Does anyone have experience with Anxiety Disorders?

[gumboot]

I just have a question for anyone with a bit of experience with anxiety disorders. Given the incredible wealth of experience and knowledge wandering about this place, it's as good a place as any for some advice.

Basically, someone close to me has an anxiety disorder, in the form of panic attacks that can be quite debilitating.

Although they are relatively rare, it somewhat stunts our activities together as I enjoy being outgoing and doing new and interesting things that are outside normal every day life.

This other person, however, is more than a little hesitant to do such things out of fear of a panic attack. They take medication for it, which I gather helps, but isn't 100% effective on its own.

I don't know much about such disorders, and really want to know what *I* could do, or encourage them to do, in order to help them.

I understand such things can be quite incident specific, so if anyone has some useful insight and would like to discuss the matter in more detail please feel free to PM me. Otherwise any general advice would be much appreciated!

-Gumboot

 

[wipeout]

Unfortunately, I know all too much about anxiety attacks. There can be few, if any, vicious circles more vicious than the downward spiral they can drag people into. Avoidance of the triggers is probably not the way forward as the number of triggers can increase and increase.

I would suggest exercise. Get really fit. I believe people have to ride the attacks out and be confident in the body's ability to do so. The more attacks you get through, the more you will feel you can get through.

 

[skeptifem]

I would say avoiding the triggers is a good idea until a doctor can help with a non drug treatment program(in addition to drugs). They should really be speaking to their doctor about what to do to remove the need for drugs (or if thats not possible lessen the need). Things work differently for different people and so i think its best to consult a professional.

 

[Lisa Simpson]

Avoiding the triggers is the worst thing to do. It just makes you more and more afraid of the thing you are afraid of. Start small. You didn't mention what is triggering them, but if for example, it is a fear of having a panic attack while far away from home, start by traveling a short distance. Tell your friend that if they have a panic attack, to let it happen. The adrenaline overload will only go on for a few minutes. But the fear of the adrenaline overload can go on for hours. That's the part that anxiety sufferers fear. He/she should consider getting a drug like Xanax that is only for the immediate panicky times. It's very addicting, so it is only taken once in a while.

Exercise is an excellent suggestion, too.

 

[uruk]

I suffered from panic attacks also. While the causes of the attacks are psychological, some of the symptoms of the attacks are physical in nature.
One of the biggest physical causes is hyperventilation. Hyperventilation will cause the person to feel like they are having a heart attack. (to which I have an almost phobic fear of) The person who is hyperventilating will feel like the can't catch thier breath. Sometimes they will get a tingling feeling in thier extremities. Thier heart rate will increase. They will have a feeling of "disconnectedness". (In my case the hyperventilation also lead to swollowing alot of air into my stomach which added to the "suffcating" effect)
In all a very alarming experiance. The best thing to do for hyperventilation is to breath into a paper or plastic bag to decrease the amount of oxygen in the blood stream.

I also took medication for my attacks (Xanax) but the drug really didn't address the underlying cause. How I dealt with psychological aspect was to face my fear and rationalize it out. (and the bag helped alot) In my case the fear was irrational.

I'm not saying this will work for your friend because the source of the anxiety may be different. Your friend may need a really good psychiatrist or try to work it out for him/her-self. But drugs alone aren't going to solve the problem.

I hope this helps. And good luck to your friend.

 

[Joppy]

As I understand, a lot of times stress plays a role in the on set of anxiety attacks.

Did the doctor offer cognitive behavior therapy as a treatment?
en.wikipedia.org/wiki/Cognitive_therapy
(sorry can't post link yet)

I think the best is just to be understanding and supportive, and leave the treatment to doctors.

 

[Dancing David]

There is alot of good advice going on here, anxiety is a really wierd duck and it manifests in a lot of really strange ways.

To sum up:
1. There is little you can do other than ask the person what behaviors you have that are helpful or harmful, often talking is a big problem, if someone is already in panic mode talking can overstimulate them.
2. Encourage them to not use caffine (gently, almost overcasualy and never when they are near any sort of panic).
3. Encourage them gently to get enough excercise and sleep. It is best to not even mention that it is related to the panic, just ask " Would you like to go for a walk".
4. Take care of yourself and set good boundaries on yourself. That way you can continue to be there for them.

 

[Iamme]

What many people don't realize is there can be a medical association between anxiety disorder which then leads to panic disorder...all stemming from a medical condition. One that I know of is the condition called mitro valve relapse (A heart condition). Once a person starts feeling 'anxious'... this creates a downward spiral of mental thoughts, like "Are they noticing my weirdness?" Then THIS can lead to social fears where in social surroundings, like just being in a grocery store (especially the checkout line where you are 'trapped' between people)...stuff you have done for years with no problem prior, can suddenly out of the blue, bring on the onset of an attack because of all the 'what-if thinking' that has become enbroiled in your brain over time. And the worse it gets, the worse if gets.

