![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
[email protected]Shown: posts 14 to 38 of 58. Go back in thread:
Posted by Kevin on December 2, 1999, at 9:55:06
In reply to Re: social anxiety - benzos., posted by GS on December 1, 1999, at 22:30:53
> Benzodiazapines with longer half lives already mentioned in this thread such as klonipin and even shorter acting like ativan or xanax are perfectly safe and effective for anxiety disorders. That is what they are made for and why they are named "anti-anxiety".
>
> Why are these drugs overlooked or simply not mentioned as a first line of treatment???
>
> GS***Because they can be addictive and can impair cognition, memory, and motor skills. Apparently the withdrawal from Xanax, in particular, can be quite fearsome (even to the point of involving seizures).
-Kevin
Posted by Rick on December 2, 1999, at 12:36:37
In reply to Re: social anxiety - benzos., posted by Kevin on December 2, 1999, at 9:55:06
GS is right, and many studies support his assertions.
According to my pdoc (licensed, practicing PhD/MD since 1979), weaning off of Klonopin (if and when I choose to do so) will be no problem whatsoever, as long as I don't exceed 3 mg/day, and taper gradually when the time comes. Now, this was addressed specifically to me; perhaps for someone with a history of alcohol abuse or recreational drug use, the story would be different. Having taken Xanax, Tranxene, and now Klonopin, Xanax was indeed the only one that felt as if it could conceivably lead to addiction by making you "feel good".
This is not to say that my pdoc particularly *likes* Klonopin; he'd prefer that the Nardil had worked for my Social Phobia. But what would *you* choose:
Nardil: Long wait for kick-in + inconsistent effect + anorgasmia + severe hypotension (I started out slightly hypertensive)+ dizziness and falling down + insomnia + urinary problems + occasional spaciness, etc., or
Klonopin: Quick, consistent 75-100% improvement + no side effects (other than fatigue the first week)? And, at least at low doses, cognitive impairment is NO problem for me. In fact, my mind is sharper because I'm focusing on important and/or fun things instead of anxiety. Indeed, my company and my client have recently given me separate awards for creative, impactful business analyses. And when I present or speak in a meeting, I can actually think clearly and express my thoughts instead of freezing up and trembling. If that's "cognitive impairment" and memory loss, then please, impair away!
Rick----
> > Benzodiazapines with longer half lives already mentioned in this thread such as klonipin and even shorter acting like ativan or xanax are perfectly safe and effective for anxiety disorders. That is what they are made for and why they are named "anti-anxiety".
> >
> > Why are these drugs overlooked or simply not mentioned as a first line of treatment???
> >
> > GS
>
> ***Because they can be addictive and can impair cognition, memory, and motor skills. Apparently the withdrawal from Xanax, in particular, can be quite fearsome (even to the point of involving seizures).
>
> -Kevin
Posted by Rick on December 2, 1999, at 12:49:57
In reply to Re: social anxiety - benzos., posted by Rick on December 2, 1999, at 12:36:37
One more thing worth mentioning: If you read the literature (the serious research, not the "sky is falling" stuff that is way too easy to find on the net), you'll see that that benzo-induced problems with cognition, memory, and motor skills are found primarily in the elderly. So doctors do need to exercise extra caution in prescribing benzos to senior citizens.
But I'm NOT elderly (yet), and Nardil made me fall down several times -- once in a public restroom, and once resulting in a nasty bruise on my head from my own bathroom sink. But I certainly haven't had any such problem on Klonopin.
Rick
Rick
---
> GS is right, and many studies support his assertions.
>
> According to my pdoc (licensed, practicing PhD/MD since 1979), weaning off of Klonopin (if and when I choose to do so) will be no problem whatsoever, as long as I don't exceed 3 mg/day, and taper gradually when the time comes. Now, this was addressed specifically to me; perhaps for someone with a history of alcohol abuse or recreational drug use, the story would be different. Having taken Xanax, Tranxene, and now Klonopin, Xanax was indeed the only one that felt as if it could conceivably lead to addiction by making you "feel good".
