Posted by Rick on August 24, 2001, at 16:23:30
In reply to Re: Xanax and panic, Rick, posted by Thrud on August 24, 2001, at 2:30:28
> > You shouldn't be too quick to dump the Xanax without giving yourself time to adjust to the side effects, and perhaps even finding that you can lower the dosage without losing benefit.
>
> True. Could you give me some idea how long I should wait? Especially with regards to the sexual dysfunction effects I am getting with Xanax.I’d try to give it a minimum four weeks to see if there’s any sign of improvement in the side effects.
Forgive me if you’ve already addressed this earlier in thread, but when you were on Remeron did you try augmentation strategies to restore sexual function? I recently read a study of augmentation with Wellbutrin (as I recall) that showed no significant restoration of sexual function vs. placebo. They both "worked" in something like 30% of the subjects. But augmenation to restore sexual function has helped many – and even where it might be a placebo effect, who cares so long as it helps. There have been many reports of success with low-dose Wellbutrin augmentation, BuSpar, OTC Yohobimide (sp) (but avoid if you have high blood pressure), Ginkgo, Viagra, dopamine agonists, and many more. While these agents are usually used to reverse *AD* sexual function, I know they’ve helped people with SD induced by other kinds of meds as well.
When I took a low doses (so no food restrictions) of the MAOI-B selegiline (aka Eldepryl, deprenyl, Junex (sp), etc) with Klonopin (and nothing else except a beta blocker), it actually led to *too much* sexual stimulation (+ cognitive enhancement). Selegiline is well known as a strong libido and performance enhancer. But it is very stimulating overall, in a way that mildly reduced my social phobia benefits (unlike $$$Provigil/Alertec/modafinil). But in retrospect and based on what I’ve heard since , only *very* tiny doses are needed for steady-state stimulation...as little as 2.5mg three times a week. My own “low dose” of seligiline was 5-10 mg/day, so in retrospect maybe I could’ve had the benefits without added anxiety if I had taken less. I’d definitely keep Selegiline augmentation (not solo!!!!!) in mind as something to consider if benzo sexual dysfunstion remains – but don’t use it with an AD!
> Used it [moclobemide] ages ago (for a about a year). Not very good for my panic, still left me with some significant sexual dysfunction. (getting the idea I am a hardcase ???)
No pun intended, right? I might not be quite as prone to that side effect as you, but after six weeks of Nardil, I was completely anorgasmic until three weeks after I discontinued it. I was naive about psychotropics back then, and that side effect sure threw me for a loop! High dose Neurontin also gave me problems, but nothing like Nardil.
>
> > On the OTC front, some panic specialists find that Taurine supplementation is all that is needed for some patients. (Taurine is an amino acid, one of the ingredients in Red Bull -- not that I'm suggesting you use Red Bull!)
> >
> What Taurine about co-morbid depression?Frankly, this sure wouldn’t be my fisrt choice anyway. But as you mentioned in your post, perhaps treating the panic, without adding sexual dysfunction, just might alleviate your depression. Even if it didn’t, you might be able to take a low enough dose of an AD to avoid the sexual dysfunction.
>
>
> > Finally, several Israeli studies found that mega-doses of Inositol (a B vitamin) work as well as SSRI's in panic (and OCD), without side effects. See Medline.
>
> I am very interested in this stuff. I think I will buy some and see what happens.
>Yes, may be worth a try, but be prepared to down a lot of capsules, or to buy the powdered form to mix with liquids. The studies of Inositol use 12-18g/day, and the OTC capsules usually top out at 500 mg. I’ve seen a few 1000 mg capsules advertised on the net.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11386498&dopt=Abstract
> Any indication how long I must endure before the "bad" list before it subsides? I am under the impression that as part of the tolerance-dependence process the bad list tends to subside.
> Any personal experiences from yourself or aquaintances on this "running in" period would be most greatly appreciate it.Definitely, tolerance usually develops to the side effects. Maybe not always 100% tolerance, but pretty close in most cases. Changing the regimen, even at the same daily dose, can definitely have an effect. As long as I never take more than one dose of Klonopin in a four hour period, there is no fatigue. But if I take two doses closer together -- even small ones -- it will make me a little sleepy. BTW, The few times I've taken it at bedtime (long ago), I would always wake up groggy and actually be MORE prone to anxiety for the next 24 hrs.
I’m not sure our reactions are similar. The first benzo I took for my severe social phobia was as-needed Xanax. I didn't like it -- made me feel like I had been hit over the head with a hammer -- but perhaps I would have adjusted had I taken it ongoing. After two years, I have a bunch left that I intended to use for insomnia. But since I started taking regular Klonopin (almost always *before* 3 pm), I've almost forgotten what insomnia is.
I started Klonopin at 3 mg for the social phobia (sometimes I had near-panic attacks and one or two full blown – but not panic disorder). It wasn’t long that I found out that less actually worked better for me, and eliminated most of the modest fatigue I had had at 3 mg. Most of the fatigue was gone within weeks. But it takes longer for lots of people! Again, give it a min four weeks, and perhaps carefully experiment with reducing the dose a bit, with your doctor’s approval. (As you know, the longer you’ve been on it – especially for a short-acting benzo like Xanax – the more gradually you have to taper off. Some people don’t have this problem, especially if they don’t go down to zero, but many do, especially when starting with a high dose and after having been on the med for a month or two.) BTW, whicle I need to once again acknowledge that stats do not equal individuals, the mfr of Klonopin found no increased benefit in panic disorder for 3mg/day vs. 2mg.
I'm sure this is old territory to you, but:
-- Do you drink much? Benzos essentially double
the impact of alcohol, and more than a modest
amount of booze can easily worsen depression
even if it makes you feel better initially.
-- I was long skeptical that caffeine could
have any significant effect on my SP, but
I cut way back I found I had fewer "blips" in
the effectiveness of the weekends. I still
drink full-strength coffee and full-strength
Coke on weekends, though.You may have already tried these suggestions, but you should go to the full-search page on this site, and you’ll come up with tons of personal experiences. Or just browse. And post again if you don’t get more responses to this. Also, if you haven’t already done so, visit and/or post and/or search through Usenet, especially alt.anxiety.panic. (You can do this all free through http://groups.google.com )
Rick
poster:Rick
thread:76063
URL: http://www.dr-bob.org/babble/20010822/msgs/76264.html