Suggestions and advice needed please.

[DNR]

I have very severe anxiety, its crippling and I cant leave the house far at all, I try everyday and have counselling every week over the phone alongside cbt which I am on a waiting list for, I do practice techniques when out from self study of cbt and my counselling.

I really want to start medication, but my ability to speak to a doctor is difficult as no one can really due to covid and I end up talking to a health care assistant that specialises in mental health. I explained I would need to start on a micro dose and build up every seven days and would really need a sedative to help me through the First two weeks,

Citalopram is the med I am looking to start as sertraline didn't agree with me, and citalopram helped my mum get better through the same problem which seems genetic agoraphobia. 2.5mg going up every seven days till I reach 20mg, with diazepam as an when to help if needed, is that unreasonable to ask for? Because they reject this idea completely.

I know I should fight to speak to the doctor not a healthcare assistant as he may be more understanding and willing to perscribe the diazepam, as the healthcare assistant wants me on 10mg straight away with no chance of diazepam, when I won't be able to handle the initial anxiety spike as I am phobic towards meds already so this is huge for me and my mind will create my worst nightmares on sugar pills if I thought they was antidepressants.

I just cant seem to get past the barrier of the healthcare assistant, she is nice but feel my anxiety is above her knowledge and I need to get something done about it, but on my terms. I hate ringing the doctors as I've asked about diazepam before alongside and was given some but they are out of date as I wasn't ready and fear them seeing me as drug seeking, and my other fear is being made to go somewhere or sectioned even though I am not suicidal in any way as I've rang a few times over three years being pretty much housebound.

I appreciate any replies, suggestions and what you would do if you was agoraphobic and suffering panic attacks outside. I am actively engaging in therapy and trying very hard with this my request for advice is pointing more towards medication please, thank you.

[NoraB]

Speak to your GP and if they think that diazepam is necessary, then they will prescribe it for you.

You need to understand that, the more drugs we put into our system, the more side-effects we will experience, and then we need more drugs to counteract those side effects. And people with anxiety struggle to cope with side-effects. Then there's the addiction issue...

Nobody is going to section you for requesting a drug. What's that about?

Alongside my numerous other MH disorders, I function on a level of agoraphobia - always have. At my worst, opening the front door to bring the milk in took hours of psyching myself up. Standing by the door hyperventilating and feeling sick. Walking down the street is hard, even on my good days, but my headphones do help there because they provide a barrier between me and the environment. I had an aunty who had this condition so I guess genetics are at work with me - like you and your mum. My aunty couldn't go beyond her garden gate, and for about 30 years. I think of her every time I try and convince myself not to go through the door..

I just keep having to push myself. I had a panic attack while driving a few years ago and I didn't drive for months after but I knew it was important to get back into the car because the reason I learned to drive in the first place was to avoid having to use public transport because it's too much for me to handle alone, and for numerous reasons.

Meds are helpful as a way of calming things down in order to be more receptive to therapy but they only mask the anxiety. It's therapy that will give you the tools to be able to function with this DNR..

[DNR]

Speak to your GP and if they think that diazepam is necessary, then they will prescribe it for you.

You need to understand that, the more drugs we put into our system, the more side-effects we will experience, and then we need more drugs to counteract those side effects. And people with anxiety struggle to cope with side-effects. Then there's the addiction issue...

Nobody is going to section you for requesting a drug. What's that about?

Alongside my numerous other MH disorders, I function on a level of agoraphobia - always have. At my worst, opening the front door to bring the milk in took hours of psyching myself up. Standing by the door hyperventilating and feeling sick. Walking down the street is hard, even on my good days, but my headphones do help there because they provide a barrier between me and the environment. I had an aunty who had this condition so I guess genetics are at work with me - like you and your mum. My aunty couldn't go beyond her garden gate, and for about 30 years. I think of her every time I try and convince myself not to go through the door..

I just keep having to push myself. I had a panic attack while driving a few years ago and I didn't drive for months after but I knew it was important to get back into the car because the reason I learned to drive in the first place was to avoid having to use public transport because it's too much for me to handle alone, and for numerous reasons.

Meds are helpful as a way of calming things down in order to be more receptive to therapy but they only mask the anxiety. It's therapy that will give you the tools to be able to function with this DNR..

My fear of being sectioned is rather irrational, I have rang up my doctors a few times over the time of two years, roughly six times and have been prescribed citalopram at my request and one doctor gave me seven 2mg diazepam unfortunately I wasn't ready at those times and the meds go out of date, I feel I could handle most side effects just not the ramped up anxiety and my full intention is to use the diazepam for a week/two weeks and any left over strictly for emergencies if the doctor decided to prescribe.

