Anyone here dealing with general/social anxiety issues?

mind_the_gap

As the title says, anyone here in this position right now (or in the past)? If so, what drugs are you on if any? How well do they work for you and what are the downfalls of them?

ON xanax at the moment but want to get off the stuff. However, getting off the stuff simply isnt an option unless I can develop some coping skills (for the original problem). Tried to do without the pills yesterday on a workday and ultimately I descended into a total wreck.
Have started therapy as of 2 weeks ago - but its going to be a long process - and i'm not confident that the results are guaranteed.

Would be most grateful for any input for those out there with experience of the problem - either as victims of it or med. professionals that work with people in this situation.

eth0_

You really really really need to see a psychologist or counsellor regarding this, so it's good that you've started with that. What kind of therapy are you doing? CBT?

Drugs alone are just dampening the symptoms and don't "fix" anything. And it's really not good to be on xanax daily for an extended period of time.

mind_the_gap

eth0_ wrote: »

You really really really need to see a psychologist or counsellor regarding this, so it's good that you've started with that. What kind of therapy are you doing? CBT?

I did mention CBT to him - but I don't think its cbt we're doing right now. I am doing this through an 'employee assistance program' (ie. employer pays for external company to do this sort of thing - but has no knowledge of who accesses the scheme). There will be 6 sessions - 2 of which I have completed. After that I have to pursue it off my own bat with another practicioner. Don't mind paying for it as such but i'm dispondent about ever making the breakthrough if yesterday is anything to go by.

If anyone has the knowledge, can they pm me details of a cbt specialist - located anywhere in the West of Ireland - or even the midlands?

eth0_ wrote: »

Drugs alone are just dampening the symptoms and don't "fix" anything. And it's really not good to be on xanax daily for an extended period of time.

Don't get me wrong eth0_ - i appreciate you mentioning that...but I'm all too aware of the problems of these bloody drugs. I had my homework done before I ever went on them - and knew I was entering in to a pack with the devil ...for which payback is beginning to take place now.
However, the practicalities of fixing the problem properly make me fearful to say the least. If i'm lucky, I might be able to make it work in 6 months. Or it could take a year or years...with the possibility of never finding the solution.

sam34

eth0_ wrote: »

Drugs alone are just dampening the symptoms and don't "fix" anything. And it's really not good to be on xanax daily for an extended period of time.

that kind of anti-drug propaganda really bugs me.

let me start out by saying that i do think psychological therapies such as cbt are very helpful for treating anxiety disorders. they provide lifelong skills that a person can use. i'm not denying that at all.

but, the drugs are hardly the work of the devil!

SSRIs have proven efficacy in treating anxiety disorders.

and by "treating" i don't mean "dampening the symptoms" or "masking" them.
i mean curing the illness.

i'm not claiming they're 100% effective, but they do work.

lets face it, most people in Ireland do not have access to psychological services. so, how else can we explain the fact that some (again, not all) people on SSRIs will recover fully, and after an adequate treatment period will no longer require medication?

now, certainly, the meds have side effects. but show me the drug that doesn't? if you take paracetamol for a headache you might get side effects from it.

with regard to xanax, sure, that is only treating teh anxiety symptoms rather than the underlying illness. the idea and best prescribing practice is that if someone requires xanax they are only prescribed it for a pre-defined time limited period, while they are waiting for the SSRIs to take effect.

and yes, xanax and all benzos can be addictive. if they are prescribed properly, and taken properly (the patient needs to accept some responsibility here) this effect can be minimised.

i really dont think it's a good idea to diss the meds completely. they absolutely have a role to play. and scaremongering about them may very well put people off seeking help, which would be doing those people an injustice.

eth0_

sam34 - you misunderstand me, I am not 'anti-drugs' at all!
I just wanted the OP to be aware that benzo's are incredibly addictive and not something you should be on long-term and for that reason he/she should be having therapy to address the underlying issues causing their social anxiety.

I think a lot of GP's in Ireland - and this has been my own personal experience - are happy to just prescribe someone benzo's or anti-depressants and never once ask the patient if they would like to be referred for therapy.

sam34

eth0_ wrote: »

sam34 - you misunderstand me, I am not 'anti-drugs' at all!
I just wanted the OP to be aware that benzo's are incredibly addictive and not something you should be on long-term and for that reason he/she should be having therapy to address the underlying issues causing their social anxiety.

