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Dr. Bob is Robert Hsiung, MD,
[email protected]Shown: posts 26 to 50 of 58. Go back in thread:
Posted by Mark on December 4, 1999, at 14:21:18
In reply to Re: social anxiety - benzos - to Elizabeth, posted by Jane on December 4, 1999, at 11:51:45
I think that benzos are not the best choice. Although they may releive some physical symptoms for some people, such as rapid heartbeat etc, they don't provide the more complete change in brain chemistry and change in outlook that SSRIs provide, and I hope what MAOIs can provide.
Posted by Rick on December 4, 1999, at 16:56:21
In reply to Re: social anxiety - benzos - back to Rick., posted by Louise on December 4, 1999, at 11:19:09
> It's silly to say that just because a benzo is longer lasting that it's less likely to cause dependency.
Did I say that? I can't find the word "dependency" anywhere in my post. I thought we were discussing the potential for and severity of withdrawal symptoms. I guess you are implicity -- and incorrectly, I would submit -- implying that dependency always leads to severe withdrawal symptoms upon discontinuation. Actually, it sounds like we *agree* that dependency is not a bad thing if it is theraputic and safe for the body. At the risk of citing an overused -- but very true -- point, one would not ask a diabetic to give up his or her insulin or medication because he or she has become dependent on it.
Looks like a marathon thread developing here, but I'll personally stop here and say Elizabeth's post was a model of logic and reason.
Rick
Posted by Louise on December 4, 1999, at 17:48:14
In reply to Re: social anxiety - benzos, posted by Mark on December 4, 1999, at 14:21:18
Mark,
This may be true for some people but not for all. I apparently am med sensitive to all SSRIs and even the newer SRNIs. My situation is that I'm not depressed; I just have general anxiety disorder which can lead to agoraphobia if left untreated. I've tried Prozac, Zoloft, BuSpar, Celexa, and now Effexor XR. For some reason my body has strange reactions to these meds. For instance, I developed severe rashes on Zoloft and BuSpar. I'm currently trying Effexor XR, but after only 4 days I've developed tinnitus and some nausea on this drug. I've even had bad side effects on the benzo, Klonopin.
No one wants to be dependent on any medication. However, sometimes you have to choose between what works vs. what doesn't, i.e., a functional life vs. a life of anxiety and agoraphobia. It's a no brainer for me.
Louise
> I think that benzos are not the best choice. Although they may releive some physical symptoms for some people, such as rapid heartbeat etc, they don't provide the more complete change in brain chemistry and change in outlook that SSRIs provide, and I hope what MAOIs can provide.
Posted by GS on December 4, 1999, at 17:54:37
In reply to Re: social anxiety - benzos - back to Louise., posted by Rick on December 4, 1999, at 16:56:21
> Looks like a marathon thread developing here, but I'll personally stop here and say Elizabeth's post was a model of logic and reason.
>
> Rick
***********************************************
Bravo to Rick and Elizabeth too!GS
************************************************
Posted by saint james on December 4, 1999, at 19:25:20
In reply to Re: social anxiety - benzos - back to Rick., posted by Louise on December 4, 1999, at 11:19:09
> Rick,
>
> It's silly to say that just because a benzo is longer lasting that it's less likely to cause dependency. Any benzo will eventually cause dependency if taken continually for several weeks.
>James here....
No it is not silly, I think. Longer acting ones taper the dose sloewly so there is less w/d. Xanax is short acting and tends to be more addictive because of this. Addiction to benzo has no negative health effects, as long as your doc will continue to prescribe.
j
Posted by Louise on December 4, 1999, at 20:09:21
In reply to Re: social anxiety - benzos - back to Rick., posted by saint james on December 4, 1999, at 19:25:20
James,
I disagree ... withdrawal is withdrawal. Have you ever completely weaned off Klonopin? Or have you ever gone from Klonopin to Xanax or Ativan? Just curious.
Louise
> > Rick,
> >
> > It's silly to say that just because a benzo is longer lasting that it's less likely to cause dependency. Any benzo will eventually cause dependency if taken continually for several weeks.
