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 Post subject: Anxiety treatment
PostPosted: Tue Dec 17, 2013 1:03 pm 
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This is my first post to the forum after long-lived spectator status, and a lot of you guys seem to have great insights.
I've been on suboxone for a lil over a year and a half, and it's worked wonders for my cravings and fibromyalgia pain in combination with other therapeutic methods. What's it's done for me has been a huge relief, becoming a functional person again physically and emotionally/spiritually (not just from the med itself, but from what it's allowed me to do for myself). For a while now I've had a job, a volunteer job, physical strength, a great guy worth marrying one day, a home that is not my mothers house and dignity I never had before when I was abusing painkillers.
My problem is that I still have a great amount of anxiety, it's not always a problem bad enough to need treatment but it gets worse over certain periods of time and I've been in one of them for a couple months. Things that trigger it worst are losing things (and tearing the room apart for an item I probably already held in my hand minutes before), dreading things like going to work, car rides especially on the beltway (which I know started the day I last got in a car with someone with road rage and almost got into a completely avoidable accidental due to said rage), dental issues (something I can never forget about for a minute), being around fighting/yelling/chaos/bad energy, feeling helpless over day-to-day issues, confrontation, and sometimes just the monotony of being at home for a long period of time with no decipherable trigger at all. It helped when my pain doctor (sub) prescribed me flexeril which is a non-narcotic muscle relaxer so i would stop grinding my teeth at night. I didn't even realize i was doing it until I started waking up clenching/grinding my teeth uncomfortably and it became obvious. So at least now I'm not afraid to fall asleep thinking I'll wake up with half my tooth missing from that damage. But i still have to get through the day and it's getting increasingly difficult to communicate to anyone without them saying it's in my head or I'm doing it to myself (meant well) or saying it'll be fine when they don't get why I don't get that. And while I'm grateful that my teeth still look fine it's another reason my bf and mom and others don't understand why I'd be so anxious about it. Certain ones don't feel fine and the dentist was even able to tell me why.
Sorry I'm getting to the point. I guess what I'm saying is that no doctor seems to want to prescribe a benzo for someone on sub and it's the most humiliating thing in the world to ask or for me to even talk about anxiety with any doctor. Don't get me wrong mine is great but he typically doesn't write those kinds of meds for anyone because he thinks it should be done by an evaluating psychiatrist and I respect that. The last time I was prescribed a benzo for anxiety was the last time it got really bad for a while, early this year. It was .25 mg of Xanax to take as needed, like 15 or 20 pills per month and I remained on it for 3 months and didn't need another prescription when it got better, so I didn't ask for one at that point. Oh and by the way this was prescribed by my pain/sub doctor who I do have a good rapport with and think i earned back some decent trust after being on sub a while.
I've talked to him about the anxiety at recent appointments (monthly) but I didn't ask for any medicine because aside from it being uncomfortable I think he's been gracious about it in the past and I don't want to abuse that when I know he's not entirely comfortable with it and only prescribes it in exceptional circumstances.
It's not that it would need to be Xanax but I just haven't had anything else work as well for times with such acute symptoms. I was also on a medication called vistaril that is non-addictive and treats anxiety. It wasn't very effective but not useless, so I think i may talk to my doc about that at my upcoming appointment since it feels like my only option right now.
I went to see a primary care physician my mother recommended to deal with this problem and I don't think I'll see him again because I wouldn't want to pay to feel he way i did in there. He wasn't a monster or anything but he's dead set against Xanax or anything like it, so if I try vistaril again I just figure I may as well consult the doctor I already have and with whom I feel less like a helpless patient. Anyway the last thing I tried at his recommendation is a new anti depressant called vilazodone, and it made me sick to my stomach (usually doesn't happen with anti depressants for me). Other strategies I've tried are walking (which I love and use for exercise treatment of fibro along with occasional yoga), writing which I love and have always done, buspar, Zoloft, Paxil, abilify, meditation, Wellbutrin (gave me panic attacks), one other I can't remember and even adderal to help organize my thoughts and help me focus on coping activities like writing, yoga, etc. I was also in therapy for a year after I started sub. All were ineffective to varying degrees.
Since there's a lot of fighting between my bf's family members and I struggle in an environment like that I also tried staying at my moms for a night or weekend here and there to decompress. She's moving in a couple months though so I won't even be able to do that habitually soon.
Sorry for such a long and involved post, but does anyone have any suggestions, thoughts, questions, feedback I should consider? Suggestions of any variety (I.e. Medication, tips for communicating with doc and ppl around me, therapeutic methods, or thought reminders/perspectives to consider when anxious) are welcome.


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 Post subject: Re: Anxiety treatment
PostPosted: Tue Dec 17, 2013 3:30 pm 
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Outline everything you've said here, rationally with your Suboxone prescribing DR. In my mind you would seem like a good candidate for a PRN benzodiazepine of some sort at times of high stress if all other options are eliminated totally. I can tell you that a DR willing to prescribe the two concurrently always feel 'better' about prescribing it PRN in low dosages and lowish numbers and as that has been your experience, that experience has been beneficial with the same DR, it makes sensed that barring anything your DR is aware of it would be a possible choice for you at this point.

