Can you be prescribed clonazepam if you don't get panic attacks?

[Mazzii342]

My anxiety is severe but it never gets to the point of a panic attack. I get many of the symptoms- like a racing heartbeat and laboured breathing, as well as shaky and restless, but I never have the type of attack that completely grips me. I feel like what stops me is my fear of being embarrassed in public. I've had panic attacks after a situation, where there are no people, but never around people. For example the other week I ran to the toilets after a particularly horrible day, (I hadn't slept at all in the night, and my lecturer criticised my work which I was very proud of at the time) and I burst into tears, was shaking, found it hard to breath etc etc.

My question is, is this enough to be prescribed clonazepam? Or something similar? These things happen all the time. My mind is racing with thoughts, my stomach turns I shake and I often miss uni and work because of it. I feel like if I had something that would calm me down, I might be able to have more of a life without this paralysing fear of just everything.

I am on citalopram may I add. It doesn't seem to do a thing, and have been on it for 6 months.

Thanks! :D

[MyNameIsTerry]

As far as I know this med is licenced for epilepsy, not for anxiety or panic disorders. This means a doctor can still prescribe it, as long as there aren't any NHS directives not to (then only private doctors still can), but they do it "off label". This means taking full responsibility for prescribing.

GP's do it with some meds like antidepressants licenced in depression but not anxiety or panic but this is because there are other guidelines from the NHS or NICE stating they can. Beyond that, if a GP won't, it means seeing someone specialised - in this case, a psychiatrist.

They are likely to be wary prescribing a Benzo for regular use as dependence can become a possibility. A psychiatrist can do more and stabilise patients and then wean then off from dependence but a GP shouldn't be doing that these days.

You could try but with Benzo's it's normally for very short periods. To take the edge of starting an antidepressant for a couple of weeks, for instance.

Diazepam is the norm but anything beyond short term is specialised still so it's for a psychiatrist.

The likelihood is no because antidepressant treatment should be able to do what you need or therapy (or both).

[panic_down_under]

I am on citalopram may I add. It doesn't seem to do a thing, and have been on it for 6 months.

If you're not taking the maximum 40mg then the dose should be increased. OTOH, if you are then a different antidepressant should be tried. Sertraline (Zoloft) would be a good choice. In most cases an overnight switch from one SSSRI to another goes fairly smoothly.

While benzodiazepines may ease the heightened anxiety antidepressants can produce initially, and for occasional breakthrough anxiety, they probably shouldn't be taken on a daily basis as there is evidence they reduce the effectiveness of antidepressants by blocking hippocampal neurogenesis (http://www.americanscientist.org/issues/feature/depression-and-the-birth-and-death-of-brain-cells/99999) which is what produces their therapeutic response (see: Stefovska VG (https://www.ncbi.nlm.nih.gov/pubmed/18991352), 2008; Wu X (http://www.biologicalpsychiatryjournal.com/article/S0006-3223(09)00106-1/abstract), 2009; Sun Y (https://www.ncbi.nlm.nih.gov/pubmed/23639432), 2013; Nochi R (https://www.ncbi.nlm.nih.gov/pubmed/23963779), 2013; Boldrini M (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4374628/), 2014)

[Mazzii342]

As far as I know this med is licenced for epilepsy, not for anxiety or panic disorders. This means a doctor can still prescribe it, as long as there aren't any NHS directives not to (then only private doctors still can), but they do it "off label". This means taking full responsibility for prescribing.

GP's do it with some meds like antidepressants licenced in depression but not anxiety or panic but this is because there are other guidelines from the NHS or NICE stating they can. Beyond that, if a GP won't, it means seeing someone specialised - in this case, a psychiatrist.

They are likely to be wary prescribing a Benzo for regular use as dependence can become a possibility. A psychiatrist can do more and stabilise patients and then wean then off from dependence but a GP shouldn't be doing that these days.

You could try but with Benzo's it's normally for very short periods. To take the edge of starting an antidepressant for a couple of weeks, for instance.

Diazepam is the norm but anything beyond short term is specialised still so it's for a psychiatrist.

The likelihood is no because antidepressant treatment should be able to do what you need or therapy (or both).

Ah yeah you're right. Think I was a little mixed up between that and diazepam. I know a lot of people are prescribed clonazepam for their anxiety but I think that's when panic attacks are frequent.

