. Last Christmas I was on prozac and remember seeing the beautiful Christmas tree, all the family ect and not being able to emotionally connect. That is one side effect I will not accept. Effexor doesnt do that to me.
Doctor, sorry to keep repeated posts, but do you know anything about the drug Tandospirone (Sediel)? Its similar to Buspar but used mostly in Asia (I live in China),
Also, I wonder if I could possible have PAWS, I seem to have all the symptoms, and my symptoms do come in waves. Last month was a breath of fresh air. I had almost no anxiety, I was going out with friends and enjoying life but early this month the anxiety crept back in for no real reason. http://hubpages.com/hub/Post-Acute-Withdrawal-Syndrome .
Or I may just need to stay off google.......
I was wondering if your buspar dose may have been too low. I was put on buspar and told that less than 30 mg was subclinical. I know that our circumstances are different but it was just a thought. Buspar made me feel panicky and manic and itchy and fatigued (and I felt unheard by the doctor) so I stopped taking it. I think my anxiety (or ocd) was somewhat improved after several months on the med though.
I too, don't accept that apathy as a side-effect. To me that is more depressing than not taking the med at all.
Heart rate is suppose to increase with exercise. With increased fitness it usually returns to baseline quicker. Increased heart rate is something most of us experience with anxiety so I guess from that perspective it may be alarming for some people.
Maybe shorter or less intense exercise could be helpful there. Something like Tai Chi, etc could help with relaxation too, as the doctor suggested.
Another thought was that it could be diet-related. Maybe due to something that you are consuming in the morning. (Forget that one, probably not relevant.) Or related to your neck/ back problem. I was wondering if the drinking coincided with that at all. Or the anxiety with that.
I'm not sure about PAWS. It's been over a year though so I'm guessing it's an emotional reaction. I have taken excess meds and I know stuff like that can take a long time to recover from. For me, I would conservatively say nine months. I guess that differs for each person though and for different drugs/ alcohol. Don't know if this is relevant but I was told that we are emotionally damaged, not physically or permanently damaged from our poor choices.
I was wondering about whether to delete my reply as I don't think it adds anything. ??
I will say it is getting better, as time goes by, im much better now then three months ago, and three months ago was better than the three months before that ect. How long were you on buspar? Maybe I didnt give it long enough or the dose high enough. I still have a box in my home, all these meds are OTC here. I hate to treat myself, but its the way it works here. You reply added a lot. Last night I bought some propronolol at the local 7-11 (love this country) but it seemed to make me dumber than a box of rocks--it did help the anxiety though.
Hi. At least you have noticed some improvement. I think it is more difficult when things feel the same or worse. Better is good. Must be hard that you are having a hard month after such a good one previously.
I started taking the buspirone (buspar) just before Christmas and stopped taking it around April I think. Say four months. I was playing with the dosage a bit during that time so it may have been inadequate for some of that time.
I'm not sure how long is recommended before this drug is expected to work. I know that for other types of medication it can be between four and six weeks.
5 mg a day sounds pretty low. I think the starting dose is for 5 mg three times a day. I think I was started on 30 mg and then because I was getting periods of extreme anxiety was told to split the dose (15 mg twice daily. I'm sure I probably took 10 mg three times a day too).
Buspar is a prescription med here and the psychiatrist had to write away to get special dispensation in order for me to access it. I ended up giving my remaining bottle back to my doctor.
It's pretty sad that it's all OTC. Is probably easily accessible via the net too.
Can't you talk to your doctor again about the medication, etc? Was the spacey feeling you had last time when you took it due to anxiety?
You've got to be careful with the meds and also with possible drug interactions. Minimum I would talk to your doctor. You don't want to kill yourself because all the meds caused you to be excessively sedated and caused you to stop breathing, etc. Drugs can be dangerous if not treated with respect.
Your doctors would have given you treatment plans though, wouldn't they? For your neck and for your anxiety?
Nice thread here, don't know if I should drop in again...
Buspar - the therapeutic range is 30 - 75 or even 90 mg a day. It is also the classic drug that doctors prescribe and that patients report "isn't working" even though they are feeling better. My thoughts on why - First lots of people in this country with anxiety compare all anxiety drugs to Valium... and, unlike Valium, Buspar doesn't have any immediate benefit, isn't sedating, in fact may even be associated with some increased alertness, and doesn't make you feel any kind of buzz. The most typical side effect that we see with this medication is a transient flush or energized state that lasts for perhaps 20 minutes after a dose. The best way of avoiding or reducing that is to take the medication in small doses. In fact I have had patients taking the medicine 5 times a day at the beginning. Two other reasons why Buspar is the least respected (tip my hat to Rodney Dangerfield) of effective medications - anxiety is especially variable from hour to hour and day to day.... and Buspar's effects take 2 - 4 weeks after you get to a therapeutic dose to kick in.... so, you have a condition that naturally varies a great deal and you are trying to identify the effect of something that takes weeks to work... the reason why I always do several standard anxiety rating scales before and during treatment.... that way we can notice the effect at least on paper.
However, if you could tolerate this medicine and gradually take it up to a therapeutic dose it might help your anxiety... and if the effect of a therapeutic dose wasn't enough, it would probably allow you to tolerate a higher dose of Effexor (venlafaxine).
You are taking a very low dose of lamotrigine (therapeutic range is generally 100 - 400 mg a day). Neurontin is pretty clean in terms of drug interactions. So I don't think you need to be too concerned about drug interactions from adding either Buspar or Effexor.
