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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 9 of 9. This is the beginning of the thread.
Posted by Raymond on March 21, 2000, at 17:10:29
Hi, My name is Ray and this is my first post on this site, having only found it today. I am a recovering alcoholic, who is now in the process of looking into the reasons (self-medication?) that I drank, as I have always been prone to panic and/or anxiety attacks. I know I need psychotherapy, and my first tentative foray into that area matched me with a well-meaning doctor who prescribed Klonopin for me, 2mgs. 4x/day. It worked (oh, how it worked!), but I quickly realized that it was doing for me what the alcohol always did...took the edge off life, and in some instances I absolutely shined as an employee, partner, and all-round human being. I also saw the insidiousness of it for that reason. So I stopped it on my own and stopped therapy after a few sessions.
After a year, I am barely hanging with my high-profile silicon valley job...sometimes I want to crawl under my desk and hide....or drink or take 2 mgs, in which case everytthing would be alright.
I don't want to live with this fear anymore. Talk to me!
Posted by bob on March 21, 2000, at 19:12:03
In reply to Klonopin or Alcohol?, posted by Raymond on March 21, 2000, at 17:10:29
"Well-meaning" is one term I can think of for a doctor who **starts** a patient on ***8*** mg of klonopin/day....
Hi Ray,
First of all, you've come to a very good place. There are a lot of people with a lot of different perspectives and a lot of experience. It doesn't mean you'll get the perfect answer, but you'll get a lot of support. Welcome.
I think that you already know the answer to your question, if you can phrase it as "klonopin or alcohol?" The answer is neither, at least how you've experienced them.
If you have a high-profile silicon valley job, you hopefully have the sort of health plan that should go along with it. NOW is the time to make use of it -- forget about saving $$$ so those HMO execs can have a bigger year-end bonus.
You may not need "psychotherapy" per se, meaning some psychodynamic 4-sessions-per-week process that'll take you 20 years to change that lightbulb in your head, but some form of therapy will probably help.
Since you sound pretty sure you have some form of panic or anxiety disorder, you probably want to find someone who can provide you some concrete behavioral techniques for addressing that anxiety. Then, you can start getting at the underlying causes for that anxiety.
A lot of people here also like to have a different doctor for their meds; some are fine talking to the same person who writes their scripts. That's up to you. As one who goes the two-person route, I find my therapist and my psychiatrist have complementary areas of expertise that give me a broader range of "coverage" with respect to my disorder ... and you shouldn't rule out the role your GP can play in this as well. Your GP may be a good place to start, in fact, in getting referrals for the other specialists.
Be up front and honest about your history with alcohol and with the klonopin. The first is a serious concern; the second might actually be a blessing in disguise. If you responded well to klonopin the first time (but then again, who wouldn't at 8mg/day ... the dosage guidelines I just read mention 1-3 mg/day as ideal), it might be a good place to start again. But that's as long as you feel you can control your dosage and, if you can't, you advise your pdoc right away.
Keep in mind that treating anxiety disorders isn't the rosy world that those Paxil commercials make it out to be -- it can be a long road with a lot of bumps and potholes along the way. If you don't look for a quick fix, you won't be disappointed. Face it as the serious issue it is, know that there is help available, have some patience in making your way to a stable place of well-being.
Put the work in to gather a good team to work with you. One positive about anti-anxiety meds is that they do produce faster results than most anti-depressants, so with a more knowledgeable doctor on your side you may very well find some reasonable relief soon.
But, again, look at this as a distance event, not a sprint. As you've found out once already, a quick fix with an even quicker conclusion can make things worse than they were in the first place.
be well,
bob
Posted by CarolAnn on March 21, 2000, at 19:24:19
In reply to Klonopin or Alcohol?, posted by Raymond on March 21, 2000, at 17:10:29
Ray, If Klonopin was helping you and you were not abusing it(taking more then prescribed), then I'm not sure where the problem is. But, regardless of that, you should keep trying to get medical help. There are other drugs for anxiety/panic, and there are even drugs specifically for alcoholism. You may have to try a couple different therapists until one "clicks" but you will find it worth the effort. Good luck! CarolAnn
Posted by Raymond on March 22, 2000, at 10:07:07
In reply to How about back to some serious treatment?, posted by bob on March 21, 2000, at 19:12:03
Bob,
Thank you for the info; you had some good insight and mentioned a couple of points that I hadn't considered before. One of my problems is I'm too intelligent for my own good sometimes, and I have to keep the tendency to self-educate and self-diagnose in check.
I am currently checking out three referrals to pdocs I have recieved this week...I should make a decision by Friday. I'll let you know how things are going.
One humorous footnote: I share the mini-refrigerator in my office with a few other people on my floor. This morning when I arrived and went to put my lunch in the ref, I saw 3 cans of beer.
Who says God doesn't have a sense of humour!
Will keep in touch,
Ray
Posted by bob on March 22, 2000, at 18:54:34
In reply to Klonopin or Alcohol?, posted by Raymond on March 22, 2000, at 10:07:07
> One of my problems is I'm too intelligent for my own good sometimes, and I have to keep the tendency to self-educate and self-diagnose in check.
... straddling the fine line. Gotta love it.
Well, no, I guess you don't HAVE to love it....
Glad to hear about the pdoc referrals. If alcohol has been a serious problem -- enough that you think you'd be given a double diagnosis of anxiety disorder + alcohol abuse, then you **really** should check out the info on Dr. Bob's site, as well as the threads here and there, about Naltexone. It's a medication that has been used to treat alcohol abusers and, whadayaknow!, it also can boost the effects of antidepressant medications ... particularly SSRIs if I remember correctly.
