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Non-drying anti-anxiety drugs?

Q:  I have a question regardig anxiety and Sjogrens.  I am experiencing increased
symptoms of anxiety and feelings of being overwhelmed which make my dry mouth/dry eyes
symptoms worse.  I know it's not good to be so stressed all the time and it is a
vicious cycle because I 'worry' about the increase in symptoms, which increases
my level of stress and insomnia.  I have been on Ambien for sleep (about 10
years and attempting to 'wean' myself off.  I also am prescribed Propranolol (by
my PCP) for the anxiety AND willing to stop both of these but fearful of
increasing my sjogren symptoms if I do.

QUESTION:  Is there an antidepressant that is more likely to address insomnia/anxiety BUT less likely to increase sjogrens dry mouth/eyes?  It seems I am needing some help to get
myself out of a CNS problem of my 'flight/fight' response cycle.  At least this
is how I understand it.  It is difficult to determine how much of my
anxiety is from (or about) dealing with Sjogrens.  I do not want to take a
medication that would increase my dry eyes/mouth symptoms but living with this
stress is not good for me either.  I eat well and have taken up QiGong and have
had some success sporadically but am finally willing to turn to medications as I
think this is a physical response that I need help with.
I have an appointment with you (but not til September) and any ideas or
suggestions would be appreciated.  I do not like taking medications but can't
continue to feel this overwhelmed.  I will do whatever I can because the anxiety
is keeping me from 'living'.

A:  This is one of the most perplexing conditions for those who suffer with autoimmunity.  Our book, A Body out of Balance, addresses some of the techniques that have been used successfully by patients. Biofeedback and meditation can help but you must find a good practitioner of each and continue for some time to master the techniques. Then again, a support group or individual visits with a reassuring therapis could be very beneficial.

That said, anxiety can also be associated with thyroid disorders and heart palpitations, hopefully these have been excluded. Unfortunately, most all of the medications used for depression/anxiety can increase dryness. A consult with a psychopharmacologist (psychiatrist with special training in pharmacology) can provide the best options. Buspar has been a good option in my experience for short term use. Also, beta blockers (Atenolol) can help if palpitations are present.

Continuing to focus on stress reduction and addressing insomnia and healthy diet and exercise can help. Some find Acupuncture helpful. Recent studies suggest Acupuncture may increase adenosine at nerve endings, which has an anti-inflammatory effect.  The Sjogrens Syndrome Foundation (www.sjogrens.org) has funded a research project at Columbia looking at anxiety in a mouse model for Sjs. There is some evidence that neuroinflammation may be involved. In general, focusing on anything further you can do to decrease inflammation makes sense, which is also helpful to decrease cardiovascular risk.

At some point trying to slowly taper off Ambien will be beneficial. The body becomes dependent on it, and it is not of additional benefit, but It is very hard to remove from the system. This group of medications is designed for short-term use for a good reason; they are difficult to remove and often people remain on them for long periods. The Sjogrens Syndrome Foundation has some helpful tips on insomnia and if you look on their website you will find a book they recommend.

dr c.

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1 Comment   »

  • vasculitis symptoms says:

    Not that I am any answers but I have had some success with the muscle cramps by taking vitam b with added vitamin c, and vitamin d. I am not sure why they have seemed to help but I have not had cramps since I have started taking them each day and its been about 3 months. I was having terrible cramps that woke me at night screaming in pain. Hope this helps but I would ask your MD before trying it. Good luck!!

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