I fully understand and have the same issues hiding behind doors, the intense anxiety I do really push myself as my biggest fear is shat you mentioned regarding your aunt, I am working really hard with counselling and self study and on the waiting list for the higher version of cbt.

I just have a fear of not being in control hence the section fear and the feeling of no control over my own body, thank you for your reply.

[panic_down_under]

Citalopram is the med I am looking to start as sertraline didn't agree with me, and citalopram helped my mum get better through the same problem which seems genetic agoraphobia. 2.5mg going up every seven days till I reach 20mg, with diazepam as an when to help if needed, is that unreasonable to ask for? Because they reject this idea completely.

No, unless there is some medical reason why this is unsuitable, it isn't unreasonable. I'd be asking for a definitive explanation why the 2.5mg strategy has been rejected. You're the one that ultimately calls the shots on treatment. They are merely the hired help. That said, I don't know how difficult NHS apparatchiks might be able to make things if you create waves so use your own judgement on this.

I know I should fight to speak to the doctor not a healthcare assistant as he may be more understanding and willing to perscribe the diazepam, as the healthcare assistant wants me on 10mg straight away with no chance of diazepam,

While they can prescribe 10mg citalopram, and that is the minimum dose pill (it also comes in liquid form), how much you take is up to you.

On the diazepam, if you are able to get it then by all means take it if you need to as white-knuckling through anxiety only reinforces it, however, benzodiazepines (BZDs) can significantly reduce the effectiveness of antidepressants by blocking hippocampal neurogenesis which is how ADs (also therapy) create the therapeutic response (see: Boldrini M, 2014; Nochi R, 2013; Sun Y, 2013; Song J, 2012; Wu X, 2009; Stefovska VG, 2008).

when I won't be able to handle the initial anxiety spike as I am phobic towards meds already so this is huge for me and my mind will create my worst nightmares on sugar pills if I thought they was antidepressants.

Very true, unfortunately. Not all initial side-effects are necessarily caused by ADs and other meds. Anxious minds can make lives much more difficult than any med if given half a chance.

I hate ringing the doctors as I've asked about diazepam before alongside and was given some but they are out of date as I wasn't ready and fear them seeing me as drug seeking, and my other fear is being made to go somewhere or sectioned even though I am not suicidal in any way as I've rang a few times over three years being pretty much housebound.

Diazepam has a very long shelf-life so you either were prescribed it a long time ago, or it was sitting on the chemist's selves for a long time. If it was the former then I can see how you could be accused of drug seeking, and I'd be very surprised if you could be sectioned because of it. They'd have to built psych inpatient wards on every street corner if that was a criterion.

[DNR]

No, unless there is some medical reason why this is unsuitable, it isn't unreasonable. I'd be asking for a definitive explanation why the 2.5mg strategy has been rejected. You're the one that ultimately calls the shots on treatment. They are merely the hired help. That said, I don't know how difficult NHS apparatchiks might be able to make things if you create waves so use your own judgement on this.



While they can prescribe 10mg citalopram, and that is the minimum dose pill (it also comes in liquid form), how much you take is up to you.

On the diazepam, if you are able to get it then by all means take it if you need to as white-knuckling through anxiety only reinforces it, however, benzodiazepines (BZDs) can significantly reduce the effectiveness of antidepressants by blocking hippocampal neurogenesis which is how ADs (also therapy) create the therapeutic response (see: Boldrini M, 2014; Nochi R, 2013; Sun Y, 2013; Song J, 2012; Wu X, 2009; Stefovska VG, 2008).



Very true, unfortunately. Not all initial side-effects are necessarily caused by ADs and other meds. Anxious minds can make lives much more difficult than any med if given half a chance.



Diazepam has a very long shelf-life so you either were prescribed it a long time ago, or it was sitting on the chemist's selves for a long time. If it was the former then I can see how you could be accused of drug seeking, and I'd be very surprised if you could be sectioned because of it. They'd have to built psych inpatient wards on every street corner if that was a criterion.

I cant get the speak to the doctor only the healthcare assistant my doctors is very busy and poorly rated by patients and assessors that go in to check standards, the healthcare assistant seems to read from a sheet no other way except 10mg upto 20mg the week after, this won't work for me as I've only just got myself taking paracetamol again, plus she will only give me seven citalopram tablets at a time meaning she will pressure me to take her suggested dose and not my plan. She will only give me seven tablets because I've had boxes of citalopram before and not taken them because I wasn't ready roughly twice.

