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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 7 to 31 of 65. Go back in thread:
Posted by Lisa Simpson on June 13, 2001, at 6:35:26
In reply to Re: more about Xanax and depression » gilbert, posted by Elizabeth on June 12, 2001, at 22:46:14
Hi Elizabeth - PMFBI, but I was interested in what you were saying about Xanax. I was first introduced to it in the States when I nearly died from an asthma attack acerbated (is that the right word?) by pneumonia (I had to be intubed and ventilated, and it was a terrifying experience.) Afterwards I was so anxious, they gave it to me in hospital. Anyway, I think it is a marvellous drug, and have managed to get my UK GP to prescribe it to me over here when I have had panic attacks etc. Apparently it is not widely used over in this country. When I take it, I take it in the doses you are talking about, and found it "cheered me up" as well as helping the attacks. I take it for about a week in large doses, and then stop. I don't have a problem with stopping. (I would rather not! I would like to take it all the time, as it makes me feel generally much better than I normally do. But I stop without any side effects.)
BTW, while I'm here, I never got involved in any of your discussions about benzos, although I did read quite a few of the threads. I just wanted to say that I agreed with the things you said - I support you completely.
Lisa
Posted by gilbert on June 13, 2001, at 17:21:16
In reply to Re: more about Xanax and depression » Elizabeth, posted by Lisa Simpson on June 13, 2001, at 6:35:26
Elizabeth,
I did not have a problem feeling depresssed on Xanax until after being on it for over a year, however the depression did coincide with an extreme drop in business plus I was on and off ssri's for the last nine months. I don't think that helped stabilize my brain chemistry. I truly cannot point to the xanax for sure. My wife says that when I was on montherapy with xanax that she thought I was doing great and doesn't understand why I screwed aound with anything else at all. Well basically I have let the stigma of benzo use push me in directions I probably shoudn't have. Oh well live and learn.Gil
Posted by Fred Potter on June 13, 2001, at 17:56:21
In reply to Re:Elizabeth, posted by gilbert on June 13, 2001, at 17:21:16
I agree with what everyone's saying about Xanax. Like Elizabeth I need 2mg to help bring down severe anxiety or panic. 0.5mg doesn't seem to help much with anything. However, as my doc allows a maximum of 4mg a day this means I'm only allowed 2 panic attacks per day. I told him that was the maximum as he didn't know. I wish I'd told him 12mg now. If I ask for a repeat too early questions are asked. I feel guilty for treating my condition. Weird
Posted by grapebubblegum on June 14, 2001, at 9:54:17
In reply to Re:Xanax, posted by Fred Potter on June 13, 2001, at 17:56:21
Pill. In my opinion xanax and klonopin are kissing cousins so for the purposes of this discussion I'm ignoring their differences (hey Gil, I'd quit klonopin too if it gave me the "limp bizkit"; I'm just lucky that I'm different and/or female and have gotten the turbo-charged sex life back but if klonopin ruined my sex life I'd drop it like a hot potato as well.)
Back to my point, my pdoc did renew a klonopin Rx for me recently but with some reservations. Typically I think she is the smartest pdoc in the world, and maybe she is, but I didn't appreciate her mini-lecture that klonopin is ok only for a very short-term therapy because it does not address the root of the panic disorder (like SSRIs DO address it? I think not) and that klonopin is only a "feel-good" pill. I was disappointed in her basically pooh-poohing the only med that has made me feel normal for a long time.
I experience it as no kind of "feel-good" pill at all; rather a "feel normal because I don't have panic attacks knocking on my mental door all the time" pill. And what is wrong with that?
Keep in mind I only take .125 mg three times per day which is ridiculously miniscule but actually helps me. In my experience, a tiny steady dose of benzo keeps me feeling normal and raises my threshhold for P.A.s; if not prevented, P.A.s once underway require so much benzo it would kill me to derail the attack. So, to her credit, she did agree with and praise my theory that P.A.s are best PREVENTED rather than allowed to crop up at which point (for me, anyway) they are VERY HARD to derail; so she gave me an Rx but I am a little irked that she is still suspicious that I might become "addicted" or "dependent" in light of the microscopic dose I am taking. Come on, give me a break.....
Posted by Cam W. on June 14, 2001, at 10:02:01
In reply to Didn't appreciate my pdoc calling it a feel-good, posted by grapebubblegum on June 14, 2001, at 9:54:17
G-Bub - How dare she! Everyone knows we call them "mother's little helper". (Sorry, I couldn't resist) - Cam
;^)
Posted by grapebubblegum on June 14, 2001, at 10:28:45
In reply to Re: Didn't appreciate my pdoc calling it a feel-good » grapebubblegum, posted by Cam W. on June 14, 2001, at 10:02:01
What, you're serious? That is the pharmacist's slang?
