Posts Tagged ‘anxiety’

Xanax vs Ativan for Anxiety

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Saturday, February 20th, 2010
xanax pills

Xanax and Ativan are both members of the benzodiazepine family and are used for the treatment of anxiety related disorders.  They can also be used for muscle relaxant and anti-convulsive effect.

How does Xanax vs Ativan compare?

First, they are both high potency.  This means that they are relatively strong among their class of medication.

Xanax has a half life of 6-20 hours while Ativan has a half life of 10-20 hours.  This means that your body gets rid of both of these medications relatively quickly.  By comparison, Valium, another popular benzodiazepine, has a half life of 20-100 hours.

This is both good and bad.  It’s good in that you clear the drug out of your system quickly.  It’s bad in that it means that drug delivery is relatively quite rapid.  When you stop taking the medication, it quickly clears from your body, which can result in horrible withdrawal.

Both are fairly addictive when used for long periods of time.

In a survey of 31 clinicians with detox experience, 84% said that Xanax is “especially problematic” for withdrawal.  Ativan is also highly addictive and has similar withdrawal incidences, but has somewhat less of a bad reputation.

Efficacy

Both Ativan and Xanax are highly effective for the short term treatment of anxiety and neither has been indicated for the long term treatment of anxiety.  Both work at fairly high rates to treat panic symptoms.

One study of 74 patients showed that the two have similar efficacy for treating of anxiety at around two weeks.

Remember, both have very similar chemical activity and similar half-lives.

Side effects

Both have similar side effects.

Xanax and Ativan both cause some degree of memory impairment.  One study showed that Ativan was among the “most frequently associated with amnestic effects” in the benzodiazepine class.

The way that memory impairment is tested for is as follows.  Participants are told to memorize a set list of numbers or words then are given the medication and asked to recall them.  This, or some variant, is used to show if memory impairment happens.

It’s somewhat artificial and does not replicate the more realistic use of the medications over several weeks.  It has been shown that the memory impairment side effect may be attenuated to some degree over time.  On the other hand, other studies have shown that long term use of Xanax or Ativan can cause memory and attentional problems.

Both Xanax and Ativan are also both associated with sedation.  One study showed that Xanax was among the least sedating of the benzodiazepines while Ativan was among the most sedating.

Another study showed that Ativan has slower onset of sedative and memory effects, but that they lasted longer than with Xanax.

Note

There are very few studies that directly compare Ativan vs Xanax.  This is likely because drug companies have no reason to compare comparison studies when there is the chance that their medication may come off in a bad light.

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Lyrica Medication Uses, Side Effects

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Wednesday, February 10th, 2010
Pill capsule

Lyrica, generic pregabalin, is a new medication that has anti anxiety, anti-pain and anti-convulsive activity.  Those effects means it has many uses.

In the United States, Lyrica is approved for partial epilepsy, diabetic neuropathy, postherpetic neuralgia and fibromyalgia.  In Europe, it is approved for treating generalized anxiety disorder.

How can it do all that?

On a chemical level, Lyrica is a lot like GABA, which is a neurotransmitter involved in slowing down the activity of certain parts of your brain.  More specifically, Lyrica binds to calcium channels and reduces their intake of calcium.  Doing so lowers the release of other neurotransmitters like norepinephrine and glutamate, which are involved in anxiety and other processes.

This chemical action is very similar to that exhibited by the benzodiazepines, which are known for high addiction and abuse potential.  Because of this similarity, there is the concern that Lyrica can be abused to get high and could possibly be addictive.  It seems that this is possible, but to significantly lesser degree than with the benzodiazepines.

Lyrica has been used by some doctors for off-label uses such as treating arthritis.  While such use may have benefit, it’s important to note that in 2009 a subsidiary of Pfizer plead guilty to marketing inappropriate uses of Lyrica as part of a major settlement.

Dosing:

Lyrica is typically given at from anywhere from 150mg daily to 600mg daily.  Depending on the specific use, the dose may vary.

Use for fibromyalgia

Lyrica was approved in 2007 as a treatment for fibromyalgia, the first medication for that condition.

Patients who take Lyrica for fibromyalgia have reported moderately positive results. On a fibromyalgia pain scale of 1-10, those on it will have roughly a one point reduction in pain compared to those treated with placebo. Roughly 30% of those with Fibromyalgia who use Lyrica will experience a 50% decrease in pain, while only 13% on placebo have such a reduction.

In looking at those numbers, it’s important to remember that, as a condition, fibromyalgia is difficult to treat with very few people reporting significant improvement over time.

Use for diabetic peripheral neuropathy

Lyrica appears to be a solid treatment for diabetic peripheral neuropathy (DPN).  According to an independent analysis by the Cochrane review, 50% of patients with DPN and who take Lyrica report significant reduction in pain over time.

