Page 1 of 2 1 2 LastLast
Results 1 to 15 of 30
  1. #1
    metamorphosis's Avatar
    Forum Addiction:

    Join Date
    Jan 2013
    Gender
    Male
    Location
    Colorado
    Posts
    392
    Mentioned
    0 Post(s)

    Adding Abilify 2.5mg for depression and anxiety

    I am adding a low dose of Abilify, as an adjunct to the lexapro. I am usually against AP's or AAP's for anxiety disorders but Abilify is unique, and shows promise at low doses (1-5mg)for depression and possibly anxiety.
    So, it is only day 2 and I am taking it during the day. Some have side effects of akathisia and somnolence. I haven't had either yet but its early on. It is also one of the atypical's with lowest sie effects. It's dose a can be varied depending on the mental disorder with depression and anxiety being on the low end. It's mechanism of action should really make it a third generation anti-psychotic.

    It is a DA2 partial agonist. So , basically it is a dopamine mediator and stabilizer



    They use it's scientific name in the graph, aripiprazole. It's easy to see how Abilify levels it out. While other anti psychotics fluctuate.
    It is also a 5HT1a agonist and a 5HT2a antagonist.
    This is from a very informative CNS paper, the link below:

    Aripiprazole, an effective SGA for the treatment of schizophrenia, has a unique pharmacologic profile in that it functions through partial agonism at D2/3 receptors.1 Aripiprazole does not induce extrapyramidal symptoms, an increase in prolactin, weight gain, type II diabetes, or sedation. Instead of blocking D2/3receptors as is the case with other antipsychotics, aripiprazole acts as a partial agonist at dopamine receptors. In vitro assay shows aripiprazole to be less potent as a receptor agonist than dopamine (range 30% to 80. In behavioral tests, aripiprazole blocks apomorphine-induced climbing behavior (mediated by dopamine receptors) at low dose without inducing catalepsy, unlike typical antipsychotics which do produce catalepsy. This suggests that aripiprazole’s primary mechanism of action of partial agonism at D2/3 receptors has successfully differentiated antipsychotic efficacy and the adverse effects associated with typical antipsychotics.
    Aripiprazole is a partial agonist of 5-HT1A receptors at therapeutic concentrations as well. Clozapine and the SGAs ziprasidone and quetiapine also exhibit 5-HT1A partial agonism at clinically effective doses. This distinguishes aripiprazole and these other atypical antipsychotics from first-generation antipsychotics, and suggests they may have particular utility in ameliorating the affective components of psychosis, such as anxiety and negative symptoms of schizophrenia. It appears that the distinctive therapeutic profiles of SGAs are related to partial agonism at dopamine and serotonin receptors.

    http://www.primarypsychiatry.com/aspx/articledetail.aspx?articleid=1149

    5HT1a agonists have been used to treat depression and anxiety.

    This from Wiki:
    Some of the atypical antipsychotics like aripiprazole[21] are also partial agonists at the 5-HT1A receptor and are sometimes used in low doses as augmentations to standard antidepressants like the selective serotonin reuptake inhibitors (SSRIs).[

    5-HT1A receptor activation has been shown to increase dopamine release in the medial prefrontal cortex, striatum, andhippocampus, and may be useful for improving the symptoms of schizophrenia and Parkinson's disease.[33][34] As mentioned above, some of the atypical antipsychotics are 5-HT1A receptor partial agonists, and this property has been shown to enhance their clinical efficacy.[33][35][36] Enhancement of dopamine release in these areas may also play a major role in the antidepressant and anxiolytic effects seen upon postsynaptic activation of the 5-HT1A receptor.[37][38]

    http://en.wikipedia.org/wiki/5-HT1A_receptor

    Here is a very short and succient article by a pdoc:
    They use it's scientific name in the graph, aripiprazole. It's easy to see how Abilify levels it out. While other anti psychotics fluctuate.
    It is also a 5HT1a agonist and a 5HT2a antagonist.
    This is from a very informative CNS paper, the link below:
    http://thoughtbroadcast.com/2011/09/13/how-abilify-works-and-why-it-matters/