I thought that was reserved for stuff like Valium. Or was that the mothers little helper of yesteryear? Is klonopin really called a "M.L.H."? I'm just incredulous because I find it does not actually seem like a little helper at all except that it prevents panic attacks.
If anything, although I am functioning fine now, I find that my temper is a bit of a problem now that I am on klonopin monotherapy. I have been wondering (and I know you could only wager the vaguest of guesses) could this be attributable to klonopin itself, or to discontinuation of Paxil, or could my slight temper problem be my "real" personality resurfacing?
By "temper" I simply mean getting a little more upset than I used to. i.e., there was a juvenile flamefest on my own message board yesterday and I entertained thoughts of taking down the 100-user, 1000 posts per day wildly popular board... I took a shower and thought about it and cooled off so to speak.
Somehow I think that while I took Paxil or Zoloft my real and normal emotions were suppressed and now I am feeling real feelings again that are sometimes problematic but normal life-feelings. Yet I don't become predisposed to the crippling and insidious anxiety that creeps in unnoticed until it erupts into a debilitating panic attack.
I'm not being touchy toward you, Cam, becasue I know you were winking, but does the general populace really think klonopin is a feel good pill? Like I said, to me it is only a feel-like-staying-out-of-the-E.R. pill.
Posted by Cam W. on June 14, 2001, at 13:08:29
In reply to Is that REALLY what they call it?, posted by grapebubblegum on June 14, 2001, at 10:28:45
Geeb - Sorry, I was only kidding. I was just thinking of the Stones song. I don't think any pharmacist's, including me, think that of any benzodiazepine.
I find that clonazepam is good anxiolytic, with little chance of true addiction. I only have seen a few people use clonazepam to "escape". Most people just use it to take the edge off of the anxiety that they feel
I do agree with you about the return of emotions. I think that the body just doesn't know what to do when it can "feel" again. Once my Effexor kicked in, I could cry during sappy commercials on T.V. or get mad at a wrestling match (Doh!). This has gone away, for me. I am now learning to live again, without the extreme mood swings.
Again, my humblest apologies. I didn't mean to cause you any consternation; I meant it as a joke.
Sincerely Cam
> What, you're serious? That is the pharmacist's slang?
>
> I thought that was reserved for stuff like Valium. Or was that the mothers little helper of yesteryear? Is klonopin really called a "M.L.H."? I'm just incredulous because I find it does not actually seem like a little helper at all except that it prevents panic attacks.
>
> If anything, although I am functioning fine now, I find that my temper is a bit of a problem now that I am on klonopin monotherapy. I have been wondering (and I know you could only wager the vaguest of guesses) could this be attributable to klonopin itself, or to discontinuation of Paxil, or could my slight temper problem be my "real" personality resurfacing?
>
> By "temper" I simply mean getting a little more upset than I used to. i.e., there was a juvenile flamefest on my own message board yesterday and I entertained thoughts of taking down the 100-user, 1000 posts per day wildly popular board... I took a shower and thought about it and cooled off so to speak.
>
> Somehow I think that while I took Paxil or Zoloft my real and normal emotions were suppressed and now I am feeling real feelings again that are sometimes problematic but normal life-feelings. Yet I don't become predisposed to the crippling and insidious anxiety that creeps in unnoticed until it erupts into a debilitating panic attack.
>
> I'm not being touchy toward you, Cam, becasue I know you were winking, but does the general populace really think klonopin is a feel good pill? Like I said, to me it is only a feel-like-staying-out-of-the-E.R. pill.
Posted by Elizabeth on June 14, 2001, at 13:21:51
In reply to Re:Xanax, posted by Fred Potter on June 13, 2001, at 17:56:21
> Like Elizabeth I need 2mg to help bring down severe anxiety or panic.
Hi. Glad to know I'm not alone.
> However, as my doc allows a maximum of 4mg a day this means I'm only allowed 2 panic attacks per day. I told him that was the maximum as he didn't know.
It sounds like you have pretty severe anxiety, if you need 2 mg Xanax more than twice daily. Have you thought about taking Xanax (or another benzo) around-the-clock, or adding an antidepressant? (Tricyclics seem to be more tolerable for a lot of people with panic disorder than SSRIs -- they cause less initial agitation/jitters. Nardil is probably the best choice, but it can have a lot of side effects, in particular weight gain and sexual dysfunction.)
