Anxiety

Will methadone and buprenorphine together cause withdrawal? How do I stop precipitated withdrawal? What dose of buprenorphine is best? Do I have to be in withdrawal to start Suboxone?
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SueReed
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Anxiety

Post by SueReed » Fri Oct 18, 2019 12:12 pm

Hello Im new. I will be going to a rehab center as soon as my insurance is settled. I have taken tramadol on and off for 8 years. I started using for my anxiety because it really helped. Of course things got out of hand and I got up to 8 50 mg a day. Over the last year I have tapered to 2 50 mg a day but my anxiety is back full fledge. Its intermittent so I can go a few months or weeks with no major anxiety attack and then boom I have a week long attack. Cant sleep, cant shower, cant eat, legs going like i have Rls, crying ect. Now Im still taking Tramadol so its not withdrawals. When I have an attack I go up to 150 Mg a day from 100 to help control the anxiety. Then I have to take a few weeks to get back down to 100mg again. Point is I cant seem to get below 100mg because of the extreme anxiety I started taking them for in the first place!
Theres a family history of mental illness... both brother and sister are bipolar.
I went to psyc doctor and explained it all. She wanted to start me on Celexa to get my anxiety under control then work on trams. Well i took the first 20mg at 9pm and it was HORRIFIC. EVERY AWFUL side effect and anxiety was 10xs worse.
Doctor told me to go to the hospital to get flushed. She thought maybe serotonin syndrome. They gave me IV saline because I was dehydrated from not eating, drinking and sleeping. And I only took my usual 2 50mg of trams the day before nothing more. Er doctor said not serotonin syndrome just my anxiety. DR then tried to give me a shot of Lorazepam and I was scared to let him. I didnt want it to make me feel worse! RN finally talked me into half a dose and it did calm me a bit. My question is will the suboxone help my anxiety? Will they let me take anxiety meds with it? Thank you.

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Re: Anxiety

Post by jonathanm1978 » Sat Oct 19, 2019 4:13 am

Since I have no idea on your question(s), this one is gonna be for someone with more knowledge than me. Wish I could give you some answers..
Adam Wayne P.
DOB: July 1, 1985
October 8, 2013

RIP little brother. Gone, but not forgotten.

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Re: Anxiety

Post by jennjenn » Sat Oct 19, 2019 12:09 pm

I don’t have any experience really with anxiety meds and suboxone together and as far as if you can take them with your suboxone, that would depend on what anxiety medication and your doctor honestly so it’s hard to say.

Are you sure you’ll be prescribed suboxone at this treatment facility? I know there’s plenty of doctors that prescribe suboxone with someone who’s drug of choice is tramadol but also if you’re down to 2 a day most of the time (when your anxiety isn’t out of control), you’d be raising your tolerance pretty significantly imo once you start buprenorphine. Surly they’ll put you on a small dose but without knowing your complete tolerance I’m just guessing about all this. Regardless, suboxone has been known to actually help ppl with depression somewhat but I don’t think it’s totally legal to be used just for anxiety..... but you’re also not just using it for anxiety lol so I’m probably confusing you even more at this point. Hopefully one of our doctors here will see your thread and give ya some advice. Good luck no matter what you do and good for you that you’re entering treatment and getting help with all this!
Jennifer

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Re: Anxiety

Post by SueReed » Sat Oct 19, 2019 5:42 pm

Thank you Jennifer. My anxiety is finally calming down, like I said the attacks last about a week. During the attacks everything seems like its the worse thing in the world so you are right at 100 mg (sometimes 75mg) I dont know that Suboxone is the answer. I admit the psychological part is the worst for me. The thought have not taking them to calm me causes me anxiety! Im scared to death of taking antidepressants and Im afraid the doctors wont trust me to use Ativan correctly only during my attacks. I still have 4 of the 6 Ativans given to me from the hospital. Took 1 the night I came home from the hospital to sleep and 1/2 the next night to sleep per my husband asking me to. They make me tired and I dont enjoy that but if they help during my attacks Id rather take those intermittently then have an ssri in my system all the time. I guess all I can do is talk to a few addiction/mental healh specialist and see what they think the best plan would be.

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Re: Anxiety

Post by jennjenn » Sun Oct 20, 2019 9:38 am

I understand the part about not wanting something in your system all the time but if you start suboxone it will be in your system all the time and something you’ll maybe someday if you decide to stop, you’d have to taper off over a period of time just like you would an antidepressant. So really, anything (almost) is going to be like that to some extent. I wouldn’t worry about that so much because you just gotta do what you gotta do to live a better quality of life.

I speak to a lot of patients at work who are starting suboxone and having to stop benzos (because at my doctor’s office it isn’t allowed to be taken together). They have a really really hard time getting their anxiety under control and I feel so bad for them because I see how it’s just making them miserable. It sucks to be in treatment and still struggling with anxiety.... it’s like you get help for one thing and then another comes popping up. The patients who cannot take a benzo usually are prescribed an antidepressant or a different drug that treats anxiety. I have recently noticed a few are being prescribed Vistoril and they said it does help somewhat. I don’t know how well it works but it does help with a few of them. If Ativan helps you then I truly hope you’re able to take it. I took Vistoril a few days once in jail when they used it for my withdrawal lol. I think each patient is different and should be treated differently and not like Jane who’s also got this issue.

