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I know about the benzodiazepines, but what other meds are good for anxiety? I have never had any luck with SSRI's and SNRI's.

Abilify seems to be helping with my GAD, but I'm still left with a very bad panic type of anxiety so I would be looking for meds that are good for panic. This panic is leading me to avoid certain situations and activities that I must be active in and avoiding just makes it worse.

The one SSRI that I didn't try is Luvox. Is there any reason to believe that this would be better than any other SSRI for a panic type of anxiety?

Basically what I'm asking is what are good non-benzo meds for panic?

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I know about the benzodiazepines, but what other meds are good for anxiety?

I find a low dose of Zyprexa is good for that fingernails on blackboard sensation of anxiety that I have lived with for my entire life. This is 2.5 mg per day orally or 1/3 of a 5 mg Zyprexa Zydis tablet taken buccaly (between cheek and gums). The difference in dosing is due to buccal administration bypassing first pass metabolism and the ~30% loss of drug to said metabolism.

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To me the most definitive symptoms of a panic attack are the physical ones, if you can't even look calm how can you stay calm?

You said that you were avoiding certain situations, it sounds to me like beta blockers would be a good choice for you, all they do is block the adrenal receptors in the brain (i'm pretty sure anyway). Basically your heart won't be as likely to beat out of your chest, I've noticed far less jitters, shakes, sweating (i typed swearing accidentaly, but i suppose that too) and restlessness. The simple fact that your anxiety doesn't translate into physical symptoms is a huge help. I'd give it a go.

Also, they work wonders with a low dose benzo.

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Another good option is neurontin. I know the snake oil salesmen marketed it for everything, but one thing it really IS good for is panic and anxiety.

I find seroquel paradoxical. I get so sleepy if I use it during the daytime it increases my anxiety/irritability because I cannot function. But if I'm at home freaking out, yeah a small dose will chill me out (then cause me to fall asleep).

Abilify would NOT be so good for anxiety I would think. Zyprexa did help for me.

If you haven't tried benzos yet, buspar might be a reasonable option. It works well for some people.

Benzos are really a last resort as far as I'm concerned, though I'm currently on a bunch. This was more for avoiding a flip out episode, though, mania wise, than anything.....

Anna

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Thanks guys. The AAP's that are said to be good for anxiety (Zyprexa, Seroquel) are very sedating, and to me there is a difference between sedation and lack of anxiety. With sedation you're just sleepy, but the mind can still be in a state of anxiety. At least this is how it is with me.

Neurontin is an interesting suggestion, and I know that it is used for GAD, but I didn't know that it was good for panic. I probably am going to bring up the possibility of beta blockers. I just don't know if they will contribute to my depression or not. Also do they help with anxious thoughts or just the body's reaction to them? I need something that helps my mind's reaction and not just my body's reaction.

Luvox ... I don't know. I'd hate to waste a month only to find out that it won't work and in fact would make my anxiety worse.

I need to work a lot of this over in therapy, I know, and I'm working on getting the therapy that I need, but I'm just looking for med options.

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Beta blockers are good for some sorts of anxiety (performance anxiety, some PTSD), but they can aggravate depression and worsen asthma and respiratory problems. Also, if you're prone to low blood pressure, they can worsen that. I don't see them used all that much for panic attacks, but they might be worth a shot. I'd be more likely to try BuSpar or Neurontin myself.

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Buspar was a horrible drug for me. It didn't do much of anything except give me side effects. I'm a little shocked about Neurontin because I didn't know it was useful for panic. Wikepedia is very negative about it.

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Thanks guys. The AAP's that are said to be good for anxiety (Zyprexa, Seroquel) are very sedating, and to me there is a difference between sedation and lack of anxiety. With sedation you're just sleepy, but the mind can still be in a state of anxiety. At least this is how it is with me.

The suggested dosage of Zyprexa (2.5 mg per day) is below the threshold for significant antihistamine effect. It is really only affecting serotonin receptors at that dosage and it is non-sedating IME. It is very relaxing, but not it is not sedating until you reach the 5 mg per day dosage IME.

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Thanks guys. The AAP's that are said to be good for anxiety (Zyprexa, Seroquel) are very sedating, and to me there is a difference between sedation and lack of anxiety. With sedation you're just sleepy, but the mind can still be in a state of anxiety. At least this is how it is with me.

The suggested dosage of Zyprexa (2.5 mg per day) is below the threshold for significant antihistamine effect. It is really only affecting serotonin receptors at that dosage and it is non-sedating IME. It is very relaxing, but not it is not sedating until you reach the 5 mg per day dosage IME.