Also, I know that this is unhelpful for a lot of people, but have you tried any nonpharmacological treatments (cognitive-behaviour therapy, etc.) I use a meditative/self-hypnosis technique that I practised under non-panic conditions, and although it doesn't prevent panic attacks (since I can't predict when one is going to come along), it has helped a lot with anticipatory anxiety.
> I wish I'd told him 12mg now. If I ask for a repeat too early questions are asked. I feel guilty for treating my condition. Weird
Sadly, that's not weird. It's very common. (I can only imagine how I'd feel if I needed an early refill of buprenorphine.)
-elizabeth
Posted by Elizabeth on June 14, 2001, at 13:35:52
In reply to Didn't appreciate my pdoc calling it a feel-good, posted by grapebubblegum on June 14, 2001, at 9:54:17
> Back to my point, my pdoc did renew a klonopin Rx for me recently but with some reservations. Typically I think she is the smartest pdoc in the world, and maybe she is, but I didn't appreciate her mini-lecture that klonopin is ok only for a very short-term therapy because it does not address the root of the panic disorder (like SSRIs DO address it? I think not) and that klonopin is only a "feel-good" pill.
The "root cause" argument is a common error that people make when trying to justify undermedicating anxiety disorders (and pain, for that matter). I get that rap all the time when I mention that I take buprenorphine for depression. The fact is, nobody knows what the "root cause" of panic disorder (or any other psych disorder, for that matter) is. There's no reason whatsoever to suppose that antidepressants "address the root cause" and that benzos don't.
I sometimes think that the "root cause" fallacy is a red herring, that what people really mean when they say this kind of thing is that suffering is good for the soul and that if you have spontaneous panic attacks (or whatever), you must deserve them in some way. Ahh, modern Puritanism.
> I was disappointed in her basically pooh-poohing the only med that has made me feel normal for a long time.
I know just how you feel.
> Keep in mind I only take .125 mg three times per day which is ridiculously miniscule but actually helps me.
Like, a quarter of the smallest strength tablet? Weird. I wonder if maybe you don't metabolise it normally or something. That's a very low dose even for someone who's taking it around the clock (although, as you note, taking it that way has the advantage of preventing panic attacks).
> In my experience, a tiny steady dose of benzo keeps me feeling normal and raises my threshhold for P.A.s; if not prevented, P.A.s once underway require so much benzo it would kill me to derail the attack.
It's hard to kill yourself with benzos. (So don't try, everybody.)
> So, to her credit, she did agree with and praise my theory that P.A.s are best PREVENTED rather than allowed to crop up at which point (for me, anyway) they are VERY HARD to derail; so she gave me an Rx but I am a little irked that she is still suspicious that I might become "addicted" or "dependent" in light of the microscopic dose I am taking. Come on, give me a break.....
Yeah, it seems like a lot of pdocs don't understand the difference between addiction and pharmacologic dependence. Don't they teach them this stuff in medical school?
-elizabeth
Posted by gilbert on June 14, 2001, at 13:41:26
In reply to Re: Xanax » Fred Potter, posted by Elizabeth on June 14, 2001, at 13:21:51
Grapebubblegum,
Here I am wining for a week on the post about how sensitive the ssri users are and you frreaking out on me about Cam's joke. I like his joke. I love my little peach friends. They are gillies little helpers. I used to love the color of the prozac pills too...the 10mg were a super nice shade of green. I think the benzo stigmas need a little humor. Like I said in my posts below that we are sensitive to people criticizing our meds because it threatens us. If we lighten up and have a little fun with it maybe the stereotypes will fade. Now Cam that damn song is going to be stuck in my head all day.......Mothers little helpers na na na na na na na na na na na na....it's the Stones right.......
Gil
Posted by Elizabeth on June 14, 2001, at 13:48:26
In reply to Is that REALLY what they call it?, posted by grapebubblegum on June 14, 2001, at 10:28:45
> What, you're serious? That is the pharmacist's slang?
>
> I thought that was reserved for stuff like Valium. Or was that the mothers little helper of yesteryear?Some people still feel that way about benzos.
Hey, when you say "stuff like Valium," what do you mean? Like, do you think that there's a serious difference between Klonopin and Valium (other than potency and a few differences on the molecular level), and if so, what is it?
> Is klonopin really called a "M.L.H."? I'm just incredulous because I find it does not actually seem like a little helper at all except that it prevents panic attacks.
