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4 hours ago, Butterflykisses said:

I am on a cocktail of medications that are pretty effective. I recently added Vistaril, 200mg (50mg 4x/day) and it really helps underlying anxiety and physical symptoms of anxiety. Anyone else find it at least a little helpful? I don’t want to use benzos so this is a good alternative for me.

glad its working for you, for me personally it barely had any effect

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I just recently got prescribed 25mg of Vistaril and it made me sleep really late into the morning or early into the afternoon. Also, it was making me more depressed than usual, so I stopped taking it and I felt a little better. I personally won't be taking it anymore, but I'm glad to hear that it's helping you!

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On 12/30/2018 at 11:42 AM, Butterflykisses said:

I am on a cocktail of medications that are pretty effective. I recently added Vistaril, 200mg (50mg 4x/day) and it really helps underlying anxiety and physical symptoms of anxiety. Anyone else find it at least a little helpful? I don’t want to use benzos so this is a good alternative for me.

Happy to hear that the Vistaril is working well for you!!......I tried it for awhile and it didn't do so well for me, personally.

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Vistaril (Hydroxyzine) is an older antihistamine with some nasty long term effects. As with all sedating antihistamines you tend to get used to the sedation over time. Vistaril is also anticholinergic, putting you are risk for dementia. I banned all anticholinergics from my regimine. 

 

https://www.pharmacytimes.com/publications/issue/2012/april2012/the-anticholinergic-cognitive-burden- :

The Anticholinergic Cognitive Burden

APRIL 08, 2012
Elena Beyzarov, PharmD

Drugs with anticholinergic properties have been linked with clouded cognition and even increased mortality.


With the impending allergy season once again threatening to ruin spring, patients and health care providers share the common goal of containing the well-known allergic symptoms that appear to bloom right along with many of the offending flowering plants. Systemic antihistamines represent a major pharmacotherapy component in the management of seasonal allergies, so a discussion of recent renewed concerns over the anticholinergic effects of various medication classes—most relevantly antihistamine products—appears timely.

Alarming Evidence

A recent editorial published in The New York Times forewarned consumers and physicians about the underestimated ability of common “drug store staples”— including analgesics, antihistamines, and various psychotropic agents—to adversely affect brain function via interference with acetylcholine. 1 Several research endeavors were cited, one of which examined whether use of agents with “possible” or “definite” anticholinergic activity (determined according to the anticholinergic cognitive burden [ACB] scale) increased the risk of cognitive impairment and mortality in older people. 2

References

1.Rabin RC. Cocktail of popular drugs may cloud brain. http://well.blogs.nytimes.com/2012/02/27/cocktail-of-popular-drugs-may-cloud-brain/.Accessed February 29, 2012.

2.Fox C, Richardson K, Maidment ID, et al. Anticholinergic medication use and cognitive impairment in the older population: the medical research council cognitive function and ageing study. J Am Geriatr Soc. 2011;59(8):1477-1483.

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2 hours ago, notloki said:

Vistaril (Hydroxyzine) is an older antihistamine with some nasty long term effects. As with all sedating antihistamines you tend to get used to the sedation over time. Vistaril is also anticholinergic, putting you are risk for dementia. I banned all anticholinergics from my regimine. 

Good point......I did try Vistaril for a short while, but it never worked for me......

Not to go off topic, but now I'm wondering about trazodone--is it considered anticholinergic?.....I couldn't find it on any of the lists.

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8 minutes ago, CrazyRedhead said:

Good point......I did try Vistaril for a short while, but it never worked for me......

Not to go off topic, but now I'm wondering about trazodone--is it considered anticholinergic?.....I couldn't find it on any of the lists.

Trazodone is not.  It lacks affinity to the muscarinic receptors.

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41 minutes ago, Butterflykisses said:

It might not be the best option, but I have exhausted a lot. 

I would not say causing alzheimer's is not the best option. There are lots more to try.

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3 hours ago, CrazyRedhead said:

What else have you tried for anxiety?.......Just curious....

all the benzos except valium. All atypical antipsychotics except fanapt and rexulti. A lot of typical antipsychotics. All SSRI's, most SNRI, clomaprimine, anafranil, buspar, inderal, all mood stabilizers. and I can't think of more at the moment. 

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11 hours ago, Butterflykisses said:

all the benzos except valium. All atypical antipsychotics except fanapt and rexulti. A lot of typical antipsychotics. All SSRI's, most SNRI, clomaprimine, anafranil, buspar, inderal, all mood stabilizers. and I can't think of more at the moment. 

That is a lot.....Did the benzos you tried just not work?

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8 minutes ago, Butterflykisses said:

No they worked but my doctors are not keen on prescribing them for long periods of time because of abuse risk. I see pdoc today and might try Buspar again instead. Yes, I have tried A LOT. :(

Just shows how pdocs can be so different.......I have never had a problem getting clonazepam, which I take daily, as prescribed...I have never abused it....My doc did try other things before prescribing the benzo, but nothing else worked, especially for sleep......If I don't get any sleep, all my conditions just get worse...

