Medications for Generalized Anxiety (With CASE EXAMPLES) | Psychiatrist
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- Опубліковано 23 вер 2023
- GAD is a common anxiety disorder characterized by excessive worry and other symptoms. While there are many helpful treatments for generalized anxiety disorder(GAD), in this video, I dive deep into how the process for choosing a medication works. I illustrate these concepts by going through several case examples. These cases also illustrate the point that treatment must always be individualized as each person responds to and tolerates different medications differently. I discuss SSRIs (selective serotonin reuptake inhibitors) such as escitalopram (Lexapro), paroxetine (Paxil), sertraline (Zoloft), citalopram (Celexa), and fluoxetine (Prozac). I also discuss SNRIs (serotonin norepinephrine reuptake inhibitors) such as venlafaxine (Effexor) and duloxetine (Cymbalta). I review the benzodiazepines such as diazepam (Valium), lorazepam (Ativan), alprazolam (Xanax), and clonazepam (Klonopin). I discuss the pros and cons of this well-known medication class and why short-term use is preferred. I also review some of the less-commonly-prescribed medications for GAD such as Buspirone (Buspar), Gabapentin (Neurontin), Pregabalin (Lyrica), Hydroxyzine (Atarax/Vistaril), Clonidine (Catapres), Guanfacine (Intuniv/Tenex), Mirtazapine (Remeron), and Propranolol (Inderal).
Who Am I?
I'm Dr. Jeff Knuppel, a psychiatrist (M.D.) with over 20 years of practice experience. My goal is to create helpful and interesting videos about mental health and self-improvement. If these topics interest you, please subscribe so that you don't miss any new videos when they are released. Thank you!
DISCLAIMER: This channel is for general informational purposes only and does not constitute the practice of medicine or other professional health care services, including the giving of medical advice, and no doctor/patient relationship is formed. The use of information on or linked to from this channel is at the user’s own risk. Please consult your healthcare professional before making any changes in your treatment. I do not respond to requests for medical advice, either as comments/questions on this channel or as direct messages to me.
Were there any points from the video you found particularly helpful? Also, if you want more information on pregabalin and gabapentin for anxiety, I've created a more recent video about those: ua-cam.com/video/r44PDcP-roQ/v-deo.html
I had extreme anxiety disorder yet it does go away. I was on meds however self dialogue and calming thoughts is what eventually was my ultimate cure I believe. There is always hope.
I'm glad you found an approach that works for you. Medications certainly aren't always the answer and don't work for or agree with everyone. I appreciate that you said there's always hope -- I agree!
Best video I've found on meds and/ for gad
Wow, thanks!
Thankyou for explaining these different medications & examples
You're welcome! I'm glad it was helpful.
Thank you Doctor for this excellent explanation of the medication options available.
You’re welcome! I’m glad it was helpful.
Very well professionally thought out video!
Thank you! I hope it was helpful.
Thanks for the video, very helpful. Merry Christmas to you all.
You're welcome! Glad you found it helpful. Merry Christmas to you, too.
I have taken Zoloft for years and it’s worked wonderfully. I have Klonopin for panic disorder as needed. Thanks for this informative video!
You’re welcome! It must be a relief to have figured out what works for you. Thanks for your comment and for watching.
Thank you doctor for your detailed explanation on medicine.I am going through severe menopausal anxiety and my doctor has exactly prescribed the same medicine as you said.Intially I felt my symptoms were getting more worse so I was scared and apprehensive about taking the medicine but I am now much relieved after hearing you.Thankyou so much.God bless
Thank you -- I'm glad the video was helpful for you. I hope your treatment works for you and agrees with you going forward!
How are things going now?
You never mentioned lamictal or any mood stabilizers. 🙏🏽. I’d love to hear about those being prescribed for anxiety. Thanks so much
Thank you for your comment. You bring up an interesting point about mood stabilizers like Lamictal (lamotrigine) and their role in managing anxiety. While they are not as commonly prescribed as some other medications for generalized anxiety disorder, they can be an option in specific cases. Due to the vast range of possible treatments and the focus of the video on the most common medications, it wasn't possible to include all alternatives. I really appreciate your interest in this topic and your suggestion. For detailed information and guidance on this, a healthcare provider would be the best resource, as they can offer personalized advice based on individual health needs.
