Dr. Gary M. Glass, MD

Anxiety, like depression, is both a natural "state" of life and an illness. Your decision making should be based on three criteria: 
#1. Is the anxiety a direct result of a life circumstance, i.e. break up in a relationship, pending job evaluation, etc., or does it seemingly come out of nowhere?
#2. Is there a family history, i.e. do other family members suffer from anxiety?
#3. Is it getting better or getting worse?

Is it a bit more tricky? I like to use the analogy of a cold. We all wake up several times a year with a runny nose, sneezing, and perhaps coughing and generally feel like "sh-t." We don't run to our doctor...we realize we have a cold and will feel pretty badly for several days and it will pass on its own. 

You raise a very popular question. First, it is wise to try and withdraw from the medicine, however, certain questions are necessary to make the right suggestions. First, how long have you been on them and at what doses? Second, have you engaged in any meaningful psychotherapy during this time?
If you have been or are in therapy that makes it easier because you can use the strength of your therapeutic relationship to ease you through the withdrawal. If not you may want to consider it.
Let's separate the two. Paroxetine is not difficult to stop...I would cut you does in half for several days to a week and then again. If this is difficult, consider shifting days...e.g. take two pills M, W, and F and one pill T, Th and Sat. and then drop down again.
Diazepam is a different and more complex issue however, I would use the same approach...depending on the dose, drop by 25% for five to seven days and then by another 25% for a week until you are down to a very small dose and then either stop it fully or alternate days for a week or two then stop it fully.
I would strongly recommend that you taper the diazepam first while remaining on the Paroxetine and then stay on the Paroxetine for several weeks to ensure stability before withdrawing from that.
During the period of tapering/discontinuing, you would benefit from creating a routine in which you make each day similar to the others. For example, going to sleep at the same time, awakening at the same time...doing roughly the same events in the morning and afternoon etc. Of course, changes can be made but should be restricted to either necessary or emergent changes and/or pleasant changes such as staying out late to celebrate an occasion. An exercise routine would be helpful and can include anything from simply walking a mile or more three times per week up to daily gym workouts with both cardio and weight training...again the goal is not to become a body-builder but rather to "gobble up" excess anxiety and to give yourself a sense of mastery of your own body and spirit. Most importantly you should be extra cautious about using alcohol, cigarettes or other approaches to help keep you at ease while withdrawing from the medicines.
A serious concern is to both be proud of stopping the medicines but not foolish...if you sense depression returning or anxiety growing be sure to return to your provider and keep them apprised along the way of your progress. It may be possible that you have to return to Paroxetine and if so you should, under the direction of your doctor. Although I find Diazepam and its cousins, Xanax and Klonopin to be very useful and beneficial medicines, we have to be especially cautious as we age. Feeling a little light-headed or unsteady is one thing at age 46 and quite another at age 70, especially if one gets up and out of bed at night. It is all too common for these medicines to leave an elderly person unsteady leading to a fall in the middle of the night and then serious problems develop...  
I congratulate you on your insight and decision and wish you luck with the process....as always your own personal physician, hopefully psychiatrist is your best guide.

I am sorry you are feeling this way. It has long been known that we can treat anxiety and panic with medication or with psychotherapy...needless to say the best approach is to combine both approaches. First, you need to find a psychiatrist...please note, I said psychiatrist, not a counselor, not a therapist, a psychiatrist who is the unique professional who can fully comprehend the medical and psychological aspects of your problem. Once you find a psychiatrist you feel good about, i.e. you feel you can trust, you feel are actually listening when you speak, it then is time to unburden yourself about your life's stresses. It is also time to begin a regimen of medication designed for anxiety and panic. The best approach is to use a calming antidepressant such as Zoloft or Lexapro along with an anti-anxiety agent. I prefer Xanax in small doses...Yes I know Xanax has become a dirty word in today's world but it sill is the quickest and most complete way to provide you with relief. Of course, it is potentially addicting but if you are going to abuse a drug you would already have done so...a wise psychiatrist will consider your potential for substance abuse and observe carefully while treating your disorder. With the benefit of medication, your disorder will likely resolve rather quickly, i.e. two months...then the serious work takes place in therapy to understand the emotions and try to maintain them under control while withdrawing the medication. Remember: (l) Psychiatrist you can trust, (2) Medication relief with antidepressant and anti-anxiety and (3) Psychotherapy to gently provide the ability to withdraw the medicine. Good Luck!

