Generalized anxiety disorder medication help?

[daryn]

Dear Doctor

About 8 years ago I was diagnosed with GAD, which I inherited from my mother. I am what you would term extremely bad GAD. I also have later in life developed agroraphobia. I am now 31 years old.

About 5 years ago I had would people would call a nervous breakdown. I was away in France for a friends wedding and a few days before I left, I came extremely anxious. My doctor gave me 1mg Xanor tablets to take with and because I was so bad on the day I was leaving he gave me a Valium injection. The whole trip I was in a constant state of anxiety. The Xanor made me more sleepy than actually suppressing the anxiety symptoms. When I returned back home to South Africa (Cape Town) I thought I would slowly get better, but I actually became worse. Now for the first time in my life I was having ad least 2 to 3 anxiety attacks per day. A psychologist prescribed me 1mg Ativan tablets. Which at my worst I was having to take 3 tablets 3 times a day, just to make it through the day. At the same time they put me on the drug called Effexor XR (venlafaxine hydrochloride) which I had been on in the past and it was not doing anything even with the dosage being increased. They then add Remeron (mirtazapine), which in about 2 days made me feel almost normal. It felt like a miracle.

I had a bit of anxiety about 2 years ago and went on Remeron again which did nothing for me this time. Nor did the Effexor XR.

When I was about 9 years old they put me on Tofranil (imipramine hydrochloride) and also tried it in my early twenties in higher dosages but no good. I have also tried Zoloft also no help.

I am very scared of Xanor and Ativan as they are highly addictive and the longer one uses them the higher the dosage you need to take to achieve the same results.

I am writing to you as my psychologist is away at the moment and my General Doctor has given me 1mg Xanor SR (slow release) to take in the mornings which is the worst part of the day for me. If the SSRIs and the SNRIs aren’t helping ad least the ones I have tried, would is there for me to try.

I have made major progress with my anxiety and have not had an anxiety attack for about 3 years and I now understand my symptoms more by seeing a psychologist and cognitive behaviour techniques.

My reason for my new anxiety symptoms is I am in a family business with my parents and we are in property development and with the state of the global and local economy it seems that my business is going under and I will lose everything. This is definitely one of my worries I would normally have which seems to becoming a reality.

I need some suggestions as this problem is not a short term thing and a more long term medication with be required.

[Faye Lang, RN, MSW]

Hello Daryn,

Your description of inheriting your GAD from your mother suggests that you have learned to use her coping style, which is to become increasingly anxious in response to life events. One does not inherit such disorders per se; that does not mean that it is not a very difficult situation to manage. The fact that your are receiving behavioral techniques is encouraging, as they are what will give you long term relief through altering the behavior of anxious response. Medications will provide short term relief, and will not address the underlying issues. It may be helpful for you to review the techniques you have already received from your treatment provider, to be sure you are using them appropriately. You might benefit from making a list of the life events that are contributing to your anxiety, and then try to identify a strategy to address them. For instance, if the worst case scenario is that you will lose your business, what can you do now to prepare for that event, and what are your options to move on: look for job openings in your area, pursue training in a different field, see if you can merge your business with another, as in a partnership.
The medications that are available to you may help you calm yourself to examine what you may be doing or not doing that adds to your anxiety episodes. If you can identify one of your behaviors and your anxiety response, see if you can identify an opposite behavior to use that would decrease your anxiety. Begin with small steps and advance as you are able to do so. Making a concerted effort to examine what happens before, during and after anxiety episodes will give you insight as to what you might successfully alter.

I sincerely hope this will help you, and that your continuing treatment is helpful to you.

Faye, RN, MSW