Anxiety? Anyone have anything that works for them?

[cmd2014]

I'd recommend just getting him to an appropriately trained mental health specialist (either a psychologist or psychiatrist, both of whom have doctoral level training in psychodiagnotic assessment) for a good diagnostic workup. Both will work with your PCP to develop a treatment plan once you have a better understanding of what is going on. ADD/ADHD are both lifelong neurodevelopmental disorders that are present from childhood, and do not have a sudden onset, so it is unlikely that this is the issue (or at least not what is tipping the balance here, as if he does have it, he would have had it all his life). OCD is also typically more of a lifelong issue, and also does not have a sudden onset (and it would be obvious to a mental health professional if this was the issue). OTOH depression, panic disorder, and GAD can be triggered by stressful life events, and you'd want to rule out anything physical as a cause of his symptoms (which his PCP should already be working on). No-one can diagnose without a thorough work-up and an actual examination, so please don't think you can just get opinions here and read up on stuff and figure it out on your own. He needs professional help. Most therapists aren't trained in the kind of differential diagnosis required of more serious mental health issues (the focus of their training is typically on helping people through relationship issues or normal life stresses, not more serious mental health issues). Once you have a diagnosis, the treatment plan will be more clear. For depression and anxiety, CBT and medication management of symptoms (in combination) is typically the standard of care. Usually people work with a psychologist for the CBT while their psychiatrist or PCP prescribes and monitors the medication management part.

I know this is scary. It will be a lot less scary once you have things in place in terms of diagnosis and treatment. Things often get better pretty quickly after that. I hope he feels better soon!

 

[PintoBean]

In the meantime, while the docs do their thing, some "over the counter" suggestions -
1. adult coloring books
2. crocheting
3. massages (we opt for reflexology to keep our clothes on and avoid parts of the skin that may have an eczema or psoriasis problem)
4. yoga

 

[Gypsy]

I haven't read the other advice here. I've had an anxiety disorder since I was 20. I'm 41 now.

Zoloft isn't that great for anxiety. ALL these medications take WEEKS to take effect. You need to build them up in your system. And you CAN NOT stop ANY OF THEM cold turkey. You need to carefully step down over weeks.

And a GP is not a good doctor for continuing care.

Find a psychologist that specializes in "medication management". They are also called psychopharmacologists.

Be careful. You don't want one that is actively involved in studies at a research center. They will use you (I know this from personal experience) for their research and will switch your medications for no reason except to see 'what happens'. No.

You want someone who believes in mediation, in CBT therapy, and works closely with a good therapist or several good therapists. You want someone that will start you on ONE medication. And then if needed add another or two. But they should not make more than ONE major change to the medication routine at any time.

And they will want to see your husband every month or so at the start. Then once the symptoms are managed, then every two months. NO MORE than that. AND they should ALWAYS be available by some means (pager, cell, text, email).

You do not want someone who keeps prescribing any of the below for regular use:
Benzodiazepines:
Xanax or Niravam (alprazolam)
Klonopin (clonazepam)
Ativan (lorazepam)
Valium (diazepam)

Your husband should have either xanax or ativan or valium ON HAND, for episodes (panic attacks) like the one you described. But should NOT be using it regularly except for very short bursts (no longer than 3 weeks). They are addictive and NOT good for regular use at all.

Selective norepinephrine reuptake inhibitors (SNRIs) are the ones I take. But it is NOT one size fits all. What works for one person will NOT work for another. So you need a REALLY good doctor to tailor the medication to your husband.

The doctor should listen to your husband very carefully about symptoms and experiences, should ask good questions AND BE EMPATHETIC. They should CARE about side effects and discuss them with your husbands.

Your husband should feel SAFE with the doctor. If his gut tells him that something is off, find someone else.

 

[cmd2014]

Only four states currently allow prescription privileges for psychologists (Iowa, Illinois, New Mexico and Louisiana). Everywhere else you will be required to work with either a psychiatrist or your primary care physician (PCP) for the medication management part of a treatment plan. Medication is not always required or recommended, but can be a helpful part of treatment in some cases. Typically SSRI or SNRI meds are recommended (depending on the diagnosis), but these take time to have therapeutic benefit and can temporarily increase symptoms until this happens. So I would agree with Gypsy about the need to wait it out and to be cautious about working with a physician who is too willing to go from one to another to another without allowing adequate time for any of them to work (or anyone suggesting long term use of benzodiazepines).

In states where psychologists do not have prescription privileges, the best expert would be a psychiatrist for the medication piece and a psychologist for the CBT psychotherapy piece, as the majority of people derive the most therapeutic benefit from a combination of both. But many PCP's are also quite skilled at medication management for anxiety and depression (a good portion of family medicine practice is the provision of follow up care in regard to mental heath issues), so they might suggest working with them on the medication piece and referring to psychology for the psychotherapy. CBT is also central to treatment, so be cautious of anyone suggesting medication management alone without adjunctive CBT psychotherapy. But what your husband should do in his specific case will depend on his diagnosis, so getting a psychological or psychiatric diagnostic workup done is your best first step.

