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Suggest Treatment For Severe Anxiety
Question: I I am a 30-year-old female and I cannot seem to get my anxiety under control. I am a psychologist myself, but after trying antidepressants and several types of benzos, I cannot seem to find anything to help with my panic attacks. I have also tried CBT and other therapeutic approaches.
Brief Answer:
Consultation
Detailed Answer:
Hello, and thanks very much for your question.
I'm sorry you are suffering so much from anxiety. Let me give you my thoughts.
First, let me discuss medications. You say you have tried several antidepressants and benzos. Can you be a bit more specific? Have you tried, for at least 4 weeks (at least this long to be considered an adequate trial), one of each class of SSRI, SNRI, TCA, MAOi, and atypical (Remeron, Wellbutrin)? Have you tried long-acting (Valium, Klonopin) and moderate-acting (Ativan) benzos?
Regarding therapy, as you likely well know given your profession, CBT is regarded as the most effective for anxiety. How long did you try CBT?
With these answers I can be more helpful with my advice.
Dr. Sheppe
Consultation
Detailed Answer:
Hello, and thanks very much for your question.
I'm sorry you are suffering so much from anxiety. Let me give you my thoughts.
First, let me discuss medications. You say you have tried several antidepressants and benzos. Can you be a bit more specific? Have you tried, for at least 4 weeks (at least this long to be considered an adequate trial), one of each class of SSRI, SNRI, TCA, MAOi, and atypical (Remeron, Wellbutrin)? Have you tried long-acting (Valium, Klonopin) and moderate-acting (Ativan) benzos?
Regarding therapy, as you likely well know given your profession, CBT is regarded as the most effective for anxiety. How long did you try CBT?
With these answers I can be more helpful with my advice.
Dr. Sheppe
Above answer was peer-reviewed by :
Dr. Raju A.T
I have tried SSRIs, SNRIs, TCA, MAOI, Wellbutrin (not Remeron as far as I can remember), Clonazepam, Risperdal, Xanax, Diazepam, and Ativan. Is there a longer acting Diazepam versus Xanax which is primarily used for panic disorders? I have been in CBT for several years and have seen my psychiatrist for 13 years. I hope this helps. Thank you!
Sincerely,
Ashley
Sincerely,
Ashley
Brief Answer:
Followup
Detailed Answer:
This certainly appears to be a treatment-refractory situation. What doses of benzos were you using? Typically these work well for anxiety at least in the short term -- I'd be surprised if even benzos at adequate doses were not touching your anxiety. The long-acting ones, as you ask, are Valium and Klonopin, both of which it appears you have tried. Gabapentin and Vistaril are also sometimes used for immediate anxiety relief. Some long-term medications you can consider at this point are Remeron and Seroquel, both of which are sometimes effective in anxiety. Electroconvulsive therapy, sometimes seen as a last resort treatment, is unfortunately not effective for anxiety disorders.
When I've gotten this far with medications with my patients, and nothing seems to be working, I begin to consider personality disorders, in your case something like avoidant personality disorder, dependent personality disorder, or obsessive-compulsive personality disorder. These are not improved with medication, but (for better or worse) take years of psychodynamic psychotherapy, even psychoanalysis, to treat effectively. Has this possibility been explored with you yet?
Dr. Sheppe
Followup
Detailed Answer:
This certainly appears to be a treatment-refractory situation. What doses of benzos were you using? Typically these work well for anxiety at least in the short term -- I'd be surprised if even benzos at adequate doses were not touching your anxiety. The long-acting ones, as you ask, are Valium and Klonopin, both of which it appears you have tried. Gabapentin and Vistaril are also sometimes used for immediate anxiety relief. Some long-term medications you can consider at this point are Remeron and Seroquel, both of which are sometimes effective in anxiety. Electroconvulsive therapy, sometimes seen as a last resort treatment, is unfortunately not effective for anxiety disorders.
When I've gotten this far with medications with my patients, and nothing seems to be working, I begin to consider personality disorders, in your case something like avoidant personality disorder, dependent personality disorder, or obsessive-compulsive personality disorder. These are not improved with medication, but (for better or worse) take years of psychodynamic psychotherapy, even psychoanalysis, to treat effectively. Has this possibility been explored with you yet?
Dr. Sheppe
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Above answer was peer-reviewed by :
Dr. Naveen Kumar
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