>
> This is not to say that my pdoc particularly *likes* Klonopin; he'd prefer that the Nardil had worked for my Social Phobia. But what would *you* choose:
>
> Nardil: Long wait for kick-in + inconsistent effect + anorgasmia + severe hypotension (I started out slightly hypertensive)+ dizziness and falling down + insomnia + urinary problems + occasional spaciness, etc., or
>
> Klonopin: Quick, consistent 75-100% improvement + no side effects (other than fatigue the first week)? And, at least at low doses, cognitive impairment is NO problem for me. In fact, my mind is sharper because I'm focusing on important and/or fun things instead of anxiety. Indeed, my company and my client have recently given me separate awards for creative, impactful business analyses. And when I present or speak in a meeting, I can actually think clearly and express my thoughts instead of freezing up and trembling. If that's "cognitive impairment" and memory loss, then please, impair away!
> Rick
>
> ----
> > > Benzodiazapines with longer half lives already mentioned in this thread such as klonipin and even shorter acting like ativan or xanax are perfectly safe and effective for anxiety disorders. That is what they are made for and why they are named "anti-anxiety".
> > >
> > > Why are these drugs overlooked or simply not mentioned as a first line of treatment???
> > >
> > > GS
> >
> > ***Because they can be addictive and can impair cognition, memory, and motor skills. Apparently the withdrawal from Xanax, in particular, can be quite fearsome (even to the point of involving seizures).
> >
> > -Kevin
Posted by Louise on December 2, 1999, at 21:09:44
In reply to Re: social anxiety - benzos. - ADDENDUM, posted by Rick on December 2, 1999, at 12:49:57
Rick,
I disagree with your analysis of Klonopin v. Xanax and Ativan. I took Xanax for a couple of years and then wanted to try a longer-lasting benzo, so my pdoc prescribed Klonopin. Did you know that Klonopin is roughly twice as strong as Xanax mg. for mg.?
I had strange side effects while on Klonopin that I had never had before, such as depression, aggression, unrealistic anger, memory loss, depersonalization, etc. The person taking that drug was not me, so after almost 6 months I was asked by my family to go back on Xanax. End of story, right? Wrong!
While I was on Xanax I was taking approximately 3 mg. per day. For most of the 6 months I was on Klonopin I was taking 2.5 mg. per day, so when I went back to Xanax I assumed 2.5 mg. would be sufficient. I soon started having severe withdrawal ... had there been any Klonopin in the house I would have taken it. I had to increase the Xanax to 4 mg. until the withdrawal from the decreased benzo level went away (took about a week for the withdrawal symptoms to completely go away). In time I was able to wean back down to my usual 3 mg. of Xanax per day.
I'm not exactly knocking Klonopin ... it just didn't work for me. Everybody's different and someone else might have a completely different reaction while taking it, but to say that Klonopin is less addicting than Xanax or Ativan is just plain nonsense. I've been there and done that.
Louise
Posted by JohnB on December 2, 1999, at 23:35:52
In reply to Re: social anxiety-HELP!!! (Follow-up to Kevin), posted by Rick on November 30, 1999, at 13:47:22
Rick's right on. Moclobemide is another MAOI, selective for MAO-A, and reversible. This avoids the tyramine induced "cheese effect" which Rick referred to. This is what also makes Moclobemide popular. The New York State Psychiatric Institute conducted two studies regarding the efficacy of Moclobemide. Their most recent study, results published 1/98, suggests that ". . . the magnitude of its clinical effect is small."
