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TherapistMarryAnn, Therapist
Category: Mental Health
Satisfied Customers: 5804
Experience:  Over 20 years experience specializing in anxiety, depression, drug and alcohol, and relationship issues.
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I am taking prescribed .5mg XanaxXR four times daily. Also

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I am taking prescribed .5mg XanaxXR four times daily. Also Effexor XR 150mg. once daily. How long does it take for the meds to bind to receptors to get permanent relief from attacks? Also, since I am taking my meds as prescribed, sooner or later they will kick in, won't they? But why does it take so long to get all day relief? I am in second week of med regime and it's been an up and down experience every day except for twice when I felt great.

Thank you

Hi, I'd like to help you with your question.


When your doctor told you 12 to 15 days, he was being slightly optimistic. The pharmaceutical companies often state to patients that they will have significant relief within 14 days. The actual well researched truth, and this is very consistent with medications that affect biochemical absorption of serotonin and norepinephrine, is 6 to 8 weeks with 6 weeks being the average. While it is true you can be sedated out of your anxiety, that is not what you are looking for. So in the meantime, you may wish to try non medication anxiety control such as Cognative Behavioral therapy (CBT).


Some people also find that supplements can assist in mood stabilization and anxiety reduction. Although not all doctors adhere to this, research in both the UK and the US is very promising. Omega 3 fatty acid 1000mg, Calcium 100 mg, Magnesium Glycinate 100 mg, and Zinc 10 mg daily should help you. Please make sure you check with your doctor before trying this regimen.


Let me know if I can help in any other way,


TherapistMarryAnn and 3 other Mental Health Specialists are ready to help you
Customer: replied 6 years ago.
I don't know how this works but one question....the meds will work eventually and I will be back to my old self again, right? I trust my psych doc but I need reasurrance right now. At this time I feel like I will never get better.

I want to encourage you that the odds are in your favor that the medications will kick in within the time frame we discussed. However, every person's biochemistry is unique and not all medications combinations work with all people. If you do not experience some lessening of symptoms in the next 14 days, do not hesitate to request a different medication regime. Even though pharmaceutical companies do much research on psychiatric medications, the process of treatment is still, to a large degree, trial and error.


In the meanwhile, hang in there. There is an excellent chance the medications will work. But if they do not, there are many other medications to try. You can also consider counseling to help you. And there are many resources to educate you on other ways to improve your mood and reduce your symptoms. Here are some to get you started:


Self-Coaching: The Powerful Program to Beat Anxiety and Depression, 2nd Edition, Completely Revised and Updated by Joseph J. Luciani


Healing Anxiety and Depression by Daniel G. Amen and Lisa C. Routh


Overcoming Anxiety, Panic, and Depression: New Ways to Regain your Confidence by Arthur H. XXXXX, XXXXX Gardner


The Anxiety and Phobia Workbook by Edmund Bourne


You can find these books on or your local library may have them for you.


The more you know, the better your chances of recovery. Although medications are great to help your symptoms, therapy and education can help you reduce or eliminate your depression and anxiety for good.



TherapistMarryAnn and 3 other Mental Health Specialists are ready to help you
Customer: replied 6 years ago.

Just curious....You said:


The actual well researched truth, and this is very consistent with medications that affect biochemical absorption of serotonin and norepinephrine, is 6 to 8 weeks with 6 weeks being the average.


My question is why does it take so long for the meds I'm taking (XanaxXR & EffexorXR) for this to take effect on panic disorder. It's true I don't have the attacks because of the dose of XanaxXR I'm on but I sure don't feel like myself. I'm not calmly sitting here waiting for the whatever to kick in and feel great again. Do I make sense? I feel what I feel and work hard at cognitive therapy but it really, really doesn't help all that much. Anyway, why does it take so long for the meds to kick in?


Thanks again,




The medications work by slowly allowing each neuron to absorb greater amounts of serotonin and norepinephrine. The process by which this works is complex including the stimulation of certain receptor sites on the structures of each receiving neuron.


Psychotropic medications are very helpful but they are not your individual biochemistry. They are boosting, in a general way, very sensitive and complex chemical processes. As a result, you may feel better and not have panic attacks, but you may also feel blunted and limited in your connection to the world. This usually passes after an adjustment period but that time frame varies with each person.


To give you an idea of what is going on, there are more than 100 billion neurons in your brain, the majority of which are in your cerebellum. To grasp this number fully 10,000 neurons formed each second from the moment of your conception to your birth. To boost serotonin in this many neurons without causing you to have a serotonin cascade (serotonin syndrome) the medications have to be given in a way that allows your body to slowly raise the level of beneficial neurotransmitters rather than quickly. Yes, it is true that medications could be given to you which would most likely remove any feelings of anxiety and depression almost immediately, but the effects on your overall mental health would be so dangerous that it would impossible to market such a medication. That is why patience and supportive therapies are used in the interim.


Let me know if I can help in any other way,


Customer: replied 6 years ago.
Thanks for the info, Kate. I seem more able to not blame myself for how I'm feeling when I'm given full info. Been in this place before and never thought I'd be again but docs who knew what meds I was on and why I was taking them just handed out the narcotics one after the other with no time lag inbetween. I thought because I was on a maintaince dose of meds for PD I would be okay. Wrong!! Now I have to deal with something I prayed I'd never have to deal with again, Plus the stress from the constant pain changing my brain chemicals didn't help either. Fine time to find out that info after the fact! My psych doc and I both decided not to change my Effexor dose right now so if there was any problem he wouldn't have to guess which one was causing it. Had a good day today and you were part of why. Your answers helped me relax a lot. You have no idea what a comfort it is to be able to ask these questions that I need to know. My doc is great but we only have so much time to do the business at hand. He promised me he would get me back to my old smiley self, full of life again but at times it's hard to believe that could ever be true. Thanks for filling in the gaps for me. And I thank God for letting me find this was just "by accident" that I did.