    [QUOTE] So, Abilify is a potent antagonist at the dopamine D2 and D3, serotonin 5-HT1A and 5-HT2A receptors, a moderate one at dopamine D4, serotonin 5-HT2C and 5-HT7, alpha1-adrenergic and histamine H1 receptors, and even does a little serotonin reuptake inhibition.
    Like Seroquel, Geodon, and Clozaril (clozapine), Abilify is a partial agonist at serotonin 5-HT1A receptors, but what makes it special (for now) is also being a partial agonist at the dopamine D2 receptors. Blocking 5-HT2A, and having a positive effect on 5-HT1A and D2 are responsible for fewer movement disorder and prolactin problems, and all those agitating/antsy/activating side effects.[/QUOTE
    ]
    http://www.crazymeds.us/pmwiki/pmwiki.php/Meds/Abilify

    Here is Crazy Meds. 2 part paper with plenty of links and their down to earth writing style If you want to see studies and/or do research. This is it!
    http://www.crazymeds.us/pmwiki/pmwik...veRundownPart1
    http://www.crazymeds.us/pmwiki/pmwik...veRundownPart2
    So,I will try to keep this updated as time goes on or I find more useful information to share.
    Also, please respond and leave comments or add to this!
    I would also like to hear from Abilify users past and present!

    Here is a long research paper by CANMAT abot medication stratigies for anxixiety and co-morbid disorders, publishes in 2012.
    https://www.aacp.com/pdf%2F0212%2F0212ACP_Schaffer.pdf


  2. #2
    UltraShy's Avatar
    Forum Addiction:

    Join Date
    Nov 2012
    Gender
    Male
    Location
    Milwaukee, WI
    Posts
    81
    Mentioned
    0 Post(s)
    I do love Abilify ads on TV: "Two out a three patients on an antidepressant still experience depressive symptoms" (...so ask your doc about adding Abiify to your wonder drug that's failed to do wonders, 'cause two wonder drugs will surely do better than one wonder drug alone, or at least it will do wonders for our bottom line here at Big Pharma, Inc.).

    I love how the ads effectively say SSRIs fail or are less than fully effective for most patients. It's big pharma bashing big pharma.

  3. #3
    metamorphosis's Avatar
    Forum Addiction:

    Join Date
    Jan 2013
    Gender
    Male
    Location
    Colorado
    Posts
    392
    Mentioned
    0 Post(s)
    ^

    Of course these companies want to make money. WTF else would they be doing this for. It's like any other industry. There are bureaucratic issues but people can't lose hope. New medications are coming out. It may take time but they are.

  4. #4
    Equinox's Avatar
    Forum Addiction:

    Join Date
    Oct 2012
    Gender
    Male
    Location
    Australia
    Posts
    377
    Mentioned
    0 Post(s)
    Good luck, a bit more info on how Abilify may work:

    Mechanisms of Action

    Aripiprazole is what is known as a partial agonist (stimulator) of dopamine D1, D2, and D3 receptors, in contrast to all other typical and atypical antipsychotics, which are full antagonists (blockers) of dopamine receptors. The partial agonism means that when aripiprazole binds to the receptor, it activates the receptor only about 20%, but never any more, no matter how high the dose or blood levels of the drug are.

    Since aripiprazole “sits” on the receptor, any degree of excess dopamine that may occur in mania or schizophrenia cannot reach these dopamine receptors, so aripiprazole effectively produces an 80% functional blockade. The 20% stimulation (agonism) of dopamine D2 receptors is sufficient to make aripiprazole the only typical or atypical antipsychotic that significantly lowers prolactin levels. Aripiprazole is also a partial agonist at serotonin 5HT1A receptors, like the drug buspirone (Buspar), which is known for its antidepressant and antianxiety effects. Aripiprazole is a full blocker of 5HT2A receptors, which might also contribute to its antidepressant effects, and (like the antidepressant Trazodone) its ability to increases the deeper phases of sleep known as slow wave sleep.
    Aripiprazole (Abilify), the Atypical Atypical Antipsychotic

  5. #5
    Ironman's Avatar
    Forum Addiction:

    Join Date
    Aug 2012
    Gender
    Male
    Location
    USA
    Posts
    2,243
    Mentioned
    21 Post(s)
    I was prescribed it, but I don't remember it having any effect on me for some reason.