Nevertheless, if you want it, you need to speak with a Canadian pharmacist and see what he or she requires. There are CVS pharmacies in Windsor, Ontario, which is right across the river from Detroit, Michigan. So, you can dial information and ask for the number of a CVS pharmacy there. I understand (just word of mouth), that some pharmacies will honor prescriptions written by U.S. docs, while others required a Candian MD. I'm sure your doc could get a Windsor doc to write a prescription if your psychdoc is willing to speak with him/her. Separately, there are some mail-order firms in Europe from whom you can order prescription drugs. You can find them through a web search. However, the more legitimate firms require a physician's prescription. Also, you'll likely pay more than you would having your prescription filled in Canada.
I considered Moclobemide and even a Moclobemide\Selegiline combination. My psychdoc said that, with a Moclobemide\Selegiline combination, he could vary the levels of MAO-A and MAO-B selectivity to achieve an optimal combination. However, on later reflection, he mentioned it wasn't that simple. Neither drug would alter GABA levels, as is the case with the "gold standard," Nardil. Nardil elevates GABA 100%, and GABA is the primary inhibitory neurotransmitter in the brain. So, I'd say there are a host of meds, other than Moclobemide, which have demonstrated greater efficacy in clinical studies and, therefore, more likely to give you the benefit you're seeking, without the inconvenience of having a prescription filled in Canada.
You should do your own Medline search and see for yourself. It's completely free, and there's no registration, password, etc. Most or many of the studies and reports have abstracts, from which you can cull key information. The address is
http://www.ncbi.nlm.nih.gov/PubMed/
Also, it's sponsored by that National Institute of Health (NIH), which is a government agency. That means there's no hidden agenda, and no one is trying to sell you anything. Pretty neat. I'd suggest you initially search by typing in the phrase
"social phobia" AND treatmentIt's important to type social phobia in caps as well as capitalize the AND. Later, you might want to search
"social phobia" AND moclobemideor "social phobia" AND nefazodone
or "social phobia"
Also, try to use the generic drug name, such as nefazodone instead of Serzone, when doing a search. Most authors will use just the generic name, and you'll miss the articles if you don't use it in your search terms.
See you. JohnB :)
------------------------Br J Psychiatry 1998 Jan;172:70-7
Placebo-controlled trial of moclobemide in social phobia.
Schneier FR, Goetz D, Campeas R, Fallon B, Marshall R, Liebowitz MR
Department of Therapeutics, New York State Psychiatric Institute, NY 10032, USA. [email protected]BACKGROUND: Moclobemide, a reversible inhibitor of monoamine oxidase A, previously has been reported to have efficacy in the treatment of social phobia. METHOD: Seventy-seven non-responders to one week of single-blind placebo were randomly assigned to moclobemide or placebo for eight weeks of double-blind treatment. Outcome was assessed by independent evaluator, treating psychiatrist and self-ratings. After eight weeks, patients who were at least minimally improved continued treatment for a further eight weeks. RESULTS: Intention-to-treat sample response rates at week 8 were 7/40 (17.5%) for the moclobemide group and 5/37 (13.5%) for placebo (NS). Moclobemide was significantly superior to placebo on 2 of 10 primary outcome measures. Moclobemide was well tolerated. CONCLUSIONS: Moclobemide may have efficacy in the treatment of social phobia, but absence of significant differences on most primary outcome measures and small effect sizes for all outcome measures suggest that the magnitude of its clinical effect is small.
Publication Types:
Clinical trial
Randomized controlled trial
PMID: 9534836, UI: 98196335
Posted by Rick on December 3, 1999, at 14:17:09
In reply to Re: social anxiety - benzos - to Rick., posted by Louise on December 2, 1999, at 21:09:44
Louise -
Sorry to hear about your bad experience with Klonopin. But you'll note that -- despite my pdoc's pronouncement that he has rarely seen a withdrawal problem in a situation like mine -- I am very careful to use qualifiers like "primarily" in my posts. I did not, and would not, make an absolute statement, because I know there are sometimes cases like yours where things work out differently. While research and years of professional experience have conclusively demostrated that Klonopin is far less likely to cause withdrawal difficulties than the shorter-acting benzo Xanax, that certainly does not mean no one ever has the opposite reaction (or rebound anxiety which presents as withdrawal symptoms). You said it yourself: everybody's different. Statistically speaking some people are going to end up as outliers, or atypical cases.