I would call that a *BIG* helper. < G >
> If anything, although I am functioning fine now, I find that my temper is a bit of a problem now that I am on klonopin monotherapy. I have been wondering (and I know you could only wager the vaguest of guesses) could this be attributable to klonopin itself, or to discontinuation of Paxil, or could my slight temper problem be my "real" personality resurfacing?
How long ago did you stop taking the Paxil?
SSRIs do often have the effect of smoothing out irritability/overreactivity/bad temper. (I think that this often results in a feeling of flatness or apathy, like you described.)
> I'm not being touchy toward you, Cam, becasue I know you were winking, but does the general populace really think klonopin is a feel good pill?
I don't think that it's that well known. But if you asked Joe Average whether someone who takes Valium or Xanax every day is a "drug addict," my guess is that he'd probably say yes.
-elizabeth
Posted by Daveman on June 15, 2001, at 0:56:10
In reply to Gillies little helpers, posted by gilbert on June 14, 2001, at 13:41:26
In the immortal words of Mick Jagger and Keith Richards: "What a drag it is getting old....."
Dave
Mothers little helpers na na na na na na na na na na na na....it's the Stones right.......
>
> Gil
Posted by grapebubblegum on June 15, 2001, at 9:44:57
In reply to Mother's Little Helpers, posted by Daveman on June 15, 2001, at 0:56:10
No worries, Cam, I wasn't upset at your joke but I was wondering if that is the pharmacist's slang (and y'all are allowed slang, of course) but not directing it at you, my bestest pharmacist friend, yes, of course I was sensitive to a possible stigma for that particular drug I had heretofore not heard of.
Gil, I had not seen your posts about SSRI users being sensitive (insensitive? I'm lost, direct me).
At that moment in time I had little sense of humor, having just had the mini-lecture from the pdoc who typically understands me so well, and of course I was a little bent.
Elizabeth, interpret no implications in my "stuff like Valium" phrasing... I just don't know benzos from shinola, that's why I ask Cam these things. I have no prejudice against or for any of them except we all know that Valium has been the scapegoat of drug stigma for decades... am I right? I grew up in the seventies and eighties and Valium was the household word when wanting to describe someone as being addicted.
Lots of stigmas out there. I told you guys that my sister is an R.N. and she admits that whenever she hears "psychoactive meds" a prejudice closes right down over her brain. I asked her why and she said, "Because we see so many people checking in to the hospital who are addicted." I want to say, "But----" but her mind is already closed.
My doc does seem pretty smart, and I didn't quote her exactly. I do give her a lot of credit, though.
As a non-sequitur to the above discussion, since we can never sort out the topics of people who need/use wisely prescriptions and those who don't, depending on who is doing the judging, many of whom make the rest of us "look bad" (as in my sister's closed-minded 'tude) I'm gonna post a link below for you, Cam, or anyone who is interested. Come on out and at least READ one thread in my message board, folx! Many of you are so smart and witty (Gil)(I didn't say that; it was a subconscious thought you imagined I said) that I'd love to have you guys as witty banter partners. I have been weeding out juvenile and obnoxious posters, with Dr. Bob as my moderation style mentor.
Anyway Cam, the link may be of interest to you, or you may say "*yawn* I know that happens all the time, what else is new."
Posted by grapebubblegum on June 15, 2001, at 10:18:17
In reply to Gil, Cam, Eliz...... everyone..., posted by grapebubblegum on June 15, 2001, at 9:44:57
In this thread, the poster "A Tetherball From Bouganville" is talking about selling her Rx meds at school.
Now, maybe I'm getting old and crotchety. I graduated from high school in '83, and sure, plenty of drugs went around, but I don't think kids even got Rx meds back then (high school kids, I mean.) Also notable to me is the way kids don't even know what the meds are or what they are for. http://pub66.ezboard.com/fbeckoranythingelsechatterhostedbygrapesfrm2.showMessage?topicID=55.topic
btw, I am the big cheese there, grapeswhizzzz, the board owner. :o]
Oh, and I hope you don't mind, Gil, but I quoted you in another thread in which we were discussing meds and sex, I quoted your hilarious, "Celexa, no sexa" etc. essay.
Posted by gilbert on June 15, 2001, at 16:23:15
In reply to Linky-link, posted by grapebubblegum on June 15, 2001, at 10:18:17
Linky-link,
Go ahead use what ever you want the only usefull data in my posts are humor or sarcasm....got all these med geniuses around here I feel like an undescended testicle most of the time.
Grapebubblegum,
Check out any threads from this week or last week and you will see I was complaining about ssri attitude of acceptance versus the scarlet letter benzos. By the way I was kind of teasing you too....probably shouldn't pile on when someone is in the middle of a med change.......Sorry your benzo buddy......
