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Dr_Broadland
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Joined: 19 Jul 2007
Posts: 62
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# Posted: 25 Jul 2007 10:08
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There are many treatment modalities. In this thread, I would like to keep the discussion focused on drugs used for the treatment of and their side effects.
A most significant advance occurred in the 80's with the introduction of diazapam (Valium). Susequently, many other similar drugs such as lorazepam, alprozolam, etc were introduced.
While a reasonably effective drug in controlling stress and relaxing the patient, Valium is also somewhat habit forming. It has 24 hour effectiveness, so if you see somebody popping Valium every 6-8 hours, you should suspect habit formation. Most people who find benefit from diazepam, do so at a dose of 2-10 mg daily.
Lorazepam is shorter acting and less habit forming. It is also more immediately acting acute stress, and can be more easily withdrawn after it has become redundant. It can be given in doses of 1-2 mg three to four times a day.
It should be noted that most of these drugs have a side effect of sleepiness and driving while taking these drugs can be dangerous.
Taken on prescription from a good doctor and as prescribed, these drugs do have a role in the management of stress today.
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Dr_Broadland
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Joined: 19 Jul 2007
Posts: 62
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# Posted: 27 Jul 2007 12:43
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There are many other Benzodiazepines besides diazepam and lorazepam, which have similar effect on stress but vary in duration of action and side effects. Benzodiazepines such as Oxazepam, (Serax), Clorazepate (Tranzene) are amongst these.
However there is one Benzodiazepine which should be noted specifically, in relation to the management of episodic stress or panic attacks. This drug is Clonazepam, and though the indication for management of panic attacks is not well documented, I have would it very useful in the management of panic attacks. Interestingly, dependence or habit formation is notably absent and its effectiveness in this condition and in the management of minor epilepsy is not as well known as it should be.
In summary, Lorazepam (Ativan) for acute stress of the type "my girl friend has left me", Diazepam (Valium) for chronic stress when used judiciously, and Clonazepoam (Klonopin in the United States and Rivotril in Europe, South America, Canada, India, and Australia) for episodic stress or panic attacks – these three are the useful pharmaceutical products in the management of stress.
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logi
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Joined: 13 Aug 2007
Posts: 1
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# Posted: 13 Aug 2007 15:15
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How long do I have to take medication for panic attack?
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Dr_Broadland
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Joined: 19 Jul 2007
Posts: 62
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# Posted: 15 Aug 2007 14:30
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Benzodiazepines, in general, have a habit-forming tendency. One has to avoid long term use of this type of medication. Also, if somebody is being prescribed this group of medication, one should avoid diazepam (Valium) because of many reasons:-
1. It was the first one and has acquired a big name for efficacy and is therefore requested more by people who are looking for "a fix".
2. Its half life is over 20 hours, and would therefore be a bit more habit forming.
3. 3There are other alternatives available and they are not as habit forming.
However, for Panic attacks (episodic acute stress) Clonazepam (Rivotril) is very effective and does not have a tendency to create a habit or addiction. I have used it for three to six months period at a time without creating a drug dependence. I have found to be very, in fact, extremely effective in the prevention of Panic attacks.
Also when it is used on a long-term basis as an anticonvulsant in minor motor seizures (myoclonic seizures) and in petit mal, it does not exhibit any tendency to dependence, addiction or abuse.
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NonCIMLL
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Joined: 21 Jul 2007
Posts: 5
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# Posted: 18 Aug 2007 20:44
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Why does a drug for panic attacks also work for epileptic seizures?
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Dr_Broadland
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Joined: 19 Jul 2007
Posts: 62
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# Posted: 18 Aug 2007 22:58
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Benzodiazepines, like all drugs, have their desirable effects and side effects. When the first one, Diazepam (Valium) was introduced, it had a very good controlling effect on anxiety and stress. Side effects were noticed. These were drowsiness, relaxation of muscles, undesirably long period of action, dependence, etc. These side effects were noticed to a greater or lesser extent as other similar drugs were tried. and newer drugs were introduced to take advantage of the side effect to produce a desirable therapeutic goal.
In fact Diazepam's side effect of muscle relaxation is still used for manipulation of joints. Flurazepam (Dalmane) was used for insomnia, and its long life in the blood was a deterrent, but triazolam (Halcion) was much shorter and quicker acting Clnazepam (Rivotril) was discovered to have an extraordinarily good relaxing effect in controlling the spasm of some form of epilepsy. While it was used for this condition, some doctors experimented and concluded that it also has a very good effect on preventing episodic anxiety attacks i.e. panic attacks.
The diazepines used in the past for insomnia are not much used now. Lorazepam (Ativan) is more commonly used for anxiety because of its quicker action and short life. Valium is still used cautiously for its effect on chronic anxiety and also intravenously for relaxing for manipulation of joints. Clonazepam has found a nice place in the treatment of some forms of epilepsy and for panic disorders.
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Dr_Broadland
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Joined: 19 Jul 2007
Posts: 62
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# Posted: 31 Aug 2007 10:39
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Medicine for prevention of stress.
Modern medicine relies heavily on various chemicals or drugs. The approach has consistently been towards a specific medicine or a group of medicines to cure or give relief in an illness. Preventive medicine has been more recently. However if you look at the emphasis in modern times of preventive medication, there can be no doubt that it is driven by commercial forces. The examples are plenty – aspirin in old age, cholesterol reduction medication (the statins), oestrogen therapy for prevention of osteoporosis. The guidelines are clear – Take this for the rest of your life and you will not get that illness or condition, says the pharmaceutical company, omitting to say "we will get rich in the process".