> >
>
> James here....
>
> No it is not silly, I think. Longer acting ones taper the dose sloewly so there is less w/d. Xanax is short acting and tends to be more addictive because of this. Addiction to benzo has no negative health effects, as long as your doc will continue to prescribe.
>
> j
Posted by saint james on December 4, 1999, at 23:54:26
In reply to Re: social anxiety - benzos - to James, posted by Louise on December 4, 1999, at 20:09:21
> James,
>
> I disagree ... withdrawal is withdrawal. Have you ever completely weaned off Klonopin? Or have you ever gone from Klonopin to Xanax or Ativan? Just curious.
>
> Louise
James here.....I take atavin as needed with no problems. When I was in retail during christmas I took 3 mgs atavin daily for 4 months and got off it smoothly
using slow reduction of dose.There is a big difference in W/D in an agent (xanax) leaves to body quickly (a few hours with
amount of agent in blood decreasing quickly ) Klonipin leaves the blood over 24-48 hrs, so the decrease is gradual. This is why Klonipin is often used to get someone off Xanax ( amoung the benzos is considered the most addictive, due to its short life it produces euphora quickly and then a few hrs later it is gone.) Once a day dosing covers you all day. You are chasing w/d all day with a short acting agent as you taper the dose, with a long acting agent you can dose 1X a day and then slowly reduce the dose over months. This makes for a steady state of benzo in the body, instead of peaks and valleys. You are never going to beat addiction if several times a day you start to feel funny as the benzo level drops.In general my feeling is that there are some of us who need scheduled (adictive) meds to function so leave us alone, dammit ! I take Dexadrine and now some cronic pain people who need their morphine or fentanyl to function. Another friend has a generalized anxiety disorder and has taken Xanax for years, always the same dose. Her doc has made it clear he will perscribe for as long as she needs it. Yes she is phycically dependent on Xanax, but she needs it to function normally. It's a no brainer.
j
Posted by Louise on December 5, 1999, at 8:03:29
In reply to Re: social anxiety - benzos - to James, posted by saint james on December 4, 1999, at 23:54:26
James,
Just as I suspected ... you've never tried Klonopin, nor have you withdrawn from it. Geez, I'm not trying to pick a fight, but why would a pdoc give a patient a stronger benzo like Klonopin to help with withdrawal from Xanax? And I've taken Xanax for 3 years and I've yet to experience the "euphoria" that you describe, and Ativan has about the same half-life as Xanax. And I did wean off Xanax for over a year, and have only recently gotten back on it.
I'm not against Klonopin if it works for you or anybody else, but saying that taking it is better than another benzo for withdrawal purposes is not true. I've tried both, and the only thing that helps with withdrawal is very, VERY slow tapering of the drug, as pointed out in Elizabeth's post.
Please, James, no insults. You obviously haven't read all my posts. Thank you.
Louise :-)
> > James,
> >
> > I disagree ... withdrawal is withdrawal. Have you ever completely weaned off Klonopin? Or have you ever gone from Klonopin to Xanax or Ativan? Just curious.
> >
> > Louise
>
>
> James here.....
>
> I take atavin as needed with no problems. When I was in retail during christmas I took 3 mgs atavin daily for 4 months and got off it smoothly
> using slow reduction of dose.
>
> There is a big difference in W/D in an agent (xanax) leaves to body quickly (a few hours with
> amount of agent in blood decreasing quickly ) Klonipin leaves the blood over 24-48 hrs, so the decrease is gradual. This is why Klonipin is often used to get someone off Xanax ( amoung the benzos is considered the most addictive, due to its short life it produces euphora quickly and then a few hrs later it is gone.) Once a day dosing covers you all day. You are chasing w/d all day with a short acting agent as you taper the dose, with a long acting agent you can dose 1X a day and then slowly reduce the dose over months. This makes for a steady state of benzo in the body, instead of peaks and valleys. You are never going to beat addiction if several times a day you start to feel funny as the benzo level drops.