Lamictal saved me. What wonderful medication kill anxiety and even helps with seasonal depression. 1 month and 8 days on it and Lamictal killed my anxiety.
I’m glad to hear it’s been so helpful for you.
@@AlanAssuncao08What dose?
I was on cymbalta for 14yrs. My new psychiatrist suggested I change because my anxiety was coming back. He prescribed lexapro which made me really ill. I am now back on my cymbalta 90mgs and Valium when needed 5mg. Which does nothing. I don’t feel like I can keep living like this. It’s to much. I have lost both sons to homicide, lost both parents, divorced, lost job after 25 yrs of fed service became homeless and now currently back employed and now here comes the anxiety and panic attack disorder. Please please help me. I don’t want to feel like this I am afraid to be home alone. Haven’t slept or eaten. It’s too much.
Good video!
Thank you!
There are no natural alternatives that do what the benzos do
I suffer from depression, GAD and panic attacks. My doctor has prescribed Serhop in the morning. Quetiapine (150mg) & Clonazepam(2mg) in the night. I have been taking this medication for a couple of years but nothing has changed. During panic attacks, my doctor has prescribed Petril 0.5 mg. Still, I struggle at my workplace and in my personal life with anxiety issues.
Thanks for sharing. I hope you can work with your doctor to find a regimen that works better for you (or find a new doctor).
Psychological input is also equally as important for anxiety.
For sure. Non-medication approaches should be tried before medication if possible.
Only medication that helped greatly was the MAOI Nardil. Completed wiped out my depression too. Had no problems with any interactions and the side effects were less than the SSRIs and TCAs
Thanks for sharing that. I'm glad to hear that Nardil has worked for (and agreed with) you. The MAOIs aren't used often due to dietary restrictions, but they're definitely viable options for some people and shouldn't be forgotten about.
@@JeffreyKnuppelMD thanks so much for your comment! Yes, it is an amazing medication. Personally, i have not had one bad reaction with the diet (and been on Nardil for over 20 years now). Thanks again, enjoying your videos.
You’re welcome, and thank you for watching!
I watched so many videos and research a lot. there are not one video (from MD or psychiatrist) who have mentioned anti-depressant meds cause decrease of low white blood cell. I know it is a rare side effects but they do happen
Thank you for watching the video and for bringing up an important point. You're absolutely right that antidepressants, like all medications, can have a range of side effects, some of which are quite rare. In the context of this video, I focused on the most common and clinically significant side effects associated with medications used for generalized anxiety disorder to keep the content concise and relevant for a broad audience. Rare side effects, while important, are not typically included in an overview due to their low incidence, but I appreciate you highlighting this. It's always valuable to have comprehensive discussions with healthcare providers who can tailor information based on individual health needs. Your input helps emphasize the complexity and individuality of medication management. Thanks again for your comment and for contributing to a deeper understanding of this topic.
I can't think of anything to get motivated about
I wish you the best with whatever you've got going on.
Doctor what do you call short of breath ,chest tighten.but can breath slowly,and hard when i need deep breath.thank you.
If you’re having any problems breathing, please see a healthcare professional for further evaluation. I can’t give medical advice to someone I haven’t evaluated.
@@JeffreyKnuppelMD thank you and good luck
@Bongheeyou Thank you.
Thanks for sharing your thoughts. 0.25 mg of Clonazepam helps within 15 minutes. Sounds like it can be used for longer durations. My cognitive ability had a severe effect. I was diagnosed with PPPD in 2022 for the last two years since February 2022. Currently on .5 mg Clonazepam, 15 mg of mirtazapine and 50 mg of Sertraline. Deep breathing and cardio exercises help for a short duration. As soon as i am upright, dizziness or swaying sensations come right back. Any comments??
Thanks for your comment. I’d be guessing as there are so many possible causes for symptoms like that. Hopefully you’re working with a prescriber who knows what they’re doing and can keep troubleshooting that with you to figure it out.
