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Have debilitating social and general anxiety disorder. Prescribed anti-depressants. Have side effects. Suggestions?

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I have a debilitating social and general anxiety disorder and am tired of shelling out half a weeks pay to only be prescribed anti-depressants (Zoloft, Wellbutrin) to control my lifelong anxiety. These anti-depressants only provide me with unwanted side-effects and either do nothing for my constant anxiety or, in the case of Wellbutrin, magnify it significantly. Every physician and psychiatrist I've been to seem to string me along with these monthly "check ups" only to assure me that the prescribed medication also alleviate anxiety. They do not. The only medication I've found that frees me from the disabling circuitous worry of my constant anxiety is alprazolam, but each doctor doesn't seem to understand that it's my anxiety that leads to depression because I am so hindered by it that I am basically rendered useless due to the constant barrage of unnecessary worry. Why is it so hard to get a .5mg script for xanax when I am not a substance abuse candidate and really only thrive when this drug effectively "sets me free?" I am myself when I take a dose and can actualize my life in a satisfactory manner. I'd trade dependence of this medication for the daily turmoil I have to live through. I also suffer from IBS, which alprazolam is also used to treat, so why the discrimination? I'm only in requirement of .5mg once a day, so why the reluctance to prescribe?
Posted Thu, 25 Jul 2013 in Anxiety and Stress
Answered by Dr. Anjana Rao Kavoor 48 minutes later

Thanks for writing to us,

I understand you have General Anxiety Disorder, Social Anxiety, Irritable Bowel Syndrome, occasional agoraphobia due to anxiety and depressive disorder as well. These can be quite debilitating and interfere with day to day functioning and it is only natural to want to get rid of them at the earliest.

Sertraline(zoloft) is a selective serotonin reuptake inhibitor and is an anti depressant but it is used and also approved by the FDA (Food and Drug Administration) for use in anxiety disorders like Social anxiety disorder, panic disorder etc. Several studies have confirmed the use of this drug in these conditions.

Bupropion (wellbutrin) is also an antidepressant but differs from other antidepressants in its properties. Studies have shown that this drug is useful in depressive disorders but it does not show clear benefit for anxiety disorders. In fact, occasionally anxiety can be a side effect.

Now your question is why not alprazolam on a long term? This drug belongs to a group of drugs called benzodiazepines. They produce muscle relaxation and anxiolytic effect that relieves symptoms very efficiently, BUT, this drug has properties of what is known as tolerance and dependence. Tolerance is when increased dose of this drug will be necessary as duration of intake increases. So now you may need a small dose but that wont be the case in a few months from now if taken regularly. Dependence as you know is when you are unable to stop taking the drug which is mainly due to withdrawal symptoms and rebound symptoms. Withdrawal symptoms consist of anxiety, irritability, insomnia, tremors, seizures etc. Apart from these, the drugs also have side effects during the treatment like fatigue, ataxia, slurred speech and rarely other psychiatric complications.

Discuss the problem with your psychiatrist. Switching bupropion may help allay your symptoms instead of resorting to alprazolam. There are more options for treatment if this does not help you and do keep in mind that medicines like sertraline take a minimum of 2 weeks to act, it may take more. So be patient.

There are also psychological therapies available that can help you a lot in handling anxiety in addition to medicines. Both combined have shown better results in patients. A qualified psychologist can administer this.

Hope this answers your query,
Dr. A. Rao. Kavoor.
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