Starting Medication? (Anxiety/Panic Disorder)

Miscellaneous and Personal Stuff I Must Share
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Hey everyone - looking for some feedback and experiences! I’ve had varying amounts of generalized anxiety disorder, panic disorder (intermittent), and (I suppose, but it’s hard to separate it all out) depression since around 2005. I’ve always done well with a combination of CBT and exercise. I’ve had a flare-up in the past year, and I’ve kind of hit an unpleasant plateau with the CBT and exercise combo. I’m at a point where it’s not the worst, and I’m muddling through, but there’s this low-grade presence that is not good for the overall quality of life!

My therapist has broached the possibility of adding an SSRI to the mix and I’m bringing it up with my GP. Any advice or thoughts as I go down this road? I’m trying to be hopeful for some positive change.

One note - I was on Fluxoxamine (Luvox) for about 2.5 years some time ago. Worked ok, but there was about 35 pounds of weight gain that came right off when I tapered off of it. My only experience so far.

To add - I’m not looking for responses that anti-anxiety/anti-depression meds are an illegitimate crutch/pushed by the medico-industrial complex to paper over the reality of the dystopian capitalist nightmare we live in/etc. I mean, you can give those responses, but I’ve been there; heard that and am not that interested in it.

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My mother had good results with Lyrica (pregabalin). She had occasional mild panic attacks. She also had rheumatoid arthritis so she had the added benefit of reducing some of the discomfort from that. But she did experience a little weight gain.

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Interesting coincidence, CNN has just reported that Luvox is a possible treatment for Covid.

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Wow; that’s super weird! I need to look that up, I wonder how that works.

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I have CPTSD and anxiety and I discovered that when I was prescribed a beta blocker (bisoprolol) for high blood pressure it also reduced my anxiety by a huge margin. Dunno if that’s helpful to you but I have to say the beta blocker has zero side effects for me and the anxiety reduction is extremely welcome.

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One piece of advise is that, if you can, I think I would see a pschiatrist specifically. My GP is great, but when I was having some issues last year, his pharmeceutical solution wasn’t the best for me, so I sought out a psychiatrist, and things have been much better and much more closely monitored and adjusted as needed. I see someone has mentioned the beta blocker – I take a light dose of metoprolol myself and it has helped with anxiety by keeping my pulse down. (I take separate medication for my blood pressure, as well) . I also take gabapentin – that one I really can’t feel much of an effect from, but I guess it somewhat takes the edge off. I have Xanax on an as-needed basis, but that one I’m very careful about. I still have the same bottle that my GP prescribed me almost a year ago. There’s another drug called hydroxyzine that is supposed to have similar panic relieving properties without as much risk of abuse as benzos. I haven’t tried it yet, as my psych said he’ll prescribe it for me if I run out of Xanax, but I don’t look to be running out of it anytime soon.

Good luck! As I’m sure you know, it takes a bit of fiddling before figuring out what works, that’s kind of why I suggest seeing a psychiatrist if you can.

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I got very little info from the little piece, but apparently Luvox prevents brain swelling that is one of the damaging symptoms of Covid. This was a report from the CNN TV doctor whose name eludes me at the moment. Despite this promising treatment for people who do contract severe cases it appears there has been little work done on this because it’s an existing low cost drug with no big profit picture like creating a vaccine.

Also, try the new stuff and see what happens. Don’t be afraid to say it’s not doing what you need and then give it up and try something else. Nothing ever really got the job done for me, but in the end I don’t regret looking.

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I would recommend seeing a psychiatrist. Therapist and GP don’t know enough about the medications to mix and match and stabilize you. I have Bipolar 2, 80% depression, 20% manic. I take Effexor XR (SNRI) (also helps with anxiety/panic attacks which I used to get) and a mood stabilizer lamictal (it’s also an anti-seizure med). Your illness is valid and based on what you wrote, your brain chemistry is off. I’ve been on meds almost 15 years and I’m doing well. I feel my emotions but I don’t get down into the valley or up to the mountain top for long. Overmedicated means you won’t feel anything. I don’t seem to carry extra weight because of these meds. I see my Dr. every 6 months as a checkup to determine if I’m still stable. I still do CBT, although my exercise regimen is almost non-existent…There are some really good meds out there, just be patient as it might take a little while to get the right mix. Even though I don’t know you, I’m really proud of you for reaching out and getting honest about your needs. It’s so easy to feel stigmatized for needing meds for our illnesses.

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My son has a similar dx to yours and finds the lamictal/lithium/hydroxizine combo very effective without much in the way of flattening affect or side effects. Took a little while to get it all balanced right but the lamictal was the one that finally sealed the deal and made it all work together for him.

