And I’m sorry to go off-topic on a board I hardly ever post in. That’s against “netiquette”, or something, I’m sure.

noooo…… be welcome! and i hope you return often…

there are few posts where “off topic” is a problem (the book salon or blue america are examples where there is a guest).

While on the Klonopin, I’ve been working hard at changing the way I think about things and all that stuff. I’m also considering CBT or some other program, too. I’ll look into the ones you described.

If you wouldn’t mind coming over to the blog and letting me know what you think about long-term, low-dose benzo treatment, I’d appreciate it. I’ve discovered that they’re somewhat out of favor, but have found studies that suggest it’s not too bad, as well. The key seems to be keeping the dose low…higher doses are likely to develop tolerance to sedative effects, although not necessarily anxiolytic effects.

Please let me know what you think. Hopefully you’ll read this. I read firedoglake somewhat often but do not check the comments very much…so if you’d be so kind as to contact me more directly that would be helpful.

Thanks again.

And thanks to “S” for posting my link here. Not the usual place for such a link, but hey, it led me to someone who seems to know their stuff.

D

I read FDL daily but have never posted before. I find that if I wait someone will bring up the very points I find curious or interesting and expound on them. I watched the Larry King interview with Tenet the other night and wow, I don’t creep out easily but this guy did it for me. I’ve been watching for someone with a psych.
degree to analyze Tenets not so subtle control tactics in his manner of speaking. Specifically the way he uses the interviewers name at the beginning of every response. What’s with that? It was “Larry, blah blah blah.” Larry, blah blah blah blah.” Is this from the SpyMasters Hand Book because it sure didn’t matter what BS he spouted after that the interviewer in this case was just left sitting there with a silly grin on his face. I have to give Larry a break, he is a friendly interviewer and not given to being adversarial but I would have loved it if he would have stood up and said, “George, you’re sounding like a manipulative, lying asshat, George. Did I say George, George?”

I would love to be able to take public transport, but as a sales rep it is impossible. Plus it stinks out loud in central Indiana. I do my part by working virtual as much as I can.

Oh gosh, I know…My boyfriend has to have a car or he simply could not earn a living. And I have the luxury of living in the major NYC Metropolitan area…I have no excuse NOT to use it.

I would love to see all of the folks interviewd asked how they expect to deal with whatever priority they cite when the country has the largest deficit in history, the war is draining the treasury, the militaty is over-stressed and desperately needs to be re-equipted and rebuilt, the Social Security under funding problem lurks, Medicare underfunding is also coming to a head and there is a growing demand for an increased government role in domistic issues such as education and universal health insurance, etc.

The question has become not “, would you pull out of Iraq and if so when?”, but “how long can we afford to stay (in terms of both blood and treasure)?” Can we even fund the basic priorities that they declare without a massive re-funding (read tax increase) of the government? How will their position on the “war on terror” affect the nations ability to fund that endeavor and the many other domestic priorities they favor?

I’d love to see someone dicuss these issues with a healthy dose of reality, not just platitudes and sound bites designed to apeal to 14 people in New Hampshire, Iowa or California!

What’s catching my eye this morning? An internet buddy of mine started chronicaling his health ordeals in an effort to help others who suffer from his condition. It’s pretty surreal and I had no idea he was going through so much. If anyone is interested, you can read his story about anxiety/panic disorder. I’m glad he’s doing better!

That and watching George Tenet weasel, lie, and dodge culpability disgusts me.

Good morning grs -

Thanks for posting your friend’s blog.

I’m glad his symptoms have been releived, and I regret the doc who diagnosed him with the panic disorder didn’t give him more accurate info.

Although panic disorder (four or more panic attacks per month) sometimes remits spontaneously, effective treatments for panic disorder (pharmacologic and non-pharmacologic) offered soon after the onset of symptoms appear to decrease the risk that the initial symptoms will persist.

That’s a good thing. People with chronic panic disorder restricting their activities (agoraphobia) have a greater risk of suicide than people with mild to moderate depression.

