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/ Best treatment for Anxiety... Ideas?

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Wallker on 15 Feb 2018

Hi all.
I'd would like to know what is the best medication for anxiety in your opinion. Severe anxiety I mean, as in a somebody cannot eat ,sleep or do anything atm because of it.

EuanM - on 15 Feb 2018
In reply to Wallker:

I haven’t suffered from severe anxiety but have had definite mood improvements from cold water swimming.

It can be a mentally challenging thing to do but it doesn’t give you the opportunity to think about anything else. 

The cold is also supposed to act as an anti inflammatory and therefore helps joint and muscle pains. I was using it to recover from running injuries. 

You get the added boost of a big endorfine dump when you dry off as well. 

There are plenty of article online about the benefits - https://health.spectator.co.uk/fewer-illnesses-less-stress-cold-water-swimming-can-change-life/

Safety is obviously really important but going and going with a group is always a good idea. 

ClimberEd - on 15 Feb 2018
In reply to Wallker:

Read 'Lost Connections' by Johann Hari and try and build on its ideas.

I find the writing style intensely irritating, and a touch sanctimonious, but the general message is very good. (simply put, people, community, a sense of security and a sense of purpose will give robust mental health.)

In the very short term if the mental health is crippling then drugs can help. Sorry not to be able to help with specifics. 

1
Muttly on 15 Feb 2018
In reply to Wallker:

here are some good self help resources.  http://www.cci.health.wa.gov.au/resources/consumers.cfm

dr_botnik - on 15 Feb 2018
In reply to Wallker:

Sertraline.

But it's important to remember that a medication regime in isolation won't fix everything. You should actively try engaging in therapies such as CBT, mindfulness, etc. The medication will (hopefully) just reduce your symptoms enough that you can successfully engage in these practices to rewire the way your neurons fire.

Hope this helps, if you want more specific methods for coping with anxiety I could run through some or point you towards some resources, all the best.

minimike - on 15 Feb 2018
In reply to Wallker:

Based on my wife’s experience it required a combination of talking therapy, both psychotherapy and cbt, along with regular exercise (running/swimming in her case) and medication (sertraline). AFAIK the choice of medication is very personal and some people have to try a few before they find an effective one. 

Also, I’d just ask if your GP is ‘onboard’ with this kind of thing. Some are amazing, others just reach for the pills and leave it at that. If yours is in the second category maybe seek a second opinion from someone with a special interest in mental health. Your surgery or local mental health charity can often suggest good people.

Hth, it can be debilitating and hard to take these steps so if you need an advocate try calling mind or similar! Don’t be afraid or ashamed, it’s incredubly common...

mike

Rigid Raider - on 15 Feb 2018
In reply to Wallker:

I've suffered spells of anxiety and have always found that my anxiety is self-inflicted and based on ignorance of the real picture, so that confronting the concerns and finding out the real truth always helps. 

And yes, exercise helps as any mountaineer knows. Long operiods or introspection can help you to think things through and the endorphin high makes you feel good.

4
marsbar - on 15 Feb 2018
In reply to Wallker:

https://moodgym.com.au

Can be helpful.  Exercise definitely helps.  The "just do one little thing a day" approach can help if being  overwhelmed is an issue. 

If you can't eat I can recommend hot chocolate with cream as a way of getting calories in.  Also banana and peanut butter and full fat milk blended in a smoothie.  

If it is this bad it may be that you do need to rest and take it easy.  

Not sure which medication is best, you may need to try a few.  

JJ Krammerhead III - on 15 Feb 2018
In reply to EuanM: there is a chapter in Roger deakin's book waterlogged about the effects of cold water on all kinds of maladies including anxiety.  Birdwatching and of course hillwalking are often cited as aids to fighting anxiety  . Climbing perhaps, after some recovery! 

 

bedspring on 15 Feb 2018
In reply to Wallker:

I suffered with anxiety for years, its a habit. My turning point was a book called The Power of Now.