I probably do need therapy, I was signing up to counselling at my university and when I told me doctor, she said that it's easier than her signing me up as I would be on the waiting list for a long time. But I ended up being too anxious to even go to counselling at the uni so now I have nobody to talk to. I am at a new surgery now maybe I'll see if they'll set me up with somebody.

Thanks for your reply! If I'm not prescribed them it's okay. I just want something to take the edge off every now and again (I know of the addiction possibilities with benzos so I wouldn't use them often), just when I am so anxious that I can't leave the house. I had some of my dads once and they worked wonders, I got up, got ready and went to work no problem!

---------- Post added at 10:56 ---------- Previous post was at 10:52 ----------


If you're not taking the maximum 40mg then the dose should be increased. OTOH, if you are then a different antidepressant should be tried. Sertraline (Zoloft) would be a good choice. In most cases an overnight switch from one SSSRI to another goes fairly smoothly.

While benzodiazepines may ease the heightened anxiety antidepressants can produce initially, and for occasional breakthrough anxiety, they probably shouldn't be taken on a daily basis as there is evidence they reduce the effectiveness of antidepressants by blocking hippocampal neurogenesis (http://www.americanscientist.org/issues/feature/depression-and-the-birth-and-death-of-brain-cells/99999) which is what produces their therapeutic response (see: Stefovska VG (https://www.ncbi.nlm.nih.gov/pubmed/18991352), 2008; Wu X (http://www.biologicalpsychiatryjournal.com/article/S0006-3223(09)00106-1/abstract), 2009; Sun Y (https://www.ncbi.nlm.nih.gov/pubmed/23639432), 2013; Nochi R (https://www.ncbi.nlm.nih.gov/pubmed/23963779), 2013; Boldrini M (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4374628/), 2014)

Yeah you're right, i'm only on 20mg. They were considering increasing the dose but I was too anxious to go back, especially as I'm now at a new doctors. But I have a nasty infection at the moment so I have to go anyway, so might ask about that while I'm there.

And yeah you're very right, I'm one of those people who don't like taking anything that can cause addiction issues, but I'm also very careful. So if I ended up getting diazepam or anything, I'd be very careful to make sure I just take them at times of heightened anxiety, like when I need to go to work or uni and I just can't because of it. Maybe it'll take the edge off.

Thankyou for your reply :yesyes:

[panic_down_under]

But I have a nasty infection at the moment

This may be exacerbating your anxiety. Anxiety disorders (also depression) are immune system disorders in some respects and when the system goes into overdrive to combat infections this can also impact these disorders.

[Mazzii342]

This may be exacerbating your anxiety. Anxiety disorders (also depression) are immune system disorders in some respects and when the system goes into overdrive to combat infections this can also impact these disorders.

You're very right it hasn't helped by a long shot. But the anxiety I'm experiencing has been going on for years, so I still feel like some kind of prescription for meds to help me calm down in times of crisis might be nice

[panic_down_under]

You're very right it hasn't helped by a long shot. But the anxiety I'm experiencing has been going on for years,

Yeah, sorry, I didn't mean to suggest the infection was responsible for your anxiety, only that is was probably making a bad situation even worse.


so I still feel like some kind of prescription for meds to help me calm down in times of crisis might be nice

The problem is that the only meds which are usually effective fairly quickly are the benzodiazepines (BZDs) which many doctors are reluctant to prescribe, especially in the UK. The non BZD antileptics work for some, so does buspirone (Buspar), but they all have issues too. I believe GPs can only prescribe buspirone for a limited duration.

The only other medication with pretty good anti anxiety properties is the prescription antihistamine hydroxyzine (Vistaril), but I suspect the NHS bureaucracy probably won't allow it to be prescribed for anxiety.

Unfortunately, because of such impediments many end up opting for alcohol, or illicit drugs, all of which tend to worsen anxiety disorders and depression in the longer term.

[MyNameIsTerry]

Yeah, sorry, I didn't mean to suggest the infection was responsible for your anxiety, only that is was probably making a bad situation even worse.



The problem is that the only meds which are usually effective fairly quickly are the benzodiazepines (BZDs) which many doctors are reluctant to prescribe, especially in the UK. The non BZD antileptics work for some, so does buspirone (Buspar), but they all have issues too. I believe GPs can only prescribe buspirone for a limited duration.