Gil
Posted by Elizabeth on June 15, 2001, at 17:21:22
In reply to Gil, Cam, Eliz...... everyone..., posted by grapebubblegum on June 15, 2001, at 9:44:57
> Elizabeth, interpret no implications in my "stuff like Valium" phrasing... I just don't know benzos from shinola, that's why I ask Cam these things. I have no prejudice against or for any of them except we all know that Valium has been the scapegoat of drug stigma for decades... am I right? I grew up in the seventies and eighties and Valium was the household word when wanting to describe someone as being addicted.
I rememeber very little of the '70s (not from too much Valium, but just because I was quite young!), but Valium does have a reputation for being one of the more abusable benzos. It's rapidly taken up into the CNS and then redistributed throughout the body, so it acts rapidly but briefly. Some people find it pleasurable, weird as this seems. I've taken it a couple times and didn't find it particularly exciting. It's also not as good an anxiolytic as the high-potency benzos (Klonopin, Xanax, Ativan), IMO.
> Lots of stigmas out there. I told you guys that my sister is an R.N. and she admits that whenever she hears "psychoactive meds" a prejudice closes right down over her brain.
Gosh. "Psychoactive meds" like imipramine, propranolol,
Well, I guess it's a good start that she recognises it as a prejudice.> I asked her why and she said, "Because we see so many people checking in to the hospital who are addicted." I want to say, "But----" but her mind is already closed.
That is a shame. I think that a lot of doctors who specialise in addictions also tend to be against prescribing benzos, opioids, etc., even when they're clearly indicated.
Posted by Elizabeth on June 15, 2001, at 17:37:11
In reply to Linky-link, posted by grapebubblegum on June 15, 2001, at 10:18:17
> In this thread, the poster "A Tetherball From Bouganville" is talking about selling her Rx meds at school.
Antidepressants, no less!
I have a friend whose father is a doctor and who went to high school in the '70s. He used to raid the supplies at his father's office. Not antidepressants or benzos -- stuff like Dilaudid, Quaalude, Seconal, etc.
> Now, maybe I'm getting old and crotchety. I graduated from high school in '83, and sure, plenty of drugs went around, but I don't think kids even got Rx meds back then (high school kids, I mean.) Also notable to me is the way kids don't even know what the meds are or what they are for.
Jeez. I started taking Prozac in 1990, my junior year in high school. I knew a few kids who were taking things like Ritalin or lithium (Prozac was pretty new at the time), but it wasn't a common thing. By the time my sister was in high school (she's 6 years younger), though, there were lots of kids taking psych meds.
> btw, I am the big cheese there, grapeswhizzzz, the board owner. :o]
So what is it with you and grapes, anyway? Not that I have anything against grapes. Some of my best friends are grapes. :-)
-elizabeth
Posted by paulk on June 15, 2001, at 18:53:43
In reply to more about Xanax and depression, posted by Elizabeth on June 12, 2001, at 16:37:42
I hadn’t heard that there was a XR version anywhere. Who is making it?
I talked to a University Psydoc about this very issue - he said because the patent was out, no one would pay for the studies - etc. etc. (and several other cures are gone wanting for the same reason)
I’m taking a very low dose (.25mg/day) of Clonazepam, which is also suspected of having some antidepressant effect (some study mentioned some seritonin activity), but in my mind Xanax (Alprazolam) was even better that way. Unfortunately, it was quite a bear to manage frequent dosing at a low level, so I stopped it many years ago. Xanax quits so fast and nasty that I can see why it would be addictive. Sure wish there was an XR version to try.
I’m now also taking Nardil. Figured out why it is started the way it is – (starts off at 15mg – ramps quite rapidly and then back to 15 – 30mg/day) – the drug only has a 1-2 hour half-life – so it seems strange – until you figure that the enzyme it is deactivating has a much longer half-life of being replaced (no mention of this in the PDR BTW). You need to have about 90% of MO enzyme deactivated before it can start to work – and then it might take a few weeks. It seems like it may have started working just in the last day or so – not bad so far.
Do you know if the low BP side effect is a ‘primary’ effect of the drug or a result of the lowering of the MO enzyme level?
I understand why one shouldn’t take SSRIs and the like but I don’t understand why there would be a need to discontinue other MOAIs when switching between types? After all, the Nardil would wash out in a day or so? Are they acting on different enzymes?
I’m also wondering if I should get a med-alert bracelet - I understand that Demerol (meperidine) can be fatal – I would hate to be in a car accident and get Demerol in the ER that could kill me.