  6. #6
    metamorphosis's Avatar
    Forum Addiction:

    Join Date
    Jan 2013
    Gender
    Male
    Location
    Colorado
    Posts
    392
    Mentioned
    0 Post(s)
    Quote Ironman View Post
    I was prescribed it, but I don't remember it having any effect on me for some reason.
    If you can remember,
    How long were you on it?
    What dose?

  7. #7
    JaneDoe's Avatar My So-Called Self
    Forum Addiction:

    Join Date
    Feb 2013
    Gender
    Female
    Location
    U.S.
    Posts
    87
    Mentioned
    0 Post(s)
    I love Abilify. It has saved my life in more ways than one. Not only did it end my feelings of suicide, it has greatly helped with my anxiety. It is also the only thing, including therapy, that has ever helped with my social anxiety. It began working within one week of taking it. I was put on it last Spring, around May or so. For the first time since I was a kid, I was able to go to my family's Thanksgiving and Christmas functions. I usually spend the holidays alone out of fear. I also spent a great deal of time at the lake during the summer, which was something I have been unable to do since moving near the lake 5 years ago. I was too afraid to go before. I've done a lot of new things since being put on the Abilify, things I couldn't have done before. No matter what anyone says about it, I'll always be grateful to it and to whomever created it.

    I take 5mg's, btw. I started out with either .5 or 1 mg.

  8. #8
    metamorphosis's Avatar
    Forum Addiction:

    Join Date
    Jan 2013
    Gender
    Male
    Location
    Colorado
    Posts
    392
    Mentioned
    0 Post(s)
    Quote JaneDoe View Post
    I love Abilify. It has saved my life in more ways than one. Not only did it end my feelings of suicide, it has greatly helped with my anxiety. It is also the only thing, including therapy, that has ever helped with my social anxiety. It began working within one week of taking it. I was put on it last Spring, around May or so. For the first time since I was a kid, I was able to go to my family's Thanksgiving and Christmas functions. I usually spend the holidays alone out of fear. I also spent a great deal of time at the lake during the summer, which was something I have been unable to do since moving near the lake 5 years ago. I was too afraid to go before. I've done a lot of new things since being put on the Abilify, things I couldn't have done before. No matter what anyone says about it, I'll always be grateful to it and to whomever created it

    I take 5mg's, btw. I started out with either .5 or 1 mg.
    I am happy it has worked so well for you. Are you taking it as a mono-thearpy or do you take other meds with it? Also have you experienced any weight gain and/or carb cravings? Any other side-effects?

    I am inpatient and am starting at 2.5mg. I might not increase it at all. We'll see, hopefully it will work well with the 10mg lexapro. I think it will.

  9. #9
    JaneDoe's Avatar My So-Called Self
    Forum Addiction:

    Join Date
    Feb 2013
    Gender
    Female
    Location
    U.S.
    Posts
    87
    Mentioned
    0 Post(s)
    Quote metamorphosis View Post
    I am happy it has worked so well for you. Are you taking it as a mono-thearpy or do you take other meds with it? Also have you experienced any weight gain and/or carb cravings? Any other side-effects?

    I am inpatient and am starting at 2.5mg. I might not increase it at all. We'll see, hopefully it will work well with the 10mg lexapro. I think it will.
    Thanks I hope it works well for you also I take it with 20mg's of Celexa. And yes, unfortunately, it has affected my weight as well as my blood sugar levels. Luckily, my blood sugar levels used to be low and all it did was make them normal. But that can be a problem for those who have normal blood sugar levels and begin taking Abilify. It can even cause diabetes in severe cases. I can't say it makes me crave carbs though, because I always crave carbs lol. It does make losing weight very difficult though. I have a lot of weight to lose and lost 65lbs, but since it has acclimated to my system, I have stopped losing weight, despite trying and eating healthier.

    besides affecting weight and blood sugar levels, the only other side effect I've noticed is teeth grinding. I usually do it while asleep, but notice it sometimes while I am awake as well.

  10. #10
    metamorphosis's Avatar
    Forum Addiction:

    Join Date
    Jan 2013
    Gender
    Male
    Location
    Colorado
    Posts
    392
    Mentioned
    0 Post(s)
    Yeah, I've heard people say, even at 5mg that their appetite increased. As far as diabetes and is concerned.Taking it at a low dose, people go as high as 15-30mg tops. So the effects should be reduced at such a low level. Anti-psychotics and even atypicals are known to cause weight gain, contribute to diabetes, and possible T.D. but that is at a regular dose for Bi-polar 1 mania or mixed states or schizoid. conditions. As far as blood sugar is concerned. I am at a normal level, at least I was 1 1/2 yrs ago,lol. My appetite has increased but I attribute that to the Lyrica, pregabalin . That med. will eat you out of house and home!