I think a lot of GP's in Ireland - and this has been my own personal experience - are happy to just prescribe someone benzo's or anti-depressants and never once ask the patient if they would like to be referred for therapy.

apologies if i misunderstood... i tend to get on my high horse quite quickly!

i suppose the reason gp's reach for the prescription pad so quickly is two-fold:
a) they and the patient want a quick cure (altho the ssri's take a few wks to work, they're still quicker than therapy)

b) the psychological services here are grossly under-resourced. i have worked on and alongside many different psychiatric teams and not one of them has had a full time psychologist. that is an absolute disgrace. the waiting lists are huge... years in some places. so often there's no point asking the patient if they want a referral, as it's not a practical option.

mind_the_gap

You both make valid points from what I can see. One point that you raised Sam is something in all my reading up on the subject, I have not seen before. You suggested that theres a possibility that SSRI's in themselves can sort out this problem all on their own?? Have I understood that correctly?? - as i have been working on the assumption that ALL drugs can only mask over the problem without addressing the underlying issue?

Even if they don't, my big question right now is this;

Given that i've been on xanax for much longer than I anticipated - and that I really can't even begin to consider tapering off it until the underlying problem is sorted, should I be looking at switching over to an SSRI - on the basis that they may be the lesser of two evils (all the while, continuing on with psychotherapy)??

If so, which drugs should I be discussing with my GP?

The other issue is that I simply cannot cope with dealing with these 'episodes' without meds right now. If I was to switch - from what I've read - there may be problems in this regards when it comes to switching over to an SSRI. In the event that I have an 'episode' in the middle of this swithover, is it still possible to use xanax to tide me over?

I realise its critical to get professional advise on all of the above. However, what I am asking for here are suggestions which I can put forward to my GP - so I will not be following any advise suggested on this thread without approval/consent of a med. professional.

eth0_

You can use SSRI's and xanax together but you can't expect Sam to give you treatment options without meeting you and knowing the full story.

Go back to your GP and discuss tapering down the xanax if it's concerning you. And stick with the therapy :-)

sam34

Hi mind the gap,

disclaimer, so that tallaght01 doesnt get cross with me, this is not to be construed as medical advice, i'm just giving my opinion and telling you how i practice. you will need to discuss everything with your gp.

with regard to the ssri's, yes, i have seen many people do very well on them. they can, on their own, lead to full remission of symptoms, ie what we'd consider "cured". that said, some people may get incomplete resolution, but improve to the extent that their symptoms are very manageable. sadly, a minority, very much the minority, will not improve to a significant degree.

its pretty hard to predict who will fall into which treatment group.

a combination of ssri's and cbt will give you the best chance at recovery.

when you ask about "underlying issues", i guess it all depends on what you mean by that. and i dont mean to be smart with you when i say that.

the thing with anxiety disorders is that they lead a person to spiral into a pattern of maladaptive coping behaviour, which is self-perpetuating.

eg, imagine that you get anxious about speaking in front of a group, and that you're in college where you need to give a presentation to your class every week.

you obviously get very worried about that, and are wondering what you can do. then it hits you, you can just skip that class this week, and all will be ok. so thats what you do. and you're safely in your little cocoon, no major anxiety because you've avoided it.
but there's now a little thought growing in your head "i'll be ok as long as i dont go to that class". the next week rolls around, and now you've got two reasons not to go to this week's class - a) you're nervous and b) you recall how it was all ok last wk when you didnt go. so you dont go. that thought growing in your head is now rooting more firmly. you're reinforcing it. and it's going to keep growing and perpetuating itself. in a few weeks/months it might be that you feel you shouldnt go to any of your other classes at all, just in case you might to be called upon to do something you're not comfortable with. so you avoid college altogether.....

and so the behaviour escalates....

now, in themselves, meds are not going to break that behaviour pattern. thats what cbt will do. meds will treat the underlying biochemical anxiety thats perpetuating the behaviour. but behaviour patterns take time and effort to change.

i'm guessing that's what you mean by issues- patterns of behaviour?
meds are obviously not going to change past experiences/life circumstances etc.
they will only alter the underlying biochemistry thats gone wrong.

my usual approach to patients is this :(bearing in mind i dont have access to a psychologist):

commence an ssri. NB to warn patients that they may have increased anxiety for the first few days, but that this settles.

if they need it, give them a benzo (such as xanax). NB to warn them about using it more than prescribed, and the potential of addiction.
tell them the benzo will be short to medium term, while waiting for the ssri to work, and that i will ne stopping the benzo once they are improving.

tell that the use of an ssri is medium to long term. a minimun of 6 months for anxiety disorders. that doesnt necessarily mean life long.

tell them that the ssri's are not addictive, despite what they may have read/heard from friends. yes, they have to be withdrawn slowly and there can be withdrawal effects but they are not addictive in that you do not keep needing higher doses to get the same effect. (this is a very common myth and prevents a lot of people from seeking help).

i would say to you to ask your gp about an ssri. i dont think i should mention one in particular here, that may be straying too far into medical advice. so just ask about ssri's in general.