In the morning, write on a piece of paper.

Something wonderful will happen to me today.  It usually does

I will smile today.                                                  Then  Smile

I will say something nice to someone.                  Then try to

I am totally responsible for my life, how I act and react.  Because you are ;-)

 

Its not easy, and anyone one who says it is, does not understand. I do slip back from time to time. But remember Bad times come, but they go. Good times come, but they will go, so enjoy them.

Good luck.
 

aln - on 15 Feb 2018
In reply to Wallker:

I suffered from anxiety attacks 20 odd years ago, to the point where eg, I'd be out shopping and it would build to the point where I'd dump my shopping and literally run out of the shop and go home. Although it affected me to that degree I was still conscious that it was irrational, I don't know if that's the case here. My doctor prescribed beta blockers, they don't have a psychological effect but they slow your heart rate so you don't get into the cycle of feeling anxious, your heart rate increasing, noticing that then that increasing the anxiety. It helped me take a step back, look at what was happening, then take control of the situation and the anxiety, rather than it controlling me. It might not work for everyone but it certainly helped me. 

Post edited at 10:16
Dave Cumberland - on 15 Feb 2018
In reply to Wallker:

Best advice would be no medication, but learn TM, Transcendental Meditation.

It takes four mornings to learn and made one woman on our course look ten years younger and it saved another's life.

I can put you in contact with a very helpful person, TM is available in all areas, GPs recommend it.

Best wishes.

DC

12
slab_happy on 15 Feb 2018
In reply to Wallker:

Re: medications -- it honestly depends on your individual neurochemistry. Different people respond to the same medication in different ways. For example, some people in the thread have name-checked sertraline, but some people actually get more anxious on that.

So it can take some trial-and-error to find the right med for you; you need a doctor who you get on with, who's willing to listen to you about side-effects and work with you to find something that helps.

I agree with what everyone else said about trying non-medication methods too, and again it can take some trial-and-error to find what helps you (whether that's CBT or a different form of therapy, relaxation training, yoga, mindfulness, etc.).

But if you can't sleep, eat or do anything, "go for a brisk walk! think positive!" isn't going to cut it. You may need medication in the short term to get things under control so you can try other methods (and it's possible you'll be one of us unlucky sods who need medication for life, and there's no shame in that, but there's a lot of stuff to try first).

See your doctor. Start there.

Good luck, hang in there, and I hope things get easier soon!

combatrock on 15 Feb 2018
In reply to Wallker:

Mirtazapine has helped me a lot. The only downside is weight gain (3 stone of it!). CBT therapy helped too, I did an online course recommended by my GP. It helped me recognise when 'it's the anxiety talking'. Doesn't mean I can stop my mind going to those places all the time, but I can now at least recognise when it's my own head 'lying' to me and gradually learn to ignore it/shrug it off. Please go to your GP or a local support group as everyone is different and you need to find what works for you. It does get better though.  

anaeurope - on 15 Feb 2018
In reply to Wallker:

I know that the Cbd oil is great for a number of conditions, especially anxyety, acting on the specialized receptors in the brain.

It is edible, therefore easy to take, like cooking oil, added to food or even just as medication, taking a few drops.

You can see more info here in the link:

https://www.vigorfield.com/online-store/health-tips/cbd-oil-hemp-extract.html

 

5
womblingfree on 15 Feb 2018
In reply to aln:

Another one for beta blockers, as it doesn't mess with your serotonin you're still you, just the physical symptoms are damped down

Be persistent with the NHS, accessing services can be a royal pain

abr1966 - on 15 Feb 2018
In reply to Wallker:

If the anxiety is so high that its impacting on basic functions like eating....better to pop along to the GP, they may prescribe or refer to a mental health team. 

Medications collectively referred to as SSRI's.....selective seretonin re-uptake inhibitors are the first line treatment but as others have said there are a few choices such as Sertraline or Prozac etc.

