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Dr. Bob is Robert Hsiung, MD,
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Posted by utopizen on October 8, 2004, at 22:27:40
In reply to Re: Help with anxiety/benzos---partlycloudy, posted by mcp on October 8, 2004, at 4:23:37
> WIthout getting into my personal feelings about how liberally these drugs are prescribed and often as a first resort, let me just point out some obvious things. Therapy. Nutrition. Exercise. Natural Alternatives. If all three are given a genuine effort then a synthetic drug may not be needed. If it is, then so be it, but never as a first resort. Just my opinion
>you said it! these are all great things that we all should explore. And meds often allow us to make these things work for us. You might say meds HELP us to these things, follow these regimens.
I've read that minor depression can effectively be controlled through exercising 3x/day. Great! If I had minor depression, I'd be encouraged! =) I exercise daily, on my bike, and it helps. But it's just a few hours. The meds help somewhat too. I wish more so than they did, but of course, that's why I exercise as well...
No one wants to take meds. We'd all prefer to use exercise, good nutrition, etc. over meds. The side effects just aren't that cool, and I think the fact that we resort to using this board says that loud and clear. These meds sometimes lead us to suffer. But we take them because we know we suffer more without them, in many cases. I encourage you to explore all your options, just as I routinely have said similiar advice to so many on this board. =)
Posted by cache-monkey on October 9, 2004, at 1:55:15
In reply to Re: Help with anxiety/benzos: Xanax/Ativan? » cache-monkey, posted by Fred23 on October 8, 2004, at 19:33:47
> > So I'm wondering about Ativan. Anyone have experiences with it? Efficacy? Any sort of "hang over" effect?
>
> After spending a few months working with it, and getting my GP to up the dose once, so far, it seems that it may be the trickiest one to take effectively.
>
> Therefore it is likely that it is not being prescribed in an effective way, leading patients to think that it "doesn't work." Which then means they have to "choose" between Xanax or Klonopin.
>
> What I've learned so far:
> 1. I takes at least as four time as much Ativan to be as effective as Xanax.
> 2. Its duration of action is much shorter than its rated half-life, so a dose is needed every 6 hours or so.
> 3. Real Ativan is needed; the generic is useless.
> 4. It takes longer to find the "right" daily dose, so more upping of the dosage may be needed along the way.
> 5. Ativan has a more human "feel" to it than Xanax, which is somewhat distancing.
>Thanks for the input! For me I find that the lowest dose of Xanax (0.25 mg) immediate release has usually done the trick. (Although I took two at one point for my Cymbalta-induced freak out...)
So I'm wondering how to translate that to Ativan. Could you tell me what dose and frequency worked for you with both Xanax and Ativan? That might help with the translation, although I suspect it varies from person to person.
Thanks again,
cache-monkey
Posted by Fred23 on October 9, 2004, at 10:13:35
In reply to Re: Help with anxiety/benzos: Xanax/Ativan? » Fred23, posted by cache-monkey on October 9, 2004, at 1:55:15
> Thanks for the input! For me I find that the lowest dose of Xanax (0.25 mg) immediate release has usually done the trick. (Although I took two at one point for my Cymbalta-induced freak out...)
> So I'm wondering how to translate that to Ativan. Could you tell me what dose and frequency worked for you with both Xanax and Ativan? That might help with the translation, although I suspect it varies from person to person.With Xanax "borrowed" from a friend who wasn't taking it, I found that simply one 0.5 mg dose after breakfast, along with a low dose of a doctor-prescribed beta-blocker, was "enough" for the whole day.
On the followup visit I asked my GP for a benzo to do for my mind what the beta-blocker was doing for my body. He (reluctantly) prescribed a low dose of Ativan, as the generic lorazepam.
It did not behave at all like something half the strength of Xanax, with approximately the same half-life, as the books and charts show.
On the first refill, I switched to real name brand Ativan, which at least had anxiolytic properties, and didn't just act like a sleeping pill. Then I found that the "duration of action" was much shorter than Xanax, so more than one dose per day was needed. And I found that Ativan was more like one *fourth* the effective strength of Xanax. E.g., to be equivalent to 0.5 mg of Xanax, at least 2.0 mg of Ativan is needed, but throughout the day, not all at once.