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I’ve been on Luvox myself, and had some of the same issues. My doctor experimented with other SSRIs. Prozac was a bust, but it does have a nice weekly pill form. Effexor (technically an SNRI) had great effects on mood, but unfortunately had dangerous effects on my blood pressure. I settled into Celexa, which worked great. I tried the more pure version of Celexa, Lexapro, but it didn’t work as well, and went back on Celexa.

Everyone is different, of course. I’m not saying Celexa will work for you. Just that different drugs in the same class aren’t quite the same, and may work differently for you. If you don’t have the blood pressure problem, Effexor is apparently really good. And I know some people swear by Prozac (though I note it is one of the more stimulating SSRIs for a lot of people).

One benefit of SSRIs is that they have a synergistic effect with CBT. Doing both together has a greater effect than either one separately, unlike with some other drugs. So it’s definitely something worth trying.

I would agree that you should go to a psychologist to actually go on medication, and then possibly switch to using your GP only after you’re stabilized on the new meds. However, I also know from experience how that not be a practical choice, due to insurance, availability, or quality of care. (I’ve known some psychiatrists where my GP was just better, as the psychologist just didn’t have time to be thorough.) Still, you should at least probably try if you’re going to go on new psych meds.

I do think that the right medicine will likely help you out a lot. But do note they often take a bit to work, so don’t dismiss them right away. And, if you have any side effects, give them a bit to see if they go away (ask your doctor for how long to wait, and which side effects you shouldn’t wait on).

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Wow! Isn’t Luvox an SSRI?

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I was briefly on Luvox for fidgeting and stimming-type behaviors that included teeth-grinding and nail-biting, both of which were getting to be more than just cosmetic problems. Anyone who wants more details can PM me.

It worked a little, but not perfectly, because I still had to think about not doing them, I just didn’t get antsy when I didn’t.

What I did get was Luvox’s most notorious side effect, though, which is that it severely depresses one’s libido, and can make it impossible to have an orgasm.

This was affecting my marriage, so I stopped the medication.

The teeth-grinding wasn’t really grinding-- it was more tapping, and was a response to anything rhythmic around me (or occasionally the song stuck in my head), so it didn’t happen in my sleep, or I would have gone with the bite-guard the dentist wanted me to get. With my terrible insomnia, plus the fact that I was aware of doing it while awake, I looked for other solutions, though.

The nail-biting had less to do with any kind of oral fixation, than with a need to keep my nails even-- I’d bite them any time one got torn or chipped, trying to even them off. So I started keeping emery boards everywhere-- in the car, in my backpack, in my wallet-- and would use them whenever the need arose. Gross? probably, but maybe a little less so than chewing my nails. However, the nail biting habits stopped for good when I was pregnant. I knew that putting my fingers in my mouth was a good way to pick up a virus, and that was the last thing I wanted when I was pregnant.

I take clonazepam (Klonopin) for anxiety that keeps me awake, and when my mother was in hospice three years ago, my doctor gave me more of it per month, so I could also take it during the day if I needed to. If I felt anxiety building, I’d take .5mg, and it stopped the anxiety in its tracks, I’d say, 4 of 5 times. The other times, another .5mg did it. I probably averaged 2mg every 3 days, excluding what I might take at bedtime, which at the time, was maybe .25mg 2 or 3 times a week (but other nights I took 5mg Ambien-- I took that maybe 2 nights a week).

To be clear, I don’t take Klonopin to put me to sleep-- that is, it doesn’t in and of itself knock me out (albeit, a higher dose probably could, but the .25 to .5mg I take at bedtime PRN does not). All it does is turn my brain down when it’s racing.

There are plenty of epileptics who take a low dose of Klonopin on a regular basis, and function perfectly fine. It’s a benzodiazepine, but it is “cleaner,” IME, than Valium or any other I have taken (I haven’t taken them all, but I’ve had five altogether; PM me for details RE: each one). Not only is there no hangover when I take it, but I can get up and function if I need to shortly after I’ve taken it. I don’t think it’s a matter of just being used to it, because I don’t take it every day-- I take it maybe 3 times a month right now.

Another medication I have experience with is an older antidepressant, one of the tricyclics. A lot of insomniacs take then, because they make you drowsy, but most of them have lots of side effects, weight gain being a big one. However, there is one I’ve taken which actually made me lose about 5lbs, and which, like Klonopin, did not make me stuporous; if I had to get up and function shortly after taking it, I could. Even driving on it was not a problem.

That is desipramine. Now, I have not taken this specifically for anxiety, but given that it was pretty effective in stopping my brain from racing, I’ll bet it would work for anxiety. It had no sexual side effects.