Also, people do experience anxiety and that is alright too. I do know the cycle that benzodiazepines put me personally in, always evaluating mood and the need for a pill, is it there/isn't it there? Should I take it/shouldn't I take it? There use gets me a few steps closer to the nature of active addiction in my book, has never set me off the rails and has been beneficial in situations and at times but is clearly something that needs to be closely monitored and regularly have benefits evaluated thoroughly. Good luck, I hope you find something that works for you as I know how debilitating severe anxiety can be at times.

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 Post subject: Re: Anxiety treatment
PostPosted: Wed Dec 18, 2013 9:59 am 
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Thanks for your reply!
Yeah I hear what you're saying, I basically learned to manage them well last time by learning to recognize anxiety and even if I could confirm it was genuine anxiety (abnormally negative stress reaction to given situation/environment instead of just the typical one of appropriate average stress) or know because i was truly fixating on something, I could either take one preventatively to basically keep it from getting worse, or more often I'd encourage myself to wait and see if it doesn't get better either on its own or due to other coping methods. According to the scrip I was allowed to take a maximum of 2 per day so usually the first one would have therapeutic and preventative intent, and if i took a second one it was after unsuccessfully trying to deal with it other ways. And then after a few weeks on it I'd get better at learning to put off taking it until it became obvious that it was an appropriate time to do so, so mostly I'd know to wait first and this method never bothered me. Probably because it took less effort for me to monitor my mood and use discrection accordingly than it does to calm myself down when I'm actually suffering. You're right, it really can affect ones ability to function so since I work from a computer set up at my dad's house (he is my immediate supervisor as he got me a job with the company he works for) I kinda sneak the first ten minutes of work sometimes to write in my notebook, jus to scribble out a few paragraphs before having to focus on my assignments, it helps take the pressure off starting the work day and I only lose ten minutes). So if my work day is already starting out with me not feeling prepared to be there, this has helped me to at least get by. I don't have to be there until early afternoon even but I wake up at like 6 or 7 every day as well so I can have time to myself and start the day relaxed, not rushing to be anywhere to do anything or prepare for anything. I've voluntarily woken up at 5 in the morning before and not have to be at work until 8 hours later but somehow I swear to god it never feels like enough time.
I forgot to add I've also tried like distraction methods like I used to do a lot of word searches and also just simple like single stitch sewing. Like I'd just take an old piece of clothing I didn't care about, cut a line and stitch it up with a needle and thread. But these things got old quickly.
Like you said, the doctor would want small doses, and I'm fine with that. Based on how I felt back then I think .25 is a perfectly therapeutic dose for someone with my physiology and my level of issues, so that doesn't really concern me.
I just wish that if a medication like Xanax (and it's benzo brothers and sisters) were so frowned upon for people with addiction to other substances, that there would at least be more as-needed non-controlled substance medications out there to treat anxiety and panic attacks. Because it really just sucks how when you've explored it a bit, there's actually not that many options for us. And I just hate to think there's these things like anxiety meds for anxiety or panic disorder or whatever that are the effective, obvious answer for the rest of the population but even if we never abused nor felt a chemical kinship with a certain med it automatically makes me or anyone else with this problem a bad candidate because of our pasts, and the thing that makes me sad about that is that it's. LIFELONG. I know were accountable for our last choices, but when I go into a doctors office to discuss this issue I feel like I've earned the privilege to at least be taken seriously. Not that my pain/sub doctor doesn't, but it feels like that with other docs which is why I rarely go to another one for this issue. Needless to say it really takes me a while to get comfortable with one.
It's also difficult even if you're not the only one. I'm glad you who responded didn't judge me or my thoughts for bringing up the issue of medication but that's it, it feels like there's also this divide between a medical practice setting and elsewhere. My mother who is a nurse and has seen me at my worst, and my bf who is recovering have no problem with it because they see me when it gets bad, and they've been able to hear me out when my thoughts are more detailed and organized. Probably because I hate confrontation and something about the doctors office setting will leave me more tongue tied. I always feel like there's a better way I could've explained my situation and I prepare myself to say the things that resonated with the people in my life, but then later it occurs to me that I left some ideas out and just forgot when nervous. So that's something I'm working on.
At the new doc I went to see specifically for this issue though i wasn't sure whether or not he'd find out I was on suboxone/had dependency problems with opiates if I didn't tell him. But I thought I might be able to explain the situation well enough that he could stay open minded and more than that I knew I'd be tempted to tell him the entire time so I wouldn't have to feel like I was lying about my medical history and past mistakes. There's a lot of things about NA/12 steps that I don't relate to personally but I heard "you're only as sick as the secrets you keep" and that I liked, and it's really sorta been like this compass that's helped me navigate through these situations since getting straight


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 Post subject: Re: Anxiety treatment
PostPosted: Wed Dec 18, 2013 3:38 pm 
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I hear everything you're saying; you're preaching to the choir, sister! :)

One thing I'd like to add, though, is that it is becoming rarer and rarer that there is zero communication at some point, some how, regarding concurrent medication prescribing between different prescribers via the RX monitoring program. Trust me, it's more elaborate than you think, the first time I saw a print out, I was really glad I stopped 'messing around,' it almost scared me! If your pharmacy doesn't utilize it, one or the other prescriber eventually will. In my experience it's a lot easier to be up front from the beginning than waiting for that inevitable 'do they know/don't they know' shoe to drop, especially in the case of someone who's complaint is abnormal levels of anxiety. The concurrent prescribing of opioids and benzodiazepines isn't without issue, even if warranted and you're doing yourself and your prescriber(s) a disservice if you're not up front about it.