The typical *starting* dose range for Ativan is 2 - 3 mg per day, so if I've "worked up to" 2.0 mg after 3 months, I'm hoping that if I need it raised to 2.5 mg per day, my GP won't consider that the dreaded "escalation" that doctors are supposed to be on the alert for.
Posted by thug life on October 9, 2004, at 10:46:48
In reply to Re: Help with anxiety/benzos---utopizen, posted by mcp on October 8, 2004, at 4:33:58
I consider myself somewhat of a guinea pig when it comes to benzo's.Currently I am on 6mgs a day of Klonopin and found it has never given me depression and doesnt make me sleepy.I basically don't feel anything.The thing thats happening is my anxiety and panic is under full control.A lot of times ,speaking real, some people look for that sorta "high"that overcomes them to control anxiety.I believe those that do this are setting themselves up for hardship.At first I understand people need help but I also understand you need to not have that high feeling,and need a little anxiety to be able to work through it by using self-talk.Xanax to me will be abused the most..... obviously.Its like you become a slave to that pill,carrying them wherever you go etc.
I found myself almost after being diagnosed being reliant on Xanax too much.i realized I was using anxiety as an excuse.I was being reactive to my pain instead of proactive.I think Frued said we put ourselves like that...we keep ourselves sick...to get attention,understanding etc.Its like when most people catch a cold they really consume themselves with being sick and really dont want to get better.People are doing everything for them so....it feels goood to be taken care of.I guess it goes back to childhhood,having your mom be there for you.I dont know these are my ramblings......Klonopin is really the best med IMO.Withdrawl from these meds can be unpleasnt so you have to look at that aspect down the road.
Posted by mattw84 on October 9, 2004, at 11:15:28
In reply to Re: Help with anxiety/benzos, posted by thug life on October 9, 2004, at 10:46:48
Exactly, you do become a "slave" to Xanax. And in very little time at that. I found myself pocketing it instantly right along with my adderall. Seems contradictory... I would avoid Xanax even though it is probably the most effective benzo available. I am currently taking Klonopin in the morning and before bed. It has controlled my anxiety perfectly without any hint of addictive potential. GL
Matt
Posted by Snowie on October 12, 2004, at 0:16:52
In reply to Re: Help with anxiety/benzos, posted by mattw84 on October 9, 2004, at 11:15:28
Guess I'll put in my 10 cents to these benzo posts. I have probably social anxiety with a little agoraphobia mixed in for good measure.
My first pdoc started me on Xanax years ago, with great success at first. I must have been taking about 2-3 mgs. of Xanax per day. Unfortunately I was never told about the dependency issue of Xanax, and, of course, after I started reading up about it I got spooked, although I continued taking it. I didn't get any highs from taking Xanax, but I did get the rebound withdrawal symptoms before my next pill, which I didn't like. It made me feel something like an addict, which bothered me.
I tried Klonopin for several months until I started experiencing depression for the first time, and eventually went back to Xanax. I later tried Klonopin again with terrible results. This time I had withdrawal symptoms from Xanax I suppose, which was surprising since I didn't have it the first time I switched from Xanax to Klonopin.
I've also tried Ativan at some point, and I've been taking 15 mg. of Tranxene in the mornings for a couple of years. I augment that with Neurontin which keeps my anxiety level manageable.
Now down to the nitty gritty about what worked and what didn't work so well for me. Xanax worked very well for many years on anxiety and social anxiety. No highs, just that darned rebound anxiety before the next pill that I didn't like. Klonopin did wonders for my social anxiety the first time I took it, but I felt spaced out while on it some of the time. No highs on it either, but I developed depression after about 5 months of taking it, plus I also developed a bit of aggression, so I went back to Xanax. Like I said, the second time I tried Klonopin I went off of it quickly because I had strange withdrawal effects supposedly from the Xanax. Ativan didn't really do anything for me to be honest. It could have been a sugar pill for all the good it did. A couple of years ago, Xanax seemed to poop out so I tried Neurontin, which helped a lot for some reason. I then started taking Tranxene. Tranxene doesn't help much at all with social anxiety but it does okay with general anxiety, as long as I supplement it with Neurontin.
