Ask me anything!

[RealisticTrain]

Just wanted to introduce myself here. I'm Daniel, and I'm currently near the end of my psychiatry residency at the university of toronto. As such, I have vast knowledge of all things psychiatric, be it medication, alternative treatments,..anything to do with the mind!

I love helping others so I want you guys to know that I'll try to be here on the forum for as long as I can (clinic hours are a bitch) and available to answer questions. Please remember that I am a doctor in training still, and any advice that I give you MUST be approved by your attending doctor first before you attempt any changes.

I've also had my fair share of anxiety and depression in my life, so I can relate. I've made a full recovery, am doing the job that I love, and I'd you all to be able to rid yourself of these worries and just live life. And maybe I can be there to help.

Thanks!


Just a thought...maybe we can sticky this, mods?

[Exactice]

Hey Daniel, Thank you so much for joining us and lending out your thoughts. Please stay active as I am sure many members here could use some help. Thank you again and I will post up some questions myself =)

[RealisticTrain]

Hey Daniel, Thank you so much for joining us and lending out your thoughts. Please stay active as I am sure many members here could use some help. Thank you again and I will post up some questions myself =)

It's my pleasure. I'm super busy these days, but ill find time to come on as soon as i can. pharmacology and psychotherapy are my specialization. -They also encompass the most effective treatment when dealing with anxiety or depression.

[Kuma]

Hey RT. Very kind of you to offer your advice here. I have a couple of questions:

What do you think of beta blockers for anxiety (esp GAD)?

Do you think "adjustment disorder" (DSM V - 309) is a clinically meaningful dx, or is it just a way to get psychotherapy approved by insurance companies that require a diagnosis?

Of patients who present with anxiety, how do you determine which of them is most likely to respond to CBT?

Thanks!

[RealisticTrain]

Hey RT. Very kind of you to offer your advice here. I have a couple of questions:

What do you think of beta blockers for anxiety (esp GAD)?

Do you think "adjustment disorder" (DSM V - 309) is a clinically meaningful dx, or is it just a way to get psychotherapy approved by insurance companies that require a diagnosis?

Of patients who present with anxiety, how do you determine which of them is most likely to respond to CBT?

Thanks!

Hi Kuma,
Beta blockers have indeed shown to have anxyolitic properties, despite not actually being approved for them. Fight of flight response seems to be inhibited, and this method is used by many actors and musicians to calm stage fright. One big side effect from these alone seem to be night terrors and nightmares, and they have really bad counteractions with other drugs or food. Be careful with these.

Adjustment syndrome, in my opinion, has a very vague criteria and lack of specificity of symptoms and behavioural patterns that need to be present for a diagnosis. Insurance companies usually need more concrete information for your claim, so your doctor might exaggerate or even make up symptoms to make sure you get your entitled treatment

Your last question is the most difficult. Generally speaking, those who succeed in cbt are those who really devote time and energy to it. Medication is easier,just pop a pill and you're good to go. Cbt actually requires work, willpower, and an urge to succeed.
I hope I have answered your question!
- Dr. Dan

[PanicCured]

Yeah I got a question: Why do you think doctors have zero cure for anxiety and give out extremely addictive drugs at the drop of a hat that offer zero long term benefit. Please show us one documented case of actual anxiety cures where someone has been cured 100% fully from psychiatric medication. That means no need for meds or anything, just cured. Not dependent on mind numbing highly addictive substances. Tell me why I was addicted to Klonopins given to me by a doctor when I had anxiety, and I cured myself using all non conventional unpsychiatric methods.

[RealisticTrain]

Yeah I got a question: Why do you think doctors have zero cure for anxiety and give out extremely addictive drugs at the drop of a hat that offer zero long term benefit. Please show us one documented case of actual anxiety cures where someone has been cured 100% fully from psychiatric medication. That means no need for meds or anything, just cured. Not dependent on mind numbing highly addictive substances. Tell me why I was addicted to Klonopins given to me by a doctor when I had anxiety, and I cured myself using all non conventional unpsychiatric methods.

Keep in mind that anxiey, at its core, is not a disease, so it cannot be "cured". A normal amount of anxiety is necessary for your body to react to situations where it will have to either "fight or flight", to ensure survival. Here is where we get into disorders: anxiety that is [I]irrational[I] and overwhelming to the point where it impairs your every day function -that's a problem.

