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Doctors' Answers to "Frequently Asked Questions" - Anxiety

These comments are made for the purpose of discussion and should NOT be used as recommendations for or against therapies or other treatments. An individual patient is always advised to consult their own physician.

Anxiety Attacks [posted 1/14/99]
Question: I recently started 20 mg oxycontin 2 times a day. I have had anxiety attacks for the last 6 weeks, thought they were gone, and now they are back. Does oxycontin have any effect on CNS that would cause symptoms similar to anxiety like fast heartbeat, short breaths, nervousness? If so, what are my options?

Answer: Not usually, but you'd need to stop it for a while to see. Narcotics cause funny symptoms in some people. If that is the cause I'd try Fentanyl (skin patch) to see if different metabolism would help.

Anxiety Disorder [posted 1/11/99]
Question: Where can I get a list of all foods containing Tyramine, as I get a bad reaction to certain foods while using Aurorix for Panic Attacks. I was advised to quit the medication because of the bad reactions to certain foods Ex: dizzy spells, visual disturbances, tightening of the area around the Adams Apple, confusion, extreme lowering of blood pressure, skin reactions. Are it the foods causing these reactions or am I intolerant to the medication?

Answer: A dietician can give you a complete list. Some of them are: chicken liver, pickled herring, cheese(especially aged or sharp), yogurt, sour cream, beer, wine (varies a lot by type), broad beans(Fava, etc.), figs(canned only), bananas, avocados, active yeast(not with baked bread), soy sauce, raisins, chocolate.

Anxiety treatment with Beta Blockers [posted 1/11/99]
Question: I have heard that beta blockers work well with anxiety and was wondering which ones would work well? Also, do the side effects last after you stop taking the drug and while on it while your body adjusts to it? I was wondering this because I saw that one of the side effects was asthma. Will it go away after you stop taking the drug? I was thinking of taking Propranolol to help in my recovery of anxiety while seeking other help.

Answer: Works while you are taking it and the side effects will abate within 12-24 hours of stopping it. It will not cause permanent asthma, but can exacerbate existing asthma. Almost all the beta blockers have an effect. We usually use propranolol for some reason.

Clonazepam for Anxiety [posted 1/11/99]
Question: I have been taking Clonazepam for about 2 weeks for anxiety/panic attacks. I'm worried about getting addicted to this medicine. What can I do to not get addicted? I take 0.5 mg three times a day.

Answer: About the only way not to get addicted is to decrease the dosage and frequency.

Anxiety Treatment [posted 1/7/99]
Question: I was diagnosed with an inherited anxiety condition and told it would never get any better. I was placed on drug therapy with xanax. It helps at times, but is it worth it knowing I will have to be on drugs the rest of my life? I am very sensitive to drugs. we tried several different ones. My stomach would not tolerate them. Xanax is the only one that does not make me feel sleepy or drugged up. Is this a condition I will have to live with the rest of my life? Is there anything else I can do? The same condition has shown up in one of my daughters and was very serious. She had terrible anxiety attacks and was taken to the hospital at least 2 to 3 times a month. She would throw up, faint, and quit breathing. It was a terrible fright and worry. She is completely off all her medications now and is doing great. She is 30 years old. So I am wondering why the same thing cannot happen with me. I am 49 years old.

Answer: Anxiety disorders tend to wax and wane. So, some have periods when they don't seem to need medications or much lower doses. Sometimes small doses of SRI antidepressants will help this problem. It's worth trying with or in place of xanax if you haven't.

Meclizine as Anti-Anxiety Meidcation [posted 12/02/98]
Question: Can you give me information about the antianxiety effects of meclizine? Thank you.

Answer: Pretty minimally effective. But, is a sedative in some.

Anxiety & Panic Symptoms [posted 11/25/98]
Question: I am 32 and have had problems for over a year now. It started with a panic symptom of feeling like I couldn't breath got very dizzy almost passed out. I went straight to dr and he said maybe it was acid reflux and put me on Prilosec. About 3 weeks later it hit again this time it was a lump in throat couldn't swallow throat was extremely dry. Dr says same thing acid reflux and sent me in for barrium test that showed nothing wrong (I done these test standing and only drinking small amount of barium I have heard from others that had this done that they done lying and drinking large amounts) well after this the attacks became more frequent so they tried Paxil 20mg which really set me off so then they tried ativan .5 twice a day this did good for a month then he stopped it and it came back worse now they are trying klonopin and this makes me feel very drugged and heavy feeling. I have tried therapy what else can I try medicine way because I still have this feeling in throat! that interrupts swallowing I feel bloated all the time especially after eating which I don't do very much anymore lost a lot of weight. Could I have a hernia or something and would this cause such severe nervousness, I did have back problems 2 yrs ago and this seemed to start after that. Thank You

Answer: Sounds like a panic attack. But other options are acid reflux from your stomach and/or gall bladder disease.

