I was diagnosed with PD on 8/8/2024. I have never suffered from anxiety until that date. Since my diagnosis, I have severe insomnia. If I take a low dose Xanax (which my doctor doesn’t me to do every night), I sleep all night. I’ve tried taking Escitalopram and Buspirione and both made me incredibly ill. I’m looking for a med I can take during the day to get some relief that won’t kill my GI tract. I’ve also recently started cognitive behavioral therapy and acupuncture hoping for some relief. I currently do not take any PD meds as my tremor is still mild. I do take magnesium L-Threonate at night. Does anyone have any suggestion on what I could try? I feel like my anxiety is manageable during the day but at nighttime, it rears its very ugly head.
Looking for advice on anti-depressants/an... - Cure Parkinson's
Looking for advice on anti-depressants/anti- anxiety meds
I took duloxetine (Cymbalta) for several years that was prescribed for me for GAD, I still have episodes of high anxiety for which I take Klonopin, although at a very low dose of half of an 0.5 mg tab, and it helps with my tremor. ( I was recently switched to escitilopram) For sleep I take occasional valerian which seems to work well. The Klonopin will also knock me out.
Thank you for the info. Cymbalta is actually the one I was considering but all the meds seem to have such negative side effects. When I tried Escitalopram, I lost 7 pounds in 4 days I couldn’t eat, drink or sleep. My doctor said it would take 2 weeks to adjust. I told her I wouldn’t live that long.
I had no side effects with Cymbalta. Good to start slowly, 30 mg, and build up to 60mg.
If you're very medication sensitive, Cymbalta comes in 20 mg.
Good to know. I didn’t know I was medication sensitive but apparently I am. I tried 2.5 mg (half of the smallest dose possible) of Escitalopram. I couldn’t believe how sick it made me
Medications are largely processed by Cytochrome P450 enzymes, levels of which are genetically determined. That's one of the reasons why one person can have virtually no side effects from a given drug and another will experience every AE known. It can also factor into why you respond well to one medication and not another. This site has a good explanation of CYP enzymes; selfhacked.com/blog/cyp-enz...
BTW, I'm not endorsing the pharmacogenomics report they offer. These types of genetic tests hold a lot of promise, but I'm not sure they're really useful yet.
Are you looking for anxiety or for sleep? Which one? If only anxiety or only sleep, then it makes a difference what is better to use, and which might allow them for you using your alprazolam as a backup, which is what your doctor seems to be telling you, right? If you get the right thing for the right problem, then there's a number of things that will help without interfering with your doctor's wishes and which won't require you to give up your Xanax as your final backup..
A great many people have been on duloxetine for up to decades without complications, and it seems to be useful for some forms of pain, and some forms of anxiety, along with its natural antidepressant effect, so seems to be a very safe alternative if it helps you, and a lot of physicians and nurses will prescribe it without concern... And it can be prescribed concurrent with clonazepam or xanax as is appropriate, so it's not like you have to lose those if you use them as well. But when you have benzodiazepines mixed in with an antidepressant, we're using the benzodiazepines on a long-term or chronic basis, then there has to be some careful and thoughtful looking into managing them or balancing them, so that you don't become chronically dependent on the benzodiazepines .. because that dependency is not good. So in any case you want to go with the philosophy of "the lowest effective dose that gives you what you need," i e the lowest dose at which you find effective. Try to make that stick.
So best is to maybe start off with things like melatonin and Benadryl for sleep (but not anxiety), and magnesium can go along with them in combination, so you can do some playing around and all these are very safe compared to getting into the prescription anxiety meds, which means you can use those anxiety meds as episodic backup rather than as chronic..
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Clonazepam at a low dose does help with sleep quite a bit, that 0.5 mg is actually more than I start with, when I needed it for anxiety or sleep I would start with 0.25 mg (use pill cutter or your teeth or just break it in half along the line with your two thumbs), and that amount usually was pretty effective and since 0.25mg is a very low dose, clonazepam shouldn't be a problem unless you find yourself using it to three or four times a day or having to graduate higher doses and be chronic. Also clonazepam can give you a bit of a draggy, groggy hangover the next 24 hours. Xanax, on the other hand, is going to have a much shorter half life than clonazepam, so when it affects you it's going to affect you more acutely, which means you get more relief, but it may become a little problematic because it means you're going to be dosing more often which I would avoid if I can, because of the chances that you gradually become dependent on it and becoming dependent is not something to have. But that is because Xanax is always been more powerful for me than clonazepam, so I would reserve it as something I don't want to be taken constantly or chronically. But Xanax is pretty effective for both anxiety and for insomnia, and it can cool off your outer body as well because it relaxes some of the muscles in your skin which means they give off heat and you feel quite a bit cooler.