Just an aside, that is probably not relevant to you, but Neurontin is one of the few medications that has been shown to be a mood destabilizer in folks with bipolar.
I like it when experts post. I like that there is information being shared or disclosed that I can learn from. I also sometimes find myself trying to understand where my treatment broke down. Find myself trying to understand it from a different perspective.
I sometimes feel that my posting is intrusive. Is interesting that others may have doubts, etc too.
I too probably would have said that Buspar wasn't working except that instead of repeating stuff for 80 minutes I was only doing it for about 20. That's quite a significant improvement. Kind of hard to overlook.
That makes sense to evaluate anxiety before and during. (I did that for depression when I started therapy several years ago. I found it interesting and probably quite motivating.) I hate it when health professionals say that meds are working when you have a fuzzy head, etc and feel like crap. To see the improvement in black and white is helpful though.
Is interesting to learn that neurontin is a mood de-stabilizer (in people with bipolar).
I would have found this information extremely helpful had I been in Blueghost's situation.
Hello Doctor, Im very glad you did drop in again. I know you cannot diagnosis over the internet, but do you think its likely that I may be mildly bipolar even though my psychiatrist said I am not? In addition to my sister: Im pretty sure my grandfather is, he has never been diagnosed, but my mother told me he used to lay in bed with depression for days and other times lose his temper and smash stuff in the house. That sounds like bipolar as I know it. He very still very successful in career and family without medication.
I certainly think it is possible. It would depend on how thorough the assessment, In our clinic to fully assess for possible bipolar may involve an hour or two of discussion with multiple informants, although it can also be pretty straightforward. One of the problems is something called "state dependent learning" - what we recall depends to some extent on whether we are in the same mood now as we were when the events were happening. So someone who is depressed now may have great difficulty recalling times of being energized.
I defiantly agree with the state dependent learning theory. Seems when im depressed its difficult to remember the times I felt good. My psychiatrist said I have unipolar depression, we talked about it over about two sessions. I was the one who mentioned to her that I think I could be bipolar. She disagrees.
Would bipolar always be progressive? My sister seems to have improved actually.
If I do get a bipolar diagnosis, I would have to hide it--which would be easy to do since I live in Asia. Otherwise my pilot's license would be toast......
I have read about doctor's being depressed and being treated with medication, ect, talk therapy, etc.
The statistics in my country suggest one in four people at some time in their life will be depressed. Depression, etc doesn't discriminate.
I believed one doctor I saw to have some sort of psych condition. He was quite eccentric, use to have a bar fridge in is office and drink from at least three different bottles during the course of a consult. He seemed a bit messed up to me. But then I didn't appreciate him hollowering for his patients from the other end of the building. He seemed intelligent enough (one of those doctors with a doctorate). He was from Texas, I'm not sure if that explains it or not. He was just strange (different) and hyper.
I learnt about risk matrix's and about some other stuff but mainly about feeling frustrated.
I saw a community psych nurse who I'm sure had issues and was on medication.
One psychologist I saw said that she had severe postnatal depression and would have taken medication had she not been breast feeding.
Sometimes I wonder if people gravitate towards mental health because they have issues themselves. I expect some, although maybe not all, do.
What about your pilot's license and the drinking? They had a big story here last year because pilots were being assessed as drunk and were still flying.
Are you pushing for a bipolar diagnosis so as not to fly? (Subconsciously. Maybe you're just looking for the truth and something to explain how you're feeling.)
I spent a short period in the army but when I went to enlist I was denied due to my medical history (asthma).
It seems like discrimination but I guess it is in everyone's best interest. How you sure about bipolar excluding you from flying?
If there are doctors in California who get depressed it is likely not discussed too much since our wonderful Medical Board (which licenses doctors) has taken the stance that having depression means you should lose your license....
Hard to believe that it doesn't happen, though... just considering the numbers.
Same thing is true in the US about bipolar and a pilot's license. This is a relic of the days when we only diagnosed bipolar in folks who were extreme in their symptoms.
I agree that doctors should be fit to practice but I also think that experience of a mental illness could make them better doctors.
I was thinking about making a formal complaint to the health and disability commissioner here and was looking through previous complaints. One was of a nurse who killed someone because she was practicing (against medical advice) when she had a psych disorder.
I also use to go to a depression support group and one person there had said how their doctor had concerns for their safety and asked them if they needed to be hospitalized. While this person was in hospital the doctor stabbed himself in the heart. ??
Hello Doc, thank you so much for listening and replying, I wish my Psychiatrist was like you... In the event someone does have subtle bipolarity, what would be the recommended treatment for someone who is mostly depressive and never has any real manias (unless anxiety is presenting as a mania)? Would increasing lamictal be a recommended treatment, also is staying on effexor ok? If so, I will talk to my psychiatrist when I see her in four days. Also thank you too Jaquta.
Thanks for the acknowledgment. I'm sorry for putting some of the stuff out there. I've been struggling and feeling trapped and I guess those feelings have been bubbling away and have come out in my posts. Not good when it is someone elses post. Sorry.
Have you tried researching hypomania, etc? There is also a bipolar community forum where people with the disorder may be able to explain more about how their symptoms present, etc. That may or may not be helpful.
Also, keep talking to your doctor about the anxiety. Hopefully you'll get some answers soon.
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