They are usually very helpful but take 2-3 weeks on average to be notably helpful. 

Worth a chat with the GP.....therapeutic work can also help but sometimes if the anxiety symptoms are so high a short time on meds helps first...

profitofdoom on 15 Feb 2018
In reply to Wallker:

> I'd would like to know what is the best medication for anxiety in your opinion. Severe anxiety I mean, as in a somebody cannot eat ,sleep or do anything atm because of it.

I suggest you ask a doctor

2
Mike Peacock on 15 Feb 2018
Ben Sharp - on 16 Feb 2018
In reply to Wallker:

Most people seem to have said that different things work for different people, which is true enough. It sounds like your friends anxiety is severe enough to warrant a trip to the doctor who will most likely start them on some form of medication, in the short term at least. All I can say is stick with it, it might be the first drug they try or it might be the 5th but it's worth persevering. As other's have said, they might be on them for life but more likely they will be a stop gap to help them on the way to recovery.

Unfortunately there are still Doctors out there who don't distinguish between anxiety and depression, CBT may help you but where I live for example there is one CBT therapist to cover 150,000 people and I know of someone who gave up because they just didn't get on with them. Keep trying, try different doctors, try different meds and if needed seek out private help.

Post edited at 07:33
In reply to Wallker:

A few thoughts from a personal perspective...

Anxiety may be a symptom of something else, it would be worth getting a professional view of this. 

Paul Scheele does a great paraliminal CD for anxiety.

I wish you all the best.

 

 

 

 

tripehound - on 17 Feb 2018
In reply to Wallker:

Monash university based in Melbourne do a great online Mindfulness course. It is free and takes a minimum six weeks.

Mindfulness is scientifically based, taking the best from Cognitive Behavioural Therapy and ancient techniques such as meditation. If its really bad then you may need a psychotherapist

to provide taylored therapies.

I hope you find some peace.

P.s. ignore the dates online as the course runs continuously. 

 https://www.monash.edu/news/articles/learn-mindfulness-in-free-online-monash-course

Post edited at 12:11
n-stacey - on 17 Feb 2018
In reply to Wallker:

Go and see your Gp.

 

1
phizz4 - on 17 Feb 2018
In reply to Wallker:

From personal experience I would say avoid medication. Research suggests that it can be as little as 5% effective and can create more problems than it solves. (My first course of treatment made me worse, the second course, on a different medication, had no effect whatsoever but had unwanted side effects). What worked best for me was counselling, yoga, exercise and good, supportive, friends who knew about the problem. However, we are all different so that may not work for you.

6
minimike - on 18 Feb 2018
In reply to phizz4:

I don’t see why you’re getting dislikes for this.. it’s your own experience and you say that.

Medication won’t work for everyone and certainly isn’t a quick fix, but it will be part of the answer for some. My wife would never have been able to take part in the psychological therapies without it.. but in the long run I agree, it’s the non pharmaceutical parts of the treatment which have the best chance of establishing someone on a long term stable path. 

Psychological problems are complex and we have to think open mindedly about the range of options available. I’m glad you found a way that worked for you!

mike

Dave Cumberland - on 18 Feb 2018
In reply to minimike:

> I don’t see why you’re getting dislikes for this..

Equally negative comments for the suggestion about TM. That suggests people have closed minds and do not understand what TM is about. Bio-feedback creates altered chemical balance within, and this is far preferable as phizz has pointed out to the intake of drugs even for a short time.

DC

1
slab_happy on 18 Feb 2018
In reply to phizz4:

> Research suggests that it can be as little as 5% effective

That's flatly untrue.

The actual data for SSRIs is something like 20-30% greater effectiveness over placebo for depression (I happen to know the depression data better than the pure anxiety research). N.B. what this means in practice is "20-30% more people go into remission on a particular med", not "you only get 20-30% better", which is one reason why it can take trying various different meds to hit one that works.