Posted by paulk on June 15, 2001, at 19:02:35
In reply to Re: Didn't appreciate my pdoc calling it a feel-good » grapebubblegum, posted by Cam W. on June 14, 2001, at 10:02:01
> G-Bub - How dare she! Everyone knows we call them "mother's little helper". (Sorry, I couldn't resist) - Cam
>
> ;^)
Actually, "mother's little helper" used to mean a mix of amphetamines that is now sold as Adderal – back when the song came out it had a different name and was used (unsuccessfully) as a diet pill.
Posted by paulk on June 15, 2001, at 20:02:09
In reply to Linky-link, posted by grapebubblegum on June 15, 2001, at 10:18:17
> > Back to my point, my pdoc did renew a klonopin Rx for me recently but with some reservations. Typically I think she is the smartest pdoc in the world, and maybe she is, but I didn't appreciate her mini-lecture that klonopin is ok only for a very short-term therapy because it does not address the root of the panic disorder (like SSRIs DO address it? I think not) and that klonopin is only a "feel-good" pill.Seriously, your pdoc doesn’t seem to be up on the seritinergic effects of klonopin. Klonopin is THE benzo of choice for long-term treatment.
> >The "root cause" argument is a common error that people make when trying to justify undermedicating anxiety disorders (and pain, for that matter). I get that rap all the time when I mention that I take buprenorphine for depression. The fact is, nobody knows what the "root cause" of panic disorder (or any other psych disorder, for that matter) is. There's no reason whatsoever to suppose that antidepressants "address the root cause" and that benzos don't.
>I sometimes think that the "root cause" fallacy is a red herring, that what people really mean when they say this kind of thing is that suffering is good for the soul and that if you have spontaneous panic attacks (or whatever), you must deserve them in some way. Ahh, modern Puritanism.
> > I was disappointed in her basically pooh-poohing the only med that has made me feel normal for a long time.
>I know just how you feel.
> > Keep in mind I only take .125 mg three times per day, which is ridiculously miniscule but actually helps me.
>Like, a quarter of the smallest strength tablet? Weird. I wonder if maybe you don't metabolise it normally or something. That's a very low dose even for someone who's taking it around the clock (although, as you note, taking it that way has the advantage of preventing panic attacks).
Not that weird. I only need just a little - .25/day. Many others are in the same boat. My doc tells me he has many that take .25 at bedtime and .125 for the day.
See my rant at http://www.dr-bob.org/babble/20010605/msgs/65469.html> In my experience, a tiny steady dose of benzo keeps me feeling normal and raises my threshhold for P.A.s; if not prevented, P.A.s once underway require so much benzo it would kill me to derail the attack.
DITTO – BULLS EYE – EXCELLENT POINT! I hope some docs read what you just said. ( I think this phenomena is called ‘kindling’ in the litature.)
The worst problem with Benzos is the memory side effect. I think a good way to figure if you are taking too much benzos is if it starts to kill memory. Seems like it would be easy to run some tests for this. Tell your doc to test you if she thinks you are on a detrimental dosage (you aren’t) to test your memory.
I have seen folks deteriorate over time on very large dosages Benzos.
If the benzo is long acting, it sure seems it is easier to keep it at a low dose for me. I Really don’t think it is good practice to use benzos per attack (unless its for someone who is bi-polar.) If it is a short acting benzo “as per needed” is a good way to get someone with PA in even bigger trouble.
Klonopin, for me, even at a VERY low dose makes all the difference in what I do when I lose my temper. It also prevents the panic attacks (although I didn’t have that many).
Getting off higher dosages of Benzos can be nightmarish. I watched a fellow patient go through the “cold wet sheet pack treatment” getting off Valium. I think switching to klonopin and tapering would have been a much better way.
- Paulk
Posted by Elizabeth on June 15, 2001, at 22:10:17
In reply to Re: more about Xanax and depression » Elizabeth, posted by paulk on June 15, 2001, at 18:53:43
> I hadn’t heard that there was a XR version anywhere. Who is making it?
Pharmacia & Upjohn, the same company that makes regular Xanax. Xanax SR isn't marketed in the USA, though.
> I talked to a University Psydoc about this very issue - he said because the patent was out, no one would pay for the studies - etc. etc. (and several other cures are gone wanting for the same reason)
That's true, although there is something called a "use patent" (which is why you still can't get generic Prozac in the US).
> I’m taking a very low dose (.25mg/day) of Clonazepam, which is also suspected of having some antidepressant effect (some study mentioned some seritonin activity), but in my mind Xanax (Alprazolam) was even better that way.
