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StateOfRegret

A Gordian knot: anxiety medication & HPPD

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Hey all!
 
I'm still searching for a medication to treat my anxiety problems that won't simultaneously aggravate my HPPD. As many of you know, that is one tough nut to crack. My immediate thoughts:

  • SSRIs: Seem somewhat effective for my anxiety. Aggravates visuals, had to discontinue. At least HPPD symptoms returned to ''baseline'' upon discontinuation.
  • Benzodiazepines: Greatly attenuates my anxiety (particularly etizolam and clonazepam) and helps HPPD symptoms as well (particularly clonazepam). Very addictive, not a long term solution. I build tolerance to benzodiazepines pretty quickly.
  • Buspirone: Seems too ineffective to be worth it (never actually tried this one)
  • Pregabalin/gabapentin: Seem to have many of the same pitfalls as benzos, plus some extra common side effects(?)
  • Beta blockers: Ineffective in managing my anxiety, since it doesn't primarily manifest with tachycardia, tremors, flushing etc.
  • Atypical antipsychotics: Seems like a dangerous combo w/HPPD (particularly risperidone).
  • Older/atypical antidepressants, such as TCAs: Never tried any of those. Very interested in hearing personal experiences or ideas about any non-SSRI antidepressants useful in treating anxiety, particularly about how they interact with HPPD.

Thanks in advance, folks :)  Hope you're feeling all right. Looking forward to hear any and all thought on possible anxiety medications w/HPPD.

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check out my post about ashwagandha extract, shit really works. and when you feel like you have bad anxiety have a caffeine free soda, its always helped me as sugar releases a load of natural opiotes and as with eating in general releases dopamine

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Thanks for your well meaning post.
With all due respect, "if you have real bad anxiety, drink a soda" is the sort of thing someone who doesn't know bad anxiety would say.
I'm looking for experiences with anxiety medication and HPPD. :-)

 

Edit: As for Ashwagandha; I don't feel like going into these herbal supplements in this thread, but suffice to say, ashwagandha is a GABA agonist. One might as well use a well-researched benzodiazepine if looking for GABA agonism (or positive allosteric modulation, but I digress...).

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sorry i see what you mean, its always helped for me though cause im addicted to sugar and caffeine so it does the opposite of what you'd expect it would and completely mellows me out. propanolol is used for high blood pressure,it didnt do to much for my anxiety but ive heard many others say it helped, look it up

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Benzos and alcohol have been the only things that work for me, so far. None of the other meds did anything significant, even barbiturates.

 

Now that I have fully accepted this shit is with me for life... I've tailored a bit of a masterplan for my anxiety

 

Thursday evening - 3-4 light beers

Friday morning - 1mg Klono - 3-4 light beers in the evening

Saturday morning - 1 mg Klono - a few beers or glasses of wine in the evening.

Sunday morning - 1.5mg klono.

 

Sunday's klono has some effects on a Monday... So I really only have Tuesday and Wednesday without any kind of anxiety dampening. Hitting the gym hard those days helps.

 

Now, that is not a system for everyone... Just what works for me. Benzos and alcohol is not wise, for starters..... I seem to be fine with the combo, for the most part (probably as I have 12 hours between the klono and alcohol... then keep it to just a few drinks).... But it can be deadly.

 

The alcohol gives me back a bit of a social life though.... I find even just a couple of beers is enough to bring me out of my shell and have a bit of fun and laughs... To me, that is everything. I feel like I have a life again and that is all down to those beautiful benzos, as even 2 beers would send me into an anxious mess the next day, without them.

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Thanks for sharing, Jay! :-)
I don't particularly enjoy alcohol these days, but using benzos ''sparingly'' has also been the only solution that gives me a feeling of being able to handle life and my anxiety. Gotta go, just wanted to thank you for sharing your ''masterplan'' :D

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My weekly pattern is somewhat the same as Jay´s, except my ongoing Lamictal trial which only seems to reduces DP/DR and mood swings. But yeah, a few beers, some wine and a couple of benzos in my system gives me that little spark. Make sure to take a few weeks off once in a while if you´re following this system just to prevent tolerance and addiction. As an alternative to clonazepam, I´d recommend valium or oxazepam. The latter, in my experience at least , doesn´t make you drowsy, lazy and forgetful, although it might not be "strong" enough to combat full on panic attacks. And even though my Sertraline trial reduced depression and anxiety for the time being, it also worsened my visual baseline. Good luck :)

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I got propranolol. Works pretty good but only if used like twice a week. I also used Gabapentin and same applies to that. I'm not on either one anymore but I think if possible it would work best if you could alternate between Gabapentin, Propranolol and a benzo.  Take each like once a week or twice at most. Other than that I found all to pretty much stop working relatively quick other than benzos but they aren't worth taking everyday imo. Have you tried other things like magnesium, taurine, passion flower or anything along those lines?

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And even though my sertraline trial reduced depression and anxiety for the time being, it also worsened my visual baseline. Good luck :)

Right, I remember your thread about that :) .

