Posted by Elizabeth on June 8, 2001, at 23:29:44
In reply to Re: Xanax Rollercoaster effect, posted by gilbert on June 8, 2001, at 16:22:59
> It is so weird I can take xanax once a day and not have rebound maybe I am a slow metabolizer.
Maybe. Its metabolism is mediated primarily by the cytochrome enzyme p450 3a6. How much do you take? I know some people who take the full daily dose in the AM and don't have need for more.
> The worst sensation I have ever even gotten from forgetting to take the xanax is a kind of low blood sugar feeling but nothing that makes me run for a needle and a spoon like you read about.
< giggle > Not with Xanax! (Some people really get fixated on the ritual of shooting up, to the point where if they don't have anything, injecting *water*
> I also think Elizabeth makes some very valid points. I have stayed on the same maintenace dose of xanax for the last year it still gives me the panic coverage I need. I have friends and family mebers on effective doses for over 10 years.
This is typical. Some people do develop tolerance, but that is rare.
> The chances someone could get that long and stable of a result from the same ssri without increasing the dose or augmenting with a second drug or poop out is slim.
Now, that, I don't know about. It seems to me that SSRIs do poop out, but it's not clear how frequent that is. Also, if there is a tolerance phenomenon, it is much slower than benzo tolerance can be for those who do develop tolerance to benzos.
> The talk about how ssri's get to the root of panic disorder while benzos only medicate the symptoms is hogwash.
Yeah. People try to make the same claim about opioids and depression. There's no evidence to support it.
> Any drug I have taken with seratonin effects screws me up worse than prior to meds.
Now, that may be an immediate effect related to the panic disorder. Study after study has shown serotonin sensitivity in people with PD. The chronic use of SSRIs decreases this sensitivity, I would bet.
> Any drug with noraephrinine effects gives me tachycardia....
How bad? (Like, how many beats/minute?) I regret giving up on desipramine because of this relatively minor and treatable side effect.
> Take a short term ssri and see what kind of roller coaster ride you get. I was on paxil and luvox talk about up and down.
Short-acting, you mean? I never took Luvox, but I got agitated/hypomanic on Paxil.
> The benzos have been around along time. The studies on abuse even show people with panic and anxiety even ex addicts like myself don't abuse the meds.
Yeah. The information hasn't had a chance to trickle down to the average community pdoc yet, though.
> The abuse that comes from ER rooms and walk in clinics is different in that patients melt down the pills and shoot them either with heroin or cocaine.
Yes: it's the people who are abusing other drugs who look for benzos in order to abuse them. Heroin addicts seem to have a general preference for sedative-anxiolytic drugs; cocaine users sometimes like the combination (like a milder speedball?).
> Very few street addicts would be happy with the results they get from swallowing the pills.
Here's something that gets me: making benzos, opiates, stimulants etc. hard to get by prescription doesn't affect junkies a bit because the black market is completely unregulated. It just makes life harder for people with pain or anxiety or ADD or depression.
> They have to be torched and mainlined to get that instantaneous blast most addicts look for.
That's true. I don't think most people realise that. I sometimes hear that someone gets a fantastic high from oral opiates; I never fail to be surprised. They're nice, no question, but it's not a rush. I don't even have a basis for comparison, but I don't get high from oral drugs -- nothing that I'd identify as a high, and nothing that anyone observing me would identify as a high, either.
> Doctors and emergency room workers who have benzo beggars show up should look first for needle marks or crack smokers they ain't there just for the pills.....sometimes they will use the pills to get them from one fix to the next but it sure ain't for anxiety disorder.
Hmm. Arguably, addiction often arises as a result of self-medication of anxiety or mood disorders.
> I have been around and worked with addicts for the better part of 20 years and no one I know was holding up a pharmacy for xanax or klonopin......
Holding up pharmacies. Jeez. Ever see _Drugstore Cowboy_? (Note that Bobby throws away a bottle of 10 mg Valiums; when you have a bottle of something ending in "-morphone" in your hand, Valium doesn't seem like much!)
> It was not their drug of choice for abuse...it wasn't even in the top 10.....now demerol or morphine that's a different story.
Morphine has poor bioavailability when taken orally. And Demerol is just weird, although I gather that IV Demerol is an experience like no other.
> I thank God my pdoc allows me the opppportunity for a normal life with the use of xanax.
And I'm glad for you. A normal life is what we all strive for.
-elizabeth
poster:Elizabeth
thread:65576
URL: http://www.dr-bob.org/babble/20010605/msgs/65865.html