I hope you get your anxiety under control because I know it sucks to live with it every day. I’ve always had anxiety myself & I truly think I should be taking something to help it because I have had a couple of anxiety attacks recently. I just don’t think I need something every day for it like some ppl do.
Jennifer

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Re: Anxiety

Post by Ryan Ryan Ryan » Sun Oct 20, 2019 12:52 pm

I Take mirtazipine and Pristiq for clinical depression and noticed that since taking the Pristiq last year, my anxiety has really died a-lot. I am much less worried about things now so maybe you should ask your doctor about it....
The mirtazipine is great too for sleep! Also take some herbal sleeping pills and melatonin and kava.

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Re: Anxiety

Post by SueReed » Tue Oct 22, 2019 6:24 am

Todays the 4th day Im back to 75mg a day Tramadol. Will cut by 10% each week from here. I take 25 mg at 10am and 50mg at 4pm. I of course feel anxious when I think of cutting the 4pm one down because my mind still tells me I need it to get through the evening of making dinner, homework, showers, dishes ect... I have a habit of saying- "I'll do (fill in the blank) after I take my tramadol" so Im forcing my self to say NO I'll do it now! I can do it without Tramadol.
I have an appointment with a Psyc doctor who is highly regarded from what I have researched. He deals with mental illness as well as self medicating and addictions. He is also a Suboxone doctor but as jennjenn pointed out I probably wouldnt go that route at this point. Appointment isnt until Nov 7th since its the first opening available. Hopefully he can help me figure out why I have been self medicating for so long and how to treat my anxiety. Been taking melatonin to sleep 25mg. I wake up a few times but its better than laying there for hours trying to fall asleep.

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Re: Anxiety

Post by suboxdoc » Tue Oct 22, 2019 9:53 am

The proper treatment for anxiety is an SSRI (like Celexa) or SNRI (like Pristiq). My favorite is escitalopram (Lexapro), because it has very few side effects. If you had side effects from Celexa, I would recommend starting whichever SSRI your psychiatrist prescribes at a very low dose - maybe 5 or 10 mg for Celexa - and doubling the dose every 2 weeks until you get to at least 20 mg/day.

All psychiatrists hear the same thing when they prescribe SSRIs: 'I'm not depressed', for example. SSRIs are used as much or more for anxiety than they are for depression. They are NOT 'antidepressants'; they are 'SSRIs'. We also hear the comment about not wanting to be on something each day - but that comment is usually hard to take seriously when the person has been taking other substances each day that have much higher risks associated with them. When you are on the right SSRI for you, you will feel NOTHING from the medication. SSRIs are very effective at preventing panic attacks, and they reduce all forms of anxiety - including OCD, social anxiety, and generalized anxiety.

Panic attacks by definition do not last long - usually about 10-20 minutes max. Benzos are not an appropriate choice, because of the timing. It takes at least 20 minutes for Xanax to start working, and longer for lorazepam, much longer for clonazepam. Even if the tablet is sitting in the patient's hand when the panic attack starts, it won't take effect until the panic attack is ending.

Keep in mind that while you're used to taking Tramadol each day, it is not a benign thing to do. Tramadol is pulling your tolerance around, and putting you into minor withdrawal each day - which impacts all sorts of bodily functions. Besides the opioid effect, Tramadol blocks norepinephrine reuptake - i.e. it has actions very similar to Pristiq. But with Pristiq, those actions are stable all day, allowing your body to adjust to them. With Tramadol the effect comes and goes, so your body never fully adjusts.

Anxiety is common in early recovery. During active addiction people use a very effective tool - repression - to avoid seeing things they don't want to see. The repeated shameful behavior helps the person push everything out of consciousness. But when the shameful behavior stops, the repressed thoughts and fears enter one's consciousness. Suddenly there are tons of things to be anxious about. But all of those things have ALWAYS been there. It is just easier to be unaware of them when using addictive substances.

SSRIs and their main side effects (all of the side effects go away after 3-10 days):

Prozac (fluoxetine): Activating, so temporarily can increase anxiety. No weight gain, and maybe some weight loss for some people. A little extra energy when first started.

Zoloft (sertraline): a very popular SSRI that has SNRI actions (on norepinephrine) in higher doses, over 200 mg/d. Main side effects are GI in nature - i.e. nausea. Usually not a problem if taken with food in the stomach.

Celexa (citalopram): another popular SSRI. Few side effects; no significant sedation or weight change.

Lexapro (escitalopram): a popular and very potent SSRI - the most potent of the first generation of SSRIs. Few side effects, but sometimes needs to be started at a low dose and slowly tapered up because of the strong potency.

Paxil (paroxetine): causes sedation and weight gain (about 10-15 pounds). Useful for people who aren't eating or sleeping, but otherwise not one of my choices.

The SNRIs include Pristiq, Effexor, and Cymbalta. They are good for anxiety but I don't use them as much, because they tend to have more side effects and discontinuation symptoms.

Newer generation SSRIs like Viibryd combine block of reuptake with actions at presynaptic serotonin receptors, intended to boost their action. Not clear whether those extra actions are significant.

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