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Dr Mike, PharmD
Dr Mike, PharmD, Pharmacist
Category: Pharmacy
Satisfied Customers: 95
Experience:  Doctor of Pharmacy, 20+ yrs experience, trained at the University of Iowa
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I need to see a doctor about bad anxiety and is quite bad, I

Customer Question

hello, good evening
JA: Hello. How can we be of help?
Customer: i need to see a doctor about bad anxiety and is quite bad
JA: Have you seen a doctor about this yet? What medications are you taking?
Customer: I saw a online doctor who prescribed me propranolol for s week till I see a gp
JA: Anything else in your medical history you think the doctor should know?
Customer: no, only that I have been taking 1mg of xanax each night to help relax and try to get some sleep
JA: What medications do you take daily? Are you allergic to any medications?
Customer: no medications but for the last week I have been taking xanax 1mg
Submitted: 1 month ago.
Category: Pharmacy
Expert:  Dr Mike, PharmD replied 1 month ago.

Hello! And, thanks for your question. I'm DrMike, a pharmacist with over 20 year’s experience, and I'm glad to help you today. I’ll just take some time while I review your question and get back to you with a response. I may have some initial questions for you…

Expert:  Dr Mike, PharmD replied 1 month ago.

The propranolol (which is used more for "situational anxiety" than general anxiety? It didn't seem to help it seems?
And the Xanax (it's used more for general anxiety conditions)... any help there?

Customer: replied 1 month ago.
Good evening, sorry for delay, that is perfectly correct
Customer: replied 1 month ago.
the xanax is so much better
Expert:  Dr Mike, PharmD replied 1 month ago.

Is the anxiety due to the exams? or something else...
Have you had major anxiety issues in the past?

Customer: replied 1 month ago.
the anxiety is due to worrying about situations I cannot control and terrible worrying about situations that could develop,
I have had anxiety issues in the past and I took Valium 5mg three times a day - this was about 5 years ago
Expert:  Dr Mike, PharmD replied 1 month ago.

How did the Valium work out for you... did you take it three times a day? Or did you have to take it more often?

Customer: replied 1 month ago.
I took it as the gp told me to, 3 x perday but after weeks my terrible situation resolved and I gained control so I stop taking valium and used them one or two time a year for times when I get myself worked up over something
Expert:  Dr Mike, PharmD replied 1 month ago.

Is your current anxiety, you think, due to the exams?

[I've had my share of those (and someone else's most likely)... I remember times, studying in the library (I went to the library because I thought it would reduce my anxiety. Libraries should do that, one would think.), and drinking coffee to stay awake and to increase my brain's ability to absorb information and focus. (Caffeine's supposed to do that, right?).]

Customer: replied 1 month ago.
it is not due to exams it is my business - at this time it is extremely stressful and I am really anxious all the time, to the point of trembling
Expert:  Dr Mike, PharmD replied 1 month ago.

It wasn't entirely clear from the preliminary questions you were given, are you on any other medications other than the propranolol and Xanax?

Customer: replied 1 month ago.
Sorry, I was prescribed propranolol yesterday via a online doctor, but i had from xanax that I purchased in another country and they are much, much better, I do not think the propranolol is doing anything. Apart from this I am on no other medication
Expert:  Dr Mike, PharmD replied 1 month ago.

Ok, that's excellent.
Do you have an appt with a prescriber? Is it a GP, or do you have access to someone more specialised (such as a psychologist or psychiatrist that can prescribe? In the States, a psychologist cannot prescribe...)

Customer: replied 1 month ago.
im in uk, but no I have no appointments but need to book one, just cannot face getting to the clinic to discuss, some days are a real chore to get motivated
Expert:  Dr Mike, PharmD replied 1 month ago.

I understand this... believe you me.
[I suffer from something very similar, and I don't like doctoring. I have to almost physically be dragged.]

I would entirely suggest a psychiatrist/psychologist if possible to really get "into your head". You do have control over issues that you think you don't, or issues you just don't want to deal with. You do! Even if you do realize that, that 'lack of motivation' prevents you from doing anything about it. I think it's high time for a more in-depth, a more thorough look inside that cranium. There's obviously been a lot going on since those 5 years ago that you last had that Valium.

Expert:  Dr Mike, PharmD replied 1 month ago.

I'll talk to you in just a bit as well about what I know best from the perspective as a trained chemist/pharmacist with 20+ years...

Expert:  Dr Mike, PharmD replied 1 month ago.

(I sounded like a commercial just then, didn't I...I apologize for that.)

So, there are many benzodiazepines, and several could be used for anxiety issues... (diazepam [Valium], clonazepam, lorazepam, alprazolam [Xanax], and on and on). They differ dramatically in their ability to quell your anxiety, and in how long they last...

SSRI's like Prozac (fluoxetine) are also a mainstay of anxiety treatment (and there are also many of those - they are relatively similar in their effectiveness across the board).

And then there is Cognitive Behavioural Therapy (CBT), which is essentially counseling (very effective as well).

Expert:  Dr Mike, PharmD replied 1 month ago.

(Sorry for my own delay - had to take the child to football practise - American football.) :)

Although I can't give you a prescription (as would not any online Dr as you have seen - propranolol is non-controlled substance), I can at this point give you a solid professional opinion that would show merit to any prescriber that you should decide to go to.

-You have a history of anxiety that is not necessarily brief, and not "situational" in the standard sense and is brought on by ongoing life events.
-You have been prescribed propranolol (which is usually used for situational anxiety), and you have received no relief.
-You have had a trial with Valium (diazepam, 5mg tid anxiety) and Xanax (alprazolam, 1mg qhs prn sleep/anxiety) and both have provided significant relief.

-You take no other chronic medications, have no other significant medical issues, show no history of abuse, and react well to benzodiazepines with a proven history as described above.

-You used diazepam 5mg three times daily for 'weeks' and describe no symptoms of withdrawal upon discontinuation

Valium is fast acting (30-60min), has a long half-life meaning it stays in your system for a long time (much longer than Xanax) - days as opposed to hours. If you happen to miss a dose, withdrawal symptoms are greatly reduced with Valium.
Similarly, due to its longevity in the body, when you discontinue, there is little likelihood that you will withdraw (given your history). Studies show that benzodiazepines can be taken by patients (not all patients, ofcourse) for a few months without experiencing significant effects upon discontinuation.

For anxiety, the minimal dose of Valium would be 2mg bid (or 2mg twice a day). You may well do just fine on this dosing regimen with a reduced risk of compromising side effects. You have taken 5mg tid (or three times a day) and done well on it.

My recommendation, then, to your prescribing provider is "diazepam 2-5mg bid-tid prn".

It will be up to your prescriber to write the final order of this med. My account above should greatly facilitate your access to this needed medication. -DrMike

Expert:  Dr Mike, PharmD replied 1 month ago.

(I understand the time difference; you're likely asleep at this hour).
We can definitely continue the conversation... if you're in need of or have further questions, I'm happy to continue the assist!

Expert:  Dr Mike, PharmD replied 1 month ago.

Hi, it's DrMike again...
I was wondering how your anxiety issues were coming along... Any resolution to this point or any changes?

Do you have any questions for me. I'd like to assist as much as possible.

-DrMike

Expert:  Dr Mike, PharmD replied 1 month ago.

.

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