  11. #11
    JaneDoe's Avatar My So-Called Self
    Forum Addiction:

    Join Date
    Feb 2013
    Gender
    Female
    Location
    U.S.
    Posts
    87
    Mentioned
    0 Post(s)
    Quote metamorphosis View Post
    Yeah, I've heard people say, even at 5mg that their appetite increased. As far as diabetes and is concerned.Taking it at a low dose, people go as high as 15-30mg tops. So the effects should be reduced at such a low level. Anti-psychotics and even atypicals are known to cause weight gain, contribute to diabetes, and possible T.D. but that is at a regular dose for Bi-polar 1 mania or mixed states or schizoid. conditions. As far as blood sugar is concerned. I am at a normal level, at least I was 1 1/2 yrs ago,lol. My appetite has increased but I attribute that to the Lyrica, pregabalin . That med. will eat you out of house and home!
    My appetite never increased, but I stopped losing weight and started gaining even though my diet stayed the same.

  12. #12
    metamorphosis's Avatar
    Forum Addiction:

    Join Date
    Jan 2013
    Gender
    Male
    Location
    Colorado
    Posts
    392
    Mentioned
    0 Post(s)
    Here is a study Abilify + Zoloft with positive results. It seems like a tolerable SSRI with Abilify's partial DA2 agonism and it's 5HT actions can possibly be a very good combo. Note in the study the experimental group was only on 2.5mg Abilify.

    Adjunctive low-dose aripiprazole with standard-dose sertraline in treating fresh major depressive disorder: a randomized, double-blind, controlled study.

    Lin CH, Lin SH, Jang FL.
    Source

    Department of Psychiatry, Chi-Mei Medical Center, Tainan City, Taiwan.

    Abstract

    OBJECTIVES:

    Second-generation (atypical) antipsychotics have been accepted as an adjunctive medication in patients with treatment-resistant depression. This clinical trial evaluated the efficacy and safety of low-dose aripiprazole combined with regular-dose sertraline for acute major depressive episode in non-treatment-resistant depression outpatients.
    METHODS:

    The study patients were 18- to 65-year-old outpatients fulfilling the criteria of major depressive disorder in Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. The patients were randomly assigned to 2 groups: one with sertraline 50 mg/d plus aripiprazole 2.5 mg/d and the other with sertraline 50 mg/d plus placebo. After baseline assessment, the subjects were followed up at weeks 1, 2, 4, 6, and 10. The primary efficacy was the score change of the 17-item Hamilton Rating Scale for Depression (HAM-D17), and secondary efficacies were the score of Short Form 36 Health Survey, Clinical Global Impressions-Severity, and Clinical Global Impressions-Improvement. This study also monitored patients for movement disorder using Simpson-Angus Scale and Barnes Akathisia Rating Scale.
    RESULTS:

    Twenty-one patients were assigned to the aripiprazole group and 20 to the placebo group. Because of high dropout rate, only data of the first 4 weeks were analyzed. The aripiprazole group exhibited significantly better efficacy than the placebo group in mean total score changes of HAM-D17 from the baseline to weeks 1, 2, and 4. The item "work and social activities" of HAM-D17 showed significant improvement at week 2, and the item "somatic symptoms (GI)" showed significant improvement at week 1. The aripiprazole group exhibited significant improvement in "social role function" section of Short Form 36 Health Survey at week 4. The mean total score of Clinical Global Impressions-Severity showed marginally significant improvement in the aripiprazole group. In Clinical Global Impressions-Improvement, patients in the aripiprazole group had scores of less than 2 (much improved) at weeks 2 and 4, and the scores of the placebo group were greater than 2.4 (indicating a minimal improvement). No patients had akathisia during the trial period.
    CONCLUSIONS:

    The primitive data showed that adjunctive low-dose aripiprazole could augment the efficacy of regular-dose sertraline in fresh major depressive disorder. A large-scale study is needed to confirm this finding.