Medicating for a Situational Phobia [posted 11/6/98]
Question: I have a severe fear of flying, but I have to fly for business. I had been taking valium, but it didn't seem to work -- I felt like I was still going 60 mph in 2nd gear. My doctor recently gave me Ativan to try. It still doesn't have the effect I'd like. Is there a "best" medication for situational phobias?

Answer: Often taking a SRI antidepressant with the valium helps. This may need to be started several days to a week before the flying time, you'll need to experiment. Also, increasing the Valium usually works. Ativan and valium would be expected to work in similar ways so I would pick one and increase the dosage or try an antidepressant with it.

Medicating for a Social Phobia [posted 11/5/98]
Question: This E-mail may change my life totally. I think that I have what you call a generalized Social Phobia. I work in Computer business, but I am losing most of my capabilities. I am avoiding some interactions with people. I always have a crisis of intense sweating, high blood pressure, and uncomfortable feeling at work or even in simple talking with others who has a higher ranking or whom I am not familiar with. At the same time I behave normally with people I know well. I am extremely limited at work and life, almost unable to carry out daily tasks that involve new social contacts like introduction to new people. Sorry for being lengthy but here in my country, I cannot find a doctor that can understand my case. I am feeling like this from years and hopeless. I read from Internet that my case can be treated using one of the following: Beta-Blockers, MAO inhibitors and benzodiazepines [alpazolam(Xanax) or clonazepan(Klonopin) or Ativan (lorazepan). I started to take clonazepam 2mg/day from one week, 1mg at 11am and 1 mg at 11 pm, and I am feeling better but did not loss my anxiety totally, without any serious side effects. Please recommend if this dosage is suitable for me or it is better to increase for 3-6 mg/day. How long should I take it e.g. 6 months or one year or more. I want really to start my life and be one of the normal people, and I appreciate any response.

Answer: The dosage of this drug is judged by response. Since you are better, stay with the current dosage. However, this drug will cause physical dependence(ok if you need it to function) SRI antidepressants(prozac, paxil etc) can be very effective with this type of problem and are not addicting. Also, sometimes they allow decreasing the dosage of the addicting medications.

Should I Change Meds From Serzone to St. John's Wart [posted 10/30/98]
Question: I have been taking serzone for roughly six months and have begun to experience neck and headaches. Sleep patterns are excellent and depression/anxiety patterns stabilized. I would like to reduce the amount that I'm taking from 350mg per day to 250mg per day and combine it with 900mg of St. John's Wort. Can I do this safely? Eventually, I would like to try taking only the St. John's Wort.

Answer: Why change it if it is working? I wouldn't combine the two, although it's probably safe-if it ain't broke don't fix it.

Queries about Lectopam [posted 10/23/98]
Question: I suffer from General anxiety and depression. I just started on Zoloft after trying Effexor without success. I'm also on Xanax for the anxiety. I was wondering about Lectopam and how this works for anxiety compared to Xanax, which is not helping control my anxiety.

Answer: It should if you take enough. What is your dosage?

Switching Panic Disorder Medications [posted 10/13/98]
Question: My physician recently told me that the strength of klonopin has been recalculated and that it is now believed that 4 mg. of Klonopin is equal to l mg. of Xanax. Previous data I have read stated that Klonopin was twice as potent as Xanax and that in fact 1/2 mg of klonopin equaled the potency of 1 mg. of Xanax. My doctor would like to titrate me from Xanax to Klonopin but has prescribed a dose of 4mg. of Klonopin five times per day in addition to 1 mg. of Xanax five times per day and after one month intends to reduce and eventually re- place xanax with Klonopin and then reduce Klonopin gradually. Do any of the Physicians on this site know if Klonopin has in fact been found to be only 1/4th the strength of Xanax.

Answer: Why are you switching? In general, drug equivalency data need to be used only for a starting point. Each person metabolizes the drug differently and you may need more or less than this calculation. His numbers are fairly close to what most physicians would use.

