anxiety and more: help

[empeg1]

Hello:

Any Millermom's (Millerdad's) have experience with Buspirone as a medication for anxiety. Side effects? Why does it seem that SSRI meds are used first to treat anxiety rather than the above med?

My oldest is over-taken with anxiety, PTSD in the car, panic attacks, terrified to see a doctor, afraid to leave home, especially for any length of time….. trying psychotropic medication has been a nightmare. DD also has major sleep disorders, not sleeping more than an hour or two at night and Restless Leg Syndrome and what I think is most likely obstructive sleep apnea (what a snore). Right now she is taking Ambien-CR (extended release). It took awhile for MediCal (Mediciad in California) to authorize the above. In the meantime, Melatonin, Benadryl, Trazedone, Neurontin, Ativan, Ambien 5 mg, Ambien 10 mg later, my dd's sleep finally got so bad that she just about stopped sleeping at all).

A major difficulty, I cannot get dd to the doctor, as she is quite phobic of going. The last time I tried, she was throwing up in the car, hyperventilating, trembling, pupil's fully dilated, and once at the doctor, she did not get out of the car. DD almost passed out from anxiety. So, no blood tests and her psychiatric nurse practitioner is now saying lab tests before any new medication. Now what? Perhaps I should invite said psychiatric nurse practitioner over and have her get dd to the doctor. BTW, the above panic attacks happened with medication, Ativan, which anxiety completely overrode. The health issue is very significant. DD has gained a huge amount of weight is is very obese now. She has high bloom pressure and with FASD, there is an increased risk of diabetes, weight notwithstanding. She is always thirsty. Then there is the apnea question.

As you can see, I am a bit overwhelmed. How do I approach treatment for dd's anxiety? I am considering Inositol but would really like to get blood tests first. But, how to get that accomplished? DD spends her time in bed. This is my 27 year old. And, the more her anxiety increases, the more irritable she becomes. And, then there is the unusual side effects of medications, typical with FASD. One day, after an increase of Neurontin, dd cycled between rage attacks and panic attacks, all day. I could not get her to the ER and did not want to involve the police. I simply stayed calm, lowered my voice, used empathy and tried to protect my safety and hers.

Any ideas? I hate this medication process and would simply go with supplements, but I think we need blood tests done and THAT is a brick wall.

[healthy11]

I don't have any medication information to share in your daughter's situation, but I did want you to know that we care, and hope Jisp or other members will be able to give you advice. I did find this old thread: millermom.proboards.com/thread/543/buspar-buspirone

(Would the psychiatric nurse practitioner be able to make a "house call" and/or draw her blood without going into a Dr's office? There is also a new procedure that's becoming available to test blood with only one drop: www.wired.com/2014/02/elizabeth-holmes-theranos/)

[dw]

1. There is a supplement I found that is an amino acid called L-theanine that is marketed from stress and calmness; a brand name of this is Suntheanine.
2. Can you borrow someone's glucometer and do a finger prick glucose test at home?
Fasting blood sugar over 124=diabetes (after an 8-12 hour fast). A non-fasting blood sugar over180 -200 is diabetes, too.
3. Has California enrolled medicaid recipients into managed care companies as has been done here in Illinois? If so, the services may be better in terms of having a medicaid case manager assigned to your dd. I have found the newly assigned medicaid managed care plan case managers, often RN's to be helpful so far, and I have been one to be highly critical of traditional medicaid employees over the decades.
4. It is possible to have a sleep study done at home to evaluate for sleep apnea. It is not as thorough as a sleep lab study, but it is a lot less expensive compared to the cost of a night in a sleep lab, which is about $4K! I suggest you go to one of the web sites of a nearby university hospital type place to read what they say about their sleep evaluations, with home options. I believe the psychiatric NP could order a sleep study, and CPAP if needed.
I'd go into it first, though, knowing if your dd would even consider using a CPAP. Many folks for whom CPAP is prescribed do not use it (~50%).
5. Would your dd consider the natural route? Maybe you and she or she and someone else could take a Tai Chi class? The focus is on calmness, mindfulness. would she consider learning mindfulness meditation?