 

[Tacori E-ring]

License Professional Counselors or Clinical Social Workers can also help with talk therapy. Another poster mentioned therapist only have experience with adjustment disorders or mild conditions but that is not true. Many of us also deal with chronic, severe mental illness and are trained to diagnose. Psychiatrist or psychiatric APNPs/NPs can handle the medication management. Most do not have time to do talk therapy. There are also intensive outpatient programs for anxiety disorders. I am not sure where you live but it may be a good option depending on the severity. FMLA will protect his job while he seeks treatment.

 

[msop04]

You do not want someone who keeps prescribing any of the below for regular use:
Benzodiazepines:
Xanax or Niravam (alprazolam)
Klonopin (clonazepam)
Ativan (lorazepam)
Valium (diazepam)

Your husband should have either xanax or ativan or valium ON HAND, for episodes (panic attacks) like the one you described. But should NOT be using it regularly except for very short bursts (no longer than 3 weeks). They are addictive and NOT good for regular use at all.

I wanted to comment on the bolded statements above. Yes, benzos are addictive... HOWEVER, there are many medications that are addictive. Almost all ADD/ADHD medications are amphetamine based, so they are obviously addictive. This isn't a bad thing IF THEY WORK FOR THE PATIENT and provide a better quality of life. They simply need to be managed by the prescribing physician/psychiatrist and taken as directed.

Chances are, your husband will be on some form of medication(s) to control his anxiety every day for the rest of his life, so does it really matter if he's addicted to it? This is a classic scenario of "Benefit vs. risk..." I wouldn't blacklist any meds just because they can be addictive.

There are MANY people on scheduled doses of benzos daily (lots take doses throughout the day) to keep them from getting to the point of severe anxiety or anxiety attack. Why wait until you're totally panicking when it can be prevented? If this is an option for your husband, I wouldn't rule it out before trying it. Most patients start on (and some even stay on) a low dose anti-anxiety medication (benzo or other) in addition to an antidepressant. Some even take a low dose beta-blocker to lower heart rate in an effort to control anxiety.

...Gypsy echoed what myself and others have mentioned -- that each person's body is different and may react differently to any medication. With that said, who's to say that a dose of Zoloft of other SSRI/SNRI alone won't help your husband?? Its commonly prescribed for GAD and panic disorders. It certainly helped take the edge off for my MIL, and that's all she takes for her anxiety (so it does and can happen for some people).

What I'm saying is that just because a therapy did/did not work for someone DOES NOT MEAN that it will have the same effect on another person.

Best of luck to both of you.

Tried to edit for typos, so please excuse any I may have missed!!

 

[arkieb1]

I think you need to get him to a doctor that specialises in diminished cognitive function and have him checked out properly - it would be better to rule out other serious conditions. Yes it could be panic attacks, stress and anxiety, but things like Parkinson's disease, Lewy body dementia, strokes, Huntington's disease, and a host of others all can present with similar symptoms and can take ages to diagnose.

 

[cmd2014]

License Professional Counselors or Clinical Social Workers can also help with talk therapy. Another poster mentioned therapist only have experience with adjustment disorders or mild conditions but that is not true. Many of us also deal with chronic, severe mental illness and are trained to diagnose. Psychiatrist or psychiatric APNPs/NPs can handle the medication management. Most do not have time to do talk therapy. There are also intensive outpatient programs for anxiety disorders. I am not sure where you live but it may be a good option depending on the severity. FMLA will protect his job while he seeks treatment.

True, but it depends where you are. Making and communicating a diagnosis is a protected act in many places, and in some states/Canadian provinces, it is limited to physicians and doctoral level Psychologists. And even among registered health care providers, people's training and expertise can vary (some may have a lot of experience in inpatient and outpatient mental health, but others may not have the same level of exposure to more serious mental health concerns and may instead have expertise in counselling or family therapy). In addition to this, 'therapists' or 'counsellors' can be of any training level (some have a 6 week course in counseling; contrast that to the 6+ years of training for a Master's level MSW, MFT, or LCSW or the 12+ years of training required to become a board certified doctoral level psychologist or board certified psychiatrist). In my experience, those with extensive training who are a member of a regulated profession tend to refer to themselves by their professional title (LCSW, Psychologist, Psychiatrist, Psychiatric Nurse), while those without this tend to refer to themselves as 'therapists' or 'counsellors'. So consumers need to be aware of the expertise level of who they are working with.

