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Suggest Treatment For Generalized Anxiety Disorder
Question: 87 Year Old Female (my grandmother) has pretty significant GAD. She is always anxious about where people are, getting things done right away, She calls the house multiple times a day and it is driving everyone crazy. We love her, but sometimes we cant stand her. She tends to be bossy and demanding, which probably strings from all that anxiety which I have no control over lol.
I would not want to start her on any benzodiazepine as she is not supervised and could be a fall risk. Are there any alternatives? She has a very regular sleep schedule and exercises regularly.
I would not want to start her on any benzodiazepine as she is not supervised and could be a fall risk. Are there any alternatives? She has a very regular sleep schedule and exercises regularly.
Brief Answer:
You can try Pregabalin
Detailed Answer:
Hi,
Thanks for asking.
I am Dr. Prakash HM and I will be answering your query.
Based on your query, my opinion is as follows:
1. Two options exists for generalized anxiety disorder-
a. Psychotherapy
b. Medications.
2. I am not sure, about psychotherapy being tried. If not, it will be helpful be very helpful. The excessive response can be managed easily by herself. Cognitive therapy along with self monitoring will be beneficial.
Cognitive therapy will help her in understanding that in case of inappropriate anxiety, persons interpretation of situation rather than the situation themselves are responsible for the anxiety.
Along with it self monitoring will be very helpful. Understand her response, chart it down, and then review it again.
A counselor or psychotherapist can be very helpful in the present scenario, if medications needs to be avoided completely.
3. Medications, can be used for short term period, when it is becoming too difficult. If you want to avoid benzodiazepines, then you can try using pregabalin. It will take atleast 10-15 days for improvement, unlike benzodiazepines, which will be rapid.
You will require prescription from your doctor.
4. Forming or joining self help- groups, if possible will be helpful, as risk of depression is also present due to anxiety.
5. Also mild exercises, and avoiding stimulants like alcohol, coffee, tea and certain over the counter medications, which have stimulating effect, will be helpful in improvement.
Hope it helps.
Any further queries, happy to help again.
Dr. Prakash HM
You can try Pregabalin
Detailed Answer:
Hi,
Thanks for asking.
I am Dr. Prakash HM and I will be answering your query.
Based on your query, my opinion is as follows:
1. Two options exists for generalized anxiety disorder-
a. Psychotherapy
b. Medications.
2. I am not sure, about psychotherapy being tried. If not, it will be helpful be very helpful. The excessive response can be managed easily by herself. Cognitive therapy along with self monitoring will be beneficial.
Cognitive therapy will help her in understanding that in case of inappropriate anxiety, persons interpretation of situation rather than the situation themselves are responsible for the anxiety.
Along with it self monitoring will be very helpful. Understand her response, chart it down, and then review it again.
A counselor or psychotherapist can be very helpful in the present scenario, if medications needs to be avoided completely.
3. Medications, can be used for short term period, when it is becoming too difficult. If you want to avoid benzodiazepines, then you can try using pregabalin. It will take atleast 10-15 days for improvement, unlike benzodiazepines, which will be rapid.
You will require prescription from your doctor.
4. Forming or joining self help- groups, if possible will be helpful, as risk of depression is also present due to anxiety.
5. Also mild exercises, and avoiding stimulants like alcohol, coffee, tea and certain over the counter medications, which have stimulating effect, will be helpful in improvement.
Hope it helps.
Any further queries, happy to help again.
Dr. Prakash HM
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
If Benzodiazepines were on the table, what would you recommend? Are there ones more tolerated than others? Clonazepam or Lorazepam for example?
Her PCP's office handles geriatric patients for sure, but they aren't certified.
I do understand that I need to get a prescription, especially as they are all C-IV.
She is very involved with her local XXXXXXX center, and still uses caffeinated beverages. Diet Coke and Hot tea are things that she drinks often.
I agree that Psychotherapy is the way to go, but I am not sure that she is willing to make that commitment. However, I will try.
Thanks for your insight.
Her PCP's office handles geriatric patients for sure, but they aren't certified.
I do understand that I need to get a prescription, especially as they are all C-IV.
She is very involved with her local XXXXXXX center, and still uses caffeinated beverages. Diet Coke and Hot tea are things that she drinks often.
I agree that Psychotherapy is the way to go, but I am not sure that she is willing to make that commitment. However, I will try.
Thanks for your insight.
Brief Answer:
If necessary, lorazepam
Detailed Answer:
Hi,
Thanks for asking again.
If you want to start on benzodiazepines, I would suggest lorazepam. However, if not for short period, I would want my patients to avoid it, due to risk of drug abuse, habit forming and possibility of resistance development.
If you do not want to go on pregabalin, I would suggest you to try Escitalopram or Venlafaxine. It can be used longer, and would be more useful due to possibility of her caffeinated beverages and her possible unwillingness for psychotherapy. At-least 3-4 weeks therapy, will show improvement, and side effects, if any will start reducing. Initially side effects could be more like insomnia or nausea. Starting with smaller doses and slowly increasing will be beneficial.
Hope it helps.
Any further queries, happy to help again.
Dr. Prakash HM
If necessary, lorazepam
Detailed Answer:
Hi,
Thanks for asking again.
If you want to start on benzodiazepines, I would suggest lorazepam. However, if not for short period, I would want my patients to avoid it, due to risk of drug abuse, habit forming and possibility of resistance development.
If you do not want to go on pregabalin, I would suggest you to try Escitalopram or Venlafaxine. It can be used longer, and would be more useful due to possibility of her caffeinated beverages and her possible unwillingness for psychotherapy. At-least 3-4 weeks therapy, will show improvement, and side effects, if any will start reducing. Initially side effects could be more like insomnia or nausea. Starting with smaller doses and slowly increasing will be beneficial.
Hope it helps.
Any further queries, happy to help again.
Dr. Prakash HM
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Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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