I wish my psychiatrist would prescribe Clonazepam twice daily, I do not toloerate the SSRIs etc and have GAD and major depression now, the rumination and worrying drive my depression an endless loop
I hope you can find a treatment that works for you. Thanks for your comment.
You just want a nice benzo ahah
I hope he doesn’t! Clonazepam isn’t that great and withdrawals are horrible. I’m using diazepam and it’s much more mild and it just gives me a headache when i skip a dose really, while clonazepam may give you tremors D: Really, i wish you well and daily benzodiazepines are opposite of living well…..
Lyrica, Buspirone, Trazodone
@@ivosoares9459 I just want relief
Thank you for the video.
I have dizziness, drunk like feeling since December. 24/7 Brain scan negative, BP normal, every routine test normal.
Neurologist said that I have anxiety and somatic symptoms and gave me SSRI, Scippa.
When i take the first pill after an hour i have the most terrible feeling in my life. Panick attack, shaking, nausea, vomiting, suicidal thoughts, restlessness the whole day. Just from one pill. Is this normal? This is really anxiety what cause my intense drunk like feeling all day?
I have a good life, everything is good except this sickness.
Some people are very sensitive to SSRIs and can indeed have side effects from one dose. While I can’t give individual medical advice, I would suggest that in general, if a person sees a doctor for a new-onset medical problem and isn’t comfortable with the diagnosis and treatment, it may be worth getting a second opinion.
@@JeffreyKnuppelMD Thank you Doctor for the fast reply. You are a wonderful person!
You’re welcome! Best wishes to you.
I have Restless Leg Syndrome and GAD. I need my Dopamine levels to stay normal or elevated for the RLS but most anti-anxiety meds seem to sacrifice Dopamine for elevated serotonin levels. What med can address my anxiety without decreasing Dopamine?
Thank you for sharing your concerns. It’s important to consider the unique aspects of each individual’s health. I recommend discussing these specific concerns with your healthcare provider, who can offer personalized advice based on your medical history and current condition. I can tell you that most of my patients with RLS who start the commonly used medications referred to in the video for GAD do not have a worsening of their RLS, but I also realize that each person is different, and that may not be true for you. I cannot provide individual medical advice for people I have not treated.
Magnesium,Massage!!!!!
Check your Vit B12.Serum ferritin levels
Check if you have ADHD and check if your attention is poor. If so Guanfacin, a norepinephrine blocker, that has been recently liscensed for adults might treat both your anxiety and restless leg sundome.
Sir i m on lexapro 20mg but after 1year really not working can i go with 10mg lexapro and 37.5mg venlafaxine for anxiety
I can't give individual medical advice here. There are many factors that would need to be considered before a presciber would know if that approach would make sense in your situation. It'd be a good idea for you to ask your prescriber about this question. Generally speaking, though, I can tell you that we try not to combine Lexapro and venlafaxine very often (I didn't say never) because there is an increased risk of serotonin syndrome when the two medications are combined.
Chronic relentless pain causes my anxiety and nothing works
I've been on clonazepam 2mg for like 4 consecutive months - using it like every 2nd - 3d day. Do I need to be tapered off? I'm currently on 100mg pd Pregabalin of which my Psychiatrist put me on like a few daus ago...
Generally speaking, If someone has been on clonazapem 2 mg per day for 4 months, it's best to taper instead of stopping abruptly. However you mentioned using it only every 2nd to 3rd day. Normally in a situation like that it's still best to taper, but it can probably be done smoothly over a few weeks. I'd recommend discussing that with your prescriber since I can't give individual medical advice here. Best wishes.
How about viibrryd or vilazodone?
I've not been impressed with Viibryd/vilazodone. While there may be some people who report it helps them with anxiety, it's still not FDA approved for anxiety, and there are only a couple of small studies that I'm aware of where it appeared to help with anxiety.
How long you should take SSRi's ???
It completely depends on the situation. Sometimes just a few months, sometimes indefinitely. Treatment should always be individualized for each person.
Anti depressants do not touch my anxiety. I am autistic and have ADHD. SSRI and SNRI do absolutely nothing. Pregablin also does nothing. I cant access benzos so dont know about those.