>
> In general my feeling is that there are some of us who need scheduled (adictive) meds to function so leave us alone, dammit ! I take Dexadrine and now some cronic pain people who need their morphine or fentanyl to function. Another friend has a generalized anxiety disorder and has taken Xanax for years, always the same dose. Her doc has made it clear he will perscribe for as long as she needs it. Yes she is phycically dependent on Xanax, but she needs it to function normally. It's a no brainer.
>
> j
Posted by saint james on December 5, 1999, at 13:36:27
In reply to Re: social anxiety - benzos , posted by Louise on December 5, 1999, at 8:03:29
> James,
>
> Just as I suspected ... you've never tried Klonopin, nor have you withdrawn from it. Geez, I'm not trying to pick a fight, but why would a pdoc give a patient a stronger benzo like Klonopin to help with withdrawal from XanaxJames here....
All I can say is that using a longer acting benzo to get off of a shorter one is a common practice that is well excepted. It also makes sense to me. Take a look at Bob's tips and tricks section or else where on the net about benzo dependence.
I too am not trying to fight. I have no problem with agreeing to disagree and I am always intrested in other peoples views.
j
Posted by doug on December 5, 1999, at 15:54:12
In reply to Re: social anxiety - benzos , posted by Louise on December 5, 1999, at 8:03:29
>I've taken Xanax for 3 years and I've yet to experience the "euphoria" that you describe
Louise,
I have been prescribed Xanax to take for social phobia for anticipated situations : weddings, presentations, etc. and have found that a 1.25 mg dose about an hr. before the situation/event definitely does give me a slightly euphoric/relaxing, take the edge off type of feeling that almost totally alleviates the stress and nervousness that would have normally accompanied these type situations. I suspect there is a dosage level that would produce these effects in you (of course I'm just speaking only from my experience).
Doug
Posted by Adam on December 5, 1999, at 16:52:51
In reply to Re: social anxiety - benzos , posted by doug on December 5, 1999, at 15:54:12
Benzos are useful.
One good reason: It's one of the few things I (and other's like me) could take in
combination with an MAOI to treat anxiety and insomnia simultaneously.As for abuse potential, lorazepam makes me feel wonderful. I unabeshedly admit that
I love it. I have the same bottle of lor. that I had when I was discharged from the
hospital in Jan. of this year. Half of the pills are still there. Despite its appeal
I feel no compulsion to use it. I suspect the same is true of many others.
Posted by doug on December 5, 1999, at 17:11:58
In reply to Re: social anxiety - benzos , posted by Adam on December 5, 1999, at 16:52:51
Yes I'm the same way. I rarely use the Xanax. Maybe once a month, because the anticipated events for which I use it are infrequent. I have never thought of taking it for just the euphoric feeling because of the addiction potential and potential for needing more and more to produce the same effect. My quest is to find a medication I can take daily which can work for the unanticipated situations which occur much more frequently.
Posted by Louise on December 5, 1999, at 17:54:44
In reply to Re: social anxiety - benzos , posted by doug on December 5, 1999, at 15:54:12
Doug,
I'm aware of the relaxing effect of Xanax, but I'd hardly describe it as "euphoria", although 1.25 mg. is a lot to take all at once. I also had that same relaxing feeling when I took Klonopin too, so I think it's the benzo effect, not the Xanax effect.
Louise
> >I've taken Xanax for 3 years and I've yet to experience the "euphoria" that you describe
> Louise,
> I have been prescribed Xanax to take for social phobia for anticipated situations : weddings, presentations, etc. and have found that a 1.25 mg dose about an hr. before the situation/event definitely does give me a slightly euphoric/relaxing, take the edge off type of feeling that almost totally alleviates the stress and nervousness that would have normally accompanied these type situations. I suspect there is a dosage level that would produce these effects in you (of course I'm just speaking only from my experience).