[empeg1]

DW, a Tai Chi would be good for DD, but the above would involve a car ride and that will simply wipe out any good from the class. DD has marked PTSD in the car and it is very stressful. I can indeed get a sleep stud done at home. CPAP, now that would be hard. DD has tremendous difficulty with sensory integration and cannot stand anything on her face, not face makeup, a scarf, shower water. When we talked about CPAP and a mask or even a nasal pillow, she practically crawled up the wall. Yes, she has Blue Cross for physical health but mental health is through the county. DD couldn't even get into the door or, more accurately past the phone call. There was a multi-step process to getting into the county mental health system and DD neurologically could not do all those steps, to which the @#@# therapist on the line said, well if you want help you will have to cooperate.... There would be no case management, which she needs desperately. Kaiser Permanente now has clinical social workers going into patient homes for those who just can't get into the clinic. But, dd does not have Kaiser insurance.Thank you about L-Theanine. That is one of the supplements I want to try with DD, but it will have to be one supplement tried at a time, L-Theanine, Inositol, perhaps magnesium. But dd needs lab work first.

[jisp]

Empeg1
I am sorry that your daughter is dealing with severe anxiety. You are on the right path with L-Theinine and Inositol. Keep in mind that if you use Inositol you may have to give what feels like a very large amount. When inositol was used in clinical studies for PTSD the dosing was around 20 grams. Most pills are in the 500mg level I would build up inositol slowly as too much can be as problematic as too little. If anxiety is severe enough Inositol and L-theinine alone will probably not help. Meditation and hypnosis have been shown to be effective as well. At one point when our son was dealing with severe anxiety we gave him liquid Risperdal drops. A tiny bit of antipsychotic can sometimes take the edge off of the anxiety enough so that other treatments can work. Many times when APs are prescribed people react badly and that is because the doctors use them at too high a dosing. A very small (almost homeopathic dosing) can sometimes give you better results.

DW is probably more qualified to answer or respond to this but if she is always thirsty then I would worry about possible diabetes.

Can you eliminate Sugar in any form from her diet?

[dw]

You are the FASD expert, and I am sure you know a lot more about co-morbid mental health conditions than I do, but it sounds like there is a terrible fear of leaving the house. Would the usual treatments for agoraphobia (is this the correct term for fear of leaving home?) be helpful?
Its too bad you don't live near my dd, I think she would make free home visits to teach/coach mindfulness meditation, and she is a reikei practitioner and does that on home visits, too, if your dd were interested. But they are on opposite sides of the country. I wonder if phone contact could work? I cannot volunteer my dd, but if you think this is something to pursue, send me a pm, and I can ask my dd. She also does long distance reikei, and says it works. I always have to have an open mind, you know. But again, I canon speak for her and would have to ask my dd.

It is possible to become desensitized to cpap technology. One of my patients, 40 years old, is morbidly obese, like 440 lbs, and his sleep apnea report was the worse I ever read: 250 apnea episodes per hour; hard to believe, I know. He was supposed to use a bipap mask, much more invasive than a clap mask, but he could not tolerate it at all. He also has many psychiatric issues, with hallucinations. He then gained up to 600 lbs when he moved to another state and was put in a nursing home because he could no longer walk. At the nursing home, he "got used to" the bipap mask through a process of desensitization, and now uses it. (He also lost 170 lbs, so he can walk again.He has returned back to my care, and says he uses the bipap all the time.)

[empeg1]

I know about systematic desensitization, which is for anxiety but could possibly work with sensory sensitivity? I do know that dd is very sensitive to any sense of touch on her face. I think that a mask could potentially happen but some work for this to happen would be necessary. Right now, dd will not see a therapist, having been abused by more than one mental health professional who did not understand the brain basis of her difficulties.

Agoraphobia is usually treated with a form of Cognitive Behavioral Therapy, Exposure Therapy. CBT is contraindicated with FASD. In addition, there is a strong biological basis to her anxiety.

Jisp, I will ask about the use of minute dosage of an anti-psychotic with dd. I am not at all pleased with the Nurse Practitioner. She is heavily scheduled and cannot take the time to talk on the phone, not even with the pharmacist with medication. And, I do not see her responding to the severity of the anxiety disorder. As far as co-morbid mental health issues and FASD, 94% of affected individuals have a diagnosed mental illness. Anxiety and depression are now seen as primary characteristics of the brain damage, i.e., to all the developing neurotransmitter systems inutero. Bipolar Disorder, Schizophrenia, etc. occur with much higher prevalence in individuals with FASD.

[dw]

There is a good article in this month's Scientific American about meditation benefits for various problems, including anxiety. I know, I know, it has no doubt not been studied in folks with FASD, and the person needs to want to learn. Perhaps meditation with movement might be more inviting, like Tai Chi, or Qi Gong? There are probably videos that teach these for use at home. Perhaps you could do it together, or a friend might want to join in?