Even in liquid form she wanted me to take 10mg, I have a pill cutter ready. The diazepam is purely for the anxiety thats the side effect I won't be able to cope with my argument is I need to get better I want a life and I am trying hard with counselling, cbt and exposure, I go out every morning pushing myself. The healthcare assistant said to me whats the difference between taking diazepam and citalopram, I know they are addictive but very useful when used how I want to use them.

I will panic the minute I Swallow the tablet, because its in my system and you cant get it out till it leaves the body, I was prescribed fourteen diazepam at 2mg and at the time like most with anxiety the diazepam and citalopram sat in the draw because I am phobic towards meds, when I looked at the diazepam there isn't even a date on them without a date I cant take them and never did, I would just really like the chance again to have the diazepam and citalopram as I think it could be my only chance.

I have a irrational fear of sectioning because I've rang a few times over two years roughly six times and the last time I rang they suggested mental health team when really all I wanted was to speak to the doctor not the health care assistant, I am not a drug seeker its just how I feel or my anxiety makes me feel because its got such a bad reputation for a good reason.

Thank you

[panic_down_under]

I cant get the speak to the doctor only the healthcare assistant my doctors is very busy and poorly rated by patients and assessors that go in to check standards,

Can you change GPs? A GP you can't reach is less useful than a pet rock, imo!

the healthcare assistant seems to read from a sheet no other way except 10mg upto 20mg the week after, this won't work for me as I've only just got myself taking paracetamol again, plus she will only give me seven citalopram tablets at a time meaning she will pressure me to take her suggested dose and not my plan.

How is she going to know how much you actually take?

The healthcare assistant said to me whats the difference between taking diazepam and citalopram, I know they are addictive but very useful when used how I want to use them.

Diazepam is not addictive, but dependence may develop after a while so it should be tapered off, not stopped abruptly. This is also true of citalopram.

BTW - 'fun' fact. Every human that has ever lived has been dependent on diazepam and its metabolites. It is one of the naturally occurring BZDs found in all foods [1]. While the quantities we get from food are small, they are not insignificant. Natural BZD plasma levels can reach that of pharmaceuticals in patients with some liver diseases [2] and may become so high that medical intervention is necessary [3]. My guess is benzodiazepines were originally a plant poison to which life, including Homo sapiens, have become so adapted to that we can no longer function without them.

I looked at the diazepam there isn't even a date on them without a date I cant take them and never did, I would just really like the chance again to have the diazepam and citalopram as I think it could be my only chance.

Diazepam has a long shelf-life, longer than the date printed on the box. U.S. Army tests found diazepam was still effective 8 years after manufacture (note: Medscape link which may require free registration to view, lets me know if you are unable to and I'll PM you a copy).

I have a irrational fear of sectioning because I've rang a few times over two years roughly six times and the last time I rang they suggested mental health team when really all I wanted was to speak to the doctor not the health care assistant, I am not a drug seeker its just how I feel or my anxiety makes me feel because its got such a bad reputation for a good reason.

As per my previous post, if they sectioned everyone that asked for a BZD, or didn't take their pills as ordered then most of the country would be in locked psych wards, including a lot of psychiatrists and GPs. The medical profession has much higher rates of anxiety and depression than the general public in large part because of its appalling work practices.

My mum had a similar breakdown, identical to mine panic attack in a supermarket leading to being housebound, totally irrational thoughts and fears. She eventually got dragged to the doctors not literally, and was perscribed citalopram and within a month she was back to herself again, do you think that somehow genetically it could do the same for me?

There is a genetic component to these disorders and while there is never a guarantee the fact close relatives have responded well to citalopram is likely to improve the odds of it working for you too.

References:

[1]
Muceniece R, Saleniece K, Krigere L, et al. (2008)
Potato (Solanum tuberosum) juice exerts an anticonvulsant effect in mice through binding to GABA receptors.
Planta Med. 2008 Apr;74(5):491-6. (Abstract)

Kavvadias D, Abou-Mandour AA, Czygan FC, et al (2000)
Identification of benzodiazepines in Artemisia dracunculus and Solanum tuberosum rationalizing their endogenous formation in plant tissue.
Biochem Biophys Res Commun Mar 5;269(1):290-5 (Abstract)

