Need Advice for a Friend

[parroty108]

I have a friend who has suffered with anxiety all her life, probably caused by a poor upbringing and abusive parents.

She suffers with bad social anxiety but can have a full blown attack if something stressful happens at work etc. This leaves her exhausted, sometimes depressed in the mornings and with physical effects such as ulcers, ibs and so on.

She has tried ssri which do work to some degree but she said made her feel like a zombie. Previously she had diazepam which were great if she had an attack but the doctors will no longer prescribe it.

Could someone recommend any other medication to try or herbal remedies? Because of her social anxiety, talking to the doctor is very difficult for her. She has only just started cbt.

I'm really trying to help her as shes a right state for several days if she has a proper attack of anxiety, it's awful.

[Rennie1989]

Medication affects people differently, what works for some will not work for others. It can take 2-4 weeks for medication to work and if by then it's still having a negative affect on her then she should see a doctor to get it changed. If she struggles to see a doctor then maybe you could go with her for support? Many people on here recommend Rescue Remedies for anxiety, that could be something to recommend to her.

It's great that she's started CBT, many people (like myself) have had great responses from it. It'll take time for it to work so bare with her and support her during her sessions. She'll be given homework which can be challenging at times but will benefit her in the longterm if she perseveres.

She is very lucky to have a friend like you, who is caring and supportive of her needs. Make sure to take care of yourself as well.

[MyNameIsTerry]

Hi and welcome to NMP :welcome:

I would suggest having a read through the Top Tips and Natural Remedies boards to see what others have/are recommending.

In terms of natural remedies here are a couple of ones that have been discussed a fair bit:

Inositol
http://www.nomorepanic.co.uk/showthread.php?t=64229


Magnesium
http://www.nomorepanic.co.uk/showthr...ight=magnesium
http://www.nomorepanic.co.uk/showthr...ight=magnesium
http://www.nomorepanic.co.uk/showthr...ight=magnesium
http://www.nomorepanic.co.uk/showthr...ight=magnesium
http://www.nomorepanic.co.uk/showthr...38#post1452038

Herbals are discussed less from what I have seen on here since joining. You do have to be careful with these as some interact with medication. I have seen NICE recommend further study into a combination of chamomile and gingko biloba that was seen as helpful in mild anxiety. A quick Google should pull those studies up. But gingko biloba interacts in a major way with various meds like SSRI's so make sure you use the interaction checker on Drugs.com as well as using WebMD to look at the herbal on it's own as the interactions tab with it will show you some things too. Chamomile is probably one that gets a lot of support so you could try the tea or even the supplement versions. Ginseng has been mentioned but this can have anxiety as a side effect so it's worth reading up on that. Another one I have seen have promise is ashwagandha as there are studies supporting it. There is a website called "Examine Supplements" that is good for reading about this as they compile actual studies into levels to show how valid they are. I read about ashwagandha & inositol on there. I've posted a link to the inositol page on that website in the back of NoPoet's inisitol guide posted above.

Mindfulness can be a big helper, so have a look at the link in my signature where you will find a load of free downloads and some info on studies proving it works.

In terms of meds, it's a very difficult question because we all react differently. There is a Medication board with a load of sub boards about various ones. She could try different SSRI's, SNRI's, or even anticonvulsants, MAOI's, etc but her GP will need to deal with all that.

To help you look for medication possibilities you could look at what NICE have compiled as best practice for treatment of various anxiety disorders. There are ones for GAD, OCD, Agoraphobia, etc but because you have posted on the GAD board I have just posted the GAD guidance. This mentions types of medication and in what order based on their expert panels and evidence base:

https://www.nice.org.uk/guidance/cg113

Clicking on "1 Guidance" will bring all the treatment options up including Drug Therapy sections. Their "panels" are made up of experts in these fields.

Aside from this it would be a good idea to work with relaxation techniques, guided visualisation, breathing techniques such as Calming Technique, Progressive Muscle Relaxation (PMR), etc. Her therapist should be giving her worksheets for the latter two but here they are just in case:

http://psychology.tools/relaxed-breathing.html
http://psychology.tools/progressive-muscle-relaxation.html

PMR is an old technique from the 1920's but the NHS still give it out today.

There are also loads of psychology tools here:

http://psychology.tools/download-therapy-worksheets.html

Some of those are techniques (like the breathing & PMR I posted above) but at the bottom you can view them by disorder and this brings up workbooks with additional tools and self help information that is useful.

I think it's great that you are trying to help as these disorders can be very isolating and we rely heavily on GP's who often lack time, interest or even knowledge and we get fobbed off too easily.

[parroty108]

Her GP sounds totally unhelpful tbh and says there's nothing available besides drugs. She has paid to see the councilor herself which I think is ridiculous seeing how badly she is effected by it.

I'll read up on the herbal stuff and see what might be worth trying. She isn't taking any prescription meds at the moment though.

On a plus note she said her first session with the councilor went really well.

[MyNameIsTerry]

Yes, that does sound like a classic sign of the poor GP's people complain about on here.

If you are in England & Wales there is a network of service providers, often charities, under IAPT. Look yours up here:

http://www.nhs.uk/Service-Search/Psychological-therapies-(IAPT)/LocationSearch/10008

You can then look on their website. Googling your area with "IAPT" in it usually turns them up as well and they will be detailed on your NHS local trust and council websites.

Many of the IAPT providers allow you to self refer as well as take referrals from GP's. If you have IAPT services in your area this GP will know he/she should have referred your friend to them.

Have a look on your IAPT providers website and it will tell you what services they provide. They can be quick to access for self help work but may take a few months for therapy - but it's all free because it's a NHS scheme and charities are given grants to provide services to fill these gaps.

I'm glad your friend had a good session with her counsellor.