Ask a Psychiatrist and Get Answers to Mental Health Questions ASAP
Hi! I believe I can be of help with this issue.
Benzodiazepines have been the most effective medications for treating pure anxiety and panic disorders in recent years. However, in many countries, including the US, doctors have become less inclined to prescribe this class of medications. They are a controlled substance in many countries and also in the US. This is because they are very addictive. They become very habit forming and when it is time to stop taking them, benzodiazepines can have very, very difficult side effects of withdrawal. And so the medical profession is reassessing the use of these medications.
Unfortunately, no other class of medications has been as effective as benzodiazepines. In the US, the medications that we see most replacing the prescriptions for benzodiazepines for anxiety disorders are duloxetine (Cymbalta is the brand name in the US), venlafaxine (Effexor), and escitalopram (Lexapro). These are in the SSRI and SNRI classes of medications. These are used for anxiety and for depression as well. Some people have excellent relief of anxiety symptoms, while others do not. They can also have withdrawal side effects, but not nearly as difficult as most people find with the benzodiazepines.
Then there is buspirone (BuSpar), which is also used primarily for pure anxiety disorders. Again, it is effective for some people but others find it not effective. So all of these medications are worthy of your discussing with your doctor to see which might be the most effective for you to try.
You might also consider adding a behavioral component to your treatment for your depression and anxiety. While behavioral treatment requires more effort from the patient than medications and is not as quick acting, it doesn't have the side effects nor withdrawal symptoms of the medications. If you would like to introduce a behavioral treatment, feel free to ask me another question about it. Just write “For Dr. Mark” at the beginning and everyone will know it’s for me.
Okay, I wish you the very best!
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I would like to know more about your 'behavioural component of treatment' as mentioned in your answer. Also, I just read something about natural remedy for anxiety on the net - such as Panicyl, Tranquilene. What do you think of them?
I am not familiar with these supplements, so I looked them up for you. The Panicyl seems to be based on GABA and ginseng. The Tranquilene is based on tryptophan and GABA.
First, there is no research evidence that shows GABA supplements to be effective in clinical anxiety situations. However, there is research interest in it and it has some evidence of helping mild anxiety. Tryptophan is an amino acid found in foods like turkey. Again, it has a mild sedative effect. Ginseng is well known in your part of the world. I would think you can find a cheaper GABA supplement and ginseng capsule. And tryptophan you should get by eating tryptophan rich foods rather than a supplement. Look up those foods on the net.
Now, let me turn to a behavioral approach. This includes medications if needed, but adds psychotherapy. The research shows both together are the most effective form of treatment. Psychotherapy is important because anxiety and panic and phobic reactions do not come out of nowhere and they are rarely only physiological events in your body. So therapy is an important way to manage the emotions and worries. Medications can give an important boost to your confidence as you work on learning management skills and what is going on in therapy.
I will also at the end of the posting give you a technique you can use on your own as well for when you are in the throes of anxiety and worries.
Let's work on five ways you can begin to build a behavioral program for yourself: diet, exercise, spiritual life, motivational reading and psychotherapy. The first four are to help you feel more involved and in control of yourself and what's going on inside. The psychotherapy can actually teach you skills and give you tools for managing your symptoms. This is serious for you as you need to reprogram your thinking about yourself. Spiritual life, diet and exercise are great ways to begin such a reprogramming.
Diet: cut out coffee, sugar, white flour. That may be tough. But you will see results as some of the newer research shows. And lean meats only. No fast food restaurants, no fatty foods. See what I mean about getting involved in controlling what's happening? With diet changes you are treating your problem with respect: you are acknowledging you need to make changes to get your body feeling better.
Vitamins can be useful for moods. A good quality daily vitamin, for example. One of the most important supplements is Omega 3 fatty acids, either in fish oil or capsules or in flax seed oil. Buy good quality. The clinical dosage is 1,600-3,000 mg daily. We discussed GABA above.
Exercise: 5 days a week moderate exercise, to include 3 days of strength training as you get more used to it. Pretty amazing isn't it? I told you it would require work, but what you put in to it you will get out of it. Your doctor will verify the research results showing the benefit.
Spiritual life: the medical literature is now rather overwhelming about the benefits to so many different areas of physical health of regular religious and spiritual practice. Going to church, meditation, etc. are all shown to produce benefits to the physical body. What about our mental health? Well, you will see that meditation is now a regular part of psychotherapy interventions. I don't know if you're a religious person or not. But if not, this may be a good time in your life to tune up your spiritual life. If you do not believe in G-d, that's not a barrier to your own spiritual life. Just thinking about the meaning of your life, of life in general, and studying spiritual texts and practices will help with the anxiety. And that will help with the phobic and panic reactions.