The only other medication with pretty good anti anxiety properties is the prescription antihistamine hydroxyzine (Vistaril), but I suspect the NHS bureaucracy probably won't allow it to be prescribed for anxiety.

Unfortunately, because of such impediments many end up opting for alcohol, or illicit drugs, all of which tend to worsen anxiety disorders and depression in the longer term.

Whilst that antihistamine isn't showing on the BNF database for anxiety, I kind see it mentioned on a pharmacy database so I suspect it probably is available.

GP's will likely be more comfortable with it since they are traditionally better at physical health and they may use this already for treatment of skin issues.

What about another sedating antihistamine, PROMETHAZINE HYDROCHLORIDE? I know nothing about it's application outside of sedation but I figure you will, Ian? Of The other sedating antihistamines on the BNF this one is used for sedation as opposed to just skin irritation or nausea type issues.

---------- Post added at 06:12 ---------- Previous post was at 06:04 ----------


Whilst that antihistamine isn't showing on the BNF database for anxiety, I kind see it mentioned on a pharmacy database so I suspect it probably is available.

GP's will likely be more comfortable with it since they are traditionally better at physical health and they may use this already for treatment of skin issues.

What about another sedating antihistamine, PROMETHAZINE HYDROCHLORIDE? I know nothing about it's application outside of sedation but I figure you will, Ian? Of The other sedating antihistamines on the BNF this one is used for sedation as opposed to just skin irritation or nausea type issues.

Ian,

I checked out the licensing info on the MHRA website for hydroxyzine and I can see anxiety mentioned in Patient Information Leaflet (PIL).

That's seems one to ask about.

[Shazamataz]

Have you tried a beta blocker like propanolol?

I believe they can be used on occasion as opposed to every day and are not addictive. They slow things down a bit.

[panic_down_under]

What about another sedating antihistamine, PROMETHAZINE HYDROCHLORIDE? I know nothing about it's application outside of sedation

I'm unaware of any evidence that promethazine has any specific anti anxiety properties beyond sedation.

Hydroxyzine is also a reasonably potent serotonin 5-HT2a receptor antagonist which probably produces its anxiolytic properties (it also blocks α1-adrenergic and dopamine D2 receptors which may also play a role). Other 5-HT2a antagonists that are effective anxiolytics are quetiapine and trazodone.


I checked out the licensing info on the MHRA website for hydroxyzine and I can see anxiety mentioned in Patient Information Leaflet (PIL).

That's seems one to ask about.

Good!

[Mazzii342]

I'm unaware of any evidence that promethazine has any specific anti anxiety properties beyond sedation.

Hydroxyzine is also a reasonably potent serotonin 5-HT2a receptor antagonist which probably produces its anxiolytic properties (it also blocks α1-adrenergic and dopamine D2 receptors which may also play a role). Other 5-HT2a antagonists that are effective anxiolytics are quetiapine and trazodone.



Good!

Yeah i've tried promethazine with codeine, you know the cough syrup? I genuinely had a medical reason for having it but then when I didn't need it anymore, I had a little with my sleeping tablets because it worked so well in sedating me. It may not be the best for anxiety, but it certainly helped me sleep when I had anxious thoughts causing insomnia. Unfortunately codeine/promethazine is addictive and didn't want to have it very often. But when I need a little help sleeping it does the trick!

[panic_down_under]

Unfortunately codeine/promethazine is addictive and didn't want to have it very often. But when I need a little help sleeping it does the trick!

The otc antihistamine diphenhydramine (*Benadryl) can also be used for occasional insomnia. It also has some anti anxiety properties, though it is not as effective as hydroxyzine.

* the antihistamine in Benadryl differs in some countries, and/or in some formulations. I understand that in the UK Benadryl usually contains either acrivastine or cetirizine. Both are non sedating antihistamines, but there may be some formulations containing diphenhydramine so ask your chemist/pharmacist.

[Mazzii342]

The otc antihistamine diphenhydramine (*Benadryl) can also be used for occasional insomnia. It also has some anti anxiety properties, though it is not as effective as hydroxyzine.

* the antihistamine in Benadryl differs in some countries, and/or in some formulations. I understand that in the UK Benadryl usually contains either acrivastine or cetirizine. Both are non sedating antihistamines, but there may be some formulations containing diphenhydramine so ask your chemist/pharmacist.

Funny you should mention that! Had the last of my codeine the other night and took some benadryl, slept like a baby