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Hepcat
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Post by Hepcat » Wed Mar 12, 2003 5:48 pm

Dale :

Oddly, I find my worst symptom right now is anxiety. I've had free floating anxiety and dysthymia my whole life and thought I had it beat.

Then comes CP.

Even though nearly a year has past since this whole ordeal has started, I still sleep poorly and literally shiver like a wet dog. Panic attacks are just par for the course. Worst of all, I have a medical background and this makes it worse as I wonder if every symptom is a sign of something more ominous. So, you can see where this going as I slowly become paralyzed by anxiety.

My question to you would be, as a psychiatrist, what is the treatment of choice for patients resistant to the traditional meds (ie. ssri's, Elavil, clonazapam, buspar)? is there anything new on the market that approaches anxiety in a radically different way? Exercise, eating right, warm baths, lots of sleep and herbal's haven't helped either :(

I suspect I'm not alone in this, so any advice would be invaluable :!:
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handyman

success stories

Post by handyman » Wed Mar 12, 2003 9:20 pm

Hepcat one of the newer treatments for anxiety and depression is NEURONTIN many articles on this if you do a search, and as you know it is one of the first line meds for cppps anyway. It has certainly helped me with both. maybe DALE could elaborate more as he is Psychiatrist. Hope this helps

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Hepcat
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Post by Hepcat » Wed Mar 12, 2003 10:13 pm

Thanks Handyman, but I'm all too familiar with Neurontin.

I actually have a previous thread where I mention how I responded to it.
viewtopic.php?p=1847&highlight=#1847

Poorly, unfortunately :sad:
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Richard.N
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Post by Richard.N » Thu Mar 13, 2003 5:56 pm

one of the newer treatments for anxiety and depression is NEURONTIN
That drug again :-D Do you have a URL on this please Handyman?
Richard

Age: 39. | Onset Age: 30. Onset Date: January 2002. Symptoms (back then): Supra-pubic pain, back pain, urinary frequency, urgency and difficulty, weak stream, nocturia, (and variously) chronic fatigue, IBS. Current symptoms: more frequent than normal, but pretty much under control. Current amelioration: Xatral 10mg, Mirtazapine 30mg. | Worsened By: Stress, binge drinking, strained bowel movements, bloating, sitting on hard surfaces, jogging, and regularly - THE WINTER!

I'm not a medical expert. My comment is opinion. See your medical professional.

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webslave
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Post by webslave » Sun Mar 16, 2003 2:20 am


handyman

Neuorontin

Post by handyman » Sun Mar 16, 2003 9:05 pm

Thanks Webmaster for posting reply an url to Richard N for me.

ddarcher
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I'm back!

Post by ddarcher » Tue Mar 18, 2003 5:00 am

Day 10 post antibiotics. 90% improved, survived Acapulco and had a great time. Hepcat, I do have some thoughts on the anxiety issue and I'll address these tomorrow as I just got in and need some sleep. Supervising 17 yo's is exhausting!
This communication provides general information, and is not a substitute for face-to-face medical care. Therefore a doctor-patient relationship should not be assumed by the reader.
Good luck,
Dale (Psychiatrist)

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F/U

Post by ddarcher » Fri Mar 21, 2003 1:53 pm

Two weeks today post antibiotics! 90% improved. Stopped vistaril due to a fuzzy brain feeling. No apparent increase in symptoms except for allergies slightly worse. Feeling Good! Now as to anxiety:
My question to you would be, as a psychiatrist, what is the treatment of choice for patients resistant to the traditional meds (ie. ssri's, Elavil, clonazapam, buspar)? is there anything new on the market that approaches anxiety in a radically different way? Exercise, eating right, warm baths, lots of sleep and herbal's haven't helped either
Benzodiazepines remain the treatment of choice with the best succes for treating anxiety. Obviously you have addiction potential so a non addicting alternative is being sought. The most commonly used benzos include Xanax, Ativan and klonopin. Next would be the SSRI class with paxil being the most studied. I only like buspar for mild cases, and the TCA class while effective typically has side effects worse than the disease if you get the dose into the therepeutic range which is usually 100mg plus for imipramine or it's equivalence in others. There are several drugs in each class listed above( except buspar) and you should be tried on a few before calling the whole class a failure. Also behavior mod therapy and relaxation therapy are very effective in anxiety. Much like CP you have to break the anxiety cycle so a combo of meds and therapy work best. On the research front, the anticonvulsants hold great promise. The theory is that some anxiety/panic attacks may be subclinical limbic system "seizures". Depakote can work and so can tegretol and also some of the newer meds like neurontin.
The research front is very exciting with several new class drugs in phase III trails that will possibley be available by next year. Hope this helps.
This communication provides general information, and is not a substitute for face-to-face medical care. Therefore a doctor-patient relationship should not be assumed by the reader.
Good luck,
Dale (Psychiatrist)

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Hepcat
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Post by Hepcat » Fri Mar 21, 2003 5:16 pm

Very Interesting.

Thank you Dale :)
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handyman

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Post by handyman » Fri Mar 21, 2003 9:28 pm

Dale I have had great success with neourontin for pain and anxiety with very little side effects. But the post from webmaster about pancreatic cancer scares me what do think the risk really is as an MD. I know you can not give medical opinion on board but a personal one Thanks Handyman.

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Post by ddarcher » Sat Mar 22, 2003 4:25 am

Dale I have had great success with neourontin for pain and anxiety with very little side effects. But the post from webmaster about pancreatic cancer scares me what do think the risk really is as an MD. I know you can not give medical opinion on board but a personal one Thanks Handyman.
When indicated I prescribe neurontin to my patients. It's effective with a low side effect profile and obviously it's FDA approved. If I personally needed it and it worked for me I would take it. If you have further concerns you should discuss with your Doc.
This communication provides general information, and is not a substitute for face-to-face medical care. Therefore a doctor-patient relationship should not be assumed by the reader.
Good luck,
Dale (Psychiatrist)

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Post by ddarcher » Mon Mar 24, 2003 1:05 pm

Today makes 2.5 weeks post antibiotics and almost 7 weeks since I started my regimen. Energy up- 95%, pain decrease-95%, Overall 95% improved. I will compile a full list of what I did to get here. It has been wonderful! Again I'm sometimes scared to post, afraid I may jinx it.
This communication provides general information, and is not a substitute for face-to-face medical care. Therefore a doctor-patient relationship should not be assumed by the reader.
Good luck,
Dale (Psychiatrist)

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webslave
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Post by webslave » Mon Mar 24, 2003 6:17 pm

Are you still taking the Prosta-Q?

ddarcher
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Prosta Q

Post by ddarcher » Tue Mar 25, 2003 12:50 am

Started prosta Q about 2 weeks ago. Took a while to get it.
This communication provides general information, and is not a substitute for face-to-face medical care. Therefore a doctor-patient relationship should not be assumed by the reader.
Good luck,
Dale (Psychiatrist)

ddarcher
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Bike ride!!

Post by ddarcher » Wed Mar 26, 2003 4:22 am

Did a 10 mile bike ride today! :-D Used to be an avid cyclist before CP but had to give it up due to pain and fatigue. Decided to give it a try today and it felt great. No pain during but some increased pain about an hour after. Well worth it. Trying to get my life back to normal for me. We'll see how I feel tomorrow.
This communication provides general information, and is not a substitute for face-to-face medical care. Therefore a doctor-patient relationship should not be assumed by the reader.
Good luck,
Dale (Psychiatrist)

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