But how does that compare to traditional treatment?

The traditional treatment for DPN is amitriptyline, as recommended by the American Diabetic Association, as well as SSRIs and other medications.  Lyrica seems to have similar effectiveness but may have different side effects.

For DPN, the optimal dose seems to be around 300mg daily, possibly given over two doses.

Lyrica’s Side effects:

20-30% of people who use this medication stop specifically because of a serious side effect, which is somewhat on the high side for a psychiatric medication.  Side effects seem to be dose related with increasing incidence at higher doses.

Most common side effects:

Up to 45% report dizziness

Up to 30% report drowsiness

Up to 20% report ataxia, or issues with smooth movement

Up to 16% report weight gain

Up to 15% report reduced salivation

Up to 10% report constipation

Other possible side effects

Balance issues, euphoric mood, fatigue, pain in the joints, chest pain.

Use of Lyrica may rarely be associated with difficulty paying attention and or concentrating.

There have been reports of tremors associated with this medication and there was a recent case report of an older woman who developed Parkinson’s Disease symptoms most likely due to Lyrica.

This list is not comprehensive; consult manufacturers insert for more.

Drug characteristics

Lyrica is not metabolized by the traditional enzymes in the liver, which means that it may have fewer drug interactions than most drugs.  Roughly 90% of the drug is released in the urine which means both heavy use of kidney and relatively low metabolism by the liver.

This means that kidney impairment may have a significant effect on the medication.

Diet has been shown to alter certain release characteristics of Lyrica but does not seem to effect its efficacy.

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Wellbutrin – Anxiety Concerns

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Wednesday, February 3rd, 2010
Wellbutrin Bottle

Wellbutrin and Anxiety

Wellbutrin is a popular antidepressant that also may help with smoking cessation and with attention deficit disorder.  A major question people have is, does Wellbutrin work well for anxiety disorders?  And isn’t anxiety a serious and common side effect of Wellbutrin?

First, it’s important to note that Wellbutrin is a norepinephrine and dopamine reuptake inhibitor.  While it works about as well as typical antidepressants, it does not have the standard serotonin effects, and is somewhat similar to medications for treating ADHD.

Wellbutrin is actually eventually converted to a form of amphetamine by the body.

In some ways this is good.  It means that it has less rates of weight gain and sexual dysfunction, which are quite common side effects of the standard SSRI medications like Prozac and Zoloft.  On the other hand, it may mean worse anxiety.

Does Wellbutrin treat anxiety?

There is very limited research into the ability of this medication to treat anxiety disorders.  Some pilot studies have shown similar efficacy to the SSRIs for this use.  And some have shown worse efficacy.

A recent, meta-analysis, for instance, of 10 studies including a total of 2122 patients with depression and high levels of anxiety showed that response was somewhat better to SSRIs than Wellbutrin.

Since there are studies that specifically have shown the efficacy of SSRIs to treat anxiety disorders, and no major similar studies for Wellbutrin, it is not commonly used for that type of treatment.

There may be, of course, no major studies because clinicians believe that it wouldn’t work well.

Does Wellbutrin cause anxiety?

It definitely can, as well as almost all antidepressant medications.

How likely the anxiety is and how bad it might be, however, depends on who you ask.  If you define anxiety as simply “nervousness,” then one analysis showed that Wellbutrin causes less anxiousness than Prozac and Effexor, about the same amounts as Paxil, and more than Zoloft, Remeron and Celexa.

If you, however, look at a composite of anxiety, agitation, akathisia (or feeling unsettled) and hostility, another study showed that Wellbutrin is worse than all the other antidepressants. That study showed 13.9% of people who used it had those side effects.  This is three times the amount compared to people taking Paxil and Zoloft.

Another study argued that anxiety response to Wellbutrin is dose dependent.  It said that at 150mg, the medication is about the same as placebo, with increasing issues at higher doses.

Patient experiences online tend to show that Wellbutrin can cause quite significant anxiety, especially during the first weeks of treatment.  Some users say that the anxiety can be really, really bad.  On the other hand, those who are likely to speak up online tend to not always represent the average response.

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Xanax: Side Effects, Withdrawal

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Friday, October 9th, 2009
Xanax pills 2mg

Xanax: an anxiety medication

Xanax is one of the stronger benzodiazpines (BZD), a class of drugs that slows down the nervous system, inducing calm and relaxation.

And it works quickly, and seems to have limited side effects. No wonder that it’s extremely popular, used even by those who appear to be the most successful and least need it.

Unfortunately, use of Xanax may have gone too far because long term use can cause serious problems. Benzodiazepines like it are best used for short term relief of anxiety, and generally as support for treating anxiety and panic disorders.