Research shows that for the treatment of "uncomplicated" depression when given to large numbers of research subjects all antidepressants are about equally as effective. That is to say, about 80% of those tested get better...however, they are not the same 80%. One antidepressant may work for person A and not person B and vice versa. The cautious and informed clinician will consider the individuals subjective complaints such as being more lethargic or more hyper, more prone to sleeping excessively or sleepless nights.... Other issues may come into play as well such as whether the person is employed and what the nature of their work is. For a presumably retired individual of age 70 or someone not working in a high energy field such as law enforcement, I find that Wellbutrin often gives patients both a positive attitude after one to two weeks, but also more energy and a boost to their real and/or perceived productivity. Prozac would be my second choice.

Yes, most definitely social anxiety can be cured....There are two basic approaches....psychotherapy (talking approaches) and psychopharmacology (medication.)

Talking therapies can include a very structured cognitive behavioral approach that loosely speaking is targeted specifically at the symptoms and which would include some introspection but mostly focus, journaling and thought restructuring.

Talking therapies can also include a more open ended psychoanalytic approach exploring the origins of the problem and attempting to recreate a more balanced approach to the initial conflicts or experiences that brought the signs and symptoms forward.

There are also behavioral approaches where relaxation techniques would be the focus of treatment, biofeedback which would be relaxation with technology.

Hypnosis is an unlikely but potential approach.

Of course then there is medication. The appropriate and cautious use of antianxiety agents, antidepressant agents or a combination of both is likely to be helpful more rapidly than the other approaches. Some will be uncomfortable with moving towards medication initially and some of course are uneasy about the use of benzodiazepines (e.g. xanax, valium, ativan or klonopin) which are controlled substances. In the right patient, however they are effective and safe but caution must be taken. Some of the calming SSRI's are helpful such as Zoloft or Lexapro.

Needless to say, if possible the best approach is a combination of the above.

The best professional is the one who has numerous arrows in their quiver and more importantly knows when one is a better choice than others and when to combine several options.

Best of luck you should be on your way to a resolution of the problem..

The real question is not what happens in this situation, but rather, why would you take antidepressants if you were not depressed? Is it an effort to get 'high"? If so, this will not happen and you won't have to ask the question again. Otherwise, a single dose of an antidepressant will have little effect other than perhaps an upset stomach or a mild headache and even those symptoms would be rare. Over time, antidepressants can also impact sexual drive and sexual performance with ejaculatory delay or absence in men and anorgasmia in women.
If you are not depressed, DON'T take antidepressants.

The answer to this question is simple yet complex...The simple answer is that a doctor can choose between two categories of treatment, psychotherapy or talking treatments or psychopharmacology or medication.

I always address three areas of approach. The first I call social engineering...this refers to things in ones life that can and should be changed...this might refer to a relationship, a job, a hobby, addiction, etc. In this category I often recommend an effort to routinize life and to add at least mild exercise such as walking or biking to a daily regimen....I will, of course, look for sources of stress and try and either avoid them or combat them with more positive thinking....stress avoidance is often but not always possible, stress management likewise is also possible in many instances and not in others. Making actual lists of stressors,defining those that can be avoided and those that can't and then devising a strategy to deal with those that cannot be avoided is often helpful.

Medications can be an quick answer but should not be the chronic answer as problems such as medication abuse and or addiction can replace the anxiety.

talking therapies; relaxation training, cognitive therapy, biofeedback or more tradition analytic/supportive therapy can also be helpful. The right answer depends on the individual...some are psychologically minded and some are not, some are fearful of medicines and some are prone to abuse medicines...the appropriate treatment ALWAYS requires a careful evaluation of the individual patient including family background, medical history and a comprehensive mental status examination after which an appropriate treatment plan can be generated.

The reason almost all physicians or healthcare providers caution against drinking when anxious is that the alcohol, especially to excess will reduce the anxiety...then the brain makes the conscious and unconscious link that the alcohol "cures" anxiety and you are off to the races....this is the pattern for many alcoholics...it appears innocuous at first and, in fact, is almost condoned by society, e.g., a young man is jilted by his girlfriend and becomes anxious and depressed and his friends invite him to "have a drink." A police officer is involved in a difficult critical incident such as a shooting, the death of a child or a horrific accident and his buddies take him to the bar on the way home to "chill out." The problem of course is that in the short run it works...but it is no different than an obese person being self conscious about their weight and eating comfort food to feel better...it begins a cycle of solving a problem while creating a larger and more difficult problem. Occasional anxiety is normal and an expected part of life...having a drink here and there can also be a positive, calming and socializing experience that rarely will lead to problems, however, using alcohol to calm anxiety, ease depression or to "cure" other mental or emotional issues is a path to more serious and dangerous behaviors. Simple answer, don't do it!

Gary M. Glass, M.D.