Unless you have an actual medical condition that is at the root of the anxiety, then a normal healthy person should be able to escape the bounds created by the debilitating disorder by medication therapy (by pros and/or on your own/self help books and tapes) and even changes in eating and excercisze habits. Excercize alone is supposed to be very therapeutic.

 

[blutoski]

I just have a question for anyone with a bit of experience with anxiety disorders. Given the incredible wealth of experience and knowledge wandering about this place, it's as good a place as any for some advice.

Basically, someone close to me has an anxiety disorder, in the form of panic attacks that can be quite debilitating.

Although they are relatively rare, it somewhat stunts our activities together as I enjoy being outgoing and doing new and interesting things that are outside normal every day life.

This other person, however, is more than a little hesitant to do such things out of fear of a panic attack. They take medication for it, which I gather helps, but isn't 100% effective on its own.

I don't know much about such disorders, and really want to know what *I* could do, or encourage them to do, in order to help them.

I understand such things can be quite incident specific, so if anyone has some useful insight and would like to discuss the matter in more detail please feel free to PM me. Otherwise any general advice would be much appreciated!

-Gumboot

I know this sounds like deflection, but your friend appears to have something going on already, and it's more fruitful to ask how you can fit in with this existing program, rather than invent your own therapy for him/her.

Depending on the root cause, your friend may be on a desensitization program with 'assignments' to go certain distances or to stay outside for minimum amounts of time. You may be able to help by keeping expectations within these boundaries and offering to accompany your friend on these outings.

I have some relatives through marriage with mild cases (my mother-in-law doesn't drive, and can't even be a passenger in a car when it crosses a bridge, and avoids all animals) and had a friend in college who had full-blown OCD (had to go through stop signs three times!). Sometimes there's nothing you can do to help.

 

[a_unique_person]

Get them to ask if their doctor if they can try another medication, to see if there is something more effective out there. The SSRIs are good, but no-one can really predict how effective they will be for any one person. At the extreme, what works well for one person can cause suicidal tendencies in another.

 

[a.real.girl]

I'd second the idea of follow up with the prescribing doc- for consideration of meds effectiveness vs. side effects (unique's thought) AND for any concomitant illness. Sometimes GAD is exacerbated by depression, regardless of if the sufferer believes they are depressed.

Good luck, and good on ya for trying to help.

 

[skepticdoc]

Even moderators are giving their $0.02!

Anxiety and Panic disorder can be very incapacitating. Whoever is suffering this condition needs to have a relationship with a trusted physician, either a Generalist or a Psychiatrist.

My advice is to stay away from an Internet forum advice, trust the Doctor!

 

[Dancing David]

Get them to ask if their doctor if they can try another medication, to see if there is something more effective out there. The SSRIs are good, but no-one can really predict how effective they will be for any one person. At the extreme, what works well for one person can cause suicidal tendencies in another.

Hogwash, any evidence that ADs cause suicidal thoughts? It is on the FDA warning in the US because of legislation, not evidence.

 

[skeptifem]

I haven't seen anything debunking the lilly suicides... have you?

 

[Dancing David]

I haven't seen anything debunking the lilly suicides... have you?

That is kind of a vauge response, the point is that there are some well known issues in mental health treatment of depressed people.

So could you be more specific?

1. People are at higher risk of harming them selve when they begin treatment with ADs. Why? You have an individual who is depressed and has been having thoughts of harming themselves for quite some time. They have low energy and low motivation. You begin to treat them with an AD, they have an increase in motivation and energy, if they have a bad day , they now have the energy to carry through on a suicide attempt. BUT this does not mean that the antidepressqant caused the suicidal thought.

2. It is like saying a medication that treats heart disease causes heart disease, becuase people who take the medicine have a heart attack. What is correlation and what is causation.

3. The most visible cases were the stories were the ones about children and the risk of suicide, again what is correlation and what is causation. I have done assesments with messed up kids and adults, and there is the huge problem of 'shopping' for the 'diagnosis the parent is comfortable with". I saw kids who allegedly had some sort of conduct disorder but in truth they were being abused. i saw children who heard voices and were quite psychotic, but thier parent refused to cooperate with the perscription of anti-psychotics. I met antisocial little jerks who had already raped and beaten thier siblings and thier parents want medication to make it all better, and so when thier abt-social little a-wipe acts out they blame the medication.

