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!!
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 preparesitself to either fight, run away from, or flee from that danger. If we have toget out of the way of an oncoming bus, it is quite useful to be able to movequickly. The problem is that the body does not know the difference between"real" danger such as a bus, and "perceived" danger --whichcan be triggered by so many other things including ---thoughts, feelings,memories, images, bodily sensations (even relaxation triggers anxiety for somepeople, 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 --aswell as florescent lights for some) can trigger an internal trigger and also causeanxiety. A first step to overcoming anxiety is to be able to identify what trigger(s) arehappening in each situation and dealing with the trigger(s). This can bedifficult, because they can both happen rapidly, be chained together, and besubtle. Tired eyes from contact lenses is a great example of a super subtletrigger.
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 entiresystem. With CBT one does a lot of work with identifying beliefs and makingcounter or alternative beliefs to the irrational ones. These are then testedout 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 --
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 youmanage 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 feelstressed.
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 nottaking full advantage of your lungs. If the book is moving up and down, then, congratulations, you are doing it right!
Deep breathing is an extension of this normal process. With one hand on your chest and one on your abdomen, take a slow, deepbreath, 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 naturalbreaths in a row, will produce a sense of lightheadedness. This is not harmful;just return to natural breathing.
Natural slow breathing and the deep slow breathingseveral times each day. Practice natural breathing for a period of at least 4minutes, 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.
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.
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.