Sand P, Kavvadias D, Feineis D, et al. (2000)
Naturally occurring benzodiazepines: current status of research and clinical implications.
Eur Arch Psychiatry Clin Neurosci vol 250(4): p 194-202 (Abstract)

Kotz U, (1991)
Occurrence of "natural" benzodiazepines.
Life Sci;48(3):209-15 (Abstract)

Unseld E, Krishna Dr Fischer C, et al (1989)
Detection of desmethyldiazepam and diazepam in brain of different species and plants.
Biochem Pharmacol Aug 1;38(15):2473-8 (Abstract)

Wildman J, Ranalder U. (1988)
Presence of lorazepam in the blood plasma of drug free rats.
Life Sci. 43(15):1257-60. (Abstract)

Wildmann J. (1988)
Increase of natural benzodiazepines in wheat and potato during germination.
Biochem Biophys Res Commun. Dec 30;157(3):1436-43. (Abstract)

Wildmann J, Vetter W, Ranalder UB, et al (1988)
Occurrence of pharmacologically active benzodiazepines in trace amounts in wheat and potato.
Biochem Pharmacol. Oct 1;37(19):3549-59. (Abstract)

Sangameswaran L, Fales HM, Friedrich P, De Blas AL. (1986)
Purification of a benzodiazepine from bovine brain and detection of benzodiazepine-like immunoreactivity in human brain
Proc Natl Acad Sci U S A. 1986 Dec;83(23):9236-40. (Abstract | Full text - PDF)

[2]
Baraldi M, Avallone R, Corsi L, et al (2000) Endogenous benzodiazepines. Therapie Jan-Feb;55(1):143-6 (Abstract)

[3]
Zeneroli ML, Venturini I, Stefanelli S, et al, (1997) Antibacterial activity of rifaximin reduces the levels of benzodiazepine-like compounds in patients with liver cirrhosis. Pharmacol Res , Jun;35(6):557-60 (Abstract)
[Note: no benzodiazepine synthesizing gut flora has been isolated and they almost certainly don't exist in humans]

[DNR]

Can you change GPs? A GP you can't reach is less useful than a pet rock, imo!



How is she going to know how much you actually take?



Diazepam is not addictive, but dependence may develop after a while so it should be tapered off, not stopped abruptly. This is also true of citalopram.

BTW - 'fun' fact. Every human that has ever lived has been dependent on diazepam and its metabolites. It is one of the naturally occurring BZDs found in all foods [1]. While the quantities we get from food are small, they are not insignificant. Natural BZD plasma levels can reach that of pharmaceuticals in patients with some liver diseases [2] and may become so high that medical intervention is necessary [3]. My guess is benzodiazepines were originally a plant poison to which life, including Homo sapiens, have become so adapted to that we can no longer function without them.



Diazepam has a long shelf-life, longer than the date printed on the box. U.S. Army tests found diazepam was still effective 8 years after manufacture (note: Medscape link which may require free registration to view, lets me know if you are unable to and I'll PM you a copy).



As per my previous post, if they sectioned everyone that asked for a BZD, or didn't take their pills as ordered then most of the country would be in locked psych wards, including a lot of psychiatrists and GPs. The medical profession has much higher rates of anxiety and depression than the general public in large part because of its appalling work practices.



There is a genetic component to these disorders and while there is never a guarantee the fact close relatives have responded well to citalopram is likely to improve the odds of it working for you too.

References:

[1]
Muceniece R, Saleniece K, Krigere L, et al. (2008)
Potato (Solanum tuberosum) juice exerts an anticonvulsant effect in mice through binding to GABA receptors.
Planta Med. 2008 Apr;74(5):491-6. (Abstract)

Kavvadias D, Abou-Mandour AA, Czygan FC, et al (2000)
Identification of benzodiazepines in Artemisia dracunculus and Solanum tuberosum rationalizing their endogenous formation in plant tissue.
Biochem Biophys Res Commun Mar 5;269(1):290-5 (Abstract)

Sand P, Kavvadias D, Feineis D, et al. (2000)
Naturally occurring benzodiazepines: current status of research and clinical implications.
Eur Arch Psychiatry Clin Neurosci vol 250(4): p 194-202 (Abstract)

Kotz U, (1991)
Occurrence of "natural" benzodiazepines.
Life Sci;48(3):209-15 (Abstract)

Unseld E, Krishna Dr Fischer C, et al (1989)
Detection of desmethyldiazepam and diazepam in brain of different species and plants.
Biochem Pharmacol Aug 1;38(15):2473-8 (Abstract)