Good luck with the Buspar, if that's what you decide to go with.......

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1 minute ago, CrazyRedhead said:

Just shows how pdocs can be so different.......I have never had a problem getting clonazepam, which I take daily, as prescribed...I have never abused it.

Good luck with the Buspar, if that's what you decide to go with.......

Well my pdoc is very good. She's definitely not against them and has offered them to me, but she cautiously informs me that they are not a long term drug. I have had pdocs in the past who prescribed them with no hesitation, but I was on 4mg of Klonopin for a long time and became dependent on it, so I decided Benzo's are not for me.

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As for benzos, theoretically, benzos that have high affinity for the GABAγ2 subunit are the most addictive or most liable to be physically dependent. These benzos include:

  • temazepam (Restoril)
  • triazolam (Halcion)
  • alprazolam (Xanax)
  • lorazepam (Ativan)
  • midazolam (Versed)
  • clonazepam (Klonopin)
  • estazolam (ProSom)

So theoretically, if you know yourself as having a track record of benzodiazepine dependence, these might not be the ones for you.

The other subunits for which benzos have affinity have the following pharmacological effects:

  • α1: sedation, respiratory depression, sleep, ataxia, motor impairment, amnesia, anticonvulsant effects, reinforcing behavior
  • α2: anxiolysisdisinhibition
  • α3: anxiolysis, anticonvulsant effects, muscle relaxation
  • (α3 and α5: sensorimotor information processing)

The ones with low to moderate affinity to the γ2 subunit are:

  • chlordiazeepoxide (Lirbium) (low α1, low α2, moderate α3)
  • diazepam (Valium) (low to moderate high α2, high α3)
  • oxazepam (Serax) (low to moderate, moderate α2, α3?) (oxazepam is an active metabolite of diazepam)

So perhaps if you want to try another benzo, you could probably try one of these three?

 

The typical antipsychotics typically have a good anxiolytic effect, but aren't really a good long-term use medication due to their risk of TD.

  • Have you tried prochlorperazine (Compazine)? It is one medicine that is used for anxiety. It doesn't work well for me, but it does have an indication for it, and it's one medication that is actually still in production.
  • I would recommend trifluoperazine (Stelazine), which is my favorite of all, but I have had a terrible time trying to get it filled. Apparently no one is making it anymore. I asked about three different manufacturers and my pharmacy said all three were out of stock in all strengths. The same goes for thiothixene (Navane).
  • Perphenazine (Trilafon) is one that I'm currently trying to get prescribed that I've heard has anxiolytic effects (I think you commented on my thread about that).
  • Chlorpromazine (Thorazine) is good, but it is so sedating it can hardly be used during the daytime... 25-50 mg is about all I can handle, and it barely touches my anxiety at those doses
  • I think they used to make a combination product of fluphenazine + nortriptyline for anxious depression, kinda like perphenazine + amitriptyline, but they don't make it anymore; that being said, fluphenazine (Prolixin) might be a good one for anxiety. (I think you said you've taken that one before...)

There are a few TCAs I think you may not have tried. (btw clomipramine = Anafranil)

  • Imipramine (Tofranil) has an indication for GAD, tx resistant.
  • Doxepin (Sinequan) has an indication for "anxiety." (not sure if it'd be that effective though)

MAOIs are supposed to be great for anxiety, especially phenelzine (Nardil)

  • phenelzine (Nardil)
  • tranylcypromine (Parnate) (this one tends to be stimulating but can ameliorate anxiety quite well)
  • Marplan (isocarboxazid) (last I checked, this one Validus quit making this suddenly without any word of why, and it has something to do with the FDA...)
  • Emsam (selegiline transdermal system) (might not be the best for anxiety, but works well for depression, and actually has lost its patent exclusivity, so it should technically be generic, it's just that no one has bothered to develop a generic version it seems...)

There's also meprobamate (Miltown), but no one prescribes it, nor would they be willing to, and I highly doubt you'd get any pharmacy to be able to order it as I'm sure no one makes it anymore.

 

I think you've already taken them, but anticonvulsants can help with anxiety...

  • oxcarbazepine (Trileptal)
  • topiramate (Topamax)
  • gabapentin (Neurontin)
  • Lyrica (pregabalin)
  • lamotrigine (Lamictal, Lamictal XR)
  • valproic acid (Depakene)/divalproex sodium (Depakote)
  • tiagabine (Gabatril)
  • levetiracetam (Keppra) (perhaps? evidence is controversial...)
  • zonisamide (Zonegran)

Last by not least, there're the barbiturates, but I don't think anyone'd wanna get mixed up with those unless it were absolutely their last line...

 

I hope this helps. :) 

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