My concern was that the OP indicated that her husband was seeing a 'therapist' in regard to a family therapy issue, which is more likely to be someone with a counseling or family therapy background rather than a background in mental health. They are two separate areas of expertise, and the recommendations given did not seem to reflect a high level of knowledge in mental health assessment or treatment. But most people don't know the difference between a counselor, a therapist, a social worker, a LCSW, a psychologist, a psychiatrist, etc., and assume that whomever they are seeing has the expertise to offer care in all things. Talk therapy can also mean a range of things, and the treatment has to be tailored to the diagnosis in order to be effective. At this point it is unclear what the OP'S husbands treatment needs are because his diagnosis is unclear. She says she thinks it's anxiety but his sxs don't unequivocally point to that, so step 1 is to determine diagnosis and once that is done, his treatment needs (and where to access treatment) should become more clear.

 

[Puppmom]

Wow, thank you for all of the thoughtful responses and information! A couple of things:

Zoloft - what was interesting is that it *worked* right away. Turns out that's not a good sign because it's not really designed to work until it builds up in your system. Around that time (6 or 8 week mark) is when the *dark thoughts* as DH calls them started to set in. The therapist thought he should wean (he did so under his PCP's care over two or three weeks) but the PCP said she would have gone the other way and upped his dose. DH was afraid to do that and opted to wean. Then, after that, she said she didn't want to prescribe anything and that he should see a psychiatrist. He was doing okay and acupuncture seemed to be helping so he put it off.

His therapist - she is a licensed Psychologist (in PA). Honestly, as a lay person - therapist, counselor, psychologist - I don't exactly understand the distinguishing factors. She did refer him to a Psychiatrist. They're not taking new patients until January (uh, no). Her Plan B was for him to go to a local mental health facility - their services run the gamut. They take walk-ins. DH decided NOT to contact them on Friday because his functioning was somewhat improved. I'm skeptical of this one stop shop and am researching Psychiatrists in our area. It sounds like I might encounter some challenges. I like his therapist - I feel like she's good at the services she provides but I'm not sure she can get him over this hump alone. And, for whatever reason, what makes sense to him when he's in her office is not carrying over into everyday life.

Xanax - he received a script for 20 to take on an as needed basis. He understands to only take them when his anxiety is high. He did notice on Thursday/Friday after taking two his anxiety was much lower but he felt sluggish.

He had a really good weekend and made a point to tell me he felt good today. Good is something I rarely hear these days. I don't want to discourage him but I'm afraid the good days give him a false sense of improvement when really they're just a brief respite. As an onlooker, I know. It won't be long before I get a panicked phone call.

This is definitely pushing me to my limits. In a weird way it's creating anxiety in me. I'm constantly worried about him. When I see him after work, I wait for those first few words so I can judge what zone we're in. It's very odd to go from having a spouse who is laid back, content and in control to one who is so anxious that he's just a shell of a person much of the time. I wish I could understand better what happened and how we ended up here.

For now, I'm going to continue encouraging him (outright pushing if necessary) to tell work, get to a psychiatrist and get to the doctor for a physical and request a neurological work up. We have a PPO so I think he can skip over his PCP if they blow him off. I really hope we can get this under control before his job falls apart. That would be such a huge setback mentally.

 

[msop04]

Zoloft - what was interesting is that it *worked* right away. Turns out that's not a good sign because it's not really designed to work until it builds up in your system. Around that time (6 or 8 week mark) is when the *dark thoughts* as DH calls them started to set in..

It's actually not uncommon for patients to feel a bit better right away (note: this may a bit of the placebo effect as well). Since the drug has been absorbed (meaning, "the drug has hit the bloodstream), it is in the body and is being metabolized. The 6-8 weeks comes in because that is the approximate amount of time it takes the drug to reach a specific therapeutic level in the bloodstream -- this is the maximum level it will achieve in the body, therefore the patient will have the maximum benefit for that specific drug dosage at that time. It's not that it's not working before the 6 week mark, it's just that the patient isn't receiving the full "benefit" of the drug therapy prior to that time.

Also, "bad/suicidal thoughts" can be a side effect of antidepressants (well, from many psychotherapeutic drugs). Any of these type symptoms should be reported to the prescriber immediately.

Xanax - he received a script for 20 to take on an as needed basis. He understands to only take them when his anxiety is high. He did notice on Thursday/Friday after taking two his anxiety was much lower but he felt sluggish..

Feeling sluggish is normal, as benzos tend to relax the patient to diminish the anxiety... but the dose may be just a smidge too high. Have him mention it to his prescriber.

 

[Tacori E-ring]

License Professional Counselors or Clinical Social Workers can also help with talk therapy. Another poster mentioned therapist only have experience with adjustment disorders or mild conditions but that is not true. Many of us also deal with chronic, severe mental illness and are trained to diagnose. Psychiatrist or psychiatric APNPs/NPs can handle the medication management. Most do not have time to do talk therapy. There are also intensive outpatient programs for anxiety disorders. I am not sure where you live but it may be a good option depending on the severity. FMLA will protect his job while he seeks treatment.

