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DrFee
DrFee, Psychologist
Category: Mental Health
Satisfied Customers: 437
Experience:  I help people overcome anxiety and enjoy life again.
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Is there something I can do about feeling this over anxious

Resolved Question:

Is there something I can do about feeling this over anxious feeling? I am on generic zoloft and tried to ween myself off. For some time now I've felt better but still took half the amount I was prescribed. Now some situations have arisen that have caused me to loose control and I start feeling even more depressed when I try taking my full dose of zoloft. Can someone please help me?! I feel like my answer lies with taking klonozapam which I was given with the zoloft at first and it did the trick.
Submitted: 2 years ago.
Category: Mental Health
Expert:  DrFee replied 2 years ago.

Hello! Please remember that my response is for information only, we are not establishing a therapeutic relationship.

I am a Psychologist, not a Psychiatrist --the latter is an MD who specializes in prescribing these medications. My information about these medications comes from 20+ years of working with people with anxiety and from interactions from Psychiatrists.

I can give you some detailed information regarding managing your anxiety, but before doing so I want to make sure that this is what you want. If you would rather speak to a Psychiatrist, please let me know and I will opt-out and send your question to a Psychiatrist.

Either way, please also answer this question -What do you mean by "lose control?" Do you mean that your anxiety gets out of control (panic attack) or do you mean something else (if so, what).

We'll move ahead based on your response, thanks!!

Dr. Fee

Customer: replied 2 years ago.
I don't mind who answers my question between you or the other person, I just need help. By lose control yes I mean panic attack or something to that nature I have no idea what it is. I have past thoughts I am extremely ashamed of and when this control is lost, I freak out about ANYTHING I can remember about those past actions. Thats where I mentioned before that I had been prescribed klonozapam (have no idea how that's spelled)and it seemed to help me through the zoloft setting into my system. I also wanted to ask if zoloft can have this effect on me even though I have been taking atleast half the dose prescribed? Would it take another 2 weeks or so to settle back in? If you need any other info please let me know.
Expert:  DrFee replied 2 years ago.

Hello Again,

First let me make a few comments about the medication and then I'll give you some information about anxiety. It sounds like you are a referring to Clonazepam (Brand name: Klonopin). It is a benzodiazepene (anti-anxiety) that is very effective for lowering anxiety in the short term. Zoloft is an SSRI antidepressant that is useful for lowering anxiety.

My disclaimer is that you should not be adjusting the dose at all without the guidance/help of a Psychiatrist. He/she might tell you to do the same exact thing that you are already doing, or he/she might have suggested a higher dose, or a different drug all together! The point is that it's much better to get the help of someone who knows what they are doing.

Having said that, however, if you are just starting on the Zoloft and having side effects --this is not uncommon. If your side effect is increased depression, I'd be much more concerned about that particular side effect than say gastrointestinal symptoms, dry mouth, or even a little dizziness.

The lower dose may or may not help your anxiety, however, starting with a lower dose and working up does seem to help minimize those initial side effects. In fact, I have a number of clients get Zoloft and similar drugs from a compounding pharmacy --where they can get the drug in liquid form and start with a dose lower than the lowest pill. Again, it may not be effective for lowering anxiety, but the goal is to titrate up to a therapeutic dose.

Now --here is some information on anxiety itself:


Anxiety is our body's signal that it believes danger is present, and the body prepares
itself to either fight, run away from, or flee from that danger. If we have to
get out of the way of an oncoming bus, it is quite useful to be able to move
quickly. The problem is that the body does not know the difference between
"real" danger such as a bus, and "perceived" danger --which
can be triggered by so many other things including ---thoughts, feelings,
memories, images, bodily sensations (even relaxation triggers anxiety for some
people, but also being too hunger, hot, or tired, or effects of medication).
"Overstimulation," which can occur when too much is happening and
"Understimulation," (not enough is happening such as waiting,
traffic, et) are also triggers. Anything external (sight/sound/smell/taste --as
well as florescent lights for some) can trigger an internal trigger and also cause
anxiety.

A first step to overcoming anxiety is to be able to identify what trigger(s) are
happening in each situation and dealing with the trigger(s). This can be
difficult, because they can both happen rapidly, be chained together, and be
subtle. Tired eyes from contact lenses is a great example of a super subtle
trigger.

The higher your anxiety the more difficult it is to address. You should start to rate your anxiety on a scale of 1-10, where 10 is a panic attack. You need to intervene at a 5 --anything at the 2-3 level ought to be tolerable. It takes some time to be able to identify triggers, but you can start rating your anxiety today --start by doing it at random times, like right now.

