Psychiatrist needed for anxiety disorder

[Kalorymetr]

Hi,

I saw the mental health resource topic, but I look for a doctor recommendation and not a hospital.

I suffer from social anxiety disorder. Nothing life breaking, but it started to be annoying after I had changed jobs recently and I am afraid it will spiral into something worse.

Could you please recommend good English speaking doctor that could help me? I also do therapy, but thats online as I rather do it in my native language.

 

Don't want to start a new topic so I will also ask here as its  related. Is Allerax-FC same as Atarax?

 

Thanks in advance,

I really appreciate it!

[impulse]

What part of Thailand?

[OneMoreFarang]

I think you should look for a psychologist and not a psychiatrist 

[mark5335]

10 hours ago, Kalorymetr said:

 

Don't want to start a new topic so I will also ask here as its  related. Is Allerax-FC same as Atarax?

 

They are the same. However, Atarax is no longer available here so my pharmacy provides Drozine instead (each are hydroxyzine hydrochloride 25 mg).

[Kalorymetr]

Yes, forgot to say - Bangkok.

 

2 hours ago, OneMoreFarang said:

I think you should look for a psychologist and not a psychiatrist 

I do have a therapy set up already, just need meds in case of emergency.

[CrunchWrapSupreme]

I've been using hydroxyzine for quite some time. I just ask for that at the pharmacy, and they give me whatever brand they have. Every one I've tried has had it, even out in the Issan boonies.

 

Only one pharmacist in BKK has said to me, "Careful! Addiction!", and he was quite right. It's mostly helpful as a sleep aid, as it makes you quite drowsy, to hopefully wake up feeling refreshed and with less anxiety in the morning. But take it too often and you'll find you can't sleep without it. Thus, I limit my consumption to particularly stressful days, a few times a month.

 

My wife likes it occasionally too, however doesn't like how it makes her too sleepy, so that it becomes difficult waking up. Typical dosage is 10 mg. When it's hard to wake up, cut it in half. There had previously been pills available in larger dosages, which no longer are for this reason.

Edited January 6, 2021 by CrunchWrapSupreme

[Sheryl]

1 hour ago, CrunchWrapSupreme said:

I've been using hydroxyzine for quite some time. I just ask for that at the pharmacy, and they give me whatever brand they have. Every one I've tried has had it, even out in the Issan boonies.

 

Only one pharmacist in BKK has said to me, "Careful! Addiction!", and he was quite right. It's mostly helpful as a sleep aid, as it makes you quite drowsy, to hopefully wake up feeling refreshed and with less anxiety in the morning. But take it too often and you'll find you can't sleep without it. Thus, I limit my consumption to particularly stressful days, a few times a month.

 

My wife likes it occasionally too, however doesn't like how it makes her too sleepy, so that it becomes difficult waking up. Typical dosage is 10 mg. When it's hard to wake up, cut it in half. There had previously been pills available in larger dosages, which no longer are for this reason.

Hydroxyzine is still availabe in 25 mg dosage, \several brands. It is nto addictive, but there is a lack of data on safety of long term use.

 

10 mg is the antihistamine dosage. When used as a tranquilizer, for s anxiety, the dosage is  50 - 100 mg. It will usually not cause sleepiness if the person taking it is very anxious.    For sleep, the normal dosage is 25 - 100 mg. As it has a long half life,  there may be grogginess in the morning especially if not taken long enough before morning.

 

Thais are extraordinarily oversensitive to any type of sedation and their response to sedating medications is very, very different from that of most people. Most  Westerners would not find the antihistamine dose of 10mg sufficient for sleep and certainly not for anxiety.

 

 

 

 

[Sheryl]

12 hours ago, Kalorymetr said:

Hi,

I saw the mental health resource topic, but I look for a doctor recommendation and not a hospital.

I suffer from social anxiety disorder. Nothing life breaking, but it started to be annoying after I had changed jobs recently and I am afraid it will spiral into something worse.

Could you please recommend good English speaking doctor that could help me? I also do therapy, but thats online as I rather do it in my native language.

 

Don't want to start a new topic so I will also ask here as its  related. Is Allerax-FC same as Atarax?

 

Thanks in advance,

I really appreciate it!

 

If I understand correctly you want a doctor for prescribing meds and already have a psychologist.

 

For this in Bangkok I recommend

 

https://www.bumrungrad.com/en/doctors/Suttiporn-Janenawasin

 

Feedback on her has been very positive

[EvetsKram]

4 hours ago, OneMoreFarang said:

I think you should look for a psychologist and not a psychiatrist 

Totally agree,  I spent my life working in mental health & this is not for a psychiatrist

[Lacessit]

21 minutes ago, Sheryl said:

 

Thais are extraordinarily oversensitive to any type of sedation and their response to sedating medications is very, very different from that of most people. Most  Westerners would not find the antihistamine dose of 10mg sufficient for sleep and certainly not for anxiety.

