Question:
I've had daily anxiety, worry,
with cycling panic attacks since I was
seventeen, I'm now fifty-two. I've
tried the SSRI'S and a few others but
either didn't help or side effects were
too bad to stay on.
Last 4 years has been .5mg Klonopin 3
times day. Controls the panic
attacks but in stressful situation or
crowds or if I have to speak or sing or
someone is sick, anxiety still feels
higher then it should be. Also
concentration and focus on what someone
tells me or what I am telling someone
sometimes is hard. Do you know of
a better drug that would handle these
problems or should I try upping the
Klonopin to 2-3mg a day?
Dr. Heller's Answer:
SSRI'S frequently make the GAD
worse, particularly the cognitive GAD
(genetic worry). This diagnosis
responds much better to BuSpar
(buspirone). Once successfully
treated with BuSpar (buspirone), SSRI's
such as Prozac (fluoxetine) and others
can be used without increasing the
anxiety. I go into this in more
detail in the book
"Biological
Unhappiness."
Some individuals also have PTSD (post
traumatic stress disorder) - which can
be worsened by BuSpar (buspirone). These
individuals need Remeron (mirtazapine)
to keep that under control while they
are getting used to the BuSpar (buspirone),
then the Remeron can be
discontinued. Some individuals
have to start low and go slow with
BuSpar (buspirone) due to side effects,
but this is not common.
Once the anxiety disorders are corrected,
you can look into ADHD for the
concentration and focus problems. The criteria
can be found at:
http://www.BiologicalUnhappiness.com/AD-H-Dcr.htm
I also strongly recommend the book "Driven
to Distraction" by Hallowell & Ratey to
find out more about adult ADHD, which can be
treated after the anxiety disorders are treated first.
The Klonopin helps some, but is not as helpful
as the BuSpar (buspirone) with an SSRI. The
antipsychotic medications Zyprexa (olanzapine)
and Abilify (aripiprazole) can be very helpful,
although the Zyprexa (olanzapine) can cause
significant weight gain. Some patients
respond to Neurontin (gabapentin) and
Lyrica (pregabalin), but the scientific
literature is weak backing their usefulness.
The GAD, panic, depression, and ADHD can co-exist.
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