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Ralph LMHC
Ralph LMHC, Therapist
Category: Mental Health
Satisfied Customers: 872
Experience:  20+ years as therapist, supervisor, clinic director at mental health, substance abuse treatment ctrs
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I suffer from GAD and panic disorder, which come and go. For

Customer Question

I suffer from GAD and panic disorder, which come and go. For a few months I will be fine, and then a thought of worry about panic attacks I have had in the past suddenly comes into my head and I experience severe worry and panic attacks. There is no logic as to when these worrisome thoughts will occur. I would like to find the most effective and accurate prescription drug to treat these symptoms, but also a drug that has minimal side affects, is not harmful to the body, is not addictive and does not loose its effectiveness over time. Is it possible to take 2 medications-one on a daily basis and the other only when a panic attack occurs? I really don't want to be drugged up and would like to take the least amount of medication possible. I am extremely worried and would love your expert advise asap. thank you!
Submitted: 5 years ago.
Category: Mental Health
Expert:  Ralph LMHC replied 5 years ago.
Hello.
the most effective mean of treating generalized anzie4ty disorder is psychotherapy of the cognitive behavioral type (CBT)mwhere a change in tinking and behaviour results in a change in feelings the dfrug you describe is ideal, but doies not exists. The drugs that are commonly used all have baggage, The btricyclic anfranil has been used, but it hqas a tendenct toi put on weight and cannot be used by people mwith cardiac people, The antidepressant of SSRI. or SRNI class such as paxcil or effexor have a anxiolytic effect, but here tri=oo bthere are side effects. Lastly, there are the benzsodiaapines such as Ativanand Klonapin have been used, bbut theyt have a high addiction profile. You need ti discuss the presribing docyor for a risknbenefit analysis ib=n which uou are told the consequences versus the benefits. The oi=ositive thing about CBT is there are no side effects, nor addictio and it is the the most effective and revv=ommended means of treatment.
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Sincerely,
Ralph LMHC
Customer: replied 5 years ago.
I am thinking of starting cognitive behavioral therapy, but just to start so I can get through work I would like to take some type of medication. I have tried talking with my doctor, but she is short with me and I have a feeling I am wasting her time asking questions. I relaize most of these drugs will have some side effects, but is there a particular type with the least amount of side effects and addiction issues that you would reccommend?
Expert:  Ralph LMHC replied 5 years ago.
Hello.
I am not a physician, but am quite familiar with psychotropic medications. You wull obviously need to talk to your prescribing physican. SSRI's like Paxcil,Lexapro,Luvox, and Zoloft (you tried Celexa and Citalopra),etc are often used as an anxiolytic medication. The problem is that they take from 3-6 weeks to work. Please note that it is not uncommon for the medications to loose its effectiveness after a time. People are often given a benzodiazapine to "cover" them until the other medication takes effect. You may note that anecdotally, my clients have reported different degrees of effectivess and subsequent relief from generic Klopoin. You can either go for the brand Klonapin (which is more expensive) and not clorazepam, or a different generic. You may consider a different benzodiazapam like Lorazapam (Ativan), but it as all benzodiazapines is addicting and will require a tapering to wean you off of it. Lastly, some psychiatrists that I know have used an older tricyclic antidepressant (which is indicated with OCD) Clomipramine (Anafranil). There is a problem for some people putting on weight and people with cardiac conduction problems are advised not to usr this medication. Some of the herbal teas like Valerium can be tried, but even though it is considered a food and not a drug you should discuss it with your doctor or possibly the pharmicist, not the sales person at the health food store, before using. As you can see there is no perfect solution , and trial am error takes place, but you should ask your docyor for a risk/benefit analysis discussing the pluses and minuses about any medication. Best wishes and good luck.
Sincerely,
Ralph LMHC
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Customer: replied 5 years ago.
I talked to my doctor and she told me to try buspirone. Is this a good choice according to you? She said it was milder, which I'm wanting right now because clonazepam is very toxic. I was taking 3 mg a day, and am now weaning off it, taking 2 mg of clon and 10 mg of buspirone, but I feel awful. I have this horrible burning sensation in my head, I can't stop shaking, I can't eat, it's hard to sleep, I have stomache cramps. Are these normal withdrawal feelings? I'm scared I'm going to die from these feelings. Are these feelings harming me?
Expert:  Ralph LMHC replied 5 years ago.
Hello:
I am not a physician so I can not recommend medications, but I can share the information that I have and share the experiences of my patients. Buspirone is the generic name for the anti-anxiety medication, brand name Buspar. It is designed to be used for anxiety. With respect to clonazepam, brand name Klonapin, in general the slower the taper, the milder the withdrawal symptoms so I would definitely tell my prescribing physician and perhaps she will slow down the amount that she cuts down. So please be sure to tell her what you are experiencing as she cannot help if she does not know what you are going through. In general, most physician do not drop from 3mg to 2mg overnight, but usually more gradually. There are several factors including how long you have beeen taking the Klonapin, size, etc.   Benzodiazapine detox can be dangerious, so it must be closely supervised to avoid the dangers of possible seizure, etc. Again, I would contact the physician and if necessary use the doctor's emergency number and contact her to report your symptoms. As far as as buspirone, it is not addicting so you will not have the same experience should you stop. Ten milligrams is the usual initial dose which can be titrated up.

Sincerely,
Ralph LMHC
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Ralph LMHC
Ralph LMHC
Psychotherapist
872 Satisfied Customers
20+ years as therapist, supervisor, clinic director at mental health, substance abuse treatment ctrs