I should also not that even at that low dosage where it primarily antagonizes 5-HT2A and and 5-HT6 it turns both buspirone/Buspar and citalopram/Celexa into sugar pills. Bot buspirone and citalopram used to have clear clinical effects in my mind within 60 minutes of taking a pill. Now they do nothing.

Currently, I am getting great results from 500 mg naproxen sodium TID. But that is due to lower back issues and the fact that my mind makes me manic in response to pain to ensure my emotions are always one notch higher in intensity than my physical sensations. And due to stomach ulcer side effects, I cannot continue it long term.

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I should also not that even at that low dosage where it primarily antagonizes 5-HT2A and and 5-HT6 it turns both buspirone/Buspar and citalopram/Celexa into sugar pills. Bot buspirone and citalopram used to have clear clinical effects in my mind within 60 minutes of taking a pill. Now they do nothing.

Can you please provide some source of this that's not your own rambling version of internet science? Because this assertion is just wacky.

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Ive been ion Luvox before. The only things I can remember about it that separate it from other ssris are:

- shorter half life. 15 hrs from memory. Typically you take 2 pills a day, one in the morning one at night, whereas most other ssris are around 24 hrs, once daily (except prozac which has a very long half life, though still once daily).

- it also has strange interactions with caffeine and nicotine. I read somewhere that it can increase caffeine by up to 5x, and smokers may need a higher dose than normal.

- It is particularly aimed (in the US) at the OCD market. Other ssris also work for OCD, but luvox has been given the tick as the best ssri for OCD.

- I think there is an interaction with grapefruit as well. You are advised in the PI sheet to avoid it. This isnt a problem unless you are a grapefruit lover.

I had a reasonable amount of success with Luvox. I took it for around a year for OCD, Panic Disorder and depression. My p-doc ended changing me to Paxil, and then more recently prozac.

If you havent tried luvox, it mught be worth a shot.

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I use a beta blocker, metoprolol

Other antidepressants that are quite effective are the TCA's, TriCyclicAntidepressants. I've taken Elavil at a low dose before.

Thanks. I really don't do well with AD's though I haven't tried Luvox. Elavil is just too sedating for me at any dose. I can't get up the next day because of it. I now take a sedating AD (Remeron), and it doesn't help. Maybe I'm different, but to me there is a difference between sedation and relief from anxiety.

Beta blockers might be something that I would like to look into though.

Ive been ion Luvox before. The only things I can remember about it that separate it from other ssris are:

- shorter half life. 15 hrs from memory. Typically you take 2 pills a day, one in the morning one at night, whereas most other ssris are around 24 hrs, once daily (except prozac which has a very long half life, though still once daily).

- it also has strange interactions with caffeine and nicotine. I read somewhere that it can increase caffeine by up to 5x, and smokers may need a higher dose than normal.

- It is particularly aimed (in the US) at the OCD market. Other ssris also work for OCD, but luvox has been given the tick as the best ssri for OCD.

- I think there is an interaction with grapefruit as well. You are advised in the PI sheet to avoid it. This isnt a problem unless you are a grapefruit lover.

I had a reasonable amount of success with Luvox. I took it for around a year for OCD, Panic Disorder and depression. My p-doc ended changing me to Paxil, and then more recently prozac.

If you havent tried luvox, it mught be worth a shot.

Thanks. Yeah, I heard about the weird effects with caffeine and nicotine. This could be a deal breaker for me with Luvox. I love my coffee.

I think many meds interact with grapefruit. I think several of my meds do. Luckily I don't like grapefruit.

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I'm on nardil, an MAOI inhibitor. It seems to hit gabba receptors, like the benzos. It helps with anxiety. I don't take much (30 mg) because at increased dosages I get apathetic and tired. Also helpful is atarax. I also take zanaflex, a muscle relaxant very occasionally. Oh, and I almost forgot chloral hydrate, a hypnotic, which works very quickly and is very effective. My pdoc pretty much gives me whatever I ask for and doesn't give a shit because he hates his job. Anyway, they all help for anxiety, but I recommend using any of them as sparingly as possible because they tend to kill energy.

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I hear what you said about needing something to target the thoughts as well as the sensations. I'm not the best advocate for betablockers, as they didn't help me, but I would say that they make a good first attempt. For me, it often helps if I can head off the physical panic (for me, racing heart and hyperventilation come first) because then I'm only panicking mentally, and it's easier to breakdown my issues and stop panicking.

I hope you find something that works!

N

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Thanks everyone! Vistaril is Atarax which is an antihistamine. At this point, based on what I've read here and from talking to several people, I'm even more convinced that a beta blocker is best for me. I'm going to talk to my pdoc about it when I see him in a couple of weeks. I think that a beta blocker will take away the physical component of anxiety which will make it easier to deal with the mental anxiety using CBT techniques.

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