Posted by Elizabeth on February 22, 2002, at 12:01:36
In reply to benzos for alcoholics?, posted by verne on February 21, 2002, at 13:06:16
Hi. It's right for doctors to be concerned about benzo abuse in treating alcoholics (especially considering the nasty things that can happen when large amounts of benzos and alcohol are combined), but it shouldn't be absolutely contraindicated, as your pdoc seems to believe.
A lot of people with anxiety disorders abuse alcohol in an effort to self-medicate. Benzos are a safer, more effective treatment for anxiety. I can understand your pdoc wanting to be cautious with them and try other things that work for panic disorder (many different kinds of antidepressants, for instance), but if those aren't working, a benzo should be considered. Klonopin would be my choice: it seems to be among the least-preferred benzos among people who abuse benzos.
Another concern that your pdoc might have is the possibility of behavioral disinhibition which has been documented in people with BPD who were given Xanax. I think a low dose of Klonopin would not be likely to cause this problem, but it's still something to watch out for (especially if you have a history of impulsivity).
Is there a family member who is not an alcoholic and who could be trusted to hold on to your medication and give you only the amount prescribed? That might be an idea to present to your pdoc that could make him/her more willing to consider benzos.
> I would argue that just about anyone who would benefit from benzos has used alcohol to self-medicate.
I haven't self-medicated with alcohol, but I take benzos. (to provide a counterexample) :-)
> I've been in a lot of emotional pain since November - the minutes have turned to hours at times. I've been prescribed neurotin, zyprexa, wellbutrin, serzone, depakote, and some sort of anti-emetic that may decrease anxiety.
Wellbutrin is not very good for anxiety disorders. Serzone, Neurontin, and Depakote might help with the panic disorder. Zyprexa is probably aimed at treating BPD symptoms. (Was the antiemetic promethazine or Compazine or something else ending in -zine, perchance?)
Have you tried SSRIs or other antidepressants that are effective in PD (Serzone and Remeron might help, Wellbutrin doesn't and may actually make symptoms worse)? TCAs might not be such a hot idea (because of the BPD), but MAOIs work very well too. Some people with PD get very bad anxiety when starting SSRIs; the way to deal with this is to start at a very low dose (5 mg of Prozac or Paxil, or equivalent) and increase gradually as tolerated. SSRIs and MAOIs can also help with some BPD symptoms (aggression, rejection-sensitivity, moodiness, impuslive behaviors, etc.).
> I guess depakote with all its side-effects, hospitalization or even suicide are preferable to a small dose of benzos. This is insane.
And you thought *you* were insane...! Yeah, it is absurd. I hope I've been able to help a bit. I don't know much about the kind of situation you're in, but I have a pretty good understanding of the dilemma that your doctor faces, and I wish I could help reassure him/her.
-elizabeth
poster:Elizabeth
thread:94946
URL: http://www.dr-bob.org/babble/20020222/msgs/95102.html