True, but it depends where you are. Making and communicating a diagnosis is a protected act in many places, and in some states/Canadian provinces, it is limited to physicians and doctoral level Psychologists. And even among registered health care providers, people's training and expertise can vary (some may have a lot of experience in inpatient and outpatient mental health, but others may not have the same level of exposure to more serious mental health concerns and may instead have expertise in counselling or family therapy). In addition to this, 'therapists' or 'counsellors' can be of any training level (some have a 6 week course in counseling; contrast that to the 6+ years of training for a Master's level MSW, MFT, or LCSW or the 12+ years of training required to become a board certified doctoral level psychologist or board certified psychiatrist). In my experience, those with extensive training who are a member of a regulated profession tend to refer to themselves by their professional title (LCSW, Psychologist, Psychiatrist, Psychiatric Nurse), while those without this tend to refer to themselves as 'therapists' or 'counsellors'. So consumers need to be aware of the expertise level of who they are working with.

My concern was that the OP indicated that her husband was seeing a 'therapist' in regard to a family therapy issue, which is more likely to be someone with a counseling or family therapy background rather than a background in mental health. They are two separate areas of expertise, and the recommendations given did not seem to reflect a high level of knowledge in mental health assessment or treatment. But most people don't know the difference between a counselor, a therapist, a social worker, a LCSW, a psychologist, a psychiatrist, etc., and assume that whomever they are seeing has the expertise to offer care in all things. Talk therapy can also mean a range of things, and the treatment has to be tailored to the diagnosis in order to be effective. At this point it is unclear what the OP'S husbands treatment needs are because his diagnosis is unclear. She says she thinks it's anxiety but his sxs don't unequivocally point to that, so step 1 is to determine diagnosis and once that is done, his treatment needs (and where to access treatment) should become more clear.

I can only speak for the US but LPCs (License Professional Counselors) have to have a Masters Degree and 3,000 hours of supervision post graduation. If only I could have taken a 6 week course! Haha. I have had extensive inpatient experience. I actually have more experience working with acute mental illness than the psychologists I work with in an outpatient setting. So I agree it is important to ask for credentials and experience.

 

[Puppmom]

For what it's worth DH's therapist has a lot of experience with inpatient psychiatric population. She later transitioned and focused on family and marriage counseling. She also does "classes" for lack of a better term on self esteem and assertiveness. Regardless, it seems DH needs more and she is encouraging that.

Is there a way for me to tell if she does CBT without outright asking? Are there things I can ask DH that would make it obvious whether she is or isn't?

 

[Tacori E-ring]

Is there a way for me to tell if she does CBT without outright asking? Are there things I can ask DH that would make it obvious whether she is or isn't?

I would just ask! She sounds experienced enough and I am sure has been asked before. I encourage my patients to ask what counseling theories their therapist uses. You also probably got a statement about her training/theoretical style when he started. I have only had one patient "interview" so far which is kinda of surprising. I don't mind it at all. CBT believes people have to change their thinking for their behavior and emotions to change. So she would be doing lots of "change talk." She would probably be talking about distorted thinking styles and thought changing record sheets.

 

[Gypsy]

MSOP.

I disagree with your statement about benzo addiction. Just because you are going to have a condition for the rest of your life doesn't meant that you should complicate it with a very bad addiction. This is from someone who has seen a family member in the grips of an addiction, that their doctor's completely fed with continued prescriptions for a lifelong conditions. That family member went through HELL to get clean and STRONGLY prefers dealing with their condition medicated differently than to be an addict now that they are free of it (well, not free but you know what I mean).

http://www.webmd.com/mental-health/addiction/benzodiazepine-abuse

I have benzos in the house. And I use them as needed. But I have a strong mandate to all my doctors that I will not become and addict, and they respect that and work with me on my medications to make sure that it never happens.

 

[cmd2014]

For what it's worth DH's therapist has a lot of experience with inpatient psychiatric population. She later transitioned and focused on family and marriage counseling. She also does "classes" for lack of a better term on self esteem and assertiveness. Regardless, it seems DH needs more and she is encouraging that.

Is there a way for me to tell if she does CBT without outright asking? Are there things I can ask DH that would make it obvious whether she is or isn't?

Is he doing specific homework assignments? CBT requires both cognitive homework (thought diaries, challenging maladaptive thoughts and catastrophic beliefs) and behavioral homework (graduated exposures to anxiety provoking scenarios, engaging in active coping strategies). There are also typically CBT specific reading materials given.

You can ask him. He should know what he is doing with his psychologist in treatment. Or you could ask to attend a session with him to discuss his diagnosis and treatment plan and ways you can support that (keeping in mind that he is the patient, so he would need to agree to this). Maybe this has been established already but you are out of the loop. Sometimes people aren't great at communicating with family what they've been told by their doctors. I'm reassured that she sounds like she has experience and I hope that your husband feels better soon.

@Tacori, registered people need similar training here. But we operate under a title act not a practice act, so people hang out shingles and call themselves therapists, counselors, and life coaches (nonregulated terms) without any professional training or in some cases training in some unrelated field and a 6 week counseling certificate offered through the community college. So caveat emptor in regard to the expertise of the person providing care. Unregulated people cannot bill insurance but can see self pay clients (typically at significantly reduced rates). But patients have no legal recourse if poor quality care is provided.