  13. #13
    metamorphosis's Avatar
    Forum Addiction:

    Join Date
    Jan 2013
    Gender
    Male
    Location
    Colorado
    Posts
    392
    Mentioned
    0 Post(s)
    Another study that shows Abilify's therapeutic effects for depression and anxiety!

    J Clin Psychiatry. 2008 Dec;69(12):1928-36. Epub 2008 Dec 2.
    Adjunctive aripiprazole in major depressive disorder: analysis of efficacy and safety in patients with anxious and atypical features.
    Trivedi MH, Thase ME, Fava M, Nelson CJ, Yang H, Qi Y, Tran QV, Pikalov A, Carlson BX, Marcus RN, Berman RM.
    Source
    UT Southwestern Medical Center at Dallas, 5323 Harry Hines Blvd., Dallas, TX 75390-9119, USA. Madhukar.Trivedi@UTSouthwestern.edu
    Abstract
    OBJECTIVE:
    To evaluate the efficacy of adjunctive aripiprazole to standard antidepressant therapy (ADT) for patients with DSM-IV major depressive disorder with anxious/atypical features at baseline.

    METHOD:
    Data from 2 identical 14-week studies (an 8-week prospective ADT treatment phase and a 6-week randomized, double-blind phase) of aripiprazole augmentation were pooled to evaluate efficacy and safety in the 2 subgroups. The primary efficacy endpoint was mean change in Montgomery-Asberg Depression Rating Scale (MADRS) total score from end of ADT treatment to end of randomized treatment (last observation carried forward). Anxious depression was defined by a Hamilton Rating Scale for Depression anxiety/somatization factor score ≥ 7, and atypical depression was defined by previously described criteria on the Inventory of Depressive Symptomatology-Self-Report. Both anxious and atypical subtypes were defined based on symptoms at entry into prospective ADT (week 0). Patients were enrolled between June 2004 and April 2006 in one study and from September 2004 to December 2006 in the other (total randomized population, N = 742; anxious/nonanxious population, N = 740; atypical/nonatypical population, N = 737).

    RESULTS:
    Completion rates were between 84% and 90% and comparable across all subgroups, with low discontinuations due to adverse events. Patients receiving adjunctive aripiprazole demonstrated significantly greater improvement in MADRS total score versus patients receiving adjunctive placebo, starting at week 1 or week 2 and continuing through to endpoint (anxious: -8.72 vs. -6.17, p ≤ .001; nonanxious: -8.61 vs. -4.97, p ≤ .001; atypical: -9.31 vs. -5.15, p ≤ .001; nonatypical: -8.08 vs. -6.22, p < .05). At endpoint, remission rates were also significantly higher with adjunctive aripiprazole versus adjunctive placebo (p < .05) in all subgroups. Treatment emergent adverse event profile was similar in all subgroups and comparable to the total population. Reporting of akathisia and weight gain on aripiprazole treatment did not differ between subgroups.

    CONCLUSION:
    Adjunctive aripiprazole is an effective treatment for patients with major depression presenting with either anxious or atypical features.

  14. #14
    Equinox's Avatar
    Forum Addiction:

    Join Date
    Oct 2012
    Gender
    Male
    Location
    Australia
    Posts
    377
    Mentioned
    0 Post(s)
    Quote metamorphosis View Post
    Yeah, I've heard people say, even at 5mg that their appetite increased. As far as diabetes and is concerned.Taking it at a low dose, people go as high as 15-30mg tops. So the effects should be reduced at such a low level. Anti-psychotics and even atypicals are known to cause weight gain, contribute to diabetes, and possible T.D. but that is at a regular dose for Bi-polar 1 mania or mixed states or schizoid. conditions. As far as blood sugar is concerned. I am at a normal level, at least I was 1 1/2 yrs ago,lol. My appetite has increased but I attribute that to the Lyrica, pregabalin . That med. will eat you out of house and home!
    There are D2 receptors in the pancreas which usually mediate inhibition of insulin secretion, atypical antipsychotics can mess with these and that's thought to be atleast one reason why blood sugar levels go up and so on.

    Dopamine D2-like Receptors Are Expressed in Pancreatic Beta Cells and Mediate Inhibition of Insulin Secretion

    GLUT5 expression may also play a role (atleast in Zyprexas case):

    Zyprexa's Weight Gain: Does What You Eat Matter More Than How Much?