OP- sorry for the long answer!
hope it helps
good luck

mind_the_gap

Eth0_ wrote:

You can use SSRI's and xanax together but you can't expect Sam to give you treatment options without meeting you and knowing the full story.

I appreciate that Et0_ - hence my own disclaimer in small print above.

Eth0_ wrote:

Go back to your GP and discuss tapering down the xanax if it's concerning you. And stick with the therapy :-)

I can't do that right now - its a case of getting caught between stools. Work is my battlefield where this problem is concerned. I need the drugs so that I can keep my basic cráp together..else i'll head rapidly for a whole range of major difficutlies. Need to keep the drugs and work on therapy simultaneously - then when my coping skills are up to speed, I can test the water - and gradually make the breakthrough.

sam34 wrote: »

the thing with anxiety disorders is that they lead a person to spiral into a pattern of maladaptive coping behaviour, which is self-perpetuating.

Yes, this resonates with me. I have been following a 'situation avoidance' strategy for years - even though I didn't really see it in those rigid terms at the time.

sam34 wrote: »

i would say to you to ask your gp about an ssri. i dont think i should mention one in particular here, that may be straying too far into medical advice. so just ask about ssri's in general.

Thats on the agenda first thing Monday morning. I'm very glad to hear that ssri's are a better option (with some limited potential to assist in solving problem) whilst I work through it via therapy at the same time. The benzo's served a purpose but useage is starting to escalate and I now have benzo hangovers on the days i dont use it.

sam34 wrote: »

OP- sorry for the long answer!

Don't apologise Sam. I'm very glad you gave the long version. Its explained a lot and I now know what way I want to approach conversation with my GP.

JuliusCaesar

Hi if you are looking for accredited CBT therapists (there are a lot of counsellors who did a weekend course claiming to provide CBT) go to psychotherapy-ireland.com (Irish Council for Psychotherapy) or BABCP.com (look for Find a Therapist then Republic of Ireland). Both only accredit people with a core profession eg psychologist, psychiatrist, mental health nurse etc who then do a (usually 2 or 3 year) M.Sc. in CBT on top. These people work in public hospitals, private hospitals, out-patient depts, etc as well as private practice.

mind_the_gap

@JuliasCaesar: Thanks for that. Going to hold off on the CBT for the moment until I see what direction the pyschiatrist takes things.

sam34 wrote: »

with regard to the ssri's, yes, i have seen many people do very well on them. they can, on their own, lead to full remission of symptoms, ie what we'd consider "cured".

Sam, never realised that ssri's have the potential to bring about full remission in some cases. Not looking for medical advise (waiting on appointment with pyschatrist) but curious as to whether there are certain ssri's that are more likely to have this potential??

tallaght01

mind_the_gap wrote: »

@JuliasCaesar: Thanks for that. Going to hold off on the CBT for the moment until I see what direction the pyschiatrist takes things.



Sam, never realised that ssri's have the potential to bring about full remission in some cases. Not looking for medical advise (waiting on appointment with pyschatrist) but curious as to whether there are certain ssri's that are more likely to have this potential??

HI guys.

We're maybe just getting a bit close to medical advice here. I'll keep an eye. I'm happy for a very general discussion of SSRIs etc. But we're really not here to help with personal medical issues, and it looks to me as though the original poster is moving towards using this thread to advise what direction her treatment should take.

I'll keep an eye for now, but I'll have a low threshold for closing it.

Sorry.

Kevster

Well, I'm jusdt going tgo say my piece while I still can: I was diagnosed with OCD, anxiety, and depression around 5 years ago and have been taking Lexapro (A Selective Serotonin Reuptake Inhibitor [SSRI]) for the most of those 5 years. i'm now off it, howver, and I am no longer feeling slightly sluggish and my sex-drive is back in action!

You shouldn't go to your doctor recommending that he/she put you on any particular medication. To them, that smacks of you being arrogant and thinking that they aren't doing their job right. All you can do is to be 100% honest with him/her and follow their advice.

Kevin

sam34

mind_the_gap wrote: »

Sam, never realised that ssri's have the potential to bring about full remission in some cases. Not looking for medical advise (waiting on appointment with pyschatrist) but curious as to whether there are certain ssri's that are more likely to have this potential??

sorry OP, i dont think it's appropriate for me to give more specific advice here. discuss it with your psychiatrist, who will be able to decide the best option for you.

dolphin50

Hi

Just started on Effexor 75mg yesterday, felt a bit weird yesterday and kept waking up during the nite, is this normal ? In two minds to take the second one but know i have to. Have to go to a social event today, not looking forward to it and have a big meeting in work tommorrow. Have Xanax incase i need it, would appreciate any advice