But even among psychologists there are varying degrees of expertise in diagnostic assessment and treatment of various conditions. The field is too large for everyone to be an expert in everything.

 

[Gypsy]

About CBT:

Again, nothing is one size fits everyone.

My therapist uses multiple disciplines to help her clients. With me, I specifically asked for CBT but after a while, and once we built a relationship, it became clear that pure CBT wasn't going to be as effect as a mixed discipline approach for me. CBT is a strong part of my therapy. But it's not the entirety of it, because that's not the best fit for me.

It's about fit. And, please do not take the wrong way puppmom, but this isn't about you or your comfort with his therapist. That, frankly, is largely irrelevant. HE has to be comfortable. And that is paramount.

You may need to start seeing someone yourself, this hard on you as well. And if that is the case, then you will want to find the right fit for you.

But in this case, for your husband... he is one whose comfort matters. Before I found my current therapist, I tried may different ones (7 of them total) and even though a few of them were CBT, they weren't a good personality fit for me. Personality and "clicking" with your therapist is very important.

 

[House Cat]

Wow, thank you for all of the thoughtful responses and information! A couple of things:

Zoloft - what was interesting is that it *worked* right away. Turns out that's not a good sign because it's not really designed to work until it builds up in your system. Around that time (6 or 8 week mark) is when the *dark thoughts* as DH calls them started to set in. The therapist thought he should wean (he did so under his PCP's care over two or three weeks) but the PCP said she would have gone the other way and upped his dose. DH was afraid to do that and opted to wean. Then, after that, she said she didn't want to prescribe anything and that he should see a psychiatrist. He was doing okay and acupuncture seemed to be helping so he put it off.

His therapist - she is a licensed Psychologist (in PA). Honestly, as a lay person - therapist, counselor, psychologist - I don't exactly understand the distinguishing factors. She did refer him to a Psychiatrist. They're not taking new patients until January (uh, no). Her Plan B was for him to go to a local mental health facility - their services run the gamut. They take walk-ins. DH decided NOT to contact them on Friday because his functioning was somewhat improved. I'm skeptical of this one stop shop and am researching Psychiatrists in our area. It sounds like I might encounter some challenges. I like his therapist - I feel like she's good at the services she provides but I'm not sure she can get him over this hump alone. And, for whatever reason, what makes sense to him when he's in her office is not carrying over into everyday life.

Xanax - he received a script for 20 to take on an as needed basis. He understands to only take them when his anxiety is high. He did notice on Thursday/Friday after taking two his anxiety was much lower but he felt sluggish.

He had a really good weekend and made a point to tell me he felt good today. Good is something I rarely hear these days. I don't want to discourage him but I'm afraid the good days give him a false sense of improvement when really they're just a brief respite. As an onlooker, I know. It won't be long before I get a panicked phone call.

This is definitely pushing me to my limits. In a weird way it's creating anxiety in me. I'm constantly worried about him. When I see him after work, I wait for those first few words so I can judge what zone we're in. It's very odd to go from having a spouse who is laid back, content and in control to one who is so anxious that he's just a shell of a person much of the time. I wish I could understand better what happened and how we ended up here.

For now, I'm going to continue encouraging him (outright pushing if necessary) to tell work, get to a psychiatrist and get to the doctor for a physical and request a neurological work up. We have a PPO so I think he can skip over his PCP if they blow him off. I really hope we can get this under control before his job falls apart. That would be such a huge setback mentally.

Ok,

Don't enmesh here! You don't have to feel what he is feeling. You can absolutely separate from him and be a happy person while he is having these issues. I know you are worried for him. I know you love him more than life. But he does not want you to go down with the ship! What good would that do? How would you support him then?

It is time for you to start practicing some self care. What can you do to make yourself feel better, even if just for a short period of time? Can you schedule a massage? A facial? Can you go out with the girls? What is the weather like? Can you start going for walks to clear your head? What will make you happy right now?

It is a fact that people caring for others with mental illness often end up depressed or anxious themselves. If you are slipping, you need to put the brakes on this right now!

Someone mentioned therapy...this is a good suggestion.

Remember, he does not want you to suffer! He will suffer more if you begin to get sick with him. It is ok for you to be well.

(this comes from someone with mental illness)

big hugs

 

[msop04]

MSOP.

I disagree with your statement about benzo addiction. Just because you are going to have a condition for the rest of your life doesn't meant that you should complicate it with a very bad addiction. This is from someone who has seen a family member in the grips of an addiction, that their doctor's completely fed with continued prescriptions for a lifelong conditions. That family member went through HELL to get clean and STRONGLY prefers dealing with their condition medicated differently than to be an addict now that they are free of it (well, not free but you know what I mean).

http://www.webmd.com/mental-health/addiction/benzodiazepine-abuse

I have benzos in the house. And I use them as needed. But I have a strong mandate to all my doctors that I will not become and addict, and they respect that and work with me on my medications to make sure that it never happens.

