Best anxiety meds for a smoker?

[CraftyBonds]

I've pretty much always had a social phobia since i was a child, due in large part, from what i believe, for being ridiculed for most of my childhood for being over weight; which probably does some psychological damage to an 8 year old.

I've tried a couple different psychologists over the years, but they never seemed to really help, so i'm deciding to do something with my life, and go on some anxiety meds.

From what i've read, most of the FDA approved anxiety medications recommend that you not smoke, and use minimal amounts of caffeine. the caffeine will be difficult, but cigarettes have been a crutch of mine for 6 or 7 years now, and i refuse to give them up, even for the best meds available.

so my basic question is, which anxiety meds would be preferable for a patient who plans on, and intends to continue smoking after medication? i also take Advair 250/50 and Allegra D 12 hour (not sure which dosage), if that needs to be taken into consideration. thanks

-Philo

[alliejosh09]

i have social anxiety as well. so bad to where i can't even go to school or to the mall or any public place. ii'm extremely paranoid too.
i smoke too and i'm on chlonopin or however you spell that.
and when i have panic attacks or anxiety attacks i take ativan or xanax.
don't worry everybody, i'm prescribed to them. :)

[Route666]

While there are no absolute contraindications regarding cigarette smoking and pharmacotherapy specifically, the hydrocarbons in cigarette smoke (not the nicotine) limit the efficacy of most drugs that undergo hepatic, enzymatic metabolism. The hydrocarbons found in cigarette smoke are powerful inducers of the Cytochrome P-450 enzymatic pathway - the same pathway that is responsible for the metabolism of most drugs, including psychotropics such as Benzodiazepines and SSRI's. Cytochrome pathways CYP2D6 and CYP3A4 are affected to the greatest extent.

Given that cigarette smoke induces hepatic enzymes 2D6 and 3A4, drugs that undergo metabolism via these pathways will peak and trough off abruptly. In many cases, this limits the efficacy of the drug in question, as the drug undergoes rapid metabolism and elimination. As a result, the plasma level of the drug will be lower, and efficacy could be compromised or diminished. A good example to use is Alprazolam (Xanax), as cigarette smoke reduces Alprazolam plasma levels by up to 50%.

The best source of information regarding specific interactions is the manufacturer's prescribing information for the drug in question.

As a side note, modern FSC (fire safety compliant) cigarettes (as produced in most of Canada and the United States) produce 50% more carbon monoxide and hydrocarbons relative to a non-FSC (conventional) cigarette, so the issue of enzymatic induction has been compounded as of late in certain parts of the world where these types of cigarettes are mandated. Look above the barcode or on the bottom of the pack for the letters "FSC". Such cigarettes contain Ethylene Vinyl Acetate to promote "self-extinguishing". It is the EVA content that is responsible for the increased hydrocarbon production, not to mention increased toxicity and health hazards that are largely unknown at the present time.

[Paxiled]

Yes, that's what I meant to say by saying it's not useful when anxiety is the main problem, but can be when depression is the main problem.  This case appears to be mostly anxiety, at least by what the poster has said.  But even in cases of depression, wellbutrin is so stimulating it often causes anxiety, so it's not generally a first resort med for anxiety.  Good for depression, though, and is often used with an ssri to mitigate side effects such as sexual dysfunction, lethargy, and weight gain.  At any rate, we'll let the psychiatrist handle this one.

[Brenndy]

Bupropion has shown some success in treating social phobia[23]  and anxiety  comorbid with depression,[24]  but not panic disorder with agoraphobia.[25]  Its anxiolytic potential has been compared to that of sertraline[24]  and doxepin.[26}

# 23  Emmanuel NP, Brawman-Mintzer O, Morton WA, Book SW, Johnson MR, Lorberbaum JP, Ballenger JC, Lydiard RB. (2000). "Bupropion-SR in treatment of social phobia". Depression and Anxiety 12 (2): 111-3. PMID 11091936.
# 24 a b Trivedi MH, Rush AJ, Carmody TJ, Donahue RM, Bolden-Watson C, Houser TL, Metz A. (2001). "Do bupropion SR and sertraline differ in their effects on anxiety in depressed patients?". Journal of Clinical Psychiatry 62 (10): 776-81. PMID 11816866.
# 25 Sheehan DV, Davidson J, Manschreck T, Van Wyck Fleet J. (1983). "Lack of efficacy of a new antidepressant (bupropion) in the treatment of panic disorder with phobias". Journal of Clinical Psychopharmacology 3 (1): 28-31. PMID 6403599.
# 26 Feighner J, Hendrickson G, Miller L, Stern W. (1986). "Double-Blind Comparison of Doxepin Versus Bupropion in Outpatients with a Major Depressive Disorder". Journal of Clinical Psychopharmacology 6 (1): 27-32.

[mammo]

I think they are trying every way to keep one from smoking, and that's good.  I know of no issues with smoking while on the medications, but I do know the long term effects of smoking and they're not good.  But one thing at a time. Caffeine makes anxiety worse because it is a stimulant, so maybe this should be the first thing you work on giving up.  Not all therapists are good, and you need to find another one that can address your particular issue.  Being made fun of as a child is very harmful, but if you can try to understand that kids can be cruel and so long as you carry this with you, you are still their victim. I know all this is easier said than done obviously, but forgiving can do wonders for YOU.  When you truly forgive, it's not saying that what they did was right, or that you condone it, it says that you are laying down the anger, walking away and leaving them for God to deal with.  With the right therapist you can learn to put this all behind you, and just be yourself and get beyong this social phobia, and have a good life.  When you reach this point try to give up the cigarettes.  My husband has so many health problems from smoking, a ticking time bomb, and it's all from smoking which he stopped 25 years ago.  He was very healthy, a Marine, a runner, kick boxer, so he felt he was staying one step ahead of the cigarettes and they would not affect him.  Today he can barely walk to the car.  Good luck with this and take care.

[Paxiled]

Buproprion, or Wellbutrin, is not an anxiolytic at all; it's an antidepressant that can be quite stimulating and isn't recommended for use where anxiety is the primary problem.  Don't go there.  The long-term problem with smoking is the same as the long-term problem with many meds -- they can adversely affect both the immune system and the liver.  The big problem with tobacco is, it is so toxic to so many different systems in the body long-term that in susceptible people everything is weakened in resistance.  At any rate, you'd want to stay away from antidepressants and anti anxiety meds that most impact the liver.  But as Greenlydia said, meds won't solve your problem, they'll only medicate it, and if it isn't significantly affecting your life I'd keep trying to find a therapist who specializes in what you have -- most aren't that good at everything, they're best at certain things.  Good luck.

[Brenndy]

Bupropion is an anxiolytic (medication used to treat anxiety).  Moreover, even though you state you have no intention of quitting smoking, this medication also has shown success in helping people with smoking cessation which, in your case would be a very good idea, considering the fact you are using Advair.

[RubyWitch]

I'm not aware of any antianxiety meds where smoking is contraindicated. I suggest speaking with your pharmacist, he/she would know of any such interaction.
(Could you have it confused with alcohol, which is a huge no-no with benzos?)

I'm sorry the therapists you've tried didn't help you much. Sometimes it takes us awhile to find a good "fit" with someone that we are really comfortable with and trust. I wish you would give it another try. Anxiety meds will help with the immediate symptoms, but until you get to the root cause of your anxiety and deal with that, the meds will only mask the problem.

Please speak with your doctor about medications and a referral to a therapist. Let's hope that the third time will be the charm!

I wish you the best
Peace
Greenlydia