Concerns About Longterm Anxiety Medication [posted 10/9/98]
Question: I have had anxiety disorder for 27 yrs. My mother,grandmother and I were all raised in Foster Homes. I am sure my disorder is genetic not psychological. I have been taking 1mg daily of Klonopin, 37.5mg of effexor and 25mg of trazadone daily for 5 years with great results. I am a recovering AA member of 19 years and feel badly that only a benzo can help. I cannot take enough of an anti-depressant to get a good enough effect to stop the K. My shrink is also an addictions psych and he knows I am not abusing the K. I am sure that I never will. My main side effects are drowsiness and loss of sex drive. Do you see anything wrong w/ me being on K until something better and non-addictives comes along?

Answer: No, especially not if it allows you to be functional.

Anxiety & Swallowing Problems [posted 10/2/98]
Question: I have recently developed a swallowing problem. I am finding it difficult to swallow unless I tilt my head forwards, which makes it easier but still not 'normal'. My tongue also feels a bit odd (in terms of its positioning in my mouth - ie. I am aware of my tongue when I shouldn't be) and has a lot of furring towards the back. My Adam's Apple also feels tight. I am aware that things don't feel right and when I try to swallow it feels like the food gets stuck at the back of my throat and I then involuntarily gag or have to cough to clear the food so that I can breathe. Frequent at first,now it is a problem virtually all the time. I have suffered from panic attacks which were treated with Propanolol and although I don't get them any more, my heart rate greatly increases when I the swallowing problem occurs and I have to pace around for a while to calm down. Your help would be greatly appreciated.

Answer: Hard to know if it is the panic attacks or a mechanical problem in your throat. But, you should have a modified barium swallow to check the swallowing mechanism.

Combination of Anti-Psychotics for Anxiety Treatment [posted 7/22/98]
Question: I am on a combination of anti-psychotics: Risperidone (4mg/day), chlorpromazine (250mg/day), haloperidol (15mg/day) and Penfluridol (30mg/week). I am also on Clonazepam (1mg/day) for chronic anxiety which is combined with my schizophrenia. Can I replace all the other medications with risperidone alone, probably a higher dose? Also I would like to withdraw clonazepam. Will risperidone take care of my anxiety also?

Answer: I wouldn't anticipate that one drug would work.

Question: How can Serzone help an Anxiety condition? Can it cause more anxiety or irritability? Also, is it safe to take Ativan for long periods of time? I been taking 1 to 2 mg of Ativan per day for nearly 6 months.

Answer: The parts of your brain that control depression clearly have something to do with anxiety. Either that, or the same chemical deficit that causes anxiety is involved with depression. SRIs and similar drugs like Serzone can have a major impact on so called agitated depression. They rarely help pure anxiety. Sometimes a combination of an SRI or a drug like Serzone with a anxiety drug like Ativan is necessary. Long term use of Ativan is addicting, but Serzone does not appear to be. Ativan should not be taken with alcohol or while operating machinery.

Anxiety/Panic Disorder
Question: My son, age 11, has been diagnosed by a child/adolescent psychiatrist with a type of anxiety or panic order. The physician prescribed imipromene which, as I understand, is a type of antidepressant. The dosage is 75 mg at bedtime. My son has been on the full dose of this medicine for 2 1/2 weeks. I understand from our physician that this could be considered long-term intervention. I am concerned about the implications of long-term use. I am also concerned about my son's behavior while on the drug. His teacher report unusual quietness, he does not engage with friends as in the past, and he seems overly dependent on me as parent. Do you have any insights into these questions?

Answer: What was he like before the drug? Did you have any problem with his behavior? The question is whether he is better off taking the drug or not. You'll be able to answer this since you are with him every day. There should be no problems with long term use; but, this sedation will persist in general. There are other drugs for panic disorder like SRI antidepressants. You might try other drugs and see which one he tolerates the best.

Buspar & Side Effects
Question: Buspar has been prescribed to me for anxiety disorder. I have read the commercialized information on it, but I need to know how it really affects Seratonin levels. I have experienced some dizziness with the drug along with slight fatigue. Will this pass? How harsh is the drug on my kidneys and liver?

Answer: The dizziness will usually improve over 2 weeks or so unless you increase the dosage. Not clear how the drug affects serotonin levels and it does not belong to the Serotonin Reuptake Class of drugs. There could be some liver toxicity; but, rare-minimal risk to kidneys.

Anxiety Causes
Question: My teenage daughter had respiratory problems and was diagnosed by a physician as suffering from anxiety. What are the causes of anxiety and how to overcome them? Her anxiety has led to lack of sleep and throwing tantrums at home.

Answer: Don't really know; but, it tends to run in families-especially panic disorders. This has led many to theorize that it related to genetic variations in brain chemicals. Occasionally, seen in hyperthyroidism or after drug withdrawal as well.

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