As for the relative potency of the two benzos, I could write a thesis here. (And I hate to point this out once again, but some parts of Dr. Bob's wonderful site have info which is controversial and/or has not been updated with the most recent research -- including the benzo equivalency chart.) But suffice to say that, here again, individual body chemistry is a more important determinant of benzo "equivalencies" than some set mathematical formula. To get the same anti-anxiety effect as X mg. of Xanax, Person A may need X/2 mg. of Klonopin, Person B needs X mg. of K, person C needs 2X mg., and person D just doesn't get any help from it at all.
This is why, even more so than for antidepressants, you often see the term "highly individualized" applied to benzo dosing.
For me, .5 mg of Xanax puts me to sleep, while I can take .5 mg of Klonopin with no fatigue at all.
Rick
---
> Rick,
>
> I disagree with your analysis of Klonopin v. Xanax and Ativan. I took Xanax for a couple of years and then wanted to try a longer-lasting benzo, so my pdoc prescribed Klonopin. Did you know that Klonopin is roughly twice as strong as Xanax mg. for mg.?
>
> I had strange side effects while on Klonopin that I had never had before, such as depression, aggression, unrealistic anger, memory loss, depersonalization, etc. The person taking that drug was not me, so after almost 6 months I was asked by my family to go back on Xanax. End of story, right? Wrong!
>
> While I was on Xanax I was taking approximately 3 mg. per day. For most of the 6 months I was on Klonopin I was taking 2.5 mg. per day, so when I went back to Xanax I assumed 2.5 mg. would be sufficient. I soon started having severe withdrawal ... had there been any Klonopin in the house I would have taken it. I had to increase the Xanax to 4 mg. until the withdrawal from the decreased benzo level went away (took about a week for the withdrawal symptoms to completely go away). In time I was able to wean back down to my usual 3 mg. of Xanax per day.
>
> I'm not exactly knocking Klonopin ... it just didn't work for me. Everybody's different and someone else might have a completely different reaction while taking it, but to say that Klonopin is less addicting than Xanax or Ativan is just plain nonsense. I've been there and done that.
>
> Louise
Posted by Jane on December 3, 1999, at 16:32:38
In reply to Re: social anxiety - benzos - to Louise., posted by Rick on December 3, 1999, at 14:17:09
rick, while i think that benzos with long half lives provide a "buffer" of safety against addiction, as you have read previously everyone is different, and i think most doctors are aware that regardless of benzos, these still contain the potential for addiction and this may be why it is not often mentioned as often as first line therapy. keep in mind too, that many times people suffering from anxiety require long term therapy and benzos in the long term are often associated with dependence and withdrawal syndrome. another factor is the interaction of benzos with alcohol. how often do you think people suffering from anxiety "self-medicate" by drinking a bit to relax? if they continually drink while taking benzos, they can be in serious risk for injury or accident if they're active because of the potentiating effect of benzos on alcohol effects. so i think collectively these factors make benzo less than stellar a choice in treating anxiety disorders for most individuals who are active and need to work during the day. of course there are exceptions to the rule, but exceptions are in minority.
jane
Posted by GS on December 3, 1999, at 23:55:46
In reply to Re: social anxiety - benzos - to Rick, posted by Jane on December 3, 1999, at 16:32:38
> rick, while i think that benzos with long half lives provide a "buffer" of safety against addiction, as you have read previously everyone is different, and i think most doctors are aware that regardless of benzos, these still contain the potential for addiction and this may be why it is not often mentioned as often as first line therapy. keep in mind too, that many times people suffering from anxiety require long term therapy and benzos in the long term are often associated with dependence and withdrawal syndrome. another factor is the interaction of benzos with alcohol. how often do you think people suffering from anxiety "self-medicate" by drinking a bit to relax? if they continually drink while taking benzos, they can be in serious risk for injury or accident if they're active because of the potentiating effect of benzos on alcohol effects. so i think collectively these factors make benzo less than stellar a choice in treating anxiety disorders for most individuals who are active and need to work during the day. of course there are exceptions to the rule, but exceptions are in minority.