Before desipramine, I tried amitriptyline. This worked too well. It made me stuporous, unable to function for 3 or 4 hours after taking it, and I gained almost 10 pounds in the two months I was on it. I had crazy sugar cravings, which are not good in someone with hypoglycemia.

That’s what I have off the top of my head. I’m happy to answer any questions, either in the thread, or by PM.

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Oh, yeah. Thirding, or fourthing this. Once you have been stable on something for a while you can have your GP prescribe it, but you really should see a psychiatrist to “launch” you.

It doesn’t hurt to see a therapist once a week for the first few months. They can be very helpful in monitoring you for side effects. They may see one creeping up before it gets really intrusive. You can tell a therapist at first appointment that this is your main concern.

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I’m just going to echo this. Finding the correct solution for you may take some time, and this will be frustrating. Talk with your psychiatrist. And I do mean psychiatrist. I cannot emphasize this enough. A GP is great for general practice and for getting the ball rolling, but is inefficient for getting the correct solution, whether it be meds alone, combined with CBT, or other.

This positive side effect I find quite interesting.

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I thought so. Here’s an article I just found on this subject.

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I looked up the bit about beta blockers when I was prescribed them, and the way they help with anxiety is by tamping down on the physical aspects of it. Beta-blockers are not approved by the FDA for anxiety, but they are sometimes used off-label to help treat it. Metoprolol got my average pulse down from the 90s back into the 60s and low 70s (where historically it’s usually been settled.) In conjunction, my general antsiness and constantly energized state was reduced, thus feeling less anxious overall. It didn’t make me feel any slower or sleepier or anything like that – just calmer. I’ve also been taking an ACE inhibitor for my blood pressure for going on six or seven years now, but that did nothing for my anxiety (it works great for my BP, but doesn’t seem to alter my heart rate.) It was the management of my pulse that seemed to relax things a bit.

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Propanolol (brand name, Inderal, among others) is well-known for have a wide variety of uses: it’s used for a heart condition called “long QT syndrome,” it was very commonly used for migraines before the triptans came out, and it’s used for anxiety as well.

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Adding my voice to “find a psychiatrist” (mine is actually a NP that specializes in psych medication) and “plan on it taking time.” I’m pretty balanced with sertraline, trazadone (for sleep, but its an old antidepressant) and buspirone, plus ativan for the emergency anxiety (but I get about 1 5mg pill a month, so I seldom use them, and don’t need them). Instead I have hydroxzine, which is a prescription antihistamine that is used to treat anxiety. Avoid regular use of benzos unless its absolutely necessary - they are addictive as hell.

My youngest has anxiety, depression and ADHD and has been on an alphabet soup while they try and get a balance. Anxiety and ADHD often go hand in hand, and because ADHD meds are usually stimulants, its tough. Add in a 21 year old with a 40 year old’s PVC (premature ventricular contractions - their heart throws in lots of extra beats), and medicating to not increase anxiety while solving the ADHD is hard.

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@SmartAleq - do ACE Inhibitors ever have the same effect? I’m supposed to be starting lisinopril fairly soon (for a different issue…which may have been encouraging this anxiety flare up).

I’m interested that there is such a consensus around doing this with a psychiatrist instead of just a GP. That’s really good to know. I’m the sort of person who is normally trying to go as far as I can into the “don’t use medication” approach, but I feel like I may be finding the limits of that. I don’t want to avoid medication just out of stubbornness. In some ways, I’m glad these options are available even if they are poorly understood. Hell, thousands of years ago, all they had was “suck it up” and “wine that gladdens the heart of man” (Psalms). Which isn’t much. There are some advantages to living in our time.

I’m planning on keeping up the CBT, in part because it helps me keep my thinking straight about things apart from the anxiety. It’s a good practice. But @BigT - I’ve looked at the studies that show a stronger effect with medication and CBT together.

It’s the “mess around until you find what works” part that worries me. I’m concerned about my patience and being able to recognize that it has worked, you know? I also don’t want side effects to screw with my ability to work; I’m in a “early career” stage in my field and I don’t want to get it wrong.

To add - I actually want to get my exercise regimen back. I was running 5-6 miles, and now (in part because of the anxiety flare-up) I’m good to get in a 25 minute walk.

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In my experiences, no, ace inhibitors don’t work like beta blockers. Propranolol basically goes after the hear racing, heavy breathing side of panic./anxiety… They reduce blood pressure by making your heart beat slower, basically.

If you already have high blood pressure, it might be worth checking if you could try propranolol instead (if a psych doctor says it is okay). But doing both is probably not a good idea, unless your blood pressure is just that bad.