Have a relatively balanced review:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3736946/

Or an article on a recent meta-analysis:

https://www.theguardian.com/commentisfree/2017/sep/01/antidepressants-work-shame-people-ssri

> My first course of treatment made me worse, the second course, on a different medication, had no effect whatsoever but had unwanted side effects

Yup, that's unfortunately not rare. I've been on the medication merry-go-round too, and it sucks; as I said, it can take a fair amount of trial-and-error to find a med (or non-med method!) that works for someone. I'm glad you were able to find things that worked for you.

And I will be the first person to agree that we need more research and better medications and some ways to start predicting which meds will work for which people! And much, much better access to therapy on the NHS; I've watched friends trying to get through that maze and it's not fun.

But spreading misinformation about anti-depressants is damaging and dangerous.

Anyone who's dealing with bad depression or anxiety is already struggling enough without having that added to the mix.

quirky - on 18 Feb 2018
In reply to Wallker: My personal experience took a several pronged approach , in no particular order of effectiveness :

Exercise, i joined a gym (shock horror for me) and went to early morning classes , i still do, that way i had a time and reason to get up and start my day. I found this very effective and still do. 

Talking therapy, particularly around assertiveness and emotional intelligence. 

Keep a mood diary (i modified "daylio" as it pesters me to list my daily activities and feelings. 

Trying to be less detached by doing quick and simple things as enablers to taking one tiny step forward.

I also saw my doctor and went on medication, you will hear good and bad things about this route and as i have zero medical background i will not comment as every individual is its own case and that is a discussion for you and your gp. 

Things do get better but you have to want it, there is no magic bullet, i sympathise as it is debilitating, dangerous and crippling but it doesn't have to be, there are some wonderful people out there to help you and not everything works for everyone. My experience of depression and anxiety has opened my eyes, no one is immune and it can leave your life in tatters at the time. You will get better, it will not always be this way. Forward relentless motion!!! ! One baby step at a time. 

 

Post edited at 12:38
Tall Clare - on 18 Feb 2018
In reply to Wallker:

I've had problems in this area for years - somewhat debilitated by it at the moment. As everyone says, everyone's different, but things that help/have helped me include watching my diet (lots of fruit, veg, water, and reduce caffeine, alcohol and too much 'yellow food' (i.e. dairy, carbs)), CBT, fresh air and sunshine, exercise, and knitting. This last is one that might sound odd to some but there's a lot out there about its efficacy - something to do with the repetitive, immersive actions, and keeping the hands occupied. Anyway - good luck with making it manageable.

phizz4 - on 19 Feb 2018
In reply to slab_happy:

I did clearly state that this was my experience.

Read this article: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2211353/

A quote:

Interpretation

Among adults with moderate to severe major depression in the clinical trials we reviewed, paroxetine was not superior to placebo in terms of overall treatment effectiveness and acceptability. These results were not biased by selective inclusion of published studies.

I deliberately did not name my medication so as not to prejudice the OPs options. I was told by my Doctor that the first course of treatment was likely to be 30 to 40 percent effective but that a further course of treatment after stopping the medication for several months may only be 5 percent effective. I'm not a Doctor, so I have no way of verifying these statements but I had no reason to distrust him. There is also a well documented link between this drug and increased suicidal thoughs and actions, which I referred to when citing unwanted side effects. Therefore I do not believe that my information was misleading.

Cary Grant on 19 Feb 2018
In reply to Wallker:

There isn't a single 'good' medication for anxiety and very severe anxiety will usually involve a number of different interventions. If the anxiety is a severe as you say, then it is likely that the person will be admitted to hospital for supervision and assessment. If a person is no longer able to sustain activities of daily living, then a community mental health team should be involved, a CPA in place and a discussion about hospital.