I see where you're coming from, Gypsy... I really do. I partnered in several studies about addiction and completed a residency in a chemical abuse rehab facility while in school. Being clinically "addicted" to a medication doesn't always yield negative effects -- i.e. addiction isn't always "bad" -- it simply means that a pt has been on a drug long enough to develop some level of dependence. Obviously, the level of dependence varies with each drug/dose/length of therapy/patient. Just stay with me here...

It sounds like your family member was experiencing extremely negative effects because of the level of his/her addiction. However, there are many patients who are technically addicted to certain meds, but they are able to live a more "normal"/healthy/pain-free life (depending on what they are being treated for, of course) because of their meds.

I am one of them. I take an extended release ADD medication (Vyvanse) pretty much every day and always on days I work. Can I function without it? Of course, but not nearly as well. It's very important that I am totally focused and on task when in the pharmacy (I think everyone can agree that they would like to be given the correct drug prescribed, labeled with the correct directions, filled in a timely manner by a pharmacist who is able to check for any interactions/special precautions, and counsel them when needed. )

"Addiction" is a word that automatically has a negative connotation, but that's not always the case.

Am I an addict? Well, I take an amphetamine based drug on the daily, so I know that I'm clinically "addicted" to my medication. So, yeah, I'm an addict in the clinical sense of the word. Am I an addict who has seriously negative effects if I don't take my Vyvanse? No, not at all. I can tell if I don't take it because I'm kinda all over the place mentally -- "...we need to order more vials and -- OH LOOK, A SQUIRREL!!" I'm also a little sluggish and have trouble getting motivated to start or complete tasks.

If there are other non-addictive therapies that work for a patient, then obviously that would be perfect... but that's not always the case. The reason I mention all of this is because I think it's a shame when a patient could seriously benefit from a particular drug, but it's never even attempted for the simple fact that it has the potential for addiction... Addictive drugs aren't optimal for certain populations. Responsible prescribing and drug therapy management is the key.

 

[missy]

Puppmom, I am continuing to think of you and your sending good thoughts and wishes your way and more (((hugs))). As for managing anxiety all the usual stuff-working out, meditating, chatting/venting with friends help as does looking at and dreaming about pretty bling. Superficial perhaps but whatever works and I find when I am my most anxious is when I am also most dangerous re bling purchases. Sometimes just getting out of your own head for a bit helps.

And yes I agree with House Cat. Please be kind to yourself and remember if you need professional help you should definitely find someone who can help you. Sometimes we need that extra support and expertise.

Hang in there and (((HUGS))).

 

[House Cat]

I have seen countless clinicians with various degrees and it is the consensus that benzos are not good long-term therapy for generalized anxiety disorder or any uncomplicated anxiety issue, period. I am not sure why someone would push for a benzo "addiction" on top of anxiety. What a shit storm that would be. Benzo addiction is one of those addictions that you feel in your bones forever. To have a person with horrid anxiety all of the time WITH the anxiety of addiction? What an awful thing to do to a person. Responsible clinicians will avoid that at all costs.

Besides, there are SO many other medication alternatives out there.

What I have been told by the many professionals that have been in charge of my care is that therapy is the best long-term treatment for anxiety. SSRI or SNRI antidepressants are good too. Benzos are only good for an acute attack. You need to weight the good with the bad though and be very careful when taking them. They have a rebound effect and they are highly addictive.


To the OP, has your husband been able to secure a psychiatrist appointment yet?

 

[Puppmom]

Hi, all. Sorry I've been silent. I've read everything and really appreciate all of the advice, thoughts and sharing of experiences. I was struggling to articulate responses because we're pretty overwhelmed. Quick update: DH had a pretty good run but alas, the anxiety was only on hiatus. He and his therapist had been working to get him into a Psychiatrist with a long wait (seems like this is the norm?) and they've been meeting weekly in the meantime. He stopped acupuncture a few weeks ago. It's expensive and he wasn't sure it was helping.

So...almost 10 or so "good" days. Then yesterday, seemingly out of nowhere, he woke up really shaky and had twitching in his eyes and his mind was racing. He was almost in tears and having a hard time thinking and articulating exactly what was going on. So a panicked call to the therapist and PCP. PCP got him in right away and had a connection at a local mental health services organization and sent him for an urgent ( I hesitate to say emergency because he was/is not a danger to himself or others) evaluation. He went through some intake and met with a psychiatrist. The Psychatrist prescribed him a medication that is not an SSRI because of his experience with Zoloft. He is hopeful that this will get him through until they can put a long term plan in place. And, it's possible that this medication could be a longer term solution.

I understand we're in this for the long haul now and we're just taking it one day at a time.

I'm doing my best to manage and keep my stress as low as possible. Not always successful but doing my best.