I would suggest that you don't ask your doctor for anxiety medication but rather that you explain to your doctor that you are suffering with anxiety. This will lead to your doctor asking critical questions about your signs and symptoms. For example, there are other conditions that masquerade as anxiety...hyperthyroidism can be experienced in part as anxiety, side effects of other medications can be experienced as anxiety. Enough said, the signs and symptoms you are experiencing are important to bring to the attention of your doctor but don't make the mistake of diagnosing yourself via internet. After your doctor fully explores your concerns he may or may not diagnose anxiety and may or may not prescribe medication. There are other treatments for anxiety which would include counseling, cognitive behavioral therapy, biofeedback and others.
Good luck...you should seek help, but let your learned doctor make the diagnosis and decide which treatment is appropriate.

Gary M. Glass, M.D.

Cognitive behavioral therapy can be extremely effective but it is not a treatment for any and all conditions. This treatment was designed initially by Aaron Beck at the University of Pennsylvania, one of the most brilliant and compassionate psychiatrists of all times and someone I had the privilege of training with.

CBT can be very effective for the treatment of anxiety or depression. Although there have been reports indicating its efficacy in other conditions I personally believe it is designed for anxiety with or without panic attacks and depression. Treatment must however ben undertaken by a professional who is well trained as a psychiatrist or psychologist and who has other tools in their treatment options. While CBT is a good and often preferred treatment for these conditions the diagnosis must be made carefully. For example, depression that is part of a Bi-Polar Disorder is not likely to respond well to CBT without also using medications. So, the first step in any situation is a careful evaluation which leads to a specific critical diagnosis and then and only then can someone select the most appropriate treatment.

I always caution individuals, "If the only tool you have is a hammer, everything looks like a nail." Make sure you seek CBT from someone well trained in mental health such as a Ph.D. psychologist or psychiatrist who can make the critical diagnosis and select CBT as the appropriate treatment because they have considered others and that is their preferred approach, NOT because that is the only arrow in their quiver.

Of course, the best remedy for stress is stress avoidance. I say that tongue in cheek but it is correct. First take an inventory in your life. There are stresses that are avoidable and others that are not avoidable. For example, if there is a friend who is nagging and demanding and inconsiderate of your needs and you find yourself going along with this person, spending time with them, etc. and this leads to stress as you really don't want to be there, this is an avoidable stress...you simply explain directly or indirectly that you cannot make plans with him/her. On the other hand a seriously ill mother, father spouse, child, etc will present stresses that can not be avoided and then you must look to stress management options.

There are many stress management and reduction options that can be done without professional help but none is right for everyone. For example, exercise, running, weight lifting, yoga, tai-chi, meditation can all be helpful but if they are not your style you cannot put a round peg in a square hole. On the other hand, self care such as soothing spa treatments, a bubble bath with candles and soft music may work for others. Yet others may find comfort in reading for pleasure with beautiful music on their headphones. Hiking, gardening, bicycling or knitting are all forms of stress management that work for some.

The key to the problem is (a) Determining the cause of the stress. (b) Determining if it is avoidable, always, sometimes or never. If it is avoidable then avoid it. If not keep reading, (c) Determine what gives you pleasure and relaxation. Actually sit down with a pad and a pen (oops, with your ipad) and make a list of those things you wish you could do and be expansive including many things. For example short term approaches could include the things I noted above; however, don;'t overlook the importance of vacations. Not everyone can take a Mediterranean cruise but most people can take an weekend camping or hiking or sitting on the beach. I think you get the picture. The problem is when you determine what works for you you must actually do it! Some things can be accomplished at home by yourself for limited funds, others require more money and some require additional people...obviously those are not going to work well for you at all times.

The best stress remedies are different for everyone, are different for different circumstances (stresses) and are not always available. Sometimes looking forward to time alone, a vacation, a good run or workout is sufficient if you cannot do it now.

Above all, it is easier to say what is NOT a good home remedy for stress...alcohol, drugs or gambling!

Good luck and if your home remedies don't work do not resist seeking professional help from a qualified psychiatrist or psychologist.

Like many illnesses, psychiatric or medical there is always an option to treat or not to treat and depending on the illness there is a risk option. With some medical problems one risks their life with psychiatric illnesses that is not often true...True Bi=Polar, meaning Bi=Polar Type I can get out of control and the individual can become flagrantly manic., This would refer to psychotic or the person may hallucinate and/or become delusional...they will have a tendency to engage in risky behaviors such as overspending money, getting involved in promiscuous sexual relationships, gambling or excessive use of drugs and alcohol. In the depressed phase there is always the risk of suicide.