I'm considering Xanax XR, but have heard good and bad things about it. I would love to find something that lasts a long time without the rebound withdrawal effects I experienced with regular Xanax, doesn't cause depression that I experienced with Klonopin, and helps with social anxiety (unlike Tranxene or even Ativan). I also don't want anything that would cause me to gain weight.
Snowie
Posted by awatts on October 13, 2004, at 10:03:58
In reply to Re: Help with anxiety/benzos, posted by Snowie on October 12, 2004, at 0:16:52
> ...
> I'm considering Xanax XR, but have heard good and bad things about it. I would love to find something that lasts a long time without the rebound withdrawal effects I experienced with regular Xanax, doesn't cause depression that I experienced with Klonopin, and helps with social anxiety (unlike Tranxene or even Ativan). I also don't want anything that would cause me to gain weight.
>
> SnowieI'm curious about the "bad things" that you've heard about Xanax XR. I've switched to the XR version and it levels things out. I experience no highs from it, and no longer anxiously wait for the next dose to feel normal again. However, it does not last 24 hours for me, so I take it twice a day.
Please elaborate on the bad things you've heard about XR so I can be on the lookout for them.
Thanks
Posted by Squiggles on October 13, 2004, at 10:33:17
In reply to Re: Help with anxiety/benzos -- Xanax XR, posted by awatts on October 13, 2004, at 10:03:58
I thought the virtue of Xanax was
its special application to panic
attacks on account of its speed of action.I hope they don't replace the old one
with the new XR version. There are other
"fast" short half-life benzos, though.Squiggles
Posted by jboud24 on October 14, 2004, at 18:32:35
In reply to Re: Help with anxiety/benzos, posted by Snowie on October 12, 2004, at 0:16:52
My experience with benzos for Social anxiety has been:
A) They all work to some extentB) Ativan is weak for me
C) Valium and Klonopin work the best for me
D) Xanax works very well to, but its majorly
short T1/2 left me with 4x daily dosing and rebound anxiety, and dosage escalation over the course of ~1 1/2 years.Perhaps adding and Anti-Depressant like zoloft at a low dose would allow you take the long half life benzos and avoid the depression.
Hope that helps,
Justin
Posted by Snowie on October 15, 2004, at 11:03:47
In reply to Re: Help with anxiety/benzos -- Xanax XR, posted by awatts on October 13, 2004, at 10:03:58
Hi,
Well, to start off, I can't elaborate for you as to what "bad" from Xanax XR you may experience either now or in the future because since you are taking it and it seems to be working for you, that's half the battle.
My pdoc knows that I took regular Xanax for years, but he hasn't done much to get me to try Xanax XR now, even though I have asked him about it. I don't remember what his answer was, to be honest. I was very interested in Xanax XR years ago (before it finally got FDA approval here in the States) because a few people that I used to chat with in Europe were taking it and they had great things to say about it, which is why I have been reading as many posts about it as possible.
The "good" I've heard is that it supposedly lasts much longer than regular Xanax and that it decreases or eliminates the rebound anxiety effect. The "bad" (bad in the sense that it's disappointing) is that it is much more expensive than regular Xanax, and rather than only take 1 pill a day, many have found that they need to take at least 2 pills a day, if not more. Another "bad" I've read about is that it doesn't seem to have the same potency as regular Xanax. I do hope Xanax XR would work as well as regular Xanax, without the highs and lows. For me, regular Xanax worked great for several hours, and then an hour or so before my next pill it started to wear off very fast. I would hope that Xanax XR would wear on all day without that huge drop at the end.
Hope this answers your question.
Snowie
> > I'm considering Xanax XR, but have heard good and bad things about it. I would love to find something that lasts a long time without the rebound withdrawal effects I experienced with regular Xanax, doesn't cause depression that I experienced with Klonopin, and helps with social anxiety (unlike Tranxene or even Ativan). I also don't want anything that would cause me to gain weight.
> >
> > Snowie
>
> I'm curious about the "bad things" that you've heard about Xanax XR. I've switched to the XR version and it levels things out. I experience no highs from it, and no longer anxiously wait for the next dose to feel normal again. However, it does not last 24 hours for me, so I take it twice a day.
>
> Please elaborate on the bad things you've heard about XR so I can be on the lookout for them.