> jane
************************************************
Here we go again! Please read under the posts grouped "99 Sept.14" a thread near the top of the list entitled "Lorazepam". Starting August 4th with my post (GS) and onward for quite a few posts on the subject, this has been hashed and rehashed. It was a very enlightening discussion on the so called "addiction and withdrawl" aspects of benzos. vis a vis the treatment of chronic anxiety. I hope that it can serve as somewhat informational before jumping off the cliff into making the usually uninformed generalizations about anxiolytics such as klonopin, xanax, and lorazapam.
GS
************************************************
Posted by GS on December 4, 1999, at 8:47:12
In reply to Re:social anxiety & benzos - here we go again..., posted by GS on December 3, 1999, at 23:55:46
> Please read under the posts grouped "99 Sept.14" a thread near the top of the list entitled "Lorazepam". Starting August 4th with my post (GS) and onward for quite a few posts on the subject, this has been hashed and rehashed.
************************************************
Actually, I just noticed that nearer the top of THIS list there is a thread with one post "RE: Benzo Risks - to Sean" that has the entire thread listed that I'm talking about(at the bottom of the actual post once you get in there). So once you click on that post - there it is - the entire thread - without having to go to the archive "99 Sept. 14".
Hope this makes it easier.GS
**************************************************
Posted by Elizabeth on December 4, 1999, at 9:10:23
In reply to Re: social anxiety - benzos - to Rick, posted by Jane on December 3, 1999, at 16:32:38
> rick, while i think that benzos with long half lives provide a "buffer" of safety against addiction, as you have read previously everyone is different, and i think most doctors are aware that regardless of benzos, these still contain the potential for addiction and this may be why it is not often mentioned as often as first line therapy.
For the record, I asked my therapist once what drug(s) he would consider as first-line treatments for panic disorder (not social phobia, but treatments are similar). He said either Klonopin or an SSRI would be his choice.
People with anxiety disorders are very sensitive to the side effects of antidepressants, so sometimes if they don't have depression also, there is a compelling reason to use a benzo instead.
> keep in mind too, that many times people suffering from anxiety require long term therapy and benzos in the long term are often associated with dependence and withdrawal syndrome.
(sigh) IMHO the problem is that many doctors aren't familiar with the proper way to discontinue a benzo...or worse, assume that any patient who has withdrawal symptoms must be "addicted" or abusing the benzo. I'm sure that all the people here who had withdrawal symptoms upon discontinuing Paxil, Effexor, etc. would be rather offended if their doctors had treated them like drug addicts or suggested that the withdrawal was their fault and they just had to suffer through it. Benzos have to be tapered very slowly, much more so than antidepressants. Doctors need to be aware of this. IMHO a good procedure is: (1) determine that it actually is time to stop taking the benzo; make sure the patient *consents* to the change (2) decrease by a small amount (e.g., 0.25mg/day of alprazolam) (3) continue decreasing *as tolerated* (if once a week is too often, do it once every 2 weeks, etc.); go more slowly when close to zero.
> another factor is the interaction of benzos with alcohol. how often do you think people suffering from anxiety "self-medicate" by drinking a bit to relax? if they continually drink while taking benzos, they can be in serious risk for injury or accident if they're active because of the potentiating effect of benzos on alcohol effects.
If someone is abusing alcohol, that's a special case. However, you should realize that benzos are a major part of the treatment for alcohol withdrawal! If someone truly has just been "self-medicating" with alcohol, benzos should serve as a safer, more effective substitute, and the person should no longer need alcohol.
Also of course it is not safe to assume that anyone with an anxiety disorder is an alcoholic! (I hardly ever drink, for example.)