So we are, in essence, not trying to find a cure, but rather to bring those anxiety levels down to manageable levels, and through various means of psychotherapy, to "teach" your mind not to be afraid or worried about irrational things ie. things or situations where you are not in any actual danger.

I am sorry that you feel this way about benzos. You must realize that we as doctors want to do everything to help and to help quickly, and when most people come into the emergency room at camh in a manic state of fear or worry, these types of drugs are the only thing that will immediately provide relief. They can be addictive and within 6 months of taking them you might find minor impairment in cognitive functions, such as loss of memory or concentration. That's why anti-depressants are recommended for long-term anxiety relief.

Do tell us, how where you able to "cure" yourself? I'm sure many people here would like to know!
- Dr. Dan

[PanicCured]

Do tell us, how where you able to "cure" yourself? I'm sure many people here would like to know!
- Dr. Dan

Anxiety disorder is in fact a Dis-Ease of the body, maybe more correctly termed "disorder". It occurs when one is so sensitive that anxiety is triggered at incorrect times. That is the disorder. Simply doping someone up or telling them just to relax will not get to the underlying issue. I realize some people need medication so I am not against anxiety medication as a whole. What I am against is complete lack of any long term cure from medication. We can debate the term "cure" if you want. but it simply means one is debilitated from an anxiety disorder and then overcomes it and lives a normal life. That is cured in my book. This idea that one should only seek to learn to maintain their anxiety is also misguided information. I do not have to do anything anymore to keep my anxiety under control. It is simply non existent.

Yes, I realize the fight or flight response can occur in times of danger, but that is not a disorder. No more a disorder than if one's family member dies and they get depressed. That is a normal reaction, not a depression disorder. The disorder is what many people here experience, is they are sitting on the couch watching TV and all of a sudden out of nowhere the walls start caving in and then their heart goes to 160 BPM and they feel their head will explode and pace around the home running for a safe place in full on freak out mode. That is the fight or flight response triggered in the wrong way. THAT IS THE DISORDER! That improper trigger is what can be cured. There is no medication for a long term benefit for this. Only by natural means, not only supplements and herbs, but by certain lifestyle changes and certain behavior modifications will get one past anxiety. This is something doctors can not do. Besides CBT or other qualified anxiety therapists which can be a great help.

So call it what it is. Benzos offer temporary benefit for a few hours which can easily turn sour after a few months, and offer zero in the long term benefit. If one gets addicted than they will have a whole new set of problems to deal with. Again, I would never say nobody needs meds as I assume there is a time and place for them, but call it what it is. It is not a long term treatment. They are temporary band aids. I detailed my healing path in the stickies above how I went from anxiety/agoraphobic to what I consider normal, if you care to read.

[RealisticTrain]

Anxiety disorder is in fact a Dis-Ease of the body, maybe more correctly termed "disorder". It occurs when one is so sensitive that anxiety is triggered at incorrect times. That is the disorder. Simply doping someone up or telling them just to relax will not get to the underlying issue. I realize some people need medication so I am not against anxiety medication as a whole. What I am against is complete lack of any long term cure from medication. We can debate the term "cure" if you want. but it simply means one is debilitated from an anxiety disorder and then overcomes it and lives a normal life. That is cured in my book. This idea that one should only seek to learn to maintain their anxiety is also misguided information. I do not have to do anything anymore to keep my anxiety under control. It is simply non existent.

Yes, I realize the fight or flight response can occur in times of danger, but that is not a disorder. No more a disorder than if one's family member dies and they get depressed. That is a normal reaction, not a depression disorder. The disorder is what many people here experience, is they are sitting on the couch watching TV and all of a sudden out of nowhere the walls start caving in and then their heart goes to 160 BPM and they feel their head will explode and pace around the home running for a safe place in full on freak out mode. That is the fight or flight response triggered in the wrong way. THAT IS THE DISORDER! That improper trigger is what can be cured. There is no medication for a long term benefit for this. Only by natural means, not only supplements and herbs, but by certain lifestyle changes and certain behavior modifications will get one past anxiety. This is something doctors can not do. Besides CBT or other qualified anxiety therapists which can be a great help.