 

Personally, I'm considering giving mirtazapine a go. Interesting pharmacological profile (5HT2A antagonism, antagonist at some alpha-adrenergic receptors, only very weak dopamine antagonism). One of the ''atypical'' antidepressants in that it doesn't work as a reuptake inhibitor! Psychiatrists often prescribe it together with bupropion, to counter some of the drowsiness, appetite stimulation and so on. I remember reading here that bupropion (Wellbutrin) was generally well recieved by the few HPPD sufferers who had tried it.

From wikipedia:

In contrast to mirtazapine, the SSRIs, SNRIs, MAOIs, and some TCAs increase the general activity of the 5-HT2A, 5-HT2C, and 5-HT3 receptors [...]

5HT2A activity is definitely something to be avoided, so this would be a big plus for mirtazapine in my book, at least on paper.

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You ever hear of an antidepressant called Agomelatine? I works on the melatonin system. I tried getting some from my doctor but IDK wtf he is doing he is being a fucking moron right now. Might be something to look into if you want an antidepressant with anxiolytic properties without being serotonergic. 

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Personally, I'm considering giving mirtazapine a go. Interesting pharmacological profile (5HT2A antagonism, antagonist at some alpha-adrenergic receptors, only very weak dopamine antagonism). One of the ''atypical'' antidepressants in that it doesn't work as a reuptake inhibitor! Psychiatrists often prescribe it together with bupropion, to counter some of the drowsiness, appetite stimulation and so on. I remember reading here that bupropion (Wellbutrin) was generally well recieved by the few HPPD sufferers who had tried it.

From wikipedia:

In contrast to mirtazapine, the SSRIs, SNRIs, MAOIs, and some TCAs increase the general activity of the 5-HT2A, 5-HT2C, and 5-HT3 receptors [...]

5HT2A activity is definitely something to be avoided, so this would be a big plus for mirtazapine in my book, at least on paper.

 

Judging by the wiki article it certainly looks like it might yield more benefits than a SSRI. Let us know if you give it a try!

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Thanks for your well meaning post.

With all due respect, "if you have real bad anxiety, drink a soda" is the sort of thing someone who doesn't know bad anxiety would say.

I'm looking for experiences with anxiety medication and HPPD. :-)

Edit: As for Ashwagandha; I don't feel like going into these herbal supplements in this thread, but suffice to say, ashwagandha is a GABA agonist. One might as well use a well-researched benzodiazepine if looking for GABA agonism (or positive allosteric modulation, but I digress...).

Don't discredit the viability of herbal supplements so vehemently. Acetyl-L-Carnitine is saturated in fish and can assist with memory recall and increased cognitive function, Vinpocetine is an analogous derivative of vincamine, naturally extracted from the periwinkle flower and increases oxygen levels in the cerebral cortex for enhanced mental clarity and acuity, Huperzine A addresses acetylcholine deficiencies which is a crucial neurotransmitter for working memory and focus, and it possesses antioxidant compounds. The dilemma with herbal supplements as opposed to pharmacological medication is they aren't subjected to clinical trials, thus leading to lack of empirical data; the FDA has a propensity for not giving a shit about herbal supplements and their implications which exacerbates inclusive data pertaining to these supplements. Coincidentally, the three herbal supplements I listed have gone through rigorous, placebo-controlled clinical trials, and have proved to inhibit cognitive decline.

Individuals on this forum have reported a myriad of benefits from herbal supplements, nootropics and other non-pharm compounds; pharmaceuticals are palliative in treating HPPD at best. Now to address a medication that can attenuate your anxiety issues, I'd research Lamictal; it has a beautiful pharmacological profile and is being employed off-label to treat HPPD; I'll be asking my psych for a prescription soon, as my tolerance to Klonopin is asinine and I genuinely want to alter my medication regimen. With HPPD, I'm a fanatical advocate of neuroplasticity, nutrition and copious amounts of exercise for neural regeneration and cumulative neuronal density increase within the brain. I wish you nothing but luck in finding a suitable med to eradicate your anxiety.

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Don't discredit the viability of herbal supplements so vehemently.

I don't know that I did. I would never claim that supplements, herbal or otherwise, are of no use :) I just said that I meant to discuss pharmaceuticals in this particular topic.

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I've taken Mirtazapine on and off for about 2 years after reading a post on here that read something like "Completely healed from a case of Diagnosed HPPD."  Mirtazapine hasn't affected my visual symptoms positively or negatively.  It helps me sleep and with depression.  It does nothing for anxiety.

 

I'm not sure any non-benzo medications will help you with anxiety.  Especially if you have used a benzo and can compare it to that.  Just my two cents. 

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I understand that you believe your anxiety needs neurochemical relief, and I do not suggest otherwise, but, have you tried any psychotherapy? Cognitive behavioural therapy would be the most appropriate for anxiety. It has shown to be very effective in managing anxiety disorders. This approach requires much more patience and practice, but if you can avoid medication, that would be great, wouldn't it? If anything it will help, and you should do it even if you go on meds. It has helped me lots, but my anxiety is not severe. Practicing mindfulness meditation (taught in CBT) daily rewires your brain not to respond to undesirable thought processes. If you can manage to do a couple of hours a day (1 hr morning, 1 hr evening) I am sure you will manage your anxiety much more effectively.