 

 

 

 

Are there any hypotheses as to why that should be, Sheryl? Thais also use spices, particularly chili, in quantities that would sear the hide of an elephant.

[Sheryl]

2 minutes ago, Lacessit said:

Are there any hypotheses as to why that should be, Sheryl? Thais also use spices, particularly chili, in quantities that would sear the hide of an elephant.

 

No.

 

But it is a real issue for foreigners when being prescribed sedatives or opiate pain killers. Thai doctors ignore international dosage recommendations and base their prescribing on how Thais respond and tend to consider that the norm. (Doctors who have worked in the West will usually be an exception). .

[connda]

If you've been self-medicating with a any sedative such as Atarax or a benzodiapine you're setting yourself up for anxiety issues caused by the drug itself.  Taking sedative long-term is a dragon chasing it's tail and burning it in the process.  You need increasing levels of drug over time to maintain control of anxiety and without the drug then the anxiety you're feeling has a lot to do with a lack of the drug.  The initial underlying problem just becomes compounded.

From my own experience with my wife who was prescribed sedatives for menopause I can attest - Thai doctors are great at getting you hooked on the sedative drugs but they are not good at developing plans to ween and taper you off of those drugs.

I spent the better part of a year with the help of a local government doctor (for legal prescriptions of lorazapam and diazapam) and using the Ashton Manual protocol to taper my wife off of lorazapam.  Her original doctors would have just kept her hooked because they showed no interest and no knowledge of tapering protocols.  Her initial anxiety problems were due to menopause.  But after a couple of years her problem was being addicted to benzodiazipines.  Today she's free of those drugs and she will never take them again.  The menopausal anxiety have never resurfaced.
 

If in the Chiang Mai area look through the directory at Suanprung Psychiatric Hospital.  A number of the doctors run private clinics in the immediate area.  I can't speak for anywhere else.

 

[OneMoreFarang]

19 minutes ago, Sheryl said:

23 minutes ago, Lacessit said:

Are there any hypotheses as to why that should be, Sheryl? Thais also use spices, particularly chili, in quantities that would sear the hide of an elephant.

 

No.

 

But it is a real issue for foreigners when being prescribed sedatives or opiate pain killers. Thai doctors ignore international dosage recommendations and base their prescribing on how Thais respond and tend to consider that the norm. (Doctors who have worked in the West will usually be an exception). .

I am sure you have a lot of experience and I don't want to contradict you. But...

 

When my Thai gf buys medicine in a pharmacy and they tell her to take two tablets a day I can be sure she takes at least 4. When I ask her why: Everybody does it...

 

Normally I avoid any medicine. If I take it at all then I try to take as little as possible. And it seems a little is often good enough for me. I guess it is related to the fact that I avoid taking medicine and my body is not used to lots of medicine. Maybe many other Westerners take regularly a lot of medicine and that is why they need higher dosage - just IMHO.

[Sheryl]

29 minutes ago, connda said:

If you've been self-medicating with a any sedative such as Atarax or a benzodiapine you're setting yourself up for anxiety issues caused by the drug itself.  Taking sedative long-term is a dragon chasing it's tail and burning it in the process.  You need increasing levels of drug over time to maintain control of anxiety and without the drug then the anxiety you're feeling has a lot to do with a lack of the drug.  The initial underlying problem just becomes compounded.

From my own experience with my wife who was prescribed sedatives for menopause I can attest - Thai doctors are great at getting you hooked on the sedative drugs but they are not good at developing plans to ween and taper you off of those drugs.

I spent the better part of a year with the help of a local government doctor (for legal prescriptions of lorazapam and diazapam) and using the Ashton Manual protocol to taper my wife off of lorazapam.  Her original doctors would have just kept her hooked because they showed no interest and no knowledge of tapering protocols.  Her initial anxiety problems were due to menopause.  But after a couple of years her problem was being addicted to benzodiazipines.  Today she's free of those drugs and she will never take them again.  The menopausal anxiety have never resurfaced.
 

If in the Chiang Mai area look through the directory at Suanprung Psychiatric Hospital.  A number of the doctors run private clinics in the immediate area.  I can't speak for anywhere else.

 

 

What you say is true for benzos but Atarax (hydroxyzine - actually no longer available in Atarax brand, but other brands still are) is nto a benzo and is not addictive.

 

I do  agree that anxiety related to menopause is better managed with approporiate hormonal therapy than sedatives. And that diffuse anxiety which is not related to a specific, acute event is often best managed non-pharmaceutically if at all possible.