When we increase dose SSRI, for example paroxetine from 20 to 30 anxiety can increase?
When the dose of an SSRI is increased (as in your example of increasing paroxetine from 20 to 30 mg per day), anxiety CAN increase (usually temporarily) in some people. In my experience, though, when SSRIs cause anxiety or make it worse, it usually occurs in the beginning when the medication is first started. Most of the time, though, this doesn't happen, but each person is different. Usually the anxiety that the patient is being treated for just slowly improves from the SSRI.
@@JeffreyKnuppelMD thank you so much your answer. My doctor said that this effect can continue 20 days. We will see. You are so kind
You’re welcome! Best wishes.
My GP would not refer me to psychiatrist I have anxiety, panic and recently a month ago got hit my depression from a panic attack my gp prescribed Lexapro 5mg but I’m afraid to start
A couple of things: If you're in the US, you can likely see a psychiatrist without a referral unless your insurance requires a referral. If you realy prefer to see a psychiatrist, you certainly should ask. While I can't provide medical advice here, generally speaking, if someone has significant anxiety, especially with panic attacks, starting at lower doses of SSRI's (such as the 5 mg dose you mentioned) is usually a good idea because these meds can make anxiety worse temporarily if the doses are started at the usual antidepressant starting dose (which for adults would be 10 mg of Lexapro). Best wishes to you.
How much worse will my anxiety get will it be bearable?
There's no way to predict how a given individual will tolerate or respond to a particular medication and dose. Having said that, in my experience when starting an adult on Lexapro at 5 mg per day, typically I don't see any problems. However, be sure to discuss any concerns or questions you have about your symptoms and possible medication side effects that might occur with your prescriber since they're the one treating you.
I mean can we combine SSRI and SNRI
I answered this in my answer to your previous question. We sometimes combine the two classes of medications ("always" and "never" are usually not the answers to medical questions), but we try not to combine them if we can avoid doing so because of an increased risk of serotonin syndrome.
If primary neurotrasmiter for Anxiety disorders is GABA why mess whit Seratonin ??? Why just use Sodium Valporate ? ore GABA reuptake inhibitor like Tiagabine ???
Thank you for your insightful comment. You're correct that GABA plays a crucial role in anxiety disorders, but it's important to remember that our brain's neurotransmitter system is complex, and serotonin also plays a significant part in regulating mood and anxiety. While medications like Sodium Valproate or GABA reuptake inhibitors target GABA, they might not be suitable for everyone due to their specific actions and side effects. The medications I discussed in the video, like SSRIs and others, are widely used because they have a strong evidence base supporting their effectiveness and safety in treating a range of anxiety disorders. It's key to remember that treatment for anxiety is highly individual, and what works for one person might not work for another. Therefore, I always recommend consulting with a healthcare professional to find the most suitable treatment plan.
@@JeffreyKnuppelMD I have criping Anxiety!!! Leo Longevity tould me to try SSRI+VALPORATE+TESTOSTERONE :)
What about remeron?
I mentioned it in the video. Not FDA approved for anxiety but helpful for some patients with anxiety especially who have insomnia. Some tolerate it well, but some gain weight from it.
Sorry I asked before watching the whole video. I’m suppose to start it but was nervous. Thanks for the reply.
Lexaoro, paxil , effexor and cymbalta did not work
I’m sorry to hear that. Each person is different. Care must always be individualized. There still may be non-medication or different medication approaches that might be helpful for you.
Meditation remit anxiety
Please talk about tolerance level .
Please be more specific about your question. The video covered many details of several different classes of medications.
Hi Dr.
@@JeffreyKnuppelMD My psychiatrist recently put me on Pregabalin 100mg per day- ( 2×25mg in the morning - 2×25mg in the evening. ) Will that be sufficient to treat my anxiety without developing tolerance in say over a 6 month time period?
@@JeffreyKnuppelMD I took 0.5mg of xanex felt better then stop working doctor told you hit tollareance increased to 1mg it worked then hit tollareance then taken 2mg worked then stop working I can't go further why it stop working or hit tollareance.