You should do some research before you see those pdocs. Research the meds you know about from this site already.
AHEM...
Maybe some other folks who have to deal primarily with anxiety or panic disorders might suggest other issues Ray can look into to prepare for choosing which of these three pdocs would be best for him.
Someone out there has got to have the URL of that list of questions to ask when "interviewing" a pdoc ... was that part of Dr. Ivan's site? I can't recall.
Anyway, the LAST thing you should feel going into those three appointments is worry and unease, as if you're handing the future course of your life into some stranger's hands. Go in informed, go in willing to be honest, and go in knowing that if the first of these pdocs doesn't impress you, you've got two more referrals.
And if those two don't seem to fit, get another one.
... just don't stretch it out TOO long ;^)
good luck,
bob
Posted by Klonogirl on March 22, 2000, at 21:59:50
In reply to Klonopin or Alcohol?, posted by Raymond on March 21, 2000, at 17:10:29
> Hi, My name is Ray and this is my first post on this site, having only found it today. I am a recovering alcoholic, who is now in the process of looking into the reasons (self-medication?) that I drank, as I have always been prone to panic and/or anxiety attacks. I know I need psychotherapy, and my first tentative foray into that area matched me with a well-meaning doctor who prescribed Klonopin for me, 2mgs. 4x/day. It worked (oh, how it worked!), but I quickly realized that it was doing for me what the alcohol always did...took the edge off life, and in some instances I absolutely shined as an employee, partner, and all-round human being. I also saw the insidiousness of it for that reason. So I stopped it on my own and stopped therapy after a few sessions.
> After a year, I am barely hanging with my high-profile silicon valley job...sometimes I want to crawl under my desk and hide....or drink or take 2 mgs, in which case everytthing would be alright.
> I don't want to live with this fear anymore. Talk to me!Please address your drinking problem...but I certainly understand the panic problem AND YOUR FEARS!!! I was on Klonopin for four years and it helped me......but finally it came a time when I could see that I possibly could stop taking it. I HAVE,but there are the days when I miss it so much! If you feel better and you can function in the world in a more productive manor I would TAKE the Klono >you MUST get help with your DRINKING.....your panic problem will not hurt anyone else..... you abuse of ALCOHOL..that is a different story. Take care, make yourself FEEL safe first then and make a plan for your recovery, panic and alcohol.....
Posted by ChrisK on March 23, 2000, at 6:31:18
In reply to Hey anxiety-disorder folks!! Give Ray a few tips!, posted by bob on March 22, 2000, at 18:54:34
Raymond,
Definitely lookup the information on Naltrexone available in the TIPS section of this website. I am alcoholic and started taking the Naltrexone a few months ago. You would be amazed at the way it curbs your desires for alcohol (and even Klonopin in my case). Right now I have no problem going without either.
It's been about two years since my last all out panic attack. Many people find that an SSRI plus low dose Klonopin can help with GAD and PD. By low dose I mean less than 1 gram per day. I have never heard of a valid reason for taking 6-8 mg/day. In my experience it is a good med as long as you aren't abusing it.
Ask about Naltrexone - it could help the cravings a lot.
Chris
Posted by Dr. Bob on March 24, 2000, at 0:46:28
In reply to Hey anxiety-disorder folks!! Give Ray a few tips!, posted by bob on March 22, 2000, at 18:54:34
> Someone out there has got to have the URL of that list of questions to ask when "interviewing" a pdoc ... was that part of Dr. Ivan's site? I can't recall.
I don't know if these are what you're referring to, but somebody else recently mentioned them elsewhere, so I have the URL handy:
http://www.psycom.net/depression.central.expert.html
Remember, however, that while an expert will feel more comforable with less standard treatments, just because someone's comfortable with less standard treatments doesn't mean they're an expert.
Bob
Posted by Daniel on March 25, 2000, at 22:11:43
In reply to Klonopin or Alcohol?, posted by Raymond on March 21, 2000, at 17:10:29
> Hi, My name is Ray and this is my first post on this site, having only found it today. I am a recovering alcoholic, who is now in the process of looking into the reasons (self-medication?) that I drank, as I have always been prone to panic and/or anxiety attacks. I know I need psychotherapy, and my first tentative foray into that area matched me with a well-meaning doctor who prescribed Klonopin for me, 2mgs. 4x/day. It worked (oh, how it worked!), but I quickly realized that it was doing for me what the alcohol always did...took the edge off life, and in some instances I absolutely shined as an employee, partner, and all-round human being. I also saw the insidiousness of it for that reason. So I stopped it on my own and stopped therapy after a few sessions.
> After a year, I am barely hanging with my high-profile silicon valley job...sometimes I want to crawl under my desk and hide....or drink or take 2 mgs, in which case everytthing would be alright.
> I don't want to live with this fear anymore. Talk to me!Hi Ray
I was an alcoholic and Dr. Bob's posting is right on the mark. You sound hip enough to your own tendencies not to fall into the tranquilizer trap. That said, meds can be a temporary crutch while you work out underlying reasons for anxiety. As Bob pointed out, there's no quick and dirty fix. I got physically ill from alcoholism and eventually got around to therapy. Note: there are all kinds of therapists out there, just like any other profession. Don't be too picky, but find someone you feel comfortable with and who gives reasonable feedback. I second Bob's opinion that your prescribing doc. should not be your therapist. I would also venture, apologies to Dr. Bob, that many psychiatrists make poor therapists. Shop around. PS - It has worked for me. Best of luck.
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