> Doug
Posted by Louise on December 5, 1999, at 18:03:57
In reply to Re: social anxiety - benzos , posted by saint james on December 5, 1999, at 13:36:27
James,
I've heard of pdocs giving patients Valium to wean off of Klonopin, but I've never heard of giving Klonopin to wean off of Xanax. Since I've taken both meds, when you've tried Klonopin and have successfully withdrawn from it, then please come back and tell me about your experience. Until then, I've nothing further to say on this subject.
Louise
> > James,
> >
> > Just as I suspected ... you've never tried Klonopin, nor have you withdrawn from it. Geez, I'm not trying to pick a fight, but why would a pdoc give a patient a stronger benzo like Klonopin to help with withdrawal from Xanax
>
> James here....
>
> All I can say is that using a longer acting benzo to get off of a shorter one is a common practice that is well excepted. It also makes sense to me. Take a look at Bob's tips and tricks section or else where on the net about benzo dependence.
>
> I too am not trying to fight. I have no problem with agreeing to disagree and I am always intrested in other peoples views.
>
> j
Posted by GS on December 5, 1999, at 19:12:40
In reply to Re: social anxiety - benzos - to James, posted by Louise on December 5, 1999, at 18:03:57
> > James here....
> >
> > All I can say is that using a longer acting benzo to get off of a shorter one is a common practice that is well excepted. It also makes sense to me. Take a look at Bob's tips and tricks section or else where on the net about benzo dependence.
*************************************************
This is the standard form of easing withdrawl from the shorter acting benzos...to take longer acting ones to slow the exit of this type of medicine...a time honored practice and good sound medicine. If there are doctors prescribing Valium to get off of klonopin, they've either got it backwards, are just plain wrong (doctors are occasionally), or are trying to accomplish something else altogether - other than what is being described here.
GS
**************************************************
Posted by Louise on December 5, 1999, at 19:32:17
In reply to Re: social anxiety - benzos - to James and Louise, posted by GS on December 5, 1999, at 19:12:40
GS,
Here's the best info on the net about getting off benzos. I did it, my pdoc recommends it, Dr. Shipko of the PDI recommends it, and it's the best way to withdraw from benzos (Xanax included) because it works. Take care.
http://lexington-on-line.com/naf_xanax.html
Louise
*************************************************
> This is the standard form of easing withdrawl from the shorter acting benzos...to take longer acting ones to slow the exit of this type of medicine...a time honored practice and good sound medicine. If there are doctors prescribing Valium to get off of klonopin, they've either got it backwards, are just plain wrong (doctors are occasionally), or are trying to accomplish something else altogether - other than what is being described here.
> GS
> **************************************************
Posted by Phil on December 5, 1999, at 20:13:41
In reply to Re: social anxiety - benzos - to Anybody, posted by Louise on December 5, 1999, at 19:32:17
Louise,
If you do a search on PubMed..Xanax withdrawal, you may see that there are tons of abstracts supporting the use of Clonazepam to withdraw from Xanax.
Not trying to heat up the battle here. Just pointing out some research suggesting that saint james is right.Phil
Posted by Louise on December 5, 1999, at 20:21:33
In reply to Re: social anxiety - benzos - to Anybody, posted by Phil on December 5, 1999, at 20:13:41
Phil,
I think having taken both meds that I'm a little better qualified than James to give advice on this subject. And I've done quite a bit of research on this, too. However, I agree to disagree. Peace.
Louise
> Louise,
>
> If you do a search on PubMed..Xanax withdrawal, you may see that there are tons of abstracts supporting the use of Clonazepam to withdraw from Xanax.
> Not trying to heat up the battle here. Just pointing out some research suggesting that saint james is right.
>
> Phil
Posted by GS on December 5, 1999, at 21:00:28
In reply to Re: social anxiety - benzos - to Anybody, posted by Louise on December 5, 1999, at 20:21:33
> Phil,
>
> I think having taken both meds that I'm a little better qualified than James to give advice on this subject. And I've done quite a bit of research on this, too. However, I agree to disagree. Peace.