>
> Thanks
Posted by Snowie on October 15, 2004, at 11:11:37
In reply to Re: Help with anxiety/benzos -- Xanax XR, posted by Squiggles on October 13, 2004, at 10:33:17
I suspect that you are right. If you have a panic attack and need relief very quickly, regular Xanax would probably be your best med. Luckily, I don't have that problem. I can't imagine that they would ever replace what is now a relatively inexpensive generic with an expensive, name brand XR.
Snowie
> I thought the virtue of Xanax was
> its special application to panic
> attacks on account of its speed of action.
>
> I hope they don't replace the old one
> with the new XR version. There are other
> "fast" short half-life benzos, though.
>
> Squiggles
Posted by Snowie on October 15, 2004, at 11:17:55
In reply to Re: Help with anxiety/benzos » Snowie, posted by jboud24 on October 14, 2004, at 18:32:35
Some have worked for me better on social anxiety than others, but they all seem to have their pros and cons. Tranxene hasn't helped me much with social anxiety, but adding a little Neurontin has made it more effective. However, my libido is at an all-time low. I haven't done well in the past adding an A/D to the mix. Zoloft gave me a rash, and Prozac made me feel like a zombie.
Snowie
> My experience with benzos for Social anxiety has been:
> A) They all work to some extent
>
> B) Ativan is weak for me
>
> C) Valium and Klonopin work the best for me
>
> D) Xanax works very well to, but its majorly
> short T1/2 left me with 4x daily dosing and rebound anxiety, and dosage escalation over the course of ~1 1/2 years.
>
> Perhaps adding and Anti-Depressant like zoloft at a low dose would allow you take the long half life benzos and avoid the depression.
>
> Hope that helps,
> Justin
Posted by Squiggles on October 15, 2004, at 11:52:02
In reply to Re: Help with anxiety/benzos -- Xanax XR » Squiggles, posted by Snowie on October 15, 2004, at 11:11:37
> I suspect that you are right. If you have a panic attack and need relief very quickly, regular Xanax would probably be your best med. Luckily, I don't have that problem. I can't imagine that they would ever replace what is now a relatively inexpensive generic with an expensive, name brand XR.
>
> Snowie
If it is replaced, then some other fast acting
Xanax will probably be available. I recall
a similar thing happening with MIDOL - where
it used to be just one brand, and then about 3
or 4 variations came out; i checked the ingredients and found a difference only in
dose of the ingredients.It seems to me that this diversity may be
driven by economic need. I won't say they
are just greedy, as it is possible the money
is being put to better use from providing some
minor improvements to the wealthy consumer.
For example, for research or needy countries.I hope so.
Squiggles
Posted by Snowie on October 15, 2004, at 12:41:15
In reply to Re: Help with anxiety/benzos -- Xanax XR, posted by Squiggles on October 15, 2004, at 11:52:02
I don't think regular Xanax will be replaced by the XR since, if nothing else, they do act differently. Also, Xanax XR has been available in certain parts of Europe for many years prior to the States obtaining FDA approval, but to my knowledge it hasn't replaced regular Xanax in Europe.
Snowie
> > I suspect that you are right. If you have a panic attack and need relief very quickly, regular Xanax would probably be your best med. Luckily, I don't have that problem. I can't imagine that they would ever replace what is now a relatively inexpensive generic with an expensive, name brand XR.
> >
> > Snowie
>
>
> If it is replaced, then some other fast acting
> Xanax will probably be available. I recall
> a similar thing happening with MIDOL - where
> it used to be just one brand, and then about 3
> or 4 variations came out; i checked the ingredients and found a difference only in
> dose of the ingredients.
>
> It seems to me that this diversity may be
> driven by economic need. I won't say they
> are just greedy, as it is possible the money
> is being put to better use from providing some
> minor improvements to the wealthy consumer.
> For example, for research or needy countries.
>
> I hope so.
>
> Squiggles
Posted by Squiggles on October 15, 2004, at 12:44:37
In reply to Re: Help with anxiety/benzos -- Xanax XR » Squiggles, posted by Snowie on October 15, 2004, at 12:41:15
> I don't think regular Xanax will be replaced by the XR since, if nothing else, they do act differently. Also, Xanax XR has been available in certain parts of Europe for many years prior to the States obtaining FDA approval, but to my knowledge it hasn't replaced regular Xanax in Europe.