Then along with exploring the spiritual part of life, I want you to get really into motivational videos and books. Here's a simple YouTube search I put together for you on "motivational speakers": http://www.youtube.com/results?search_query=motivational+speakers&aq=f
Some like Tony Robbins are the classic big guys. Some are newer. There are wonderful women speakers now as well. Watch them all. Get inspired. Buy a book or two.
This book is by Anthony Robbins. He's one of those speakers who fills up huge auditoriums. For a reason. He's a terrific speaker and writer. The particular book (if you like it, try his others): Awaken the Giant Within.
Which brings us to psychotherapy. You need to find a psychologist or psychotherapist to help you manage the anxiety. Fortunately, anxiety is among the most researched disorders in terms of effective treatments. And the therapies today are very effective. The preferred form of treatment today is Cognitive Behavioral Therapy to learn skills.
If you want someone who isn't as structured as a pure CBT therapist, consider seeing if the therapist also lists humanistic and/or psychodynamic therapy in their orientation. The idea here isn't that these types of therapy are magic. It's that you may want to find a therapist who will form a strong therapeutic alliance with you and will help you look at the sources of your emotions and anxiety.
Okay, that should help you get working on these symptoms and get some relief. I wish you the very best!
Now, I want to give you a tool to use for when the worry and panic is overwhelming. Here are instructions on a therapeutic protocol called Progressive Muscle Relaxation (PMR). It's really quite easy to do almost anywhere. My patients suffering from depression or anxiety, when I teach them PMR at first are amazed how simple it is and that it is a psychological protocol. It was first used in the 1920s! Since then, of course, it has been refined and many studies have been done showing its effectiveness. You will practice PMR at first when you don't wake up with an attack so that you will be familiar with it. I want you to practice the PMR at least 5-6 times before an attack or feeling acute anxiety. Why? Because when you're in the throes of anxiety, you will only remember to do something you are very familiar with it. So practicing 5-6 times is really a minimum.
I want to stress the importance of breathing as well. Part of the physiology of what is happening to you in anxiety states is that your breathing is getting shallower. This reduces the oxygen in your blood to your brain. That increases the anxiety reaction, which strengthens the attack and you are in a vicious cycle! Not good. So breathing is the primary tool. I have found in my practice that learning breathing techniques can be helpful. But some of my patients are not interested in learning more than one thing at the beginning, so I have found that just reminding you to BREATHE deeply at the same time you are doing PMR is almost as good. If you are willing to take a yoga class and learn breathing techniques, that's the best. But, breathing deeply with your PMR will help. So, we're ready for learning PMR. I want you to print my instructions below my signature and have a copy in each of the rooms of your home where you may be when you have an attack. And again, you need to practice this easy technique at least 5-6 times as soon as you can. It needs to become as natural to you as breathing. Ah, remember breathing?
Quickly focusing on each group one after the other, with practice you can relax your body like ‘liquid relaxation’ poured on your head and it flowed down and completely covered you. You can use progressive muscle relaxation to quickly de-stress any time.
What You Need:
Note of Appreciation For Dr Mark
Dr Mark, I want to thank you very much for your comprehensive and comforting answer to my question. Though I am familiar with some of the medications you mentioned, you are the one who put them into a framework to let me understand better. I have been a mental health patient for 21 years, yet nobody has suggested to me that visiting a psychologist/psychotherapist will help me more. I requested to see a psychotherapist during my last medical appointment and I am seeing one next Tuesday! Thanks for your input. About other aspect you mentioned :
1) Diet : I am careful with what eat and I don't like sugary food. As to coffee, I drink coffee with fresh milk in the morning. Abrupt jump to No Coffee is difficult. Is Decaf coffee OK?
2) Exercise : I do exercise
3) Spiritual Life : I am a Christian. One TCM(traditional Chinese medicine) physician I visited ever commented I look spiritual(not religious)
4) Motivational reading : I bought the book you mentioned Awaken the Giant Within By Anthony Robbin. One regret is that : after my last relapse in early 2006, I have not been able to read well. This is in addition to my long term problem of not being able to sleep well.
Until now, when I feel unwell, I will go to have a foot reflexology session or a body massage. Sometimes I also go scalp treatment, facial and the like. Usually after this kind of external help, I feel better.
And one last thing, you ask me to print out the instructions for the PMR steps. Excuse me but my computer skill froze at the level 10 years ago. I don't seem to be able to find the print button to print your answer.
Once again, thank you very much Dr Mark