[Also, chronic “anxiety neurosis” - a British diagnosis that appears to encompass panic disorder - have an elevated risk of strokes and heart attacks if their symptoms go untreated for two decades or more].

OK, what works for treatment?

One therapy and some drugs.

I. Psychotherapies

Psychotherapy comes in different forms – like people.

Most people imagine “psychotherapy” to be sitting around talking about life events.

This form of therapy (”insight-oriented psychotherapy”) is no better than placebo for relieving panic disorder, and far more expensive. Psychoanalysis – an even more expensive form of insight-oriented psychotherapy – is even more expensive, and also ineffective.

A very specific form of cognitive-behavioral therapy works as well as do (effective) meds in relieving anxiety disorder symptoms. Properly conducted, this therapy has been shown to reverse the abnormal brain blood flow patterns associated with OCD (the most severe form of anxiety disorder) and relieve symptoms with the same power shown by medications. Unlike medications, the benefits of the specfic therapy persist after the meds are discontinued.

This specific therapy was developed by David Barlow, PhD and Michelle Craske, PhD. They actually studied the results of the therapy with rigorous assessments and published their results. Their tools work.

Barlow/Craske wrote a series of treatment manuals (Mastery of…) detailing use of this specific therapy. For panic disorder, the title is Mastery of Your Anxiety and Panic, with one guide for patients (a workbook) and another for therapists.

Because the treatment works, ex-patients often sell their workbooks.

New workbooks may be obtained from Graywind Press (titles apparently devoured by Oxford University Press).

For reasons requiring such intricate explanations I shan’t complete them in time for hiking, most “cognitive behavioral” therapies for anxiety disorders you’ll find in the self-help section are incomplete. Many mental health professionals offerring CBT don’t have enough tools in their tool kit to do it well.

The Barlow/Crakse series brings patients and clinicians effective, university tested therapies which cure anxiety disorders in a significant proportion of patients.

II. Drugs

Two classes of medications are effective in relieving panic disorder symptoms: benzodiazapine anti-anxiety drugs (including clonazepam or Klonopin) and antidepressants (includiing the new SSRI class and the older tricyclic class).

Klonopin and its cousins relieve symptoms, but also cause withdrawal (and therefore high risks of dependency) with sustained use. Brief use of these tools can clarify diagnosis and help to bring down initial symptoms.

(Chronic use of benzodiazapines or other prescribed “sleeping pills” increases accident risks and accidental death rates in people over 60.)

Antidepressants (when prescribed for patients without bipolar disorder or psychosis) offer safe control of panic disorder for patients not pursuing CBT. SSRI’s (the Pr#z*c/ P*xil/ Z#l#ft group) work quite nicely for this.

As 90% of psychoactive meds in the US are prescribed by non-psychiatrists, info about effective use of SSRI’s for panic disorder is often helpful.

Concept: the starting antidepressant dose suggested for depression will make anxiety symptoms worse before making them better. Most clinicians don’t know this.

The easiest SSRI to use for panic disorder is sertraline (the Z one). This tool allows teh doc to start the drug at the lowest possible fraction of the effective depression dose (as little as 12.5%). Once the patient tolerates sde effects (increased anxiety symptoms) at the low dose, the dose can slowly by increased to the theraputic range.

Second concept: for most patients, the SSRI dose required to control anxiety symptoms is greater than the dose required for depression.

For sertraline, this can mean theraputic doses from 200-300 (or greater) to control panic disorder.

Hope all this helps – if not your friend, than someone else at the Lake (or their friend).

I learned the above info training and the joining the staff of an Anxiety Disorders Clinic at a major UC med school. Outside of academic med centers, the above info seems…well…a lot less available than I would like.

I’m sharing this info on the Lake so people here may help “educate” those caring for them and those they love.

PS – Disclaimer – I’ve no financial links with Dr. Barlow, Dr. Craske, or Big Pharma.