The American Psychological Association released guidelines to that effect, emphasizing the preferred use of SSRI medications for anxiety disorders.

What should Xanax be used for, for how long, and what are its potential side effects?

Use

Xanax is very good at fighting anxiety. As such it makes sense to use it in the short term for insomnia caused by worrying, and for short term control of anxiety. On the other hand, other drugs are preferred for certain types of short term anxiety, like stage-fright.

Xanax can be used for panic and anxiety disorders and has shown some ability to work for those conditions – but there may be better options that just take longer to work. The SSRIs may perform better and with less risk, and as such have been recommended for typical treatment of anxiety and panic disorders.

And you can’t forget the importance of therapy and exercise for anxiety/panic conditions, which have no side effects.

Use of Xanax after a traumatic event might be a bad idea.

Xanax’s side effects

Xanax can cause excessive sedation, memory problems, and cause or make depression worse. It can interact dangerously with alcohol as both are depressants. And it is addictive.

Long term use has been associated by some with cognitive damage. This means a potential decline in intelligence, ability to pay attention and concentrate, and decreased memory. Stopping Xanax does not always reverse these changes.

Use of Xanax after a traumatic event to help control anxiety may highly increase risk of developing Post Traumatic stress disorder. It is isn’t entirely clear how – or if – this happens.

In terms of physical side effects, Xanax has less side effects than earlier drugs, but can still cause serious physical problems either in overdosing or through interactions with other medications.

Most common side effects: drowsiness, increase salivation, weight gain and constipation.

Use of Xanax can cause difficulties with memory formation and some form of memory impairment in anywhere from 7-33% of those who use it.  It may also be associated with difficulty falling asleep, headache, and some form of cognitive impairment.

Menstrual irregularities have been reported in up to 10% of women using Xanax over an extended period of time.

Addiction and Withdrawal

We know Xanax is about as addictive as cigarettes; we just aren’t fully clear on how long dependence takes.

One study showed that 1/3 of people who used any BZD for just a month became dependent to some degree. Another showed a similar rate of addiction over a two months span, and another study put the time-line at 3-6 months.

Use of Xanax over an extended period of time may lead to serious problems upon stopping. The milder problems include anxiety, unpleasant thoughts, and disorientation. Rarer but more serious discontinuation issues include extreme sense-sensitivity, seizures and psychosis.

Do you have any thoughts on Xanax?

Withdrawal
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3 Models of Generalized Anxiety Disorder

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Wednesday, August 26th, 2009

An uncertain woman looks to the left

Generalized Anxiety Disorder

Generalized Anxiety Disorder (GAD), a disorder characterized by chronic anxiety and worry, is on the surface a bit meaningless. Everyone feels anxious and worries a lot.

What makes GAD abnormal is both the frequency of anxiety, more days than not, its length – over 6 months – and that the anxiety is pretty severe.

There are many models of how GAD works. Here are three particularly useful ones:

Avoidance:

In the avoidance model, anxious thinking is a defensive mechanism. There is a very real problem or potential consequence that could be pretty bad. To avoid thinking about the worst case scenario, sufferers barrage themselves with thoughts to distract from having to deal with “the more emotional topics.”

Treatment: A main strategy for treating the avoidance model of GAD depends on developing the cognitive skills to handle the problems directly. Desensitization, or gradually building tolerance, to the negative thoughts is key.

Another goal is to develop the ability to live in the moment and let things be.

Intolerance of Uncertainty:

In the Intolerance of Uncertainty model, the anxiety develops in response to ambiguous and uncertain situations. Those situations are “stressful and upsetting.” Because problems are over dramatized, normal life upsets can overwhelming.

The worrying becomes self-reinforcing when, anxious about problems, someone doesn’t handle them, which makes it even harder to deal with the next one.

Treatment: Similarly to above, treatment for the intolerance of uncertainty model of GAD focuses on working on internal beliefs that are leading to anxiety. Additionally, problem solving skills should be developed .

Meta-cognitive:

In the meta-cognitive model of GAD, anxiety provoking situations produce thoughts of worry, logically enough. Those initial thoughts, called Type 1 Worry, serve both a protective role as well as partly help deal with the problem by coming up with solutions.

In this model, however, the problem arises when the person starts to worry about their worrying. This Type 2 Worrying leads to excessive self-analysis and self-doubt. While the initial worrying was somewhat based off reality, the second wave is less so.

Treatment: Again, focusing on developing appropriate mental strategies for dealing with stress is a solid model.

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Stress Related Object/Orientation Disorder

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Tuesday, August 25th, 2009

An egg being squeezed in a clamp

“I never really felt connected to things,” says John M., “And I was always losing things.”

