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Dr. Bob is Robert Hsiung, MD,
[email protected]Shown: posts 1 to 8 of 8. This is the beginning of the thread.
Posted by hok on January 24, 2008, at 19:51:14
Hi guys,
I need your help. I've recently taken on a stressful job and I'm having a lot of trouble with anxiety that's causing me only a further inability to concentrate and focus on work responsibilities.
In the past couple weeks, I have experimented with a low dose of .25 mg of klonopin, and although it helps, even this small dose effects my memory and cognitive functioning. I would like to take even more, since some of the anxiety is still outstanding, but the fact that this will only further hamper my inability to perform my job prevents me from doing so.
In the past, I did great on a low dose (25-50mg) of Serzone (Nefazodone). But once again, memory impairment was a problem. It seems I am quite med-sensitive
As for the SSRIs/SNRIs, I currently take a low dose of Cymbalta and have tried the majority of them in the past. Although they help my mood, I've never really found any relief from them for anxiety.
I need some help trying to figure out some options that would be a good anti-anxiety agent with the least impact on cognition/memory. I was thinking of trying a very low dose of an anti-psychotic, but it seems there isn't a clear consensus on which one is the least mentally impairing (especially in regards to memory).
Please help, I'm getting somewhat desperate at this point.
Henry
Posted by linkadge on January 24, 2008, at 20:36:42
In reply to HELP- antianxiety options with least cognitive imp, posted by hok on January 24, 2008, at 19:51:14
If you found serzone impaired memory then an AP will likely do so too. They really are crappy for cognition.
You might try taurine, buspar, or chamomile tea, vitamin C also lowers cortisol levels.
Linkadge
Posted by Phillipa on January 24, 2008, at 20:37:13
In reply to HELP- antianxiety options with least cognitive imp, posted by hok on January 24, 2008, at 19:51:14
Just me but if you've tolerated cybalta by itself I'd ask the doc and try lowering it first. As the ad's do nothing for my anxiety just me. Phillipa
Posted by Phillipa on January 24, 2008, at 20:39:05
In reply to Re: HELP- antianxiety options with least cognitive imp, posted by linkadge on January 24, 2008, at 20:36:42
Link vita C lowers cortisol levels? I take 2000mg a day maybe that's why my cortisone is okay but getting the inject and two vials of blood one. Phillipa
Posted by Racer on January 25, 2008, at 1:14:52
In reply to HELP- antianxiety options with least cognitive imp, posted by hok on January 24, 2008, at 19:51:14
I'll second Linkadge's suggestion of BuSpar. In fact, the two very best medications I've found for reducing my anxiety are BuSpar and methylphenidate. (OK, so the second of those proves I'm completely insane, but it's true.)
I suffer from severe melancholic depression as well as anxiety, and did experience a worsening of some depressive symptoms on BuSpar, but it's something my pdoc and I are discussing trying again since I wasn't taking methylphenidate then. I'm hoping the combination of anti-depressant, stimulant, and anxiolytic might be the best answer for me.
Other than BuSpar, I recently began a low dose of Seroquel for anxiety -- once a day, at bedtime -- and haven't noticed any cognitive impairment. I haven't noticed a lot of difference in anxiety, but that's probably primarily environmental: I'm just restarting all my old meds after a failed trial of EMSAM, and going through some situational things, and replacing my car (which is a very big thing for me, NOT an exciting thing, but an anxiety producing event in a very big way), so lots of situational factors. I'd say, though, that Seroquel might be worth a try, if you end up going the AP route.
Good luck to you.
Posted by bleauberry on January 26, 2008, at 18:29:15
In reply to HELP- antianxiety options with least cognitive imp, posted by hok on January 24, 2008, at 19:51:14
I am in the camp that tends to want to beef up as much natural stuff as possible before taking on the power of meds. For example, there is a lot of overlap between bipolar and anxiety. In either case, something is just going too fast. Things to beef up would be magnesium and taurine. Others would be glycine and gaba. These are all natural bodily chemicals that have many purposes, one of them being calming overexcitation. I have seen enough stories of people who have had decades of meds stumble on to cures with simple things like magnesium.
As for antipsychotics, I do not believe a low dose of 25mg to 50mg of seroquel or 2.5mg of zyprexa would hurt cognition much. Actually longterm zyprexa can help cognition. The problem is that during the first week or so the sedation and somnolence which you will adjust to can get in the way unless you are prepared for it and wait it out.
Posted by 49er on January 27, 2008, at 15:01:03
In reply to HELP- antianxiety options with least cognitive imp, posted by hok on January 24, 2008, at 19:51:14
Henry,
Have you tried magnesium? Taking a very small amount before bedtime has done wonders for my anxiet/ There is no cognitive impairment whatsoever.
I would personally stay away from antispsychotics. They may help your anxiety in the short term but in the long term, the side effects are horrendous. I have seen this up close and personal with a friend even on a low dose.
Also, the fact that you are sensitive to even small doses of SSRIS and Klonipin tells that more powerful meds would cause you problems.
By the way, I do understand the desperation. But I really wish some had told me the same things I am telling you. It would have saved me years of heartache.
With the magesium, I would try a powered form. That way, you can start slowly. When you reach the right dose, stop and don't take any more.
Good luck.
Posted by hok on January 29, 2008, at 21:26:08
In reply to Re: HELP- antianxiety options with least cognitive » hok, posted by 49er on January 27, 2008, at 15:01:03
Thanks for everyone's feedback. So I guess the consensus is to drop consideration of the antipsychotic category since I am already so sensitive to Nefazodone at such a low dose.
As for the other suggestion of Buspar...I failed to mention that I have tried it and that I recall having cognitive dysfunction, including mild memory problems while on it. As for magnesium, I have played around with it over the years but never really found too much relief from it beyond some mild physical calming.
Meanwhile, I tried a very low dose of Klonopin (clonazepam) again the other day (0.25mg) and I did get some relief from the anxiety. Also, I noticed that I had less overall memory dysfunction than I did with Nefazodone, but I still ran into the same problem I always faced with this drug...poor word recall. I really stumble through sentences.
My new thought is to try a low-dose of Remeron (mirtazapine) again. I was on it a few years ago for about 6 months or so and had a fairly decent response. I don't really remember if I ran into any memory problems; of course, the sedation and slight weight gain were what made me to finally opt out though. At this point, I'm definitely willing to deal with it if it means getting some anxiety-relief and sleep.
...So what about it, can any comment on any cognitive or memory dysfunction from Remeron (mirtazapine)???
This is the end of the thread.
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