Most people find it to be, and there's evidence that Xanax is an antidepressant when used in high doses.
> Unfortunately, it was quite a bear to manage frequent dosing at a low level, so I stopped it many years ago. Xanax quits so fast and nasty that I can see why it would be addictive. Sure wish there was an XR version to try.
Addiction results from using large doses of a drug to get high. Anybody who's been taking Xanax for a long time will get withdrawal symptoms; that's not drug addiction, it's a normal reaction.
> I’m now also taking Nardil. Figured out why it is started the way it is – (starts off at 15mg – ramps quite rapidly and then back to 15 – 30mg/day) – the drug only has a 1-2 hour half-life – so it seems strange – until you figure that the enzyme it is deactivating has a much longer half-life of being replaced (no mention of this in the PDR BTW).
Nardil is an irreversible enzyme inhibitor; its elimination half-life isn't relevant. There's no reason to take it in divided doses, even, except perhaps to even out any side effects that you might get.
I know a guy who was able to decrease his need for Xanax dramatically when he started taking Nardil. Nardil is a great drug for anxiety.
> You need to have about 90% of MO enzyme deactivated before it can start to work – and then it might take a few weeks.
That's because antidepressant effects aren't due to the direct effects of the drugs, they're due to longer-term adaptations to the direct effects. (MAOIs seem to work faster than other ADs sometimes, though, and the anxiolytic effects of Nardil in particular may kick in sooner.)
> Do you know if the low BP side effect is a ‘primary’ effect of the drug or a result of the lowering of the MO enzyme level?
I'm not sure I understand the question. Orthostatic hypotension (slowed cardiovascular adaptation to changes in posture) is probably due to central activation of alpha-adrenergic receptors (which results from increased norepinephrine, which results from destruction of MAO).
> I understand why one shouldn’t take SSRIs and the like but I don’t understand why there would be a need to discontinue other MOAIs when switching between types? After all, the Nardil would wash out in a day or so? Are they acting on different enzymes?
That one is a mystery. It may only be a problem when switching between Nardil or Marplan (the hydrazide MAOIs) to Parnate (an amphetamine-like MAOI).
> I’m also wondering if I should get a med-alert bracelet - I understand that Demerol (meperidine) can be fatal – I would hate to be in a car accident and get Demerol in the ER that could kill me.
Demerol's pretty crappy anyway. They should use morphine. :-) Yeah, it probably is a good idea to have a medical emergency bracelet or necklace. (I prefer the latter; the bracelets seem to get in the way a lot.)
-elizabeth
Posted by Elizabeth on June 15, 2001, at 22:15:35
In reply to Re: Didn't appreciate my pdoc calling it a feel-good » Cam W., posted by paulk on June 15, 2001, at 19:02:35
> Actually, "mother's little helper" used to mean a mix of amphetamines that is now sold as Adderal – back when the song came out it had a different name and was used (unsuccessfully) as a diet pill.
There used to be diet pills that combined amphetamines with short- or intermediate-acting barbiturates, with names like Desbutal (methamphetamine + pentobarbitol) and Dexamyl (d-amphetamine + amobarbitol). I have trouble imagining what the purpose of such a combination pill would be, other than to get really trashed. (The reasoning for adding the barbiturate was that a lot of people get anxious on stimulants.)
-elizabeth
Posted by Elizabeth on June 15, 2001, at 22:32:07
In reply to Re: Linky-link » grapebubblegum, posted by paulk on June 15, 2001, at 20:02:09
> Seriously, your pdoc doesn’t seem to be up on the seritinergic effects of klonopin. Klonopin is THE benzo of choice for long-term treatment.
Not necessarily, although it is definitely a first-line treatment for panic disorder or generalised anxiety. Most benzos have the potental to cause or exacerbate depression, though, including Klonopin; Xanax is often preferable for people with anxiety and depression, despite the need for frequent dosing.
> >Like, a quarter of the smallest strength tablet? Weird. I wonder if maybe you don't metabolise it normally or something. That's a very low dose even for someone who's taking it around the clock (although, as you note, taking it that way has the advantage of preventing panic attacks).
>
> Not that weird. I only need just a little - .25/day. Many others are in the same boat.That's surprising. I took Klonopin for a few weeks at one point, and I needed 4 mg/day (1 mg in the morning and afternoon, 2 mg at bedtime). What do you take it for? (I was taking it for panic disorder and a REM sleep parasomnia.) And most people I know who take Klonopin for panic or anxiety disorders need at least 1 mg/day.