Wildman J, Ranalder U. (1988)
Presence of lorazepam in the blood plasma of drug free rats.
Life Sci. 43(15):1257-60. (Abstract)

Wildmann J. (1988)
Increase of natural benzodiazepines in wheat and potato during germination.
Biochem Biophys Res Commun. Dec 30;157(3):1436-43. (Abstract)

Wildmann J, Vetter W, Ranalder UB, et al (1988)
Occurrence of pharmacologically active benzodiazepines in trace amounts in wheat and potato.
Biochem Pharmacol. Oct 1;37(19):3549-59. (Abstract)

Sangameswaran L, Fales HM, Friedrich P, De Blas AL. (1986)
Purification of a benzodiazepine from bovine brain and detection of benzodiazepine-like immunoreactivity in human brain
Proc Natl Acad Sci U S A. 1986 Dec;83(23):9236-40. (Abstract | Full text - PDF)

[2]
Baraldi M, Avallone R, Corsi L, et al (2000) Endogenous benzodiazepines. Therapie Jan-Feb;55(1):143-6 (Abstract)

[3]
Zeneroli ML, Venturini I, Stefanelli S, et al, (1997) Antibacterial activity of rifaximin reduces the levels of benzodiazepine-like compounds in patients with liver cirrhosis. Pharmacol Res , Jun;35(6):557-60 (Abstract)
[Note: no benzodiazepine synthesizing gut flora has been isolated and they almost certainly don't exist in humans]

I could change surgeries, but honestly they are all as bad as each other here, there is like one main doctor the rest are nurses, and healthcare assistants. I am going to try and push and stand my ground for a phone call with the doctor.

She won't know, its just the seven days worth of tablets its a hassle for me, I want the tablets and to just push through without phone calls from them asking me how I am getting on and getting tablets from the chemist after seven days, basically I want to hide in my room take the meds build up and hopefully come out the other end even half better.

I was just given a White box with the diazepam in, no dates so for me even with that knowledge it would be difficult for me to take as its one of my anxieties dates on foods, meds. I would still appreciate a copy of the article to read if you could pm it me I would be thankful.

I am starting to see its an irrational fear as everyone that has replied has said the same thing in regards to being sectioned, it is not like I am refusing therapy and not trying going out even though its very limited, I agree the strain on our healthcare staff in immense especially with covid.

Thank you for your time, its greatly appreciate. I am a fan of your posts and find your knowledge amazing, a reply to a post stands out you mentioned being in meds you have travelled the world, without you can barely reach your post box. It gives me hope because I feel so stuck right now and my future is scary due to this anxiety.

Regards

[panic_down_under]

I was just given a White box with the diazepam in, no dates so for me even with that knowledge it would be difficult for me to take as its one of my anxieties dates on foods, meds. I would still appreciate a copy of the article to read if you could pm it me I would be thankful.

I've found a direct link, no reg required: Recycling Expensive Medication: Why Not? The Valium reference is under the 'Expiration Dates' heading.

you mentioned being in meds you have travelled the world, without you can barely reach your post box. It gives me hope because I feel so stuck right now and my future is scary due to this anxiety.

Yes, that's how it was. There are no guarantees, but the odds of a successful outcome are good, especially given your mother's success with citalopram. However, these disorders are often a long time in the making and don't surrender easily. The pills can do a lot of the heavy lifting, but it needs to be followed by continually extending oneself.

[pulisa]

You have to be very ill indeed to get sectioned in the UK, DNR.Likewise with hospitalisation.

You can certainly start the citalopram at a lower dose than prescribed as a therapeutic dose. Get a pill cutter and start as low as you want and work upwards gradually. You know what works best for you psychologically. The GP prescribes the tablets but you need to work at your own pace and SSRIs can be very activating for some unless started with caution.

[DNR]

You have to be very ill indeed to get sectioned in the UK, DNR.Likewise with hospitalisation.

You can certainly start the citalopram at a lower dose than prescribed as a therapeutic dose. Get a pill cutter and start as low as you want and work upwards gradually. You know what works best for you psychologically. The GP prescribes the tablets but you need to work at your own pace and SSRIs can be very activating for some unless started with caution.

This is the issue the health care assistant doesn't understand that and won't prescribe me more than seven citalopram tablets. Even offered me the liquid version but she still wanted me to take 10mg for one week and then 20mg the week after, she totally dismisses and I feel my condition is beyond her level experience, I ask to talk to the doctor requesting him by name and she rings me she's a gatekeeper blocking me, should I be firm? And demand to speak to him.