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    Anxiety worse at nights????
    suesue0910 posted:
    Why is my anxiety worse at night? It typically starts around 5-6pm. I can be doing dishes, sitting on the sofa, talking on the phone, washing dishes, etc. It isn't when it was quiet or in the middle of the night. I have 4 kids so there is no quiet around here. LOL. I can't pin point what is causing it, I am good during the day. I take 150mg of Zoloft every night before bed. I take 1mg of Ativan PRN. I don't want to take the Ativan everyday because I don't want to build up a resistance but I have been needing to take it quiet often lately. Thoughts?

    Echo0383 responded:
    Anxiety can manifest in many different ways, at different times and with or without any antecedent triggers. This is, of course, a question for your psychiatrist but here below are a few questions & things I would consider:

    - What is the history of your diagnosis or diagnoses? Has your anxiety always presented this way?

    - Are there any triggers in the evenings you might not be aware of? Underlying fears?

    - Cognitive Behavioral Therapy (CBT) is an effective treatment in addition to psychiatric medication management by your psychiatrist. A combination of the two has been shown to have the best therapeutic outcomes.

    - Is Zoloft the right medication and is nighttime the best dosing time? A side note that Zoloft is more often prescribed in the AM. Another side note: Zoloft and Paxil are generally thought to be a bit better for anxiety amongst the other SSRI medications (.e.g., Prozac and Lexapro which are sometimes more "activating")

    - Your concern about the Ativan is valid but is it helpful? Scheduled maintenance (longer-term) treatment is common and helpful for some. Of course it is ideal to take the least # of medications and the smallest effective doses, however it's important to recognize & accept (as you have) that sometimes more is needed at certain times and in certain circumstances that are more stressful. If something works for you it is always helpful to have it available PRN/as needed. Also, there are other benzodiazepines that could be more effective for you, as well as non-benzodiazepine alternatives such Atarax and low-dose/off-label antipsychotic medications like Seroquel, Risperdal & Abilify. Often times psychiatrists will target symptoms through "combined pharmacotherapy" and Rx low doses of such meds to augment the antidepressant and help anxiety.

    If your anxiety manifests in a more physical way such as rapid, chest-pounding heartbeat, beta blockers (typically used for hypertension) such as Propranolol are sometimes considered. These meds are often helpful for performers or those with "stage fright" and dampen-down the cardiac output and the physical symptoms such as tremor and sweating. Another similar medication that is sometimes used is Clonidine which is an alpha-blocker and also often used for hypertension.

    To go back to CBT and non-med management, it is often also helpful to sit with the anxiety for a period of time if you can, letting it plateau and then decrease. Breathing is also helpful here.

    While some stricter behavioral therapists (who would advocate the above) might disagree, it is sometimes helpful to, not "avoid", but rather "refocus" your attention on doing something productive, wholesome, etc. like physical activity, doing something fun with your kids, etc. In both of these approaches, changing your behavior will literally "rewire" your brain and set-down new neural circuitry pathways. This is treatment in light of the science of "neuroplasticity."

    All good things to consult with your doctor about and I hope some of this helps you. Good luck!


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