Cognitive Behavioral Therapy (CBT) is effective for learning how to control anxiety and eliminate panic attacks. Cognitive Behavioral Therapy (CBT) is often used. CBT examines the interplay between beliefs, emotions, behavior, and feelings in one's body when in a particular situation. Intervention in one area will affect the entire
system. With CBT one does a lot of work with identifying beliefs and making
counter or alternative beliefs to the irrational ones. These are then tested
out in real life situations in the form of "experiments." You can read about CBT here www.mindovermood.com and here www.nacbt.org/whatiscbt.htm


Here also is a great book, The Anxiety and Phobia Workbook by Edmund Bourne --

http://www.amazon.com/Anxiety-Phobia-Workbook-Fourth-Edition/dp/1572244135



You can find a therapist by searching at this website: www.psychologytoday.com



I know that anxiety is terrifying, uncomfortable, and for some like yourself, humiliating. It does not have to stay that way. Anxiety is extremely treatable and you can learn how to identify it early and control it. Medication is a great tool, but it will not cure your anxiety. Addressing the source and dealing with the in the moment triggers will allow you to gain control.

Gaining as much knowledge as you can about the problem will also help you.

I will give you instruction for abdominal breathing now, which is one of the best tools (when learned well) for lowering anxiety:



This is called the 4 by 4 breathing exercise because you should practice it for 4 minutes 4times a day to learn to do it well. If you are able, do this with your eyes closed, imagining a pleasant place. This is calming and designed to help you
manage stress. There are two important things to learn about breathing:



1. Learn how to breathe from your diaphragm (from your tummy area) and make that pattern a part of your daily life.

2. Become skilled at shifting to diaphragmatic breathing whenever you begin to feel
stressed.



Natural Breathing





1. Gently and slowly inhale a normal amount of air through your nose, filling only our lower lungs. Place your hands on your tummy so that you can feel it rising and falling with each breath. Count to 5 slowly as you do it.

2. Exhale slowly through your lips, counting to 5 as you do so.


3. Continue this slow, gentle breathing with a relaxed attitude, concentrating on filling only your lower lungs.


4. As you breathe, slowly repeat the word "relax" or "calm" or some other word which means the same to you.

If you have difficulty following the above instructions:


1. Lie down on a rug or your bed, with your legs relaxed and straight, a book on your tummy and your hands by your side.

2. Let yourself breath normal easy breaths.
Notice what part of our upper body rises and fall with each breath. Rest a hand on that spot. If that place is your chest, you are not
taking full advantage of your lungs. If the book is moving up and down, then, congratulations, you are doing it right!


Deep Breathing


Deep breathing is an extension of this normal process. With one hand on your chest and one on your abdomen, take a slow, deep
breath, filling your lower lungs, then your upper lungs. When you exhale, let your upper lungs go first (causing your upper hand to drop), then your lower lungs (causing your lower hand to drop).


Reminder: Too many deep breaths, instead of natural
breaths in a row, will produce a sense of lightheadedness. This is not harmful;
just return to natural breathing.



Practice



Natural slow breathing and the deep slow breathing
several times each day. Practice natural breathing for a period of at least 4
minutes, 4 times a day. The object is to train yourself to breathe from your diaphragm most of the time.

I hope that this gives you some hope and a start towards addressing your anxiety.

Please follow up with any specific questions about anything that I've said if you want. Keep in mind that there is a lot to know and learn, but you can do it --especially if you get some good help.

Regards,

Dr. Fee



Customer: replied 2 years ago.
So then I'm on the right track by increasing the dose back to normal? And also did you say that i COULD feel the same symptoms of the zoloft now, as if I just started taking it since I was only taking half and now the full dose?
Expert:  DrFee replied 2 years ago.

I don't think you are on the right track by making these decisions on your own, I think they need to be made in consultation with your Psychiatrist.

I thought you cut the dose in half and wanted to keep taking that amount----are you saying you now want to take the full dose as prescribed ? I may have misunderstood you.

You should take the medicine as prescribed and report any side effects to your Psychiatrist. Since you've already been making changes on your own, I suggest you call your Psychiatrist ASAP and get input as to what to do at this point.

Customer: replied 2 years ago.
My main problem I think might be that my doc is just an internal meds doc not a psychiatrist. But what I had been saying about my doses is that i was prescribed 2 tabs a day and after some time I felt good so I tried to cut the meds out, but only to find that it may have been a bad idea because this anxiety has been coming on. Now I'm trying to go back to the normal dose in hopes that it will straighten me out again. You wouldn't happen to know if they have sliding scale psychiatrists would you?
Expert:  DrFee replied 2 years ago.

 

I understand now!

 

Yes, while other doctors can prescribe these meds, it really is preferable to see a Psychiatrist.

 

If you are asking about sliding scale, I assume that means that you are paying cash (i.e. no insurance). The place to go would be a non-profit agency (some kind of community mental health center) or a County Agency. I would google "community mental health" --when I googled it a number of possibilities came up in my geographic area ---places called "Family Services," for example that have a Psychiatrist on staff.

 

If you need more help finding someone --let me know. I can google your geographic area and perhaps help you narrow down the choices.

DrFee, Psychologist
Category: Mental Health
Satisfied Customers: 437
Experience: I help people overcome anxiety and enjoy life again.
DrFee and other Mental Health Specialists are ready to help you
Expert:  DrFee replied 2 years ago.
Hi Alex,

I hope that you have been able to find a Psychiatrist who will take a sliding scale fee.

Thank you for your positive rating and for the bonus.
I do appreciate it!

Regards,
Dr. Fee

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DrFee
Psychologist
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I help people overcome anxiety and enjoy life again.