Published on 12, July, 2020
Hi, my name is Chris and I'm an Asperger's sufferer and the father of a high-functioning Asperger's boy, well , young adult now. My son has been suffering with depression and anxiety, and has been having severe panic attacks. Mix this lot up with Asperger's and he has has severe breakdowns that he, and we, are failing to manage. He has been prescribed Daizepam in the past, amongst other things, and it has been very effective in bringing him out of the irrational, delusional state and allowing us to talk him down. Nothing else has worked with him, including mindfulness, meditation, and the suchlike. Once he's broken down he's virtually unreachable. Unfortunately, his GP has ramped down his Diazepam dosage/prescription to 3 tablets a month (from 7)and is citing addiction. Has anyone else had experience with Diazepam and Asperger's? As it been effective? Any GP reluctance to prescribe?
Many thanks Kitsune - I think that this conversation with his GP has to happen sooner than later. Not sure why other options haven't been offered though. Tom has said that he's open to alternatives, but does need something; the GP has offered no alternative.
Diazepam is usually only prescribed for one month due to addiction problems. The dosage is usually reduced over a period of time to reduce withdrawal symptoms.
In trying to reduce my anxiety levels I learnt about the different types, and the difference between fear and anxiety. In fear the danger is unambiguous and imminent. Pathological fear is seen in specific phobias.
In anxiety the threat perceived is less certain. Excessive anxiety results in GAD (General Anxiety Disorder) and panic disorder. Panic attacks are sometimes described models of acute fear. Panic disorder, including apprehension of further attacks, is considered better modelled by anxiety.
It is important - IMHO - to understand the difference between fear and anxiety and different models of anxiety as the neural circuitry involved is, whilst not completely dissociable - distinct in some respects. This has ramifications when trying to propose effective treatment.
Chronic activation - which is characterised as activation not due to a specific imminent threat - involves heightened amygdala - dorsomedial prefrontal cortex (dmPFC). Exaggerated activation in response to an unpredictable threat involves the insula. This is quite a simplification of neural circuitry involved. The diagram below is more comprehensive.
There is considerable overlap of these neural circuits with other difficulties such as depression and some components of executive function, such as working memory and motivation, both often dysfunctional in autistic individuals. So any treatment that targets these areas and their connectivity to visceral and bodily regions affected by anxiety can have added benefits.
Panic attacks induce the physical symptoms of increased heartbeat, fast shallow breathing and perspiration. It is unfortunate that your son has found meditation to be of no benefit. The ability to control my breath, and subsequently, heart rate, has been the biggest factor in helping me move froward. It does take practice and application. I know these can be difficult. I use a visualisation process. I place a small statue in front of me. I study it intensely for a few minutes and then close my eyes and try to visualise it in all its detail. I keep at it until I can recall it accurately. I then turn it 90 degrees and do the same. Eventually, I am able to see it in my mind’s eye as if I was viewing it in a VR application. Obviously I don’t do this all in one sitting, I keep at it for once or twice a day until I achieve my objective. Whilst I do this I practise my abdominal breathing. This means I am sort of meditating at the same time. Increasing one’s working memory is useful as it is an important component of executive function and consequently motivation. If one sits properly while doing this, it can act as a good way into meditation. Another way to learn proper breathing techniques is to join a yoga or Qigong or Tai chi class that embraces teaching the correct breathing during the exercises. Physical exercise helps a lot.
Another way to combat anxiety is by stimulating the vagus nerve: https://www.psychologytoday.com/gb/blog/the-athletes-way/201905/longer-exhalations-are-easy-way-hack-your-vagus-nerve. There is a gadget that has recently come on the market to stimulate the vagus nerve: https://www.psychologytoday.com/hk/blog/the-athletes-way/201711/will-stress-busting-vagus-nerve-gadgetry-be-game-changer Serotonin is manufactured in the gut and the vagus nerve is thought to facilitate the transport of serotonin to the brain via the gut-brain axis.
Anti-depressants are certainly available. I take a small dose of venlafaxine to supplement my meditation and exercises. But obviously, your Son would need to talk to his GP about the options available.
If you would like any further information, don't hesitate to ask. I know how debilitating this condition can be. Graham
Hi, I’m aware that there are a number of other medications that can be used to calm someone down when they are having a meltdown. Maybe he could talk with his GP about alternative options if his GP is not keen on him using the diazepam?
Hi Loreen - I'm not too good with these forums either! More the mechanisms of them than anything. Thanks for replying, it's a great help. We suggested regular health checks/blood tests but they rejected the suggestion and won't prescribe Quetiepine. He's not overweight, and is now attending the gym (in the quieter times). He had been getting 7 Diazepam (5mg) per month, but they reduced that to 3. He, and we, have been trying to get him help from the mental health support team, both primary and secondary care, since February of this year, but to no avail. He's been in crisis many times, but he's dealt with and dismissed without any follow-up unfortunately. I know they have limited resources, but if he had support, then he wouldn't end up being treated under crisis! Again, thanks so much for your help.
Hi, not good at replying on here, but i wanted to say that quetiapine is a good medication for anxiety and the meltdowns associated with aspergers.
I take 200mg extended release at bedtime, which helps me to sleep, and keeps me calmer for day to day living. I also have 5 diazapam per month on repeat prescription I use these for unexpected happenings which panic me enough to cause a meltdown Without these on standby i would go into crisis and need extra mental health care.
All medications have side effects. I have regular blood tests to make sure i stay healthy . I think the diabetes may occur if there is weight gain, so i am careful to maintain a healthy diet .
I would ask to see the community mental health team. They are much more likely to be sympathetic to your sons mental health needs.
Hope this helps.
He's on anti-depressants, but they have little effect, and he was on Quetiepine, but they've withdrawn that citing possible diabetes on long-term use. He was on them for about 3 months; 2 tablets a night. Nothing else has been offered.
surely there are other medications ?