Hi, my daughter has been clean and sober 1 year

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Posted on Sun, 11 Nov 2018 in Smoking and Alcohol Addiction
Question: Hi, my daughter has been clean and sober 1 year now. She had used Meth and heroin ( no needles) But then she developed anxiety. So she was prescribed Xanax and then buspar. Then 2 weeks ago a psychiatrist started her on Latuda. She is in worse shape now and I told her to stop. She’s tired, not concentrating well, more depressed, and I just googled it and it looks dangerous to take all 3. If you have An expert in this field to ask I would appreciate it. Thanks XXXXXXX
doctor
Answered by Dr. Matt Wachsman 23 minutes later
Brief Answer:
People react differently to different medicines.

Detailed Answer:
But xanax is highly addictive and I've not seen anyone do well on it for years. It is a benzodiazepine that is both strong and short acting. This tends to put someone onto a roller coaster of going up and down. Buspar is pretty safe, though. It helps with tremor but basically shouldn't be the only drug taken.

The generally recognized medications for anxiety and depression are anti-depressants. There are a lot of them. Mirtazipine, paroxetine, buproprion, and sertraline are some of the best for anxiety and depression. Note that all of these are chemically distinct even though what they do is quite similar for this reason, another can be tried if one did not work. Latuda is a major tranquilizer. It often causes mental confusion/sleepiness/changes in personality. It is useful in the short term but unless someone has schizophrenia or other psychosis, it shouldn't be used long term.
Latuda and xanax especially are depressant and therefore can cause depression. They certainly are likely to cause concentration problems.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Matt Wachsman 36 minutes later
Several years ago she tried Zoloft and said it messed with her brain and that’s why she then tried drugs. If she was to just take buspar( less addictive I’ve heard), what drug would you add to it that wasn’t related to Zoloft? She really does seem to want to get back on track with her life, but she’s so zoned from all 3 of these it’s not working. We just threw the Latuda in the trash, after 2 weeks. It’s not agreeing with her at all.
doctor
Answered by Dr. Matt Wachsman 24 minutes later
Brief Answer:
I think you've answered it yourself.

Detailed Answer:
First, buspar is not addictive. Side effects from latuda are quite common both soon after taking and after years of continuous use.

But then, individuals react to medications differently. There are a lot of antidepressants and although they work by the same mechanism as zoloft they are not usually reacted to the same way. BUT, it is not easily predictable how someone will react.

Although an antidepressant is recommended in someone with depression and/or anxiety, which one is quite hit or miss.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Matt Wachsman 7 minutes later
Which of your anti-depressants above are not in the Zoloft group? To get off Xanax maybe she could try one not related to Zoloft, because you did mention buspar shouldn’t be the only one taken. Is there one in particular you recommend with buspar? She’s 5’4 and weighs probably 112#.
doctor
Answered by Dr. Matt Wachsman 9 minutes later
Brief Answer:
Thank you for the excellent question.

Detailed Answer:
And it's a guess for a particular person what they will react well with.
I can give a bunch of general statements.
My current patient is plain lying to get prescribed xanax and saying all other alternatives don't work as well. This doesn't apply to someone having problems with zoloft BEFORE going on benzodiazepines/xanax.

Zoloft is one particular type of antidepressant that paxil is closely related to and buproprion, mirtazipine, and sertraline are not very similar to. Therefore, one might avoide paxil and be more interested in most any other anti-depressant.
But it's a bit of a total guess if someone is going to react to another one as much as to paxil.

Thank you for really good replies that show a good understanding of the situation and what I said in previous statements. And, there's the chemistry of the different drugs which means paxil is like zoloft. And there's the clinical studies that the ones I am mentioning are indicated for anxiety as well as depression.
But mostly it's a guess and seeing what works.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Matt Wachsman 16 minutes later
Thanks so much for your help. I will have her avoid Paxil too. I would think if she was to try one of the other 3 anti-depressants , staying on buspar, along with Xanax sounds a bit much. Wouldn’t you agree. And it sounds like Xanax shouldn’t be a long term fix. Her brain recovery isn’t totally back yet, and she still feels backward and not able to work yet. Whereas she had been a good worker before. What is your usual suggestion for brain recovery to get back on track? It’s frankly been hell for all of us. I supply the food, vitamins, etc. We walk, have pets, keep praying!
doctor
Answered by Dr. Matt Wachsman 9 minutes later
Brief Answer:
Totally agree

Detailed Answer:
While I can't say about a particular patient (mainly due to the unpredictability of outcomes; but also because I haven't directly talked to the patient), I can give general info. You are correct on everything.
1) xanax is FDA approved for only a very limited period of time and is not a long term solution and is quite additive with serious withdrawal that frequently occurs and it is a sedative so it generally impairs thinking.
2) Paxil wouldn't be my first 3 picks in someone who had trouble with zoloft.
3) buspar is pretty safe. Xanax is about the least and latuda isn't as safe as anti-depressants.


Then, next good question: brain recovery. Generally, I get more questions about addiction recovery which is an easier answer (get more integrated with life outside of the addiction--> faimily and work).
On the brain recovery, first avoiding drugs that make things worse. Buspar has very little potential for that. And all the others are a maybe.
THen, the literature on brain recovery is based on stroke and concussion and not direclty on this but the situation is probably similar.
First rest. Then graded increasing activity. Avoid trauma. Avoid alcohol.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Dr. Matt Wachsman

Addiction Medicine Specialist

Practicing since :1985

Answered : 3663 Questions

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