 

[Keeliamira]

Puppmom, I am so sorry your going though this honey. Dealing with a health issue without a clear diagnosis or plan is always anxiety producing, not to mention the negative impact on your family and your own outlook. There have been some really excellent suggestions and help offered by other posters. One thing that occurred to me to mention may be a help in protecting your dh's employment. If the company he works for has enough employees, he can qualify for protected leave under the Family Medical Leave Act. He can take up to 12 weeks of leave from his job(without pay) and his position will be protected. He cannot be fired. This may provide him with the downtime he needs to get a full diagnosis and begin treatment. It may be worth looking into. Sending huge prayers, good vibes, thoughts, etc.

 

[Puppmom]

Thank you! His employer is under 50 and he's been there less than a year so I'm not sure about FMLA. I'm trying to convince him to talk to them anyway because getting laid off would be preferable to being terminated for unemployment purposes. His performance is affected sometimes and I feel his silence will lead them to draw their own conclusion that he is not skilled or competent enough to do the job.

 

[azstonie]

What I'm reading here about Xanax in specific is wrong, in terms of possibility of addiction (people confuse addiction with tolerance) and how it should be taken (interval and dose). What I'm reading here about benzodiazepines in general is also wrong.

Consult with a pharmaco-psychiatrist to get facts about benzodiazepines. Your physician or provider (internist, psychologist, family practice doc) might not have decades of experience treating patients with benzodiazepines so you will not be getting all the information or facts. Example: Xanax is not intended to treat chronic anxiety; there *is* a benzo, however, intended for just that condition.

 

[Tacori E-ring]

What I'm reading here about Xanax in specific is wrong, in terms of possibility of addiction (people confuse addiction with tolerance) and how it should be taken (interval and dose). What I'm reading here about benzodiazepines in general is also wrong.

Consult with a pharmaco-psychiatrist to get facts about benzodiazepines. Your physician or provider (internist, psychologist, family practice doc) might not have decades of experience treating patients with benzodiazepines so you will not be getting all the information or facts. Example: Xanax is not intended to treat chronic anxiety; there *is* a benzo, however, intended for just that condition.

Yes! Tolerance is that the same as a substance use disorder. There is clear criteria in the DSM which indicates when an issue is present. Can people take addictive medication safely? Of course! However, we cannot ignore the danger of Benzos or other addictive medication. I work with many types of doctors and all agree long-term Benzo use can cause cognitive issues. Makes sense as it is basically alcohol which also can damage the brain. If possible I think people should start off with medication which cause the least long-term effects. My patients have *severe* anxiety disorders and Benzos are never given because of their AODA issues. So there ARE other options.

 

[cmd2014]

What I'm reading here about Xanax in specific is wrong, in terms of possibility of addiction (people confuse addiction with tolerance) and how it should be taken (interval and dose). What I'm reading here about benzodiazepines in general is also wrong.

Consult with a pharmaco-psychiatrist to get facts about benzodiazepines. Your physician or provider (internist, psychologist, family practice doc) might not have decades of experience treating patients with benzodiazepines so you will not be getting all the information or facts. Example: Xanax is not intended to treat chronic anxiety; there *is* a benzo, however, intended for just that condition.

Yes! Tolerance is that the same as a substance use disorder. There is clear criteria in the DSM which indicates when an issue is present. Can people take addictive medication safely? Of course! However, we cannot ignore the danger of Benzos or other addictive medication. I work with many types of doctors and all agree long-term Benzo use can cause cognitive issues. Makes sense as it is basically alcohol which also can damage the brain. If possible I think people should start off with medication which cause the least long-term effects. My patients have *severe* anxiety disorders and Benzos are never given because of their AODA issues. So there ARE other options.

I agree. The literature says that it isn't just that long-term Benzo use can cause cognitive issues (mainly memory impairment, but also attentional deficits and and executive cognitive deficits) it's that it does cause cognitive deficits. They interfere with the protein formation needed to consolidate new memories (which is why they are used in high doses for conscious sedation for colonoscopies and such). In addition, long-term Benzo use causes tolerance with withdrawal symptoms and can cause rebound anxiety and rebound insomnia. These symptoms can be incredibly difficult to undo. Despite this, I see people all the time whose family doctors have prescribed Benzo's to them for years. Most sleeping pills have similar effects and are also only intended for short-term use.

Again, the more typical approach to treatment would be with an SSRI or SNRI antidepressant medication, with short-term Benzo use prescribed during the time that these need to take effect, and with gradual tapering of the Benzo's once this occurs. These other medications are highly effective, in combination with psychotherapy, for the management of anxiety. But which specific one will work best for someone sometimes takes some trial and error.

I also agree with @Tacori that tolerance and addiction are two separate things. Addiction (i.e. a substance use disorder) is only diagnosed when use leads to tolerance, withdrawal, unsuccessful efforts to reduce use, AND clinically significant impairment in some important area of functioning (for example, an inability to work, attend school, be a functioning parent or spouse). This is rarely the case among people taking prescription medications as prescribed. People can, however, become addicted to their prescription medications and start using more than is prescribed. So it's important to be careful if you are taking something that has the potential for this.

