New here...GAD help please :(

[BETosca]

Hi all-

I am new here, but unfortunately not new to anxiety. From the time I was a young teenager, I have suffered with it on and off. I don't have panic attacks, but I do suffer from persistent ruminating and often catastrophic thoughts (maybe an element of OCD there?). Usually it involves worrying about the future, specifically of my kids.

speaking of my kids, they are dd (8) and ds (6). Dd was diagnosed a few months ago as ADHD (combined) and Gifted- all that together makes her an incredibly smart but demanding kid. She is not the *reason* for my anxiety, I was bent that way long before her after all, but going through the assessment last spring set me off on a months long episode of anxiety that is still ongoing. What makes it all so crazy is that she is happy, she is doing very well in school (so far the giftedness far outshines the challenges of adhd), and is all round doing well. but, I play so many 'what if" tapes in my head it makes me nuts.

The phrase "give me an inch and I'll take a mile" describes me perfectly, unfortunately.

My anxiety manifests itself mostly in ruminating worrying, insomnia, irritability, forgetfulness. When it's really bad I don't eat because I simply don't have the appetite.

I don't have a psychiatrist, I've always been treated by my family doc. In the past I have been on SSRI's (zoloft, effexor, cipralex), ativan as needed, and zopiclone to help me sleep. I have done zoloft twice- the first time, about 12 years ago, I had virtually no side effects and it really helped. the second time a year and a half ago, I had bad gastro effects, no desire for sex, and it heightened the anxiety in the first week. so, doc switched me to cipralex, which was far better for side effects. I stayed on cipralex for almost a year, but it made me feel flat and unmotivated, and I didn't feel like I was really dealing with anything. I wasn't in therapy either though at the time so I'm sure that was a factor.

I last saw doc. in early summer. given that my anxiety has been mostly episodic in the past, he felt that a benzo (ativan) and a sleeping aid (zopiclone) would be the way to go. at the time I thought this was a good plan. but, over the summer, the anxiety has been more constant than episodic and I'm wondering if it's time to move on to an SSRI or something..

btw...a question about ativan dosing if anyone can help...it says I am to take 1 mg twice daily "as needed", which means when I am in an anxious episode. Does "twice daily" mean every 12 hours, i.e. upon waking and at bedtime, or twice during my wake hours (just wondering because he also gave me zopiclone for sleeping).

thanks everyone...any and all advice would be muchly appreciated

[paula]

Hi betosca

Welcome!

I would think twice a day means AM & PM. When you get up, depending on what time you get up? Then 8hrs after that. I don't know. I'm just saying how I'd take them? If it worry's you that much, then why don't you get in touch with your doctor and ask him, what is meant by saying take 2x daily, and at what interval's.

You mention your Anxiety, I also, suffer badly with this, as no doubt you will have seen, looking through the forum post. That's if you've looked?

I suffer with Manic Depression, Insomnia, Stress, Anxiety, and I think I could also suffer with Social Phobia.

Don't think that I'm being rude, but I couldn't help but laugh at your phrase: give me an inch and I'll take a mile. You see us in the UK pronounce it as: give them an inch and they'll want a yard!

Take care!

Paula x:confused:

[Natalie]

Hi BETosca-

Welcome the community and thanks for your post.

I read with interest, all of the medications that you have been taking. I am particularly struck by the fact that you getting these prescriptions from a primary care doc rather than a psychiatrist. Not all primary care docs have the expertise necessary to manage a complex regiment of psychiatric drugs- particularly when you describing multiple drugs, and changing drugs across time. Have you ever considered seeing a psychiatrist for a second opinion about your treatment regimen?

I am no psychiatrist myself, but I do know that many people do not have success with benzodiazepines across a long period of time. They are really intended for short term anxiety management. I also assume that the dosing instructions you reported meant 2x during the day (waking hours). However, you should definitely call your physician and/or your pharmacist for clarification. This is NOT a stupid question. Ask ASAP.

Finally, I wonder if you have ever been involved in psychotherapy? Psychotherapy has a very high success rate for treating anxiety disorders, particularly Cognitive Behavioral therapy. Most people achieve the best treatment success with a combination of medication and psychotherapy.

[BETosca]

Hi Natalie & thanks for your reply.

The more I think about my appointment with my family dr. next week, the more I think I will ask for a referral to a psychiatrist. He's a good doctor and he definitely means well, but I think psychiatric drugs can be tricky to manage. I haven't actually been on SSRIs or other antidepressants for a few years now. I thought my anxiety was always pretty transient, and the times between were generally good, so why be on something long term? Unfortunately what I've been going through now for the last 7 months is not feeling transient

I had started psychotherapy a few months back with a psychologist. She uses a variety of approaches, including CBT and Schema Therapy. I like her and I felt like I was getting benefit. But, I took the summer off because my kids were in school and it was difficult for me to arrange times. Now that they're back though, I'm going again as of Monday.

