![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 2 of 2. This is the beginning of the thread.
Posted by Alan on July 1, 2001, at 11:00:32
Posted by Alan on June 30, 2001, at 19:21:07
In reply to your problem » Alan, posted by Elizabeth on June 30, 2001, at 17:47:37
> > The partial problem is that the shorter acting Ativan is needed at about 5 MGS on only 3 - 4 days per week for performance anxiety (eves.)while the other days it would be too much.
> >
> > To keep from being overmedicated on the other days, only 3 MGS are needed. This is where the Nurontin comes in to mediate.
>
> Huh. So it doesn't work to just take the Ativan as needed -- 5 mg on the days you need that much, 3 mg on the other days? I can see how that could cause some ups and downs -- Ativan is pretty short-acting.
>
> The Neurontin idea might be worth a try. It's kind of short-acting too. I've heard of some people taking the entire dose at bedtime, but I don't know how well that would work for your purposes. My other thought would be to use a small dose of a long-acting benzo (Klonopin, Tranxene) -- not enough to cause sedation, ataxia, or other unwanted side effects -- in the "background," and take the Ativan on top of that as needed. That might smooth things out.
>
> > It's kind of a special social anxiety subcatagory that I have not been able to treat any other way.
>
> Can you tell me more about that? Have you tried antidepressants? That might seem like overkill, but some of them (phenelzine especially) can be extremely effective for social anxiety, especially if you take benzos along with them.
>
> > Alan (a fellow Chicagoan!)
>
> Oops, didn't mean to mislead. I'm afraid I'm not from Chicago: I was recommending it as a place to find good doctors in the Midwest. Our own Dr. Bob, for example. < g >
>
> best,
> -elizabeth
=============================================
I like your idea of Kl. or Tr. in the background.
One other problem with this though is that sleep architecture is already disturbed by relatively higher dosages of a benzo (which Neurontin counteracts to some degree) and therefore fatigued during the day from waking early and not enough deep sleep.Neurontin has already been tried and works to a fair degree as long as taken 3x's a day but doses above 300 per dose causes psychomotor disturbance which is not cool for professional reasons.
Been through all the AD's and too stimulating for the type of anx. been treated. Remeron, Luvox considered but not tried yet. Every one of them have sexual side effects (including with the neurontin above 900 a day) unsuccessfully treated with all sorts of things.
Might have to consider MAOI's at some point but very hesitant because of similar side effects to previous tries with TCA's that can't be tolerated (dry mouth, const, dizzyness).
Considered a low dose neuroleptic (Zyprexa) but afraid of TD. It really is for depression anyway isn't it?
Infrequent depression, just when spikes of anxiety drive it....
Any thoughts???? Thanks.
best,
Alan
Posted by Elizabeth on July 1, 2001, at 15:36:49
In reply to Re: your problem }} elizabeth, posted by Alan on July 1, 2001, at 11:00:32
> I like your idea of Kl. or Tr. in the background.
> One other problem with this though is that sleep architecture is already disturbed by relatively higher dosages of a benzo (which Neurontin counteracts to some degree) and therefore fatigued during the day from waking early and not enough deep sleep.That shouldn't happen if you're taking a longer-acting benzo. I think the early waking might be a rebound effect, if anything (this happens with alcohol, too). Benzos do have some weird effects on sleep architecture: they increase stage II sleep while decreasing slow-wave (stages III-IV) and REM (the number of REM cycles is increased, however, especially late in the night/early in the morning). I can think of a couple of things that might help correct the problem: amphetamines during the daytime (don't laugh), tricyclics at night, MAOIs.
Have you ever had a sleep study? It might be worthwhile if you think the lorazepam is causing problems and you want to correct them.
> Neurontin has already been tried and works to a fair degree as long as taken 3x's a day but doses above 300 per dose causes psychomotor disturbance which is not cool for professional reasons.
And in general! < g >
> Been through all the AD's and too stimulating for the type of anx. been treated. Remeron, Luvox considered but not tried yet. Every one of them have sexual side effects (including with the neurontin above 900 a day) unsuccessfully treated with all sorts of things.
Can you list all the ADs you've tried? I know it's a bother, but it might be helpful. Different ADs of the same class may have different effects on sleep.
> Might have to consider MAOI's at some point but very hesitant because of similar side effects to previous tries with TCA's that can't be tolerated (dry mouth, const, dizzyness).
I have the same problem with TCAs, although I feel like if I could tolerate them they might be really helpful. My experience has been that the shared side effects are milder with MAOIs (the dizziness can be bad, although I think that's easy to control) and tend to go away with time. Some people do get them really bad, but especially since you have social anxiety, they seem like a worthwhile thing to try.
And don't say you've been through all the ADs when you've never tried a MAOI! :-) Seriously, I don't mean to give you a hard time, but MAOIs are different from the other types of ADs in a lot of ways, in particular in their effect on sleep. They can work wonders for a number of sleep disorders, including nonrestorative sleep. They're novel in that they are generally considered activating but also have profound anxiolytic effects (in particular, in social phobia).
> Considered a low dose neuroleptic (Zyprexa) but afraid of TD. It really is for depression anyway isn't it?
It seems to help with a lot of things. It's labelled for psychotic disorders. I've encountered people who were using it (often at very low doses -- e.g., 1.25mg/day) for antidepressant augmentation, obsessive thoughts, primary insomnia, and severe general anxiety. (In theory, it would be great for allergies, too.)
Although they aren't unheard of, EPS are less common with Zyprexa than with older antipsychotics (Thorazine, Haldol, etc.) The most common class of EPS with Zyprexa is akathisia (uncontrollable restlessness). I tried it in doses of 2.5 to 10 mg (I was trying to get my insomnia under control, but I kept having to increase the dose and eventually gave up, a problem I've had with all the antihistamine type sedatives that I've tried) and didn't have any problems with akathisia or other movement disorders. I think that if you were taking a low-end dose, you'd have little to worry about (also, contrary to its mystique, TD is reversible most of the time, although it may take time for it to go away after you discontinue the drug).
On the other hand, Zyprexa generally isn't really helpful for the same kinds of problems that benzos help with. I dunno -- use your judgment.
best,
-elizabeth
This is the end of the thread.
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.