You are very welcome! I am glad I could help. Thank you so much for your kind words. It is so nice hear!


If there is any thing else I can ever help you with, please let me know.



Customer: replied 6 years ago.

Hi, it's me again...It seems, according to my psych doc (and I agree) that I'm now having anxiety attacks on top of the panic attacks. But he's not sure....I have him baffled. The truth is that I don't trust the XanaxXR like I used to. After having the panic attack out of no where after 12 years a couple of months ago which I never ever expected to happen, I'm afraid all the time that they won't work anymore. I don't know if it's because we haven't found the right dose yet or I haven't given it enough time to work, but I'm in a mild state of anxiety all the time. Sometimes it's really a bad attack and I think I can't go on. My head says it will work in time and my mind says but suppose it doesn't. Can you help me understand what is going on? Am I doing this to myself or is it just part of panic disorder. My doctor wants so help me but I think I'm giving him mixed signals. He said he doesn't know if I'm having a physical problem or an emotional one but something is going on that he can't figure out right now. Please help me help him. I'm seeing him again Friday.




Hello. It's nice to hear from you again!


I am a little baffled about something you said. Anxiety attacks and panic attacks are the same thing. So I am not clear on the difference the doctor is making. He may mean something else, I am not sure.


From what you said, I believe it is your thought process that is making you more fearful. You are focused on the medication working and when you have anxiety, anything you focus on becomes an opportunity to be anxious. It is a good thing to know that anxious people tend to be very highly intelligent. And when they focus on something, it can be intense. The nature of anxiety is an over focus on thoughts and feelings to the point of creating anxiety and panic. Just from talking with you the past week or so, your focus has been the medication and it's ability to help you. If you feel that it is not helping, you are going to feel anxious about it. That is very normal for someone who has anxiety disorder.


Also, the idea that "something" is wrong and your doctor can't figure it out is frightening. When you have anxiety, hearing something concrete is comforting. You know where you stand. But hearing that something is wrong but there is no answer to what it could be is very anxiety arousing, even to people who do not have anxiety.


What you can do is realize that you are ok. The nature of anxiety is to second guess, be fearful and be ever vigilant. Give the medication time to work. Try other methods of reducing your anxiety, such as the books I recommended in the meanwhile. They will offer much reassurance from people who understand anxiety and/or have gone through it.


And if it makes you feel better, have a full medical endocrine workup. That will tell you if anything is wrong that can cause your medication to not work (such as hyperthyroidism). But it is probably not necessary. What you describe is classic anxiety.

And you are doing very well handling it.


Keep me posted on how it goes with the doctor.



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Customer: replied 6 years ago.

Thanks, XXXXX XXXXX you spelled it out makes sense. I did my doctor an injustice. He was trying to figure out why the Xanax didn't seem to be working and why I was feeling the way I was describing. He said he couldn't figure out if I was having an emotional problem that was causing the anxiety or just plain anxiety which he described me being the type of person exactly as you did, which he thought was causing my distress. Of course, I told him I wasn't THAT anxious and if I was it was because maybe the meds weren't working. Truth is, now I am beginning to accept as days go by that Xanax does work, it worked in the past and will work again. I'm beginning to understand that this attack, which I thought would never happen again as long as I was taking Xanax, really threw me for a loop. When this happened, I had just learned that I had severe lumbar spinal stenosis and other than what they had already done, there was no operation available that would give me sure freedom from pain. So here I was working on accepting my life was never going to be the same again and that I had to learn to deal with the pain or find ways around it. Opiates were not an option for me. Compared to being told I had terminal cancer, not such a big deal but it was a shock I never expected to have to deal with. Now on top of that along comes this panic attack that I didn't get a chance to deal with immediately due to unfortunate circumstances. Talk about stress!! I'm trying to stop blaming myself for the anxiety I'm feeling and using other things to work it off, like getting off my butt and doing the laundry even if it causes pain, going out to the store, all those things that use up adrenaline. I'm also telling myself the "truth" instead of catastrophic lies. BTW, Dr. Hernz did suggest I get my thyroid checked. I had a blood test done when I had my internal 6 weeks ago and he only called to tell me my vitamin D level was low and to take 50,000mg. once a week for 8 weeks plus 2,000mg daily. Made me so sick so I stopped taking them. This was right when I first started seeing Dr, Hernz and neither one of us knew if it was the D making my stomach upset or the stress, although he said the low D could be a cause of my feeling depressed even though taking EffexorXR. We made a decision again to work on one med at a time until we knew what we were dealing with.


I'm so grateful for you being here for me to "talk" to. You are really an answer to my prayers. You are a very caring person and totally empathic and understanding of my fears, emotions, etc.


Hope I don't offend you, but God bless you....


Thank you Rita! You made my day with your kind words.


I am glad you added a God Bless you! I am a Christian so I definitely am not offended, but very touched. Thank you.


You have had quite a time of it. The added stress of your diagnosis is no small thing, but you are handling it well. A majority of people would feel quite anxious to be told that they will not get total relief from pain. But you continue to work on the problem and that shows courage and grit.


Slow but sure is the best option for dealing with anxiety. Everyday is another step in feeling better and overcoming your fear. Letting time pass and trusting that you will get through this the most important thing to remember.


I am glad I can be here for you.


I will add you to my prayers tonight,


TherapistMarryAnn and 3 other Mental Health Specialists are ready to help you

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