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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 6 of 6. This is the beginning of the thread.
Posted by geno on April 2, 2002, at 18:12:43
Just went to my pdoc today, My current cocktail is
Remeron 30mg
Paxil 10mg
Desiprame 25mg
Xanax 1mgI went to my pdoc and told him im feeling a bit to sedated and dont like paxils nausea. He switched me to Zoloft 25mg am to start. HE THEN SAID hes taking my xanax away, due to addictiveness. I DONT WANT THIS>
He said that zoloft at higher doses will help anxiety and will wean me off xanax.question is, how can i tell him to keep me on xanax? Should i tell him zoloft is making me to axious, as former posts state, and need the xanax? I told him about social phobia and told me zoloft will help, but he dont like me on the xanax. Im a bit pissed about this.
any comments?
geno
Posted by fachad on April 2, 2002, at 20:07:47
In reply to NEW MED QUESTIONS NEED ADVISE, posted by geno on April 2, 2002, at 18:12:43
geno,
Why are you so reluctant to go off Xanax? I'm not saying you should go off it, just wondering why you are so opposed to going off it.
A really good, well thought out answer to that question is what you need to tell you doctor. Do not tell him something you make up to make it seem like you "need" Xanax, because that will only violate basic trust and make things worse.
Questions that you need to ask yourself and spend a fair bit of time thinking about:
What benefits do you derive from Xanax? Why are those benefits unique to Xanax? How would your life be affected if you stopped taking Xanax? Would it have a negative impact on your job, the way you support yourself? Would it have a negative impact on your family and your social support system? Would your overall quality of life suffer, and if so, in what ways? Be as descriptive and detailed as possible in your answers.
Another thing to consider is to ask your pdoc if you could try a different med that he is more comfortable with, to see if it works for you as well as Xanax. If it works - great - you have worked with your pdoc to find a med that works for you and that he is more comfortable prescribing.
If it does not work as well as Xanax, be sure you can explain why, using reasons along the lines of the above questions.
Getting pissed and acting belligerent will get you nowhere. Being willing to try another med, and then, if necessary, being able to explain why it did not work, in the context of your overall functioning and your well being, may make your pdoc more inclined to reconsider prescribing Xanax for you.
Pdocs generally really want to help their patients, especially cooperative patients. So be patient and cooperative and see what happens.
-fachad
> Just went to my pdoc today, My current cocktail is
> Remeron 30mg
> Paxil 10mg
> Desiprame 25mg
> Xanax 1mg
>
> I went to my pdoc and told him im feeling a bit to sedated and dont like paxils nausea. He switched me to Zoloft 25mg am to start. HE THEN SAID hes taking my xanax away, due to addictiveness. I DONT WANT THIS>
> He said that zoloft at higher doses will help anxiety and will wean me off xanax.
>
> question is, how can i tell him to keep me on xanax? Should i tell him zoloft is making me to axious, as former posts state, and need the xanax? I told him about social phobia and told me zoloft will help, but he dont like me on the xanax. Im a bit pissed about this.
>
> any comments?
>
> geno
Posted by 3 Beer Effect on April 3, 2002, at 3:17:07
In reply to NEW MED QUESTIONS NEED ADVISE, posted by geno on April 2, 2002, at 18:12:43
geno,
You are kind of screwed with the xanax situation since he knows about your ghb abuse etc. If you are getting too anxious you could take the only real over the counter anxiolytic- Benadryl Kapseals 25-50 mgs. 50 mg will probably put you to sleep since Benadryl (diphenhydramine) is what they put in otc sleeping pills, but 25 mg might help when you have anxiety.You might suggest Klonopin as an alternative to Xanax b/c with Klonopin there is no euphoria & less addictive potential b/c of its slow onset of action & long duration/half life- plus if you take it in the morning it will last you all day (about 12 hours).
Unlike what your doctor said, the first month or more on an SSRI, especially Zoloft of Prozac increases your anxiety until your body gets used to it. But 25 mg (1/2 the starting dose) is so low you probably won't notice much of anything, & the Remeron will offset many of the negative side effects of Zoloft (insomnia, nervousness) which usually occur only at the higher 'effective' dosages (75+ mgs).
Also, don't take amphetamines like Dexedrine or Adderall if you are also taking a tricyclic like Desipramine. They are contraindicated in the PDR because the combination causes "striking & sustained concentrations of amphetamine in the brain" & will probably cause neurotoxicity/brain damage in addition to major anxiety- plus since with GHB there is a dopamine rebound when the fun part wears off, you might want to stay away from any dopamine agonists like Dexedrine.
Finally, if you are still using GHB, I think I might have found an old muscle relaxer that might help wean you off GHB- sort of like how methadone weans people off heroin, & Ritalin weans people off cocaine. This old muscle relaxer is called Baclofen & it interested me because, like GHB, it is a derivative of GABA- I don't know if it crosses the blood brain barrier though- that would be the key for it to act or feel like 'ghb'.
I might ask my doctor for it next time because Soma didn't work very well for my occasional back muscle pain/spasms, but this drug is so old I can't even find a monograph for it in the PDR, & I bet most doctors except for old farts have never even heard of Baclofen. I know if you take too much of it you can barely walk & will probably look like Johnny Depp in "Fear & Loathing in Las Vegas" after they took ether and walked around!3 Beers
Posted by djmmm on April 4, 2002, at 20:57:55
In reply to advise; Baclofen GHB connection?, posted by 3 Beer Effect on April 3, 2002, at 3:17:07
from cponline
http://cp.gsm.com/apps/images/photo_us_h/001//bacl001g.jpg
Description: Baclofen is an oral skeletal muscle relaxant. It is a structural analog of the inhibitory neurotransmitter gamma-aminobutyric acid (GABA). Clinically, baclofen is used to treat spasticity and improve mobility in patients with multiple sclerosis and other spinal cord lesions by decreasing the number and severity of spasms and relieving associated pain, clonus, and muscle rigidity. Baclofen also improves bowel and bladder function in some of these patients. Baclofen was approved by the FDA in November 1977. In February 1995, the FDA granted approval under a treatment IND to use intrathecal baclofen for the treatment of spasticity of cerebral origin; full FDA approval was granted in 1997.
Mechanism of Action: Baclofen's mechanism of action is not fully understood, but it is believed that the drug works mainly at the level of the spinal cord to block polysynaptic afferent pathways and, to a lesser extent, monosynaptic afferent pathways. Baclofen may inhibit the transmission of impulses through these pathways by acting as an inhibitory neurotransmitter itself or by hyperpolarizing the primary afferent nerve terminals, which inhibits the release of excitatory neurotransmitters such as glutamate and aspartic acids. Because large doses of baclofen cause CNS depression, it is postulated that the drug works at supraspinal sites as well. Baclofen has been described as a gamma-aminobutyric acid (GABA) agonist; the drug stimulates the GABA-B receptor. This leads to a decreased release of the neurotransmitters aspartate and glutamate and decreased excitatory input into alpha-motor neurons.
Posted by 3 Beer Effect on April 7, 2002, at 5:27:27
In reply to Re: advise; Baclofen GHB connection?, posted by djmmm on April 4, 2002, at 20:57:55
Posted by djmmm on April 7, 2002, at 8:02:05
In reply to But does Baclofen cross the blood-brain barrier? (nm), posted by 3 Beer Effect on April 7, 2002, at 5:27:27
Baclofen and the blood brain barrier
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=2023878&dopt=Abstract
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