So, having said that I have treated patients with talking therapy only and some have done great for a number of years, once even as much as l0 years without an episode leading me to question my original diagnosis...of course as I was beginning to doubt my diagnostic skills she spiraled into an out of control psychotic manic state and ended up involuntarily committed to a hospital...on the other hand there are also some people who cannot go for six or eight weeks without professional treatment lest they begin severely impaired.

Each individual makes their own decision but those that choose not to treat are often doing so while putting their family at considerable risk for humiliation, financial ruin or crumbling family relationships.

While I am sure that there are some that would speak to doing so the answer is no! First of all most people with psychosis cannot focus enough to be hypnotized and most will also have an element of paranoia that will rule against hypnosis or worse yet turn it into an attack that they must rally against...On the other hand for a select few it might be used as a relaxation technique but I for one would never recommend nor use it in such patients.

Anxiety like other personality traits may actually define your personality or may simply be a symptom....It is entirely treatable but if untreated for extended periods i.e. years it will not alter your personality, per se, but may encourage others to respond to you in a particular way...most often through avoidance or caretaking which rarely leads to a happy ending.

Like many things in medicine the answer is yes and no! For example, a cough can be a symptom of an allergy, a symptom of pneumonia or a symptom of lung cancer... Anger itself is not a mental disease....a cough is not on its own a symptom of pulmonary disease however repetitive episodes of serious anger can be a sign of anything from an autism spectrum disorder to bi-polar disorder or a personality disorder such as borderline personality. Context is everything in life, in medicine and in psychiatry.

Psychoanalysis can certainly help depression, but it takes a very long time and would not be the first or best approach. Supportive psychotherapy, or cognitive behavioral therapy combined with medication would be the first course of action. An analogy: an obese individual presents with hypertension. One good approach with a high likelihood of success would be diet and exercise. Expect a positive result, right, but the hypertension can cause multiple other problems in the meantime, so the appropriate approach is medication now, lifestyle changes later. So it is with depression: medication now, and if the person is introspective and has the resources (time & money) to pursue psychoanalysis, that could be helpful, but certainly not as a first-line treatment.

This is a most difficult, but unfortunately not uncommon question. First, it would be wise and helpful for you to attend Alanon meetings. This is not for the addict, but for the family members or loved ones of addicts. This will give you greater understanding of the disease and options for yourself. Coaxing is helpful, but not always effective. If he attended AA in the past, get him back; if he had a sponsor in the past, notify him or her; encourage an inpatient rehab stay or perhaps an IOP or intensive outpatient treatment program, usually three to four days per week, three hours per day. A last resort would be an intervention in which friends and family members, perhaps a religious leader, are present and approach your husband with, "I love you, but..." hopefully ending in an admission to a drug and alcohol rehab facility.
GOOD LUCK.

This is a common dilemma. When an addict seeks help from AA or NA and/or the recovery field the treatment approach is always, "work your program" and things will get better. They typically don't have the background or training to be able to evaluate and/or diagnose underlying mental health issues such as depression, anxiety, bi-polar disease, etc. If there is such an underlying problem it will go unnoticed and one will never get ahead of the addiction. On the other hand if they first find their way to a mental health professional (psychiatrist) the approach will be that you are drinking to avoid an underlying problem if we resolve the underlying problem everything will be fine...this does not address the immediate needs. Unfortunately the recovering community will rarely consider a referral to a psychiatrist as helpful and may even warn against it as they continue to resist medications as "drugs"...on the other hand, psychiatrists often don't consider the value of the twelve step programs...the appropriate and most useful approach is to go for both... a psychiatrist with experience in dealing with addictions AND the twelve step support of AA or NA

Simple answer, NO...there have been many attempts to treat and/or cure ADD/ADHD with diet but there is no scientific evidence that they are effective...We do have a treatment that works, psychostimulants are effective...yes, they can be problematic in teenagers, yes they can be controversial in some arenas but the proof is clear that judicious use of such medicines is extremely helpful in ADD/ADHD in addition be cautions that many psychiatrists and pediatricians will make a correct diagnosis of ADD/ADHD and begin the right medication but will stop before reaching maximum benefit, or they will decide not to treat the child during weekends or vacations...this is a real disease and the impact of it being not treated or not adequately treated can be severe.

A psychiatrist is a fully trained physician who has studied and had experience practicing all medical fields and then chose to specialize in psychiatry. Psychiatry is the ONLY field that blends the physical and the mental...the mind AND body experience. Psychologists are trained in emotions and therapy, but not in medical issues. As time goes on, we are finding more and more mental concerns are actually medically or chemically mediated and therefore the psychiatrist is the unique professional with the expertise to evaluate and treat.

Gary M. Glass, M.D.