John may be suffering from a new psychological condition that is the subject of heavy controversy.

Proponents point to a large untreated pool who, they claim, suffer from poor self- esteem and diminished quality of life.

Critics, on the other hand, say it’s just one more variation of the same and is nothing more than normal behaviors and feelings we all experience.

The diagnosis? Stress Related Object/Orientation Disorder (STROOD), a condition characterized by often misplacing things, and a sense of disorientation.

STROOD develops as a reaction to chronic stress. Psychologists say that the pressure of modern life can reshape critical pathways in the limbic system that are associated with organization and orientation. The reshaping eventually leads to a form of developed lack of focus and confusion.

Some estimates put STROOD’s prevalence as high as 5%. “It’s awful,” says Mark H., a participant in an early clinical trial. “I was always misplacing things, and not entirely clear where I was. It felt great to learn I wasn’t alone.”

Despite being a chronic condition, STROOD may be treated by Prozac and other SSRIs. And treatment should be aggressive, argue leading psychologists, pointing to diminished quality of life reported on scales from untreated sufferers.

Researchers also argue that statins may also play a role in STROOD treatment. Aggressive control of blood LDL levels can potentially help alleviate the symptoms of chronic stress.

Researchers are recruiting for the STROOD-life enhancement trial, or STROODLE.

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I think I’m losing my mind! – Are You?

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Sunday, August 23rd, 2009

I think I'm Losing My Mind!

Have you been feeling weird lately? Like things are slightly off?  Or not as energetic as you might like?

Yes?

Thought so.  How’d I know?

Because it’s perfectly normal to be somewhat tired, somewhat drained, somewhat unhappy!  It’s a hell of a lot easier to complain and feel crappy than it is to realize how good things really are.

But if you are seriously concerned about your mental health, the list below offers some questions that you might ask yourself.  If you see yourself in them, it may be worth thinking about seeing a shrink or getting some kind of help.

General

I can’t concentrate as well anymore.

I feel different over the past few weeks.

My friends are worried about me.

Mood disorders

Have you felt seriously down or unmotivated for more than a few weeks? Or have you felt irrationally happy, or excited, spending money casually?

Do you no longer enjoy doing things you used to?

Anxiety Disorders

Do you worry a lot? Is it hard for you to relax? Are there things that just make you panic?

Does the memory of some traumatic event keep coming back to you?

Psychosis/Schizophrenia

Do you believe people are out to get you? Can you read other people’s thoughts?

Does the TV sometimes talk directly to you?

Dissociative disorders

Do you often feel like things aren’t real?  Do you sometimes not remember what you did over a period of time?

Eating Disorders

Do you have difficulty eating? Do you count calories or restrict how much you eat?

Or do you eat too much and sometimes purge?

Substance use disorders

Is there something that you couldn’t live without – literally? Would stopping a substance result in physical symptoms?

Do you often blackout?

You might like:

Get Help!  Seriously.  You need it!

Source:

Abnormal Psychology, Hansell

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Anxiety Associated With Psoriasis

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Wednesday, July 22nd, 2009

Do you have psoriasis?  In addition to the physical problems, you’re probably experiencing a great deal of anxiety and emotional pain.  What can you do?

Psychosomatic problems

It might be a good idea to think about getting psychological therapy if you suffer from the following:

1) History of psychological factors causing psoriasis

2) Depression and/or Anxiety

3) Increased itching

4) Feelings of isolation, stigmatization or thoughts of suicide

Increased sensations of itching have been shown to have a psychological link, and if you’re feeling down it’s important to get help.

If your kid is suffering from psoriasis, strongly consider psychological intervention as in pediatric populations psoriasis has an even higher link to stress and life tensions.

Therapy can help you deal with your condition.  It can also possibly help reduce the severity and occurrences of psoriasis.

40-80% of psoriasis has a link to or is caused by psychological factors. And having psoriasis makes life a lot harder.  Sufferers often feel discriminated against and unattractive.  As such, ordinary activities like socializing and sexual relations evoke a great deal of anxiety.

Therapy can prevent this anxiety from exacerbating the psoriasis and causing more pain in a vicious cycle.

Moderately heavy consumption of alcohol can prevent clearance of psoriasis.

Antidepressants and Psoriasis

A trial of bupropion (Wellbutrin) in 11 patients found significant reduction of plaques.  Oddly enough, only one person actually felt like his mood improved.

That said, three psoriasis patients who were prescribed bupropion to help quit smoking suffered extreme reactions and were hospitalized.

Lithium and fluoxetine may exacerbate psoriasis.

Sources:

Psychological influences in psoriasis
Psychiatric morbidity in psoriasis: a review

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