So when someone blames the medication, you have to apply the same standard of scrutiny as you normaly would. Denial is a huge problem is mental health treatment, people cover and lie in intake all the time, coke and meth addicts come in and say that they have attention deficit disorder, drug addicts say they have panic attacks and request xanax or valium. people with bipolar disorder want to have ADs instead.

So when you state "lilly suicides". what does that mean?

Were there logitudinal or anecdotal studies, were there control groups? What validation was in place to judge the history of the patients, what would lead someone to believe that it was not the underlying condition but the medication that caused the suicides.

On The Other Hand, all psychotropic medication should be monitored carefully during the first three months, all patients should avoid all substance abuse. there are many paradoxical reaction to medications that need to be monitored. There are all sorts of confounding social factors that complicate treatment. And then there is plain old human behavior, some doctors are arrogant pigs, some patients too, some doctors ignore what thier patients tell them, some patients ignore what thier doctor tells them. Some people have been messed up for twenty years because they are alcoholics and victims of domestic violence or because they used meth for five months. So there are risks to medication, but there are lot of other things as well.

 

[skeptifem]

Eli lilly did a lot of initial testing for prozac before it was released on the market and it showed that many more people were killing themselves after taking prozac vs the already available type of antidepressant. This article also references studies done on people with no previous mental health problems who had problems with wanting to commit suicide after being placed on ssri's. its also the source of the quoted text below.

http://www.suicidereferencelibrary.com/test4~id~1002.php

By 1986, clinical-trial studies comparing Prozac with other antidepressants showed a rate of 12.5 suicides per 1,000 users compared to only 3.8 per 1,000 on older, non-SSRI antidepressants, and 2.5 per 1,000 on placebos.

this is one of those tobacco company 'they knew better and released it anyway' situations. I believe lilly was named specifically in some lawsuits over suicides/homicides in people with no such tendancies after taking prozac.

It was not until trials like the Forsyth case that Lilly's internal documents would surface, revealing the depth of the deception. This included statements from the Prozac working group in 1978, acknowledging problems with akathisia and drug-induced psychosis. Also among the documents was evidence that the company had drafted (but later abandoned) a package insert for Prozac stating that, "Mania and psychosis may be precipitated in susceptible patients by antidepressant therapy." And there was a memo dated Oct. 2, 1990, which referenced an upcoming Prozac symposium. "The question is what to do with the 'big' numbers on suicidality," the memo states. "If the report numbers are shown next to those for nausea, they seem small."
The Lilly papers also contain a series of memos referencing a study by two Taiwanese doctors entitled "Suicidal attempts and fluoxetine (Prozac) treatment." In a 1992 memo, a Lilly employee reports, "Mission accomplished. Professor Lu will not present or publish his fluoxetine [Prozac] vs. maprotiline suicidality data." In a similar case, Lilly lawyers obtained a cease-and-desist order against Robert Bourguignon, a Belgian doctor who was soliciting his colleagues' impressions regarding Prozac side effects. Bourguignon eventually prevailed, and his survey, "Dangers of Fluoxetine," appeared in The Lancet in 1997.

if you google 'lilly suicides" there are lots of hits to choose from. The reason my response was so vague is because I figured anyone with a strong opinion either way would have at least heard of eli lilly or read about the lilly suicides. It comes up a lot when researching the subject on the internet.

 

[gumboot]

Even moderators are giving their $0.02!

Anxiety and Panic disorder can be very incapacitating. Whoever is suffering this condition needs to have a relationship with a trusted physician, either a Generalist or a Psychiatrist.

My advice is to stay away from an Internet forum advice, trust the Doctor!

Does that include your internet advice?

I wasn't so much meaning "what can I do to treat them". Absolutely, as many have pointed out here, the experts are the one to do that.

It was more what I can do in a GENERAL sense, as a person with a relationship with them, to support and help them.

There seems to be a lot of great advice here, and it's along the lines of what I was thinking.

Thanks everyone for your input.

Actually just in the last couple of weeks we have been more "active" - going out places for walks and going out socially to visit other people. I think this is a promising sign.

-Gumboot

 

[Dancing David]

Eli lilly did a lot of initial testing for prozac before it was released on the market and it showed that many more people were killing themselves after taking prozac vs the already available type of antidepressant. This article also references studies done on people with no previous mental health problems who had problems with wanting to commit suicide after being placed on ssri's. its also the source of the quoted text below.

http://www.suicidereferencelibrary.com/test4~id~1002.php



this is one of those tobacco company 'they knew better and released it anyway' situations. I believe lilly was named specifically in some lawsuits over suicides/homicides in people with no such tendancies after taking prozac.




if you google 'lilly suicides" there are lots of hits to choose from. The reason my response was so vague is because I figured anyone with a strong opinion either way would have at least heard of eli lilly or read about the lilly suicides. It comes up a lot when researching the subject on the internet.