There's no one size fits all here for the treatment of anxiety. People need to experiment sometimes to find exactly what works, and to have their treatment team willing to work with them on this.

 

[distracts]

Puppmom - I have had very bad anxiety through most of my life. The state of your husband sounds like the state I was in when I was in my late teens - rushing thoughts, complete inability to remember things or do things because the anxiety was just so bad that I couldn't think in any sort of useful way. I can't remember hardly anything that happened when I was 18/19 because I was so anxious that it was just whited out with the static of my mind. It really did feel like losing my mind. A lot of the things you've described about the way he feels just viscerally bring me back to what it was like for me then. However - hopefully it IS just anxiety! It is a scary problem but it is totally treatable and many of us on this forum have been through it and come through just fine. I know it's different to hear about it than to experience it or see your spouse experiencing it. But he's still mostly functional. He's seeking help. You're doing all the right things. It is normal for it to not have a quick fix. However long it took him to get to this place, it will probably take at least that long to pull him out. But you're well on your way and it sounds like you already have a good support team in his therapist and regular doctor, and will be adding a psychiatrist soon. I know that knowing you're doing the right things isn't very comforting when your spouse is suffering and you want him to not be suffering now, but it's what comfort I can offer. You're on the path to healing, and it may take time to walk that path but you'll get there eventually.

This is the anxiety book my psychologist recommended and I found useful: https://www.amazon.com/Anxiety-Phobia-Workbook-Edmund-Bourne/dp/1626252157/ref=sr_1_2?ie=UTF8&qid=1479952483&sr=8-2&keywords=anxiety+workbook

My psychologist likes to say "when treating anxiety and depression, you have to throw everything at it at once and see what sticks," and I really think that's the best method. It seems like a lot but keep with the therapy, keep with the acupuncture, find a psychiatrist, have everything run by your GP, if his mental state seems dodgy beyond what can be ascribed to anxiety get him to a neurologist as well. Do yoga or other exercise, eat right, take magnesium and omega-3s, make sure he is always always getting 8+ hours of sleep a night, no drinking alcohol, taper down/quit the caffeine (ENTIRELY. NO CAFFEINE WHATSOEVER - this makes the biggest difference to my overall anxiety levels), make sure he doesn't have stomach ulcers (I have found that I absolutely have to take NSAIDs with Prilosec or my stomach gets angry and then I get panic attacks), etc.

Another thing - you keep saying you're taking it one day at a time. I know this is common advice but in my experience it is the opposite of what is useful for mental health problems. There are a lot of steps backward while trying to go forward. I find it helpful to zoom out and not take anything in any chunk smaller than six months. Day to day, just kind of ride the wave, and if you want to know how you've been, look back at a very large chunk of time and see if you were better than the large chunk of time before that. Because if you take it one day at a time - well, you may have ten good days, but then you'll have a bad day and you'll feel like a failure because you wanted a good day. Don't worry about the individual days. If you looked at it from the perspective of a month, maybe he had half of a good month, or over half, instead of only a week good out of the month. That's progress. Now zoom out further. As you progress in treatment you can zoom out pretty far and say "emotionally I was better this entire year than I was last year," even if you had some really shitty days, or spent a week not able to get out of bed. I don't know. For me taking things one day at a time just made me feel constantly hammered by my own failure to be perfect at all times, which just added to my anxiety. I don't know if this makes any sense? It took me a really long time to learn how to just roll with bad days being bad days but if you roll through them and focus on the big picture it makes it easier, for me at least.

And be sure to take time for yourself. Caring for someone who is in such a bad place is hard, and that's on top of your job and everything else! Don't beat yourself up if there are days when you can't do it all, or can't do it all with a smile on your face. Don't feel bad if you have to tell your spouse that you need to take some time out for yourself - remember that as much as you want to help him so he doesn't suffer, he doesn't want you to suffer either. Big hugs. You'll get through this. You're already making progress on it. Just keep moving forward.

 

[Keeliamira]

Wonderfully written distracts. I hope you are well puppmom. Been thinking about you...

 

[Puppmom]

Distracts, thank you for thoughtful response. This has definitely been challenging especially because it's new to both of us. And DH is very private so family and friends don't know. There's good and bad with that. His mother would be beside herself which would only make him feel worse. The Thanksgiving break has been good for all of us. He started to take the new medication (lamictal) Monday and started to notice improvement Friday night. That could be the meds or just a good day so we'll see. I understand what you're saying about evaluating longer stretches of time to gauge his overall mental status. That will take concerted effort on both our parts. Not knowing what's in store tomorrow is intimidating.

RE: caffeine. DH believes in healthy body healthy mind but his one vice in that department is caffeine. He weaned himself off over the past couple of weeks and hasn't had any for a little over a week now.