There are no specific medicines given as a prevention of stress. There is, of course the slight addiction potential of diazepam, which means that you take it for the rest of life, and people tend to take many of the anti-stress medications for long periods of times. But these can't be said to be preventive in nature. Clonazepam long term can be said to be preventive (of panic attacks) in the true sense of the word. Some of the modern anbti-depression drugs, e.g. PROZAC (fluoxetine hydrochloride) or Paxil (paroxetine hydrochloride), are used to a small extent for stress (Depression with anxiety)
Next week we will discuss medicine for prevention as postulated in the Ayurvedic and homeopathic systems.
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NonCIMLL
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Joined: 21 Jul 2007
Posts: 5
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# Posted: 2 Sep 2007 11:25
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Dr. Broadland wrote:
'The examples are plenty – aspirin in old age, cholesterol reduction medication (the statins), oestrogen therapy for prevention of osteoporosis. The guidelines are clear – Take this for the rest of your life and you will not get that illness or condition, says the pharmaceutical company, omitting to say "we will get rich in the process".'
I can see how that's true - the pharmaceutical companies certainly are getting richer... but isn't it also true that taking aspirin does prevent heart attacks, or whatever it's supposed to prevent. Aren't these claims true?
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Dr_Broadland
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Joined: 19 Jul 2007
Posts: 62
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# Posted: 7 Sep 2007 11:29
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There is undisputed evidence that long term aspirin benefits. Same can be applied to many drugs your doctor recommends for long term use. However, one recent failure of the medical world is oestrogen therapy for prevention of osteoporosis. It has backfired by increasing risk of breast cancer.
Cholesterol medication for the elderly is OK, except that There is new caution about its use in older women and in the very old men. We started postponing removal of benign prostatic enlargement (BPH) by starting therapy with Finasteride (Proscar). It reduces the size of prostate, but benefits may not be seen for at least 6 months. In a State supported health system as it exists in Canada and UK, this is a lot of money in the pockets of the drug companies and the pharmacies (and doctors too). Somebody forgot to mention that it may mask the symptoms of a developing prostatic cancer.
I have just become extra cautious about using any long term medication because I have seen these side effects and undesirable results far too often to blindly endorse long term preventive therapy using medication.
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TajviRAC
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Joined: 7 Apr 2008
Posts: 80
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# Posted: 19 Apr 2008 13:45
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Do you have any recommendation for some sort of herbal or Ayurvedic medicine?
Personally I prefer natural drugs and medicine if available.
Many of the plants around us contain vital drugs or contents that have tremendous medication power and can replace our modern drugs.
The best part of is, they don't have side-effects normally.
Cheers.
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Dr_Broadland
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Joined: 19 Jul 2007
Posts: 62
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# Posted: 25 Apr 2008 13:44
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Quoting: TajviRAC Do you have any recommendation for some sort of herbal or Ayurvedic medicine? Personally I prefer natural drugs and medicine if available.
There has been ample evidence of naturally occurring Oestrogenic preparations and their usefulness in menopause. The evidence is somewhat scanty as it applies to cholesterol reduction through Ayurvedic medicine.
With the practice of dietary measures recommended in Ayurveda, taking 'Medoroga Chikitsa' is helpful in weight reduction and helpful in minimizing the risk of fatty cholesterol deposits.
In a study conducted at the Gujarat Ayurvedic University, drugs such as Terminalia Arjuna and Jaharmohara were administered to heart patients. In 66 percent of the cases the levels of chest pains, palpitation and fatigue came down dramatically and blood pressure and pulse rate came back to normal.
The drug Terminalia Arjuna has been used in Ayurveda for cardiac ailments since ancient times. Arjuna is a dense and tall tree and has long, cone shaped round leaves and white bark used in medicines. This tree is called nadisarjja in Sanskrit and its bark is described as a cardiac tonic. The tree is indigenous to India though it is found also in Myanmar and Sri Lanka.
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TajviRAC
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Joined: 7 Apr 2008
Posts: 80
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# Posted: 30 Apr 2008 08:21
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Could you please tell me the scientific names or the western names of the plants you mentioned?
Or even a website with the lists would do.
I also heard that there are some books listing physical phenomena that might be observed when someone is undergoing stress.
Any help ?
Thanks.
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Dr_Broadland
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Joined: 19 Jul 2007
Posts: 62
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# Posted: 30 Apr 2008 14:01
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Quoting: TajviRAC Could you please tell me the scientific names or the western names of the plants you mentioned?
Terminalia arjuna is a medicinal plant of the genus Terminalia widely praised & used by Ayurvedic Ayurvedic physicians for its curative properties in organic/functional heart problems like angina, hypertension, and deposits in arteries etc.
He Zi
Also Known As:
Arjuna, Axjun Argun, Bahera, Bahira, Bala Harade, Balera, Behada, Beleric Myrobalan, Bihara, Chebulic Myrobalan, Hara, Harada, Haritaki, He Zi, Hirala, Indian Almond, Myrobalan. Terminalia arjuna; Terminalia bellirica, synonym Terminalia belerica; Terminalia chebula.
Family: Combretaceae.
You should be able to obtain this item from an Ayurvedic or Chinese pharmacy.
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