Very interesting, the general concensus in the mental health field does not discuss this bizzare legal precedent, we all just knew that SSRI's are perscribed to people with suicidal tendecies because the lethal dose for an SSRI is much higher than for a tricyclic, a month of a tricyclic will kill you, a month of prozac usualy won't. So i will read up, see what the logitudinal studies show now.

But a pharmacological company covering something up, well, I am shocked simply shocked to find out there is gambling going on here.

I will investigate, in mental health the assumption is that because SSRIs are perscribed preferentialy to people with suicidal thoughts it is correlative not causitive. I bet it will be hard to find recent reaserch, since fluoxetine is no an old war horse.

 

[Dancing David]

http://www.ncbi.nlm.nih.gov/entrez/..._uids=17146010&query_hl=1&itool=pubmed_docsum

DESIGN AND SETTING: A cohort study in which all subjects without psychosis, hospitalized because of a suicide attempt from January 1, 1997, to December 31, 2003, in Finland, were followed up through a nationwide computerized database. PARTICIPANTS: A total of 15 390 patients with a mean follow-up of 3.4 years. MAIN OUTCOME MEASURES: The propensity score-adjusted relative risks (RRs) during monotherapy with the most frequently used antidepressants compared with no antidepressant treatment. RESULTS: In the entire cohort, fluoxetine use was associated with the lowest risk (RR, 0.52; 95% confidence interval [CI], 0.30-0.93), and venlafaxine hydrochloride use with the highest risk (RR, 1.61; 95% CI, 1.01-2.57), of suicide. A substantially lower mortality was observed during selective serotonin reuptake inhibitor use (RR, 0.59; 95% CI, 0.49-0.71; P<.001), and this was attributable to a decrease in cardiovascular- and cerebrovascular-related deaths (RR, 0.42; 95% CI, 0.24-0.71; P=.001). Among subjects who had ever used any antidepressant, the current use of medication was associated with a markedly increased risk of attempted suicide (39%, P<.001), but also with a markedly decreased risk of completed suicide (-32%, P=.002) and mortality (-49%, P<.001), when compared with no current use of medication. The results for subjects aged 10 to 19 years were basically the same as those in the total population, except for an increased risk of death with paroxetine hydrochloride use (RR, 5.44; 95% CI, 2.15-13.70; P<.001).

- RESULTS: In the entire cohort, fluoxetine use was associated with the lowest risk (RR, 0.52; 95% confidence interval [CI], 0.30-0.93), and venlafaxine hydrochloride use with the highest risk (RR, 1.61; 95% CI, 1.01-2.57), of suicide.
- Among subjects who had ever used any antidepressant, the current use of medication was associated with a markedly increased risk of attempted suicide (39%, P<.001), but also with a markedly decreased risk of completed suicide (-32%, P=.002) and mortality (-49%, P<.001), when compared with no current use of medication.
- The results for subjects aged 10 to 19 years were basically the same as those in the total population, except for an increased risk of death with paroxetine hydrochloride use (RR, 5.44; 95% CI, 2.15-13.70; P<.001).


venlafaxine hydrochloride is Effexor

paroxetine is Paxil?

 

[Dancing David]

http://www.ncbi.nlm.nih.gov/entrez/...tool=iconabstr&query_hl=1&itool=pubmed_docsum

Some behavioral side effects of selective serotonin reuptake inhibitor (SSRI) antidepressants have been known for a long time. Since the introduction of these drugs in the 1990s, publications have regularly reported behavioral side effects in children and adolescents, including excitation, motor restlessness, social disinhibition, and above all self-injurious ideation and behavior. Clinical trials provide only limited data. Although these data suggest that some self-injurious and suicidal behavior may indeed occur in children and adolescents receiving SSRIs, they are too disparate to specify the frequency of these acts. Clinical trials provide useful data about drug efficacy, but their methodology is inappropriate for determining the frequency of such side effects. SSRI and suicidality: the data are difficult to read. Although some epidemiologic data suggest that SSRIs may increase the risk of occurrence of self-injurious and suicidal behavior in children and adolescents, other epidemiologic data show that the rate of suicide mortality in children and adolescents has decreased since the introduction of SSRIs.
…
SSRIs must be used rationally and carefully in children and adolescents. They should not be administered routinely in youth with obsessive-compulsive or depressive disorders. Their use should be reserved for severe disorders or when psychotherapy alone has been shown to be inadequate, and when they are used, efficacy and side effects must be monitored carefully and frequently.