>
> Snowie
Thanks for the information Snowie. I no longer
take Xanax myself- no longer have any panic attacks, thank God. Speaking of XR, i have heard that Lithium comes in that form. I wonder if it would help with diarrhea or if diarrhea is an effect of my Thyroxine dose - a btw question, i know.Squiggles
Posted by Squiggles on October 15, 2004, at 12:49:49
In reply to Re: Help with anxiety/benzos -- Xanax XR » Squiggles, posted by Snowie on October 15, 2004, at 12:41:15
Wait a minute - scratch that lithium XR question:
I think i know what my problem is -- i keep
forgetting - it's my diet - hardly any vegetables
or fiber -- that would do it; sorry to bother you.Squiggles
Posted by Snowie on October 15, 2004, at 13:46:33
In reply to Re: Help with anxiety/benzos -- Xanax XR, posted by Squiggles on October 15, 2004, at 12:44:37
I'm glad you no longer have panic attacks! By the way, Tranxene also comes in a sustained released formula, which I haven't tried. If the regular Tranxene doesn't do much for social anxiety, I doubt I'd have much success with the extended release, especially since Tranxene is supposedly a longer lasting benzo in the first place! Anyway, I have an appointment with my pdoc on 10/21, so I'll bring up the Xanax XR question again and see what he says.
As for the diarrhea question, I have no idea. I guess you could try it and you would find out. I occasionally have it myself but I don't take Thyroxine. However, I noticed I started going more often after my gallbladder surgery in 2002.
Snowie
> > I don't think regular Xanax will be replaced by the XR since, if nothing else, they do act differently. Also, Xanax XR has been available in certain parts of Europe for many years prior to the States obtaining FDA approval, but to my knowledge it hasn't replaced regular Xanax in Europe.
> >
> > Snowie
>
>
> Thanks for the information Snowie. I no longer
> take Xanax myself- no longer have any panic attacks, thank God. Speaking of XR, i have heard that Lithium comes in that form. I wonder if it would help with diarrhea or if diarrhea is an effect of my Thyroxine dose - a btw question, i know.
>
> Squiggles
Posted by jacot on November 13, 2004, at 20:17:46
In reply to Re: Help with anxiety/benzos -- Xanax XR » Squiggles, posted by Snowie on October 15, 2004, at 13:46:33
Has anyone out there taken Xanax in xr format?? I'm currently on Klonopin, and thinking of switching over, as it really makes me feel tired. Does Xanax have the same effects?? I have mild to moderate GAD, no panic attacks or depression.
Posted by awatts on November 14, 2004, at 8:59:27
In reply to Xanax-XR reviews...., posted by jacot on November 13, 2004, at 20:17:46
> Has anyone out there taken Xanax in xr format?? I'm currently on Klonopin, and thinking of switching over, as it really makes me feel tired. Does Xanax have the same effects?? I have mild to moderate GAD, no panic attacks or depression.
I'm on Klonopin .5mg twice a day. I have tried Xanax XR, and did not like it. It's nothing like regular Xanax. Xanax XR is also very expensive. Generic clonazepam is cheap.
Posted by jacot on November 14, 2004, at 13:03:27
In reply to Re: Xanax-XR reviews...., posted by awatts on November 14, 2004, at 8:59:27
> > Has anyone out there taken Xanax in xr format?? I'm currently on Klonopin, and thinking of switching over, as it really makes me feel tired. Does Xanax have the same effects?? I have mild to moderate GAD, no panic attacks or depression.
>
> I'm on Klonopin .5mg twice a day. I have tried Xanax XR, and did not like it. It's nothing like regular Xanax. Xanax XR is also very expensive. Generic clonazepam is cheap.
>How was it different for you than regualar xanax?? And what did you feel like it when you were on it compared to Klonopin. Just curious...