>
> Louise
>
>
> > Louise,
> >
> > If you do a search on PubMed..Xanax withdrawal, you may see that there are tons of abstracts supporting the use of Clonazepam to withdraw from Xanax.
> > Not trying to heat up the battle here. Just pointing out some research suggesting that saint james is right.
> >
> > Phil
**************************************************
There really isn't any disagreement here as I see it. Very gradual withdrawl is the answer whether it be done purely as Louise's reference article discusses or by way of using a longer half-life benzo to accomplish the same task.
Perhaps what Louise is trying to tell us is that the specific benzo klonopin (for whatever reason) didn't make her feel well in withdrawl like the other benzo - xanax - so she decided to withdraw purely with that xanax. Makes sense.
I know that I don't feel as well on other benzos that I've tried and slow withdrawl has been a little more severe feeling than with the same slow withdrawl process using lorazepam for instance (my benzo of choice).
GS
**************************************************
Posted by Elizabeth on December 6, 1999, at 1:14:00
In reply to Re: social anxiety - benzos , posted by Louise on December 5, 1999, at 17:54:44
> I'm aware of the relaxing effect of Xanax, but I'd hardly describe it as "euphoria", although 1.25 mg. is a lot to take all at once.
For the record, I take 2mg of Xanax p.r.n. to halt a panic attack. Also have the option of taking less for general anxiety. I've had the same bottle of 15 2mg tabs for 5 months, I think there are about 10 left.
Posted by Louise on December 6, 1999, at 17:44:56
In reply to benzo doses (was Re: social anxiety - benzos), posted by Elizabeth on December 6, 1999, at 1:14:00
Elizabeth,
If I took that much Xanax all at once I'd be terribly drowsy (if not asleep), but I'm glad that works for you. I tried taking Xanax PRN, but I developed severe anxiety and agoraphobia.
By the time a panic situation were to develop, it would be too late for me to take Xanax. My pdoc advised that because of an embalance in my brain, Xanax only works for me when I have a steady amount built up in my system. Although I take Xanax everyday, I have reduced my daily dose from 3 mg. to 2 mg. per day by taking glutamine and taurine supplements. Since I can't take Klonopin, I'm considering changing to Ativan, although someone suggested to me on another Board that Ativan is not as strong as Xanax, even though they believe it is more sedating.
Louise
> > I'm aware of the relaxing effect of Xanax, but I'd hardly describe it as "euphoria", although 1.25 mg. is a lot to take all at once.
>
> For the record, I take 2mg of Xanax p.r.n. to halt a panic attack. Also have the option of taking less for general anxiety. I've had the same bottle of 15 2mg tabs for 5 months, I think there are about 10 left.
Posted by Elizabeth on December 6, 1999, at 20:03:43
In reply to Re: benzo doses (was Re: social anxiety - benzos), posted by Louise on December 6, 1999, at 17:44:56
> If I took that much Xanax all at once I'd be terribly drowsy (if not asleep), but I'm glad that works for you.
Here's the interesting part: it's sedating for me too, *except* when I am having or about to have a panic attack.
> I tried taking Xanax PRN, but I developed severe anxiety and agoraphobia.
I have to take an antidepressant with it, yeah (no agoraphobia though).
> By the time a panic situation were to develop, it would be too late for me to take Xanax.
I have "auras" (much like epileptic auras) that begin a while before a panic attack. Xanax seems to kick in within a half hour.
> My pdoc advised that because of an embalance in my brain, Xanax only works for me when I have a steady amount built up in my system. Although I take Xanax everyday, I have reduced my daily dose from 3 mg. to 2 mg. per day by taking glutamine and taurine supplements.
That's interesting; I should read up more on amino acids.
> Since I can't take Klonopin, I'm considering changing to Ativan, although someone suggested to me on another Board that Ativan is not as strong as Xanax, even though they believe it is more sedating.
It's not as *potent* - you'd need a higher dose - but I don't see any reason it wouldn't work. It's a bit longer-lasting and doesn't have the awful taste (so if you need it right away you can take it sublingually).