    In this case Zyprexa is thought to make your body use fat, not carbs, as fuel, however this was less the case with abilify and others:

    In the fed state, Zyprexa and Clozaril do a massive conversion to fat utilization, Risperdal a medium, and sulpiride minimal conversion. Geodon has a lesser effect than Zyprexa, and appears to normalize; Abilify and Haldol seem close to normal.
    http://thelastpsychiatrist.com/2010/...a_and_fat.html

  15. #15
    metamorphosis's Avatar
    Forum Addiction:

    Join Date
    Jan 2013
    Gender
    Male
    Location
    Colorado
    Posts
    392
    Mentioned
    0 Post(s)
    Good point, but I have a couple of studies that show Abilify is least not nearly as potentially harmful.When compared to other AP/APPs
    I'll just throw this one out. It is a long paper but it contains a lot of graphs, tables and important info. about this issue.

    A Case Series: Evaluation of the Metabolic Safety of Aripiprazole
    A Case Series: Evaluation of the Metabolic Safety of Aripiprazole
    During treatment with aripiprazole, there was a decrease in all glucose and insulin values in the OGTT (figure 1). Improvements were already present at week 6. At 3 months, changes from baseline were significant for all glucose values as well as glycated hemoglobin (HbA1c) (table 2). For insulin, the change was only significant on fasting insulin values as well as on HOMA-IR, a measure of insulin resistance.
    The study included 7 patients with confirmed treatment-emergent diabetes on their previous antipsychotic treatment (2 identified with fasting glucose measurements and 5 meeting criteria for diabetes at 120 minutes in the OGTT) (1 patient on first-generation antipsychotics, 1 on clozapine, 1 on olanzapine, 2 on quetiapine, and 2 on risperidone). At baseline, there were also 6 patients with repeated glucose abnormalities prior to the switch (2 patients with IFG, 1 on amisulpride, and 1 on clozapine; 3 with IGT [2 on amisulpride and 1 on risperidone]; 1 with IFG/IGT on a first-generation antipsychotic). The switch to aripiprazole was done shortly after the confirmation of the glucose abnormalities.

    All newly detected cases of diabetes were reversed at 3 months follow-up. Six patients had a completely normal OGTT and 1 patient still had IGT. All fasting abnormalities at baseline were absent at 3 months follow-up (table 3). Prediabetic abnormalities dropped from 19.4% at baseline to 3.2% at endpoint (P < 0.001). All patients with confirmed prediabetic abnormalities (IFG and/or IGT) at baseline had normal glucose values in the OGTT at endpoint.
    Prolactin levels dropped significantly during aripiprazole treatment from 54.9 ng/ml (SD 60.3, min 3–max 249) to 11.2 ng/ml (SD 9.9, min 0.6–max 50.9) (F = 15.38 P < .001). Changes were most pronounced in patients with high baseline prolactin levels (treatment with either amisulpride or risperidone, F = 30.4, P < 0.001).
    The beneficial changes in metabolic parameters were most pronounced in the group with glucose abnormalities, while glucose and lipid parameters were practically stable in the patients group without metabolic abnormalities at baseline. The changes in metabolic parameters were similar in patients on monotherapy of aripiprazole in comparison to patients in whom aripiprazole was added to the existing antipsychotic treatment. This observation suggests that the amelioration of metabolic parameters after the introduction of aripiprazole may not only be explained by the interruption of the previous antipsychotic treatment.

    In 7 patients with recently detected diabetes that emerged during the course of treatment with antipsychotics, diabetes was reversible after a switch to aripiprazole. In another 6 patients with confirmed prediabetic abnormalities, these abnormalities were also reversed after a switch to aripiprazole. Remarkably, this improvement occurred rather quickly, within 3 months.43
    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2526132/

    There's plenty of more information in this paper, that points toward Abilify's side-effects as actually the opposite of other AP's by lowering glucose levels in hyperglycemic, prediabetic, and diabetic patients. Also, it was shown to lower prolactin levels. All of this shows how Abilify is different than the first and second generation AP's. It is in fact, a third generation AP, though it could also be although some psycopharmacologists and pdocs. believe it should be in another class altogether

Page 1 of 2 1 2 LastLast
Made with <3
Anxiety Space is not a replacement for a fully qualified doctor.