So call it what it is. Benzos offer temporary benefit for a few hours which can easily turn sour after a few months, and offer zero in the long term benefit. If one gets addicted than they will have a whole new set of problems to deal with. Again, I would never say nobody needs meds as I assume there is a time and place for them, but call it what it is. It is not a long term treatment. They are temporary band aids. I detailed my healing path in the stickies above how I went from anxiety/agoraphobic to what I consider normal, if you care to read.

From a medical perspective, I completely agree; lifestyle changes and proper cognitive training are the gold standard for treatment for anxiety disorders. What you might not know however, is how many people there are that simply do not respond to CBT, or have tried all the lifestyle tips and are not improving. For these people, medication is their ONLY hope. Antidepressants such as SSRI's can and usually are taken long term, and are relatively safe.
On the opposite side, there are people, like yourself, who can get "cured" by the means you suggested, however they don't respond at all to medications. I know you look at me and think, oh this guy is getting paid by big pharma, yada, yada
That's not the case. I've never taken any offers from any drug company. But I do know the medicine. And I know it well. Med school will kill you financially and perhaps emotionally, but it will make you a true doctor. People believe in herbal treatments and hypnosis, whatever, well...doctors believe in the medicine.
- Dr. Dan

[PanicCured]

I do not agree with you. Medication does not cure an anxiety disorder and when you say people do not respond to other means, that is not true. That just did not do the proper work. They either simply found a way to avoid what needs to be done such as face their fears, or they simply have not been taught how, because doctors give them pills and tell them to just relax. Most people do not do what needs to be done. If you probe you will see. But the people that took initiative and went full speed, they get better. Even if there is a biochemical cause such as a thyroid issue, blood sugar issue, Vitamin D deficiency, etc., when you go full speed you end up finding this stuff out. What I mean is, if you are totally motivated to get better and you will seek every treatment you need and do everything possible in your life to overcome it, you will find what you need and you will get better.

"doctors believe in the medicine" But pharmaceuticals do not cure anxiety so what you believe is irrelevant. A cure means they do not need to take or do anything anymore, they are normal and their body has returned to a balanced state. Some people may need an SSRI or a Benzo, sure, but it is not a cure. SSRIs are not easy to get off either and calling it "discontinuation syndrome" may sound better than withdrawal but really is it?

I was hyperventilating all the time. Not one doctor said anything to me about this. I read a book on Buteyko breathing techniques, practiced it for 5 days and my anxiety cut in half. I then continuted to practice it and learned to not overbreathe, which can lead to anxiety. And as you know, oxygen is released from the hemoglobin via the CO2 partial pressure difference, and when one overbreathes, too much CO2 is released, which causes oxygen molecules to not be released to your organs and brain from the red blood cells. The more I hyperventilated the less oxygen my body was getting. The dizzyness, and many symptoms in a panic attack have to do with too much CO2 being released from too much breathing. When I did exercises to underbreathe, such as with the Buteyko method, I was able to slowly retrain my respiratory centers of my brain, and more oxygen was released. I could feel warmth throughout my body after about 10-15 minutes of doing it. I did these exercises at least twice a day. Most importantly, I learned to breathe through my nose and keep my breathing calm and not to overbreathe. The old paper bag thing. Although I suppose that is considered not safe anymore to breathe into a paper bag. Little things like this are true healing. Learning that when a panic attack comes, to sit and be still and ride it out rather than run for a safe place.

It's like someone who is scared to fly. The worst thing to do is not fly. They need to get educated and then fly and deal with it. But a lot of people with anxiety mold their life to their disorder. This causes the disorder to go deeper. They put limits on themselves because, "I have anxiety so I do not do that." There is a lot more, but I have wrote it all elsewhere on this site. My point is, there is real healing and it works, but the person has to be willing to do the work. and let's face it, a lot of people simply won't go full speed and want instant relief. But why don't doctors say here is a Benzo to take for the temporary relief but take only of you need it, but here is the list of what you must do to reap long term benefit. The goal should be to eventually not need anything. Yet we have the whole addiction aspect of it which throws the whole thing off.

Although certain herbs and supplements can do what medication can't, which is nourish and heal the overly sensitive nervous system, ultimately, the most important is retraining the brain by changing behavior patterns and facing their fears with proper knowledge.

A simple as this sounds, it works. I wrote this a while ago. Practicing techniques like this, is what I consider true healing and this begins with a mindset to do whatever it takes: http://anxietyforum.net/forum/showth...-Panic-Attacks