> so i think collectively these factors make benzo less than stellar a choice in treating anxiety disorders for most individuals who are active and need to work during the day.
Huh? Anybody who is going to work drunk has a serious alcohol problem that needs to be addressed. This goes beyond having an anxiety disorder.
> of course there are exceptions to the rule, but exceptions are in minority.
The above is your opinion -- what you base it on is not clear. But here's a fact: anxiety patients almost never abuse prescribed benzodiazepines.
Posted by Louise on December 4, 1999, at 11:19:09
In reply to Re: social anxiety - benzos - to Louise., posted by Rick on December 3, 1999, at 14:17:09
Rick,
I'm certainly not benzophobic, but for whatever reason I wasn't able to tolerate Klonopin, and it's true that we're all different. However, according to several pdocs I've talked with, Klonopin is well known to cause depression in SOME people.
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.
For me, the big issue is not dependency. I don't have a problem being dependent for the rest of my life on a medication that allows me to function normally. If Xanax, Ativan, Valium, and even Klonopin allows you, me or anyone else to have a good quality of life, then what's the big deal?!
BTW, if the benzo equivalency chart is inaccurate, I would be interested in seeing it corrected, although most people I've talked with have pretty much agreed with its accuracy.
Louise
> Louise -
>
> Sorry to hear about your bad experience with Klonopin. But you'll note that -- despite my pdoc's pronouncement that he has rarely seen a withdrawal problem in a situation like mine -- I am very careful to use qualifiers like "primarily" in my posts. I did not, and would not, make an absolute statement, because I know there are sometimes cases like yours where things work out differently. While research and years of professional experience have conclusively demostrated that Klonopin is far less likely to cause withdrawal difficulties than the shorter-acting benzo Xanax, that certainly does not mean no one ever has the opposite reaction (or rebound anxiety which presents as withdrawal symptoms). You said it yourself: everybody's different. Statistically speaking some people are going to end up as outliers, or atypical cases.
>
> As for the relative potency of the two benzos, I could write a thesis here. (And I hate to point this out once again, but some parts of Dr. Bob's wonderful site have info which is controversial and/or has not been updated with the most recent research -- including the benzo equivalency chart.) But suffice to say that, here again, individual body chemistry is a more important determinant of benzo "equivalencies" than some set mathematical formula. To get the same anti-anxiety effect as X mg. of Xanax, Person A may need X/2 mg. of Klonopin, Person B needs X mg. of K, person C needs 2X mg., and person D just doesn't get any help from it at all.
> This is why, even more so than for antidepressants, you often see the term "highly individualized" applied to benzo dosing.
> For me, .5 mg of Xanax puts me to sleep, while I can take .5 mg of Klonopin with no fatigue at all.
> Rick
Posted by Jane on December 4, 1999, at 11:51:45
In reply to Re: social anxiety - benzos - to Rick, posted by Elizabeth on December 4, 1999, at 9:10:23
> The above is your opinion -- what you base it on is not clear. But here's a fact: anxiety patients almost never abuse prescribed benzodiazepines.
----------------------
i'm basing it on reading scientific literature that you can pull off medline (not the abstracts but the entire articles). in the introductory remarks that follows the abstract, and also in the discussion section many times you will find the researcher state the reason why physicians continue to look for alternatives to benzos is the fact that inherently there is a potential for addiction and withdrawal syndrome. the very fact that benzos are a schedule IV and therefore a controlled substance comes from clinical studies that FDA decided to warrant such restrictions.some here seems to feel very vehement about defending benzos - i dont think benzos should *not* be first line given the right circumstance, ie the doctor does not believe the patient is a potential substance abuser or have family history of such (they also don't want to be liable) - i think that all medications *including* benzos are effective given the right patient type. the problem arises when doctors who do not spend the time for each patient to carefully assess the situation indiscriminantly prescribe benzos for every anxious patient they see because its generic and cheap and also out of habit.
jane
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
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