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Comment by AnkhMorporkian | Hacker News Reader

Beta blockers aren't great for sudden panic attacks. I took them for years, and while they're great for toning down the anxiety baseline, they don't even remotely approach benzos when it comes to mitigating severe panic. Sadly the only medications you can reasonably get out there that will address an incipient or in progress panic attack are benzos.

There are other supplements/medications that are helpful (phenibut is my goto since I no longer wanted to take benzos), but none of them are fast acting or powerful enough to stop something that's already happening.

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Ah, interesting. I checked with my friend, and it turns out they had gotten mixed up. They were prescribed benzos, not beta blockers.

What made you stop taking them? My friend has been making good progress without them, but still gets some rough days. And what supplements/medicines do you use, apart from phenibut?

(To be clear, they've already spoken with a doctor, psychologist, consulted drugs.com listing of side effect, etc.)

I stopped taking them for two reasons.

1. I have an absurdly high tolerance to them (and almost all GABAergics, for that matter.) I always have, and also have an absurd alcohol tolerance. So, while clonazepam worked for me, I was taking roughly the maximum dosage designated for severe seizure disorders (I was taking 18mg/day, which if anyone is familiar with clonazepam, they'll know how absurd that is.)

2. I was starting to feel dumb. I'm not 100% sure if that was the clonazepam or the quetiapine or the topamax, but one or all of them was making me forget my friends' and family's names. So, I dropped them like they were hot.

I'll give a small rundown of my stack below. I certainly won't say my stack is bulletproof, and for people with addictive personalities it could certainly be actively harmful. I won't discuss dosages either, because frankly my phenibut dosage is irresponsible, but once again that goes directly towards my GABAergic tolerance.

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Tianeptine - for depression. It's a fast acting novel TCA that works via unknown mechanisms. In higher dosages it exhibits opioid activity, and if someone suffers from addictive tendencies it should absolutely be avoided.

Phenibut - for anxiety. It's converted directly into GABA in the brain. It's relatively fast acting. Some people, but definitely not all, can suffer from horrible withdrawals if they take it for a long time and then stop taking it. I've never had problems with it if I've run out though, and I take it daily.

Adrafinil - for fatigue and sleepiness. I suffer from an autoimmune disorder and am chronically fatigued. Adrafinil is a pro-drug for modafinil, and gets rid of your tiredness without being otherwise stimulating.

Caffeine - tiredness. I get mine powdered, but it doesn't really matter.

Vitamin D - this one helped with my depression enormously. I decided to give it a try one day after my dad was diagnosed with SAD, and did a loading dose. Within 3 days the dark circles had disappeared from under my eyes and my depression lifted significantly.

Those are everything I take on a day to day basis. I also have conditional nootropics for days when I'm in the mood for them/need to be extra productive. Noopept, aniracetam, oxiracetam, N-Acetyl Selank Amidate for days I'm feeling extra anxious, N-Acetyl Semax Amidate for a mental boost, and a few others I rarely use.

How much Vitamin D are you taking? I have been supplementing with it, but it did not put much of a dent in my winter depression. And what is considered to be a loading dose?

10,000 IU per day. A loading dose is in the range of 100,000IU to 1,000,000IU, depending on age and body weight. Hypervitaminosis D only occurs when you take a loading dose level for months or years; it's not possible to acutely overdose on vitamin D.

That's a lot. Vitamin D tests are easy to get, so I just took a few over a few months to find a dose that would keep me at ~50ng/ml. Previous to that, I had taken 5000+ IU/day for some time and the test showed my levels were very high.

It looks like this site has a nice chart: https://www.vitamindcouncil.org/further-topics/i-tested-my-v...

I did end up taking a Vitamin D test after I had started supplementing, and on that dosage I'm still a little below normal levels.

On the suggestion of someone here I tried Phenibut for sleep earlier this year. What I've found with it is that it works best taking it 4-5 days a week with 2-3 days off, otherwise my tolerance builds up. The first day I take it after a break is noticibly stronger and I could probably use a lower dose then (but I ended up just using 900mg all the time). I now do the same with Baclofen 20mg, which I prefer (but Phenibut is more effective for anxiety I hear since it is a weak baclofen plus a weak gabapentin). Anyway, if you want to try lower doeses and haven't tried this already and can go without for a couple of days a week that might work (you might need a longer break at first to clear it out).

Phenibut (and almost certainly Baclofen too) have some interactions with other medications; I had issues with diphenhydramine (numbness in mouth for 10 seconds or so after waking up; I didn't intend to take both, it didn't even seem like a good idea) and L-Theanine (mild asthma reaction, which I otherwise rarely get these days other than in the vicinity of certain cats). While not severe for me, they are the kind of things that could be severe and I think it is worth being careful with them. Withdrawal effects should be less severe with once a day usage due to the short half life (about 6 hours IIRC), but take it long enough without breaks, particularly at high dosage, and it can build up enough to cause withdrawal effects (but tapering when stopping will prevent those).

While I don't remember the details, I tried a benzo for sleep briefly after high school and found it effective only for a day or two. Between that and the potential side effects, I haven't tried them again since. I have a non-24 hour circadian rhythm and have had success with a combination of uridine monophosphate (150mg sublingual daily with maybe monthly breaks of a couple of days), Baclofen (20mg four or five days a week, at least two in a row off), and a quarter of a 5mg melatonin patch most days (I manage to forget it often enough to not need intentional breaks; at least monthly breaks of a couple of days would be a good idea). With this I've been able to avoid my sleep schedule shifting every day as it does without medication. My alertness and other issues during the day still vary quite a bit and are rarely all that good, but hopefully this will get better eventually.

Uridine monophosphate (or triacetyluridine, which is better absorbed from the digestive system but isn't usable sublingually) is also a higher risk in that it hasn't been as comprehensively studied as other things and it could have negative long term effects. I seem to need to take a high B vitamin supplement when I take it or get B vitamin deficiency symptoms (bright red around lips); even a 100% DV supplement doesn't prevent that. The combination of uridine, DHA, and choline is supposed to help with neural growth. I don't know if it would help with anxiety, but anything that helps with sleep seems like a possibility at least :/. It could potentially interact (negatively or otherwise) with things like autoimmune conditions.

Interesting that you're able to take phenibut daily. I only take a low dose once per wee, starting two months ago, and I'm already starting to get issues with tolerance and rebound anxiety.

That is interesting. I've long held a theory that my brain simply doesn't respond to GABA properly. I seem to be able to take any GABAergic in gargantuan amounts and experience very few side effects, and just feel normal. Then, once they wear off, I just go back to my normal anxious self.

The problem with benzodiazepines is that they're insanely addictive. And withdrawal is excruciating.

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