This is just one of the characteristics of this class of meds, the benzodiazepines -- some people have this happen more than others, but it's frustrating because at some point, the medication can't keep being increased because its effects fade -- it's just not safe to keep raising it.
@@JeffreyKnuppelMD So what is solution .
Gabapentin and benzodiazepines have been the only thing that worked for me.
Thanks for sharing your experience.
Is zoloft good
If you watch the video, at 1:04 I discuss the SSRIs (selective serotonin reuptake inhibitors) which Zoloft (aka sertraline) is a member of. Like any medication, Zoloft is "good" (effective & well-tolerated) for some people, but doesn't work for or isn't tolerated well by other people. Having said that, it's generally considered a solid choice for many people with anxiety.
I am suffering from Anxiety Disorder for past 15 years and have tried every possible medicines with every possible combinations but still I am suffering from it. I don't think these medicines are worth it. These medicines only work on the symptoms but not on the underlying cause.
I'm sorry to hear about your situation. Meds certainly aren't the answer for everyone. (This video was just about medication treatments, but I was upfront about that fact at the beginning of the video as there are many non-medication treatments for anxiety as well.) You might want to try to find a good therapist who specializes in treating anxiety disorders and start (restart) there. Best wishes to you.
That’s the whole point, for them to work on the symptoms.
You should be thankful you got that benefit, lots of people get no benefit.
you could try microdosing medical mushrooms if all else fails
The people mentioned need to try excersize and fish oil first. 🙂
I agree that non-medication approaches should be tried first. I mentioned at the beginning of the video that there are many non-medication treatments for anxiety but that this video was only going to cover medication treatments.
Anxiety is the Commonest psychiatric disease in the world
👆🏻👆🏻👆🏻👆🏻Anxiety’s like a rocking chair. It gives you something to do, but it doesn’t get you very far.
That's so true. I've found that many patients find that analogy helpful in the sense that they can relate to it being similar to their own experiences (although it doesn't provide a way out of feeling anxious).
Nice overview! Clearly explained, I find the idea with the fictional case examples to be a good one.
I have been diagnosed with Generalized Anxiety Disorder (GAD) and Social Anxiety Disorder (SAD). Pregabalin has almost eliminated both the GAD and SAD for me; this medication has changed my life, I'm so thankful for this medication. SSRIs, which I have tried, did nothing for me except for causing side effects.
It's worth mentioning that in Europe, where I live, Pregabalin is officially approved for GAD, so it's not considered off-label.
Thanks for your comment! I’m glad that you’ve found that pregabalin works so well for you.
I have tried gabapentin, makes me tired, didn't stay on it didn't do anything for negative ruminating and worrying. Maybe I didn't try long enough? Is pregabalin better?
@@kathleenhowe8134 I've learned over the years that "better" is a relative term. It really depends on the person. For some, pregabalin can be better but not for others. It'd be good to discuss this with your prescriber, though.
How long have you been taking the pregabalin?
I would give just about anything to get on a regular dose amphetamine. Quetiapine helps with my incredible insomnia but basically ruins the next day, and Buspirone is wreaking havoc on my working memory without any tangible benefit. I just want my neurons to fire and receive properly, for my thoughts to be Complete. Downers are not the answer for an anxious, overactive mind; it's about rerouting and rewiring the signal. And f#€k Ativan, which is just zombie food.
Thanks for sharing your situation -- It sounds like you've been through a lot. I hope you can find a professional to work with you to come up with the best treatment plan to address all of your symptoms.
Due to my anxiety and insomia I let myself to be put on Gabapentin, Zyprexa and Citalopram. Slowly went down to 900mg/1.6mg/30mg and avter having covid 2 years ago my anxiety got 1000% stronger .I can't sleep at all.I don't how long I'm going to last
Thanks for sharing that. While I'm well aware that meds aren't going to fix everything, if you're still struggling like that, I hope you have a good prescriber you're working with who can take a good look at what you're on and work with you to figure out what's working, what's not, what can be adjusted or changed, etc. I certainly wouldn't just accept everything as it is. Best wishes to you.
microdosing medical mushrooms ? for depression resistant treatment