Question: low magnesium levels can increase anxiety. How can I know if I am getting enough magnesium? Do you recommend that people with anxiety consider magnesium supplements?

Jill Edwards Says...:

These are good sources of magnesium and they look like good useful nutrition as well. To be sure of getting enough magnesium I would suggest that you eat a reasonable amount of these foods. It is easy to understand that magnesium is one of the substances that affects the contractability of muscles, so as anxiety often involves tension in the muscles, it will be involved in anxiety as well. Some of the ways magnesium is lost is through diabetes, diahorrea and alcoholism, so you would do well to see that the rest of your life style does not make you magnesium deficient.These are the foods:Natural Sources of MagnesiumMagnesium is widely distributed in foods. It is a part of chlorophyll in green vegetables. Cereals and vegetables normally contribute more than two thirds of the daily magnesium intake. They are found in almonds, cashews, mixed nuts, halibut, spinach, potatoes with skin, apples, figs, peaches, bananas, raisins, yogurt, wheat bran, oatmeal, whole grains, pinto beans, kidney beans, soy beans, brown rice, sunflower seeds and sesame seeds.I recommend not taking supplements, but changing your life style and eating habits. I do this because I think it also improves anxiety to be focused on new healthy ways of eating and living.Anxiety is debilitating. It is a physical state and it is often made worse by the things we think about it. So if we think anxiety will lead to illness or if we think we should not go out because of our anxiety and we follow our thoughts with behaviour, we will find the anxiety increase. We are better changing the behaviour and being as active as we can. The more exercise we have, the more we challenge the messages of our anxiety, the more likely we are to move on from it. We may have to try out new behaviours in stages, or steps a little at a time. If your anxiety is interfering with what you want to do in a serious way, then I do suggest that you get some counselling to support you in finding a new way to behave in front of it.Anxiety is also a naturally protective state which arose at a time when we felt there was something to be afraid of. You could make sure your understand the fight and flight mechanisms that were put in place, in order to preserve us from wild animals.Have a look at your thinking and try to work out which of your thinking makes you more anxious and which makes you more hopeful. Use the more hopeful strategy and get going with living as much as you can. Best wishes

Question: oh me again my medication was increased first venlafaxine from 180 to 225mg and sulpiride 200 to 600 but i went back down to 400 because i just didnt have any energy.not sure if this is making me feel scared in the morning

Jill Edwards Says...:

I have spoken in the previous answer about letting your doctor know about the change in medication and the need for some talking therapy around the intrusive thoughts.

This might however be useful to think about: It is from one of the UK NHS Trusts

Handy Guide – coming off medicines

Very few people actually want to have to have to take medicines every day, but many people do e.g. for

diabetes, high blood pressure, low thyroid, epilepsy, arthritis, Parkinson’s Disease and heart problems.

They take them to help control symptoms or problems that then help them get on with their life. You need

to decide what are the pros and cons of taking a medicine and the risks of becoming unwell again.

This is not a definitive guide and it's not even really very scientific. These are ideas gathered together over

many years, but should help you have a meaningful discussion with your health professional.

Why might you want or need to stop taking a medicine?

 Side effects

 Concern about long-term side effects

 Fear of addiction or dependence

 Not then being able to take something else that interacts with it e.g. pain killers

 The medicine is no longer needed – your life may have changed

 Other illness affecting the medicine

 Doesn’t help or work

 You’re too unwell to remember to take a medicine regularly or reliably

 The medicine might be making things worse

 You need to prioritise another medicine

 You’re taking too many medicines already

 You’re pregnant or breast-feeding

 Cost (e.g. the prescription tax in England)

 The medicine has been withdrawn, not available in UK or no one will prescribe it for you

 Don’t like the pain of an injection or having to go somewhere for a regular injection.

What are the advantages of stopping a medicine?

 No side effects (short-term or long-term)

 No need to collect medicines

 No stress of trying to remember to take medicines every day

 Being able to drive (e.g. if the medicine is making you feel sleepy)

 Relationships might improve

 Less stigma

 Feeling better in yourself because you’re managing without medicines

 You can find out whether it was working or not – if you get ill again at least you’ll know it was working

 Saves the cost of the prescriptions.

What are the disadvantages of stopping a medicine?

 Risk of becoming ill again and what might then happen e.g.:

o Effects on your relationships – family and friends

o Effects on your work (either getting or keeping a job)

o Effects on you e.g. the distress of getting unwell again, the need to start treatment again. This

might actually end up with you needing more medicines than you would have had if you’d carried

on

 Possibility of going into hospital or see the crisis team again

 Annoying your GP if you get ill again

 Getting some withdrawal or discontinuation effects

www.nsft.nhs.uk and click "Learn more about medication". Medicine

helplines 01603-421212(Nfk), 01473-329141(Sfk)

How can you work out how to make a decision?