Exercise, diet, meditation, CBT, etc., can all be useful, but are only effective outside of the acute phase. The main thing is to reduce anxiety levels to the point at which the person can function and to then begin  the longer conversation about changing thinking and responses. Anxiety is difficult because it  quickly spirals out of control and the brain is hard-wired to pay attention to any basic fear response irrespective of whether it is misdirected. The physical effects of anxiety will also trigger the psychological, which in turn... you get the picture. Breaking that cycle will be a priority and that may require some heavy short-term medication. The trick with psych meds is, where possible, to use them for quick(ish) relief of symptoms and to use that window of opportunity to build on the support and help needed to reduce anxiety in the long term.

If the person is not eating, I don't think SRIs will cut it, to be honest. Buspirone or alprazolam (anti anxiety), an anti-psychotic (major tranquilliser), diazepam (valium), a tricyclic anti depressant. Something quite aggressive in the short term. Things can get quite bad with very severe anxiety - malnutrition and worse. It does happen. If you are worried and if the person is not eating I would talk to either a GP or a third sector mental health organisation in your area.

I would also say to look after your own health. 

People can and do overcome very severe anxiety, but to do that the person needs to break out of the acute stage to be able to gain a little space.

Good luck.

slab_happy on 20 Feb 2018
In reply to phizz4

> I did clearly state that this was my experience.

You said "research suggests".

Okay, we're now discussing one paper on one particular SSRI. You understand that you can't generalize from that to making blanket statements about "medication" in general, right?

> Among adults with moderate to severe major depression in the clinical trials we reviewed, paroxetine was not superior to placebo in terms of overall treatment effectiveness and acceptability.

If you'll notice the passage before that, they say outright "Paroxetine was more effective than placebo". What they're arguing is that because more people on paroxetine dropped out because of side effects, therefore it's not "superior".

> but that a further course of treatment after stopping the medication for several months may only be 5 percent effective.

Well, I don't know why he'd say that.

Sometimes people do find that stopping and re-starting a med means it doesn't work the second time, but as far as I know it's not *that* common; usually a med having worked for you once is a relatively good predictor that it'll do so again.

> There is also a well documented link between this drug and increased suicidal thoughs and actions,

It's kind of a known issue with all the SSRIs -- rare but horrible.  Some people experience an increase in suicidal thoughts when starting on one (and they go away as soon as you're off the med, and getting it with one SSRI doesn't mean you'll get it with another, but I don't want to sound like I'm downplaying this, because I've had it happen to me too and it's terrifying).  I know there's some debate over whether paroxetine is particularly likely to be a problem in this respect.

Of course, ironically, by reducing depression, antidepressants also reduce the suicide rate; I believe there've been some interesting correlations done between SSRI prescriptions and dropping suicide rates.

I do know where you're coming from as regards meds side-effects; I have not been the luckiest in that respect.

These are serious drugs, not aspirin. And hey, even aspirin can cause internal bleeding. People go into anaphylactic shock from penicillin. And so on.

But I'm also aware that if it wasn't for the (right) meds, I wouldn't be alive and climbing and posting grumpily about psychiatry on the internet right now.

(In my case, the major problem is depression rather than anxiety, but yes, I tried minus the meds but with therapy and yoga and exercise and supportive friends. I tried really hard. It ... did not go well.)

If someone literally can't eat or sleep (and this has been going on for more than a few days), they're in a bad way, and need some serious help.

I am definitely not a doctor and don't play one on the internet, and I don't know the OP's crcumstances. But it seems probable that meds will be one of the options that a doctor will be considering, at least in the short-term. Meds might or might not be the first thing to try! But they are part of the toolkit.

minimike - on 22 Feb 2018
In reply to slab_happy:

seen this?

http://www.bbc.co.uk/news/health-43143889

On the Beeb this morning, haven't had time to read the actual article yet but it's here:

http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(17)32802-7/fulltext

 

slab_happy on 22 Feb 2018
minimike - on 22 Feb 2018
In reply to slab_happy:

Yup, having now read it, it’s specific to depression, not anxiety. But a seemingly clear and valuable result none the less. The study looks like reputable meta analysis as far as it’s possible to tell..


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