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Personally, benzodiazepine use on a PRN basis has not worked for me. I've had a lot of problems with clonazepam abuse. If it's there and I'm anxious, depressed or even just bored I will take some. A lot. It takes discipline that I don't have. Probably for the same reason CBT hasn't been effective for me either. It was helpful in the short-term but it's easy to fall back into old habits. But for the stronger willed a combination of the two could work wonders.

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Chris: Yep, certainly takes discipline. Oh, and good to see you posting again :) .

 

I tried a single dose (15mg) of mirtazapine yesterday night. I'm not going to make any statements wrt effectiveness yet, just wanted to say that so far, it hasn't affected my HPPD as far as I can tell. It did make me extremely tired, though. I slept well but awoke feeling exhausted and felt  'zombiefied' for hours. Upon returning from university I fell asleep again and awoke late in the evening. One of the possible side-effects is strange dreams. I had some pretty strange ones while napping, but then again, that's not too unusual for me.

I think I'll postpone giving it a real try for another week, until I have some more time on my hands.

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I'd really recommend afobaloze and tianeptine for anxiety and depression. Neither are addictive or cause negative effects upon ceasing use. (Unlike benzo's and or/ SSRI's - brian zaps anyone?) Both are available without a prescription and I have been using both. It is not a cure for HPPD but neither has worsened my HPPD or DP symptoms.

 

I tried mirtazapene (Remeron in Australia) and it make my so groggy zombie-like in the morning I decided I couldn't live life like that. It definately helps with sleep though!

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Mirtazapine: I've used it for extended periods before. Strangely enough, it doesn't cause any noteworthy HPPD worsening. Odd regarding it's pharmacological profile..

Anyway when I started it, I took 15 mg doses. Onset is quick, 30 mins to full effect. It makes you so sleepy you can barely stand. Sleep onset is quick and duration of sleep can be long, the first night I slept 12 hours straight.

This is because it's a very strong antihistamine, it also antagonizes 5HTA and B receptors, and agonizes 5HTC. It also antagonizes the adrenergic receptors.

So it's sedative and calming, tells your brain to pull the handbrake on wakefulness really!

But, tolerance to the sedative effect is reached within 10 days (according to medical data), and it can't put you to sleep no more.

I had my dose raised to 30 mg, the sedative effect came back for like 5 days.

Then I began to experience symptoms of serotonin poisoning, tremors and dissociation went out of hand. Then I had a clonic seizure (first one ever), and I stopped taking it immidately. Besides, I gained much weight very fast, due to water swelling of tissues which in turn increases fat storage. And I got so damn zombified and lost all passion for life, had much suicidal thoughts in end. Mirtazapine is anxiolytic, but made me worse in the psyche as a whole. And gave me a seizure and made me fat also (weight back to before now though)..

I was prescribed it in a period of benzo withdrawal, no medicine could calm me or make me sleep. My heart rate was up to 150 bpm, blood pressure 150/90.

After the period of Mirtazapine use, it was down at 80 bpm, blood pressure 120/70.

So it saved my life, but also almost took my life, at the same time..

I would say if you use Mirtazapine, take only 15 mg at need, not regularly, with several days spacing in between. Like if you had a long period of terrible sleep, and just need atleast one night of good sleep, take a 15 mg and you'll sleep like the dead!

How Mirtazapine could be classed as an "antidepressant" is a mystery to me. "Prodepressant" is more fitting!!

Agomelatine (Valdoxan):

It's a specific melatonin and 5HTC reuptake inhibitor. Basically, quite similar effect to pure melatonin but with longer duration.

You'll get cool dreams, that's all..

It sedates you as much as a glass of warm milk, i.e. not at all.

Not a bit anxiolytic. Not an "antidepressant" either.

A rather effectless (and pointless) medication. Cool dreams is simply not enough.. No HPPD worsening though. Might mess up your liver because of the "helping" substances in the pill (read: heavy metals)

I stopped using it after ~6 months, it had no benefit simply.

I would also like to recommend some very mild, harmless, herbal anxiolytics:

Mint (most sorts): A little bit relaxing for mind and muscles.

Hops: Yup, the famous beer ingredient, provides the bitter flavour.

Mild anxiolytic and muscle relaxant, promotes sleep. Nothing close to a benzo, but on the other hand safe to use regularly (without alcohol, that is).. Extracts, fresh, or dried forms are to be prefered, not in beer due to the risk of alcholism.

No HPPD worsening on any of these herbs.

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Hey 415! Thanks for your comments. After trying mirtazapine for a bit longer (it was a couple of months ago, so I can't recall exactly how long, but I think it was 5 or 6 days) I can definitely relate to the "pro-depressant" comment. I'm not usually prone to depression but I felt absolutely anhedonic and grim and was a general pest to everyone in my vicinity while taking it! Definitely not pleasant. I'd have to agree that it is somewhat anxiolytic, though.

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