 

But sometimes it is not, and there are also acute anxieties due to specific events that may require temporary use of medication.  in which case use of a non-addictive drug is the best approach. Use of benzos is very tricky and definitely risks exactly what you have described.

 

 

 

[Neeranam]

4 hours ago, OneMoreFarang said:

I think you should look for a psychologist and not a psychiatrist 

The issue could be that a psycholgist can't prescribe drugs.

 

There's a good place on Sukhumvit soi 43, called PSI.

[Lacessit]

2 hours ago, Sheryl said:

 

No.

 

But it is a real issue for foreigners when being prescribed sedatives or opiate pain killers. Thai doctors ignore international dosage recommendations and base their prescribing on how Thais respond and tend to consider that the norm. (Doctors who have worked in the West will usually be an exception). .

Useful information, thanks. I'll bear it in mind.

Perhaps Thai doctors are thinking in terms of a 50 kg Thai, instead of a 100 kg foreigner.

[Sheryl]

1 hour ago, Lacessit said:

Useful information, thanks. I'll bear it in mind.

Perhaps Thai doctors are thinking in terms of a 50 kg Thai, instead of a 100 kg foreigner.

 

it is not just a matter of body weight.

 

Cambodians, who are if anything thinner than Thais, re4act the way Westerners do and need Western (international) dosages. I have seen this be a big problem for Cambodians hospitalized here with cancer etc. The Thai "min doses" of pain killer ]are vastly insufficient. But they do work for Thais.

 

Thais neurotransmitters/neural wiring is such that they are very, very easy to sedate (Sitting upright in a small seat on an overcrowded night bus pouts most of them instantly asleep!). Conversely they have a high tolerance for stimulants. There is a reason why most drug abuse here involves stimulants not downers. Westerners tend to be the reverse.

 

 

[Lacessit]

1 hour ago, Sheryl said:

 

it is not just a matter of body weight.

 

Cambodians, who are if anything thinner than Thais, re4act the way Westerners do and need Western (international) dosages. I have seen this be a big problem for Cambodians hospitalized here with cancer etc. The Thai "min doses" of pain killer ]are vastly insufficient. But they do work for Thais.

 

Thais neurotransmitters/neural wiring is such that they are very, very easy to sedate (Sitting upright in a small seat on an overcrowded night bus pouts most of them instantly asleep!). Conversely they have a high tolerance for stimulants. There is a reason why most drug abuse here involves stimulants not downers. Westerners tend to be the reverse.

 

 

Fascinating stuff, probably quite a few Ph.D. theses in it. Like the Scandinavian tolerance for alcohol. My GF regularly naps in the car when we are on a long trip. Apologies for getting off topic, bad habit of mine.

[connda]

4 hours ago, Sheryl said:

 

it is not just a matter of body weight.

 

Cambodians, who are if anything thinner than Thais, re4act the way Westerners do and need Western (international) dosages. I have seen this be a big problem for Cambodians hospitalized here with cancer etc. The Thai "min doses" of pain killer ]are vastly insufficient. But they do work for Thais.

 

Thais neurotransmitters/neural wiring is such that they are very, very easy to sedate (Sitting upright in a small seat on an overcrowded night bus pouts most of them instantly asleep!). Conversely they have a high tolerance for stimulants. There is a reason why most drug abuse here involves stimulants not downers. Westerners tend to be the reverse.

 

Yeah I've gone around and around and around with Thai dentists under-anaesthetizing me and in the process have gone through about 10 dentists in as many years.  I have two dentists that seem to be able to get it right now.
What I find amazing is that doctors with medical degrees and years of scientific study can't grasp that the human biology isn't a one size fits all mechanism and that pain thresholds vary along a statistical bell curve as well as human response to drugs like opioids.  That fact seems to be totally lost on most Thai doctors.  So I assume most had rather low grades in their statistics classes.  Or just don't give a damn.
As the old saying goes, what do you call someone who graduated at the bottom of their medical school class - "Doctor." 

Edited January 6, 2021 by connda

[Kalorymetr]

Hi all,

First of all. Thank you very much for your answers. I really do appreciate it.

I have never taken any sedative in my life and I do not intend to unless absolutely necessary. I bought hydroxyzine, because I feel better when I have it on me and that is all. I would never take any beznos or other highly addictive substances, because it's simply not needed with my mild anxiety disorder.

 

I however think, I might need low doses of SSRI(to be decided by physiatrist), until the therapy starts working, because I simply cannot do my job as good as I would have and I think all the stress induced by my SAD is slowly killing me.

Edited January 9, 2021 by Kalorymetr
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