It would be a lot less traumatic to just have one prescriber or possibly two who communicate prescribing these two medications knowingly and without issue rather than have one or both not in the know, find out and feel deceived, cut off, make calls, kick out, etc. There's often consequences like this, right or wrong. I hear from people who have been discharged from Suboxone practices in similar ways quite frequently, so be careful. And I do think you're right about the NA philosophy about secrets, in my book they simply aren't conducive to recovery. Again, good luck; I hope things work out!

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 Post subject: Re: Anxiety treatment
PostPosted: Wed Dec 18, 2013 5:56 pm 
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You are correct on these points TwinCitiesHardcore, but there's actually a lot less threat of being kicked out for me personally because I'm not in practice that is an official sub clinic, it's a pain management specialist I've seen for a few years since I was diagnosed with fibro, and from what I understand it's much easier to be kicked out of a suboxone clinic than it is to be dropped from a pain management practice. I totally agree with you though that it's just so much better when everyone knows everything, so before I had my appt with the other doc I actually informed the first one the first one that I had an upcoming appt with dr. so-and-so for treatment of my anxiety. And also I promise I never would've omitted the suboxone thing (though old me would have) with the new doc, it just occurs to me that it has the great potential to limit my options in addition to making me uncomfortable during the appointment, just not as uncomfortable as lying to or intentionally misleading them would be.

Like seriously, I don't even know how I lived like that.

But as for the database thing I don't really care if they can all (any current or future docs and pharmacies) can see what scrips I have on record prob because I'm lucky to have a caring doctor and good familiar pharmacy that know how to be responsible without being excessively strict. I've never forged a scrip and was never much of a doctor shopper so I just don't worry about it. I just dont like the place it's (database and restrictions) coming from when it's a result of and fodder for the attitude of suspicion towards all patients on controlled substances.
I gotta tell you though, while unfortunately the feeling didn't last all day, there was a catharsis just posting for the first time to discuss this issue. Sorry if it was long wordy and self indulgent (like my subsequent posts) but something about that was jus kinda calming.
Thanks for your reply and feedback :)


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 Post subject: Re: Anxiety treatment
PostPosted: Sat Dec 28, 2013 5:21 pm 
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Just in case TwinCitiesHardcore or anyone else reads this, I just wanted to give an update. I had a conversation with my boyfriend last night about this problem of mine, and he noted that I seem better lately, in about the last month. Keep in mind that he is the second best informed person (the first being myself living inside my skin after all) to comment on my case. I live with him and he drives me to work everyday, so he's the constant witness to my freak outs when I'm running late for something, can't find something in our room, get increasingly antsy in the car thinking he's driving too fast, bitch about my teeth etc. And I have to live with me; I follow me everywhere. So I can recognize the accuracy in his statement when he says as he did last night that I've seemed better and it started getting better when my doc put me on the flexeril to take at night like I mentioned in my first post. My anxiety is throughout the day and I don't take it during the day, but maybe it's something about it staying in my system or improving my quality of sleep. It definitely does help with anxiety, calms you down, but it's just not prescribed for that nor would I be able to take it in the daytime without falling asleep. But it's done some good.
It's not completely off my shoulders though, unfortunately, I still get that kind of helplessness stress often, but it's not as severe. I'm not 100 percent better/functional now, but at least I went from like negative 11 to +30. So at least I don't have to get this sort of thing going through my head that goes like "I give up, don't know wat more I can do, I give up I don't care" but of course all the while still caring but wish I really didn't care cuz if it were possible for me to not care bout things on command I wouldn't have an issue in the first place
So even tho therapy didn't real do much for me when I was in it I was thinking about finally scheduling that "exit session" or with all the time passed I guess I'd call it a "follow up" session that my former counselor has thought would be beneficial since I quit. I quit it because without the benefits you're supposed to achieve with long term therapy I wanted to move on from that part of my life and have more freedom, freedom to utilize that time for more productive and fulfilling things. You never think that an hour out of the week is that much but after a while it really is. Anyway since posting on this forum about how I've been feeling was sorta a relief in itself, at least at the time", maybe going back for a session without the pressure of continuous attendance and questions and homework would be at worst, not a big waste of time for me at this point.
I also get a lot of comfort from this site :)
I know some peoples doctors tell them that participation in this forum may count as their aa/na meeting, and I get it. There's some great stuff here in the discussions and stories and I like the suboxone acceptance here compared to meetings, and even more so I like the anonymity, that makes it really comforting and it's why I felt okay putting personal shit up here.


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