Have a look at this table and tick the boxes for the nearest answer for you:

Stability (how stable you have been recently)

I have been: □

Stable for many

years with no

symptoms

□

Stable for a couple

of years or just had

a few wobbles

□

Stable for about a

year

□ Unwell in the last year

How often I

have been

unwell:

□

I’ve only been ill

once before

□

I’ve been ill a few

times before □

I’ve been ill quite

a few times

and/or had quite a

few wobbles

□

I’ve been ill lots before

and/or they may be

getting closer together

Severity (how badly ill you have been)

In the past

when I’ve been

unwell:

□

I’ve been managed

and supported by

my GP

□

I’ve been managed

as an out-patient □

I’ve been an inpatient or seen

the crisis team

□

I’ve nearly been

sectioned or have

been sectioned

Support (from family, friends, carers)

I have: □

Good family/carer

support □

Reasonable

family/carer support □

Some family/carer

support □

Very little or no

family/carer support

Relapses (getting unwell again)

If I start to get

unwell again a

relapse seems

to come on:

□

slowly over several

months □

gradually over

several weeks □

quickly over a

week or so □

quickly over a few

days

If I start to get

unwell again: □ I notice early on □

I notice but often

not how badly □

I don’t really

notice until it’s got

quite bad

□

I don’t notice until too

late

If I start to get

unwell again: □

Other people notice

early on and say so □

Other people notice

and don’t say but

would if I asked

□

Other people don’t

really notice or

wouldn’t say

□

Other people don’t

notice at all

If I start to get

unwell again: □

I listen to and

believe other

people and will

seek help early on

□

I hear other people

and might be willing

seek help early on

□

I don’t listen to

what other people

think

□

I don’t listen to what

other people think and

wouldn’t want any

help anyway

Medicines (the one(s) you are taking for the mental health problem)

Long-term side

effects: □

I get side effects

and find them hard

to cope with

□

I get some side

effects which I can

just about cope with

□

I get some side

effects but I can

cope with them

□

I don’t seem to get

any side effects at all

Do medicines

help? □

Very sure

medicines don’t

help me

□

Not sure if

medicines help me □

I’m fairly sure I

started to get

better within a

month or so of the

medicines starting

□

I started to get better

within a month or so

of when the medicines

started

If I restart

medicines: □

I get better in a

few weeks □

I get better in a few

months □

it takes many

months to start to

feel better

□

it might take many

months or longer to

start to get better

Consequences (what would happen if you became unwell again)

If I get ill

again: □

my GP should be

able to help me □

I’ll probably end up

as an out-patient □

I’ll probably end

up with the crisis

team

□

I’ll probably end up as

an in-patient

If I get ill again

it would: □

really only affect

me □

affect me and my

family □

affect me, my

family and lots of

others

□

Be a disaster for me

and my family, friends

and/or work

Risk factors (see the list on the C website for the symptoms you are taking medicines for)

I’ve looked at

the list and: □

I haven’t got any

extra risk factors □

I have a few minor

risk factors □

I have a few risk

factors □

I’ve got lots of extra

risk factors

Number of ticks

Multiply by 1 2 3 4

Scores a b c d

Your relapse risk score is: a + b + c + d =

www.nsft.nhs.uk and click "Learn more about medication". Medicine

helplines 01603-421212(Nfk), 01473-329141(Sfk)

Question: Hi i am diagnosed with agoraphobia and OCD intrusive thoughts about children which stops me from going out mostly.Around 8 months ago i stopped smoking cannabis since then ive had depression and my ocd has got worse.Im waking up feeling scared i dont know why i feel scared would you know.

Jill Edwards Says...:

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Inbox

Hi i am diagnosed with agoraphobia and OCD intrusive thoughts about children which stops me from going out mostly.Around 8 months ago i stopped smoking cannabis since then ive had depression and my ocd has got worse.Im waking up feeling scared i dont know why i feel scared would you know.

oh me again my medication was increased first venlafaxine from 180 to 225mg and sulpiride 200 to 600 but i went back down to 400 because i just didnt have any energy.not sure if this is making me feel scared in the morning

Firstly, let me commend you for stopping smoking cannabis. It tends to increase fears and will have made your situation worse. It is unlikely to have caused depression. Given the range of difficulties you are facing it is pretty certain there are other events which have brought that about.

You rightly say there are two potential sources of your fear, one is having the intrusive thoughts about children and the other is the alteration in the level of medication you are using. It would therefore be good to let your doctor know you have reduced the dose as the amount you are taking is less than usually prescribed. Changing the amount of medication can cause withdrawal which would increase your fear and anxiety.

In my small experience of intrusive thoughts, I am beginning to understand that someone who has intrusive thoughts, has been someone who has had their behaviour very much controlled over a time and that would fit in with the OCD you are experiencing. Without the heavy control, there would be no need for intrusive thoughts.

I think you need to find some "talkling therapy" around these issues, so that you can begin to negotiate some different patterns safely. You might need to think about what your parents wanted for you and how much you were able to do what they wanted you to do. Some parents have pretty high standards and it is difficult for their children to be good enough to be OK. It is however very important that you do get some personal support so that you feel safe in dealing with these issues.

Well done for keeping away from the cannabis. I do hope you will find some local support in moving on from a place where you do not feel safe to go about. Speak again to your doctor about the need for some talking support.

Best wishes