Posted by Daky on November 14, 2004, at 16:20:11
In reply to Xanax-XR reviews...., posted by jacot on November 13, 2004, at 20:17:46
Hi Jacot,
I could have written your post. My pdoc wanted me to try the Xanax-XR instead of the Klonopin for the same reason you stated. She believes some of my fatigue is related to the Klonopin, although I think the dose is quite small (I take .5 in the a.m. and .25 at bedtime, along w/Lexapro 10 mg.). This is only day two of 1 mg. Xanax-XR and I don't know if it's a placebo effect or not but I don't seem as tired. Maybe I should wait a couple of weeks and report back to you. One of my other concerns w/ Klonopin is memory loss (but then again that could be age/meno related, who knows??)
Posted by jacot on November 14, 2004, at 16:31:03
In reply to Re: Xanax-XR reviews...., posted by Daky on November 14, 2004, at 16:20:11
I too am on a very small dose..only .5mg at night, but I usually feel so tired the next day..it's awful. I also feel "out of it" and spacy..it's almost an "apathetic" feeling. I don't know how else to describe it, but it does help for the anxiety part. Please let me know how you are doing on just the xanax. I think I may try mine this week, and hope for the best....was once daily enough for you and did you feel anxious at all being on it???
Posted by awatts on November 14, 2004, at 16:43:47
In reply to Re: Xanax-XR reviews...., posted by jacot on November 14, 2004, at 13:03:27
> > > Has anyone out there taken Xanax in xr format?? I'm currently on Klonopin, and thinking of switching over, as it really makes me feel tired. Does Xanax have the same effects?? I have mild to moderate GAD, no panic attacks or depression.
> >
> > I'm on Klonopin .5mg twice a day. I have tried Xanax XR, and did not like it. It's nothing like regular Xanax. Xanax XR is also very expensive. Generic clonazepam is cheap.
> >
>
> How was it different for you than regualar xanax?? And what did you feel like it when you were on it compared to Klonopin. Just curious...
>
2 mg of Xanax XR did not help much with GAD. If I take 1 mg of regular Xanax, it will stop a panic attack in 20 minutes and relieve ALL anxiety - but it only lasts maybe 2 hours. Regular Xanax gives me a drugged, high feeling that I don't like. However, I still carry Xanax for panic attacks and that's the only time I take it.
It's been a while, but the clonazepam sedation went away after I think 3 or 4 weeks and is no longer a problem.
Guess we all react differently.
Posted by theo on November 14, 2004, at 17:31:02
In reply to Xanax-XR reviews...., posted by jacot on November 13, 2004, at 20:17:46
Xanax XR is great. It doesn't make you tired like Klonopin. To make it work right, you need to take it twice daily, I took 1mg every 12 hours.
Posted by mattw84 on November 14, 2004, at 20:31:52
In reply to Re: Xanax-XR reviews.... » jacot, posted by theo on November 14, 2004, at 17:31:02
I have trialed Xanax, Xanax XR, and Klonopin; each for about a month in duration. Everyone responds differently to any given medication -- but often there are numerous similar reactions to varying degrees...
Xanax (Alprazolam immediate release) .5 mg 4x Daily
- Almost immediate onset of action, making it great for those who will take it prn (as needed) for panic attacks.
- Compared with other benzodiazepines, my objective opinion is that this form of Xanax has the highest potential for abuse/addiction.
- Most will develop a tolerance rather quickly to it, even though it loses it "euphoric" effect it still retains the anxiolytic.Klonopin (Clonazepam generic) -- .75 mg 2x Daily
- Long acting, and can be heavily sedating. Most say the sedative effect wears of after a couple weeks of continuous use.
- Highly effective for social anxiety at lower doses; panic disorders may require higher dosing, thusly increasing the likelihood of sedation.
- Cognitive side effects not present for me (memory impairment, motor skill functionality, etc...)Xanax XR 4mg 1x Daily
- Much slower onset of action than the IR version (1 to 2 hours)
- Claims to last 24+ hours, my guess would be somewhere between 8 and 10 hours of effective coverage.
- Similar sedation to Klonopin, occasional short-term memory anomalies.
- Overall quite similar to klonopin with once daily dosing, though some may require twice daily.Any of the above are viable options for anyone with anxiety disorders. I had to go through the SSRI/SRNI loop for a while before finally getting to these effective treatments. So.. Xanax IR great "as needed" -- XR great if insurance will cover it and sure beats the ups and downs of taking the IR and having to tote your pillbox around with you. Klonopin is probably the best alternative to Xanax XR IMO. Good luck!
Matt
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