> DITTO – BULLS EYE – EXCELLENT POINT! I hope some docs read what you just said. ( I think this phenomena is called ‘kindling’ in the litature.)
Kindling refers to increased frequency of seizures in untreated epilepsy. (More generally it can refer to the same type of phenomenon in mood disorders or panic disorder.)
> I have seen folks deteriorate over time on very large dosages Benzos.
I haven't. But I have seen people take the same dose for years without problems and without needing to increase it.
> I Really don’t think it is good practice to use benzos per attack (unless its for someone who is bi-polar.)
Huh? Benzos are sometimes used to reduce psychomotor agitation in mania, but they're also used for various types of episodic anxiety. It's completely reasonable.
I think it makes more sense to take the benzo around the clock if you have frequent panic attacks. I take an antidepressant around the clock and Xanax as needed, because the antidepressant reduces the frequency of panic attacks.
> If it is a short acting benzo “as per needed” is a good way to get someone with PA in even bigger trouble.
That doesn't make sense to me. If you only take it as-needed, you don't need to be concerned about pharmacologic dependence if you ever want to go off it (or if you miss a dose). Anxiety patients, as a rule, don't abuse their medication (those who do are almost invariably abusing other drugs too).
Xanax has the additional advantage for as-needed dosing that it's fast-acting, so it can prevent an attack if you take it as soon as you feel the attack.
> Klonopin, for me, even at a VERY low dose makes all the difference in what I do when I lose my temper. It also prevents the panic attacks (although I didn’t have that many).
Benzos for anger? That's interesting. Some people with anger problems become disinhibited on benzos (like alcohol).
> Getting off higher dosages of Benzos can be nightmarish.
That's true if you take them around the clock. But then again, a lot of people really do need much higher doses. You're lucky -- maybe it's because you're taking it primarily for anger and never had frequent panic attacks.
> I watched a fellow patient go through the “cold wet sheet pack treatment” getting off Valium. I think switching to klonopin and tapering would have been a much better way.
That's the right way, yes: switch to a long-acting benzo, such as Klonopin or Tranxene, and then taper off *very* slowly. Any doctor who takes someone off benzos cold-turkey should have his license revoked, IMO.
-elizabeth
Posted by Cam W. on June 15, 2001, at 23:22:42
In reply to Re: Didn't appreciate my pdoc calling it a feel-good » Cam W., posted by paulk on June 15, 2001, at 19:02:35
> Actually, "mother's little helper" used to mean a mix of amphetamines that is now sold as Adderal – back when the song came out it had a different name and was used (unsuccessfully) as a diet pill.
Paul - I had wondered about that as I wrote my original post. It would make more sense. I had thought that it would be an amphetamine. Preludin™ came to mind, but I am not sure what was in them. I know my mom sure liked them. She did all her housework very quickly with them and was sure upset when the doc would not give her any more. - Cam
Posted by Daveman on June 16, 2001, at 0:06:29
In reply to Re: Linky-link » grapebubblegum, posted by paulk on June 15, 2001, at 20:02:09
One of the things I like about this site is the sane discussion of benzos. When reading these discussions I'm always reminded of my college philosophy courses in Hegelian logic. To simplify, Hegel believed that ideas go through three phases: Thesis (where the idea is presented absent criticism), Antithesis (where the idea comes under attack), and Synthesis (where the original idea, tempered by criticism, is modified to a more rational conclusion). In this case, benzos first were thought of as "wonder drugs" because they were so much safer than what came before as minor tranquilizers, such that they were wildly overprescribed, particularly Valium, thus the Thesis; then came the Antithesis, where the problems of benzo dependency became apparent and there was a tremendous backlash against their use. Hopefully we are starting to arrive at a Synthesis, where benzos are only prescribed were appropriate, the doses are kept at a reasonable level, and patients are properly monitored. I for one don't know what would have happened had Xanax not been available to break my panic spiral earlier this year that saw me go more than a week with almost no sleep.
Incidentally, the SSRI's are going through the same process. First the "wonder drug" Thesis, with SSRI's being given for everything from depression to anxiety to PMS to, it seems, the common cold. Now we are entering the Antithesis phase, where critics are pointing out the problems with the SSRI's, particularly the withdrawal problems that many patients were not warned about and thus suffered unnecesarily by quitting "cold turkey". Eventualy the SSRI's will reach a synthesis phase, particularly as they go generic and stop being such a cash cow for the pharmaceutical manufacturers (I say this as a happy but properly warned and monitored Celexa customer).
Dave
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