In the meanwhile, I am just trying to remind myself that this too, shall pass...

[Mark]

BETosca,

Good for you taking the steps you are describing! Moving to a psychiatrist will hopefully provide you with a better (more specialized, anyway) resource for medication management. Also, that you are returning to psychotherapy is a good idea. Schema therapy is a branch of Cognitive Therapy, and it is a very good therapy for long standing personality issues. There are more specifically focused branches of cognitive therapy designed to treat anxiety problems specifically. I'm thinking of the Mastery of Anxiety and Panic (MAP) protocol developed by Drs. Michelle Craske and David Barlow. Ask your cognitive therapist about whether she knows about that approach. Not that what you're doing will not be helpful, but it is useful often to work the approaches that are designed specifically with your problem in mind.

Mark

[BETosca]

Mark- thank you for your reply. It's too bad I didn't see your post before I had my appointment with my psychologist yesterday- but I will definitely ask her about MAP when I see her next week.

I was so glad I went yesterday. She strongly feels that I have depression (and possible major) that is caused by long term anxiety. I've had six years now of one major crisis after another (death in the family after a prolonged illness, an extramarital affair, diagnosis of one of my kids with ADHD, and on and on). I used to think that one of these life triggers got me into an anxious phase, which would be hellish, but temporary. I treated it with ativan and zopiclone.

Anyhow, she likened it to a car. If you drive from NY to LA at 100 mph and don't rest or add oil, the car will be in bad shape at the end. She said that serotonin is like that- that stress depletes the levels of serotonin, and one stress on top of another can chronically keep it low, hence depression.

Argh. Now I don't know what is the primary issue anymore- anxiety or depression. I suppose it doesn't really matter because both are treated with similar drugs.

[Mark]

Think of the various medications as helping you set limits on the intensity of symptoms you will experience. You can use psychiatric drugs to reduce the intensity of depressive symptoms, for instance, or to take away the intensity of feelings of anxiety. All of which is good stuff, but there is more you can do, and that is where psychotherapy and just good self-care comes in. In addition to regulating your symptoms, you can also help to revitalize your body through eating right, getting decent sleep (something I should do myself - hah!), exercise, etc. And treating yourself well often will improve your mood because you see yourself taking action to better yourself.

Psychotherapy, at least the cognitive variety, works on helping you to more accurately deal with the various beliefs that drive the thoughts and judgments in your head. Much depression and anxiety comes from thinking about things in an unnecessary and biased manner which we don't realize we are doing. When we examine and correct our beliefs, we also revise our jugements about events that happen to us, and when our judgments are revised, we don't need to feel so anxious or depressed (because things don't seem so pressured anymore) and some or all of the depression and anxiety just sort of goes away. This is to say - depression and anxiety are not like colds and flu which are caused by a bug which we have to fight off with drugs. Instead, we end up causing much of our own depression and anxiety, because it is so easy and natural to make thinking mistakes that make it likely we will feel bad. Cognitive therapy helps you learn how to recognize those mistakes and correct for them so you don't make them so readily.

Some more on MAP is available on this page, which contains links to the MAP books which you can purchase at Amazon and similar, and a podcast interview with Michelle Craske, Ph.D. who helped write that therapy protocol

[BETosca]

Thanks Mark and all for your replies.

I did go back to my family doctor on Wednesday. We had a good long chat. At the end, we decided to put be back on an SSRI (Lexapro), stay on Ativan prn until the Lexapro kicks in, and to take the Zopiclone as needed for sleep as needed. In the meanwhile, he is referring me as well to a psychiatrist at the hospital's mood disorders clinic- the only problem being is that it can take a few weeks to get in. But, in the meanwhile I am started and he will follow me closely- I go back in 3 weeks, by which point hopefully something should have started to happen for the better.

And of course, I'm going to go to my psychologist weekly to do what I joke as the "real" work. My mistake on going on the meds the last time was that I didn't think I needed therapy (btdt!)- but, man, was I wrong.

[Natalie]

Hi-

This sounds like a very reasonable plan.

I wish you could teach a class on the reasons why, for most, a combination of meds and psychotherapy is the best way to go:p. I feel like, as a mental health professional, I stress this point until I am blue in the face!!!

Usually, the meds get you to a place where you can do the work necessary in order to benefit from therapy.

It's very hard work, isn't it?

Good luck to you and keep us posted.