Posted by Louise on December 6, 1999, at 22:06:14
In reply to Re: benzo doses, posted by Elizabeth on December 6, 1999, at 20:03:43
> Here's the interesting part: it's sedating for me too, *except* when I am having or about to have a panic attack.
Yeah, I can understand that. Unfortunately, I don't get any warnings like you do. You're lucky in that way since you can take the Xanax PRN.
> I have to take an antidepressant with it, yeah (no agoraphobia though).
Unfortunately I'm unable to take A/Ds. I've been trying Effexor XR for GAD, but I've developed a terrible ringing in my ears and nausea, so I guess another A/D bites the dust. I had such high hopes for this drug since it's an SNRI not an SSRI.
> I have "auras" (much like epileptic auras) that begin a while before a panic attack. Xanax seems to kick in within a half hour.
You're lucky that way. I get GAD which on occasion has triggered a panic attack, but much more likely just turns into agoraphobia, which in some ways is even worse.
> That's interesting; I should read up more on amino acids.
They've helped me a lot, along with other natural remedies, but they aren't miracle cures. I'm hoping one day some other med will come along that works well on the GABA receptors without the problems of the benzos or the side effects of the A/Ds.
> It's not as *potent* - you'd need a higher dose - but I don't see any reason it wouldn't work. It's a bit longer-lasting and doesn't have the awful taste (so if you need it right away you can take it sublingually).
Xanax is very bitter. I'm going to ask my pdoc to switch me over to Ativan ... at least for a while. My pdoc is pro-Xanax because he says it's better for panic, but he says Ativan is better for your liver.
Louise
Posted by Elizabeth on December 7, 1999, at 12:12:00
In reply to Re: benzo doses, posted by Louise on December 6, 1999, at 22:06:14
> Unfortunately I'm unable to take A/Ds. I've been trying Effexor XR for GAD, but I've developed a terrible ringing in my ears and nausea, so I guess another A/D bites the dust. I had such high hopes for this drug since it's an SNRI not an SSRI.
I wonder what causes the tinnitus. That is weird.
> You're lucky that way. I get GAD which on occasion has triggered a panic attack, but much more likely just turns into agoraphobia, which in some ways is even worse.
Oh, I agree totally - I think agoraphobia is probably the most debilitating of the anxiety disorders.
> They've helped me a lot, along with other natural remedies, but they aren't miracle cures. I'm hoping one day some other med will come along that works well on the GABA receptors without the problems of the benzos or the side effects of the A/Ds.
Some of the anticonvulsants do, FWIW. Gabitril, e.g., is a GABA reuptake inhibitor. Also, I don't recall if you've tried MAOIs, but Nardil (or one of its metabolites) inhibits GABA transaminase.
> Xanax is very bitter. I'm going to ask my pdoc to switch me over to Ativan ... at least for a while. My pdoc is pro-Xanax because he says it's better for panic, but he says Ativan is better for your liver.
That's true, yeah. And yes, Xanax tastes *gross*!
Posted by Louise on December 7, 1999, at 18:18:45
In reply to Re: benzo doses, posted by Elizabeth on December 7, 1999, at 12:12:00
Elizabeth,
I wish I knew why I have so many problems with all of the meds; it's quite frustrating. My ears are still ringing, so I've finally given up on the Effexor XR. The ringing should stop ... hopefully soon.
Do they both work well on anxiety and panic? I know that Nardil works on panic, but I've also heard about the problems with weight gain. That's just what I need ... to trade one problem for another. I don't know which would be worse -- to be panic and anxiety free, or to remain agoraphobic because I feel too fat to leave the house!
Louise
>I wonder what causes the tinnitus. That is weird.
> Some of the anticonvulsants do, FWIW. Gabitril, e.g., is a GABA reuptake inhibitor. Also, I don't recall if you've tried MAOIs, but Nardil (or one of its metabolites) inhibits GABA transaminase.
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Dr. Bob is Robert Hsiung, MD,
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