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It looks like somebody else above is really sensitive to clonazepam... and I think if you find that it helps you, then I would use clonazepam for a combination of sleeping and anxiety with a very low dose because the lowest dose you can get relief from is the best one, and I've always found it is very effective at a very low dose, 0.25 mg clonazepam is a great starting dose for you to try. And clonazepam is a bit longer acting... But as I said that long half life means that if you start going up to the upper doses, you're looking at it's metabolites accumulating in your system which you don't want. When you start getting into the 0.5 mg or more TID or QID then you have to start thinking very hard about how it's going to accumulate in your system because of that long half life. It's always best to try for the balance of benefit with as little of any benzodiazepine (both Xanax-alprazolam, and Klonopin-clonazepam) as you can get on with. That's why I suggested starting with the over-the-counter things (for sleep), unless your anxiety is so much that you must have an anxiety med from your doctor.
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A little about short-term versus long-term: Whenever you have a chronic condition, you really need to talk with the doctor about how to go about managing things long-term, because long-term benzodiazepines are not that great for you. So if you were thinking this may be a long-term issue for you, you want to talk to the doctor early on about how to manage things going forward for a long-term management plan. At the proper time, at the moment I guess you are new to this so you don't know if it's going to be a long-term issue or not.
You could try St. John’s wort and rhodiola rosea.
nz.iherb.com/r/swanson-full...
These are a mild ssri and dopamine /seratonin regulator.
Also high dha fish oil.
nz.iherb.com/pr/carlson-eli...
And make sure your bloods are ok for b12 and folate .
My husband takes 1x 5mg Melatonin at night as well as 2 Magnesium and 1 venlafaxine, which is a very low antidepressant.
I’d suggest trying PD meds. They help me a lot and I don’t have tremors. I do have dystonia, gait issues freezing, and many non motor symptoms
30 mg mirtizipine before bed helped by husbands anxiety and tremor.
Melatonin might help you sleep. Also, exercise helps with sleeping and slows the progression of Parkinson's.Good luck!
Re melatonin: You might want to check out chartist's reply here: healthunlocked.com/?utm_cam...
Music is sometimes very helpful for me. If you like classical music maybe try wfmt.com/.
You can try Lithium Orotate 5 mg of Lithium Element (~ 125 mg LiOr). If 5 mg is not enough after one week or so you can increase the dosage by 5 mg up to 45 mg maximum a day.
When my husband started levodopa/carbidopa initially at a very low dose that was slowly increased (a strategy the neurologist uses to avoid the nausea that some experience) the first symptom that was alleviated was his anxiety that had presented as an impending sense of doom.
You could consider Theanine and/or Valerian.... both increase GABA so decreasing anxiety and helping sleep. Yoga Nidra is also really beneficial for decreasing anxiety and 're-setting'.
It’s natural to feel overwhelmed by a Parkinson’s diagnosis. Allow yourself time to process it and seek balance with rest and activities that bring joy or a sense of calm. I found apps like Calm help when sleep is interrupted and the monkey chatter starts. Although anxiety can be a non motor symptom too, I think the anxiety you are experiencing has more to do with getting the diagnoses. Try and stay engaged and seek out support from others in the same boat. I was put on Sinemet right away by my neurologist for the anxiety, and not for the motor symptoms. I wish I had waited
I agree with Missy0202 and her advice reflects my own experience. I was diagnosed early this year and immediately started to suffer intolerable anxiety which was so bad at night that for a while I dreaded going to bed. After a couple of months everything subsided and now I rarely get an attack. I take no medicine. I think part of the improvement was due to acceptance of my condition and counting the many blessings I still have in my life. The other part was exercise and diet and engaging in hobbies and finding things that engage - making myself more physically and mentally resilient.
Anxiety when meds wear off.
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