Posted by Rick on November 5, 2001, at 21:07:18
In reply to Alan - Nurse Wratchet (sp?) Experience - Advice?, posted by dannyboy on November 5, 2001, at 19:42:19
http://www.cmeondemand.net/PP/2001BlackBook/PP301_Sussman.html
I’m not Alan, but I hope you don’t mind if I chime in. I’d be mad, too, but hardly surprised.
Your best bet is obviously getting a more enlightened doctor. I’m not familiar with Kaiser, or how it works. But if you have any choice in doctors, simply call around and ask what kinds of treatments they use for long-term panic disorder (or PD with agorophobia, or whatever you have). If the conversation’s going in the right direction, you might even ask what they think about the relative merits of benzodiazepines vs. SSRI’s for PD. If your plan allows, and you have the financial means to pay a greater portion of the cost, you may also want to consider talking to non-network providers if necessary. In a city like LA, there should be no shortage of doctors who realize that most, or at least some, patients will do better in the long-term with Klonopin or Xanax than with an SSRI, especially if there’s no baseline depression.
A patient is a doctor’s client, and should have full rights to “fire” the doctor at any time and find a new one. (Of course, I know that in the world of medical insurance, especially HMO’s, that’s sometimes easier said than done – especially if $$$ are tight.) Doesn’t your friend-of-a-friend psych have any suggestions?
Regardless, you should definitely print out the article at the link above, and both send it to your curent doctor (with appropriate highlighting), and save it for discussion with a (hopefully) new pdoc, if necessary. It is written by a professor at a respected research institution (quoting experts from other highly-respected institutions like Harvard), and it puts the lie to every objection of hers that you recounted in your post.
In addition to the article I provided the link for above, if you run some searches you’ll find plenty of additional material that supports long-term benzo use as a viable option in PD. The abstract below is a good example.
Psychopharmacol Bull 1998;34(2):199-205
Long-term experience with clonazepam in patients with a primary diagnosis of panic disorder.
Worthington JJ 3rd, Pollack MH, Otto MW, McLean RY, Moroz G, Rosenbaum JF.
Department of Psychiatry, Massachusetts General Hospital, Boston 02114-3117, USA.
This study examined the use patterns and efficacy of the high potency benzodiazepine (HPB) clonazepam in panic patients who were treated and followed naturalistically in the Massachusetts General Hospital Longitudinal Study of Panic Disorder. Of 204 patients followed over a 2-year period, 46 percent were receiving clonazepam alone or in combination with an antidepressant. Treatment was not controlled at initial evaluation or during the followup period. The main variables assessed in this analysis included global severity of the panic disorder and stability of clonazepam dose. All treatment groups tended to improve over time without significant differences in outcome between groups. Clonazepam doses remained stable over time. Results of this study suggest that treatment of panic disorder with the HPB clonazepam achieved and maintained a therapeutic benefit similar to that obtained with alternative pharmacologic treatments, without the development of tolerance as manifested by dose escalation or worsening of clinical status.
Publication Types:
Clinical TrialPMID: 9641001 [PubMed - indexed for MEDLINE]
> Alan -
>
> I really need your advice. I went to the pdoc today, totally stoked on my success over the last few days on Xanax, and wanted to request a switch to Klonopin...
>
> Her reply - NO! "Xanax is addictive, and not recommended for long term use" end of story. When I told her that I felt very disappointed and devastated by this reply, she told me "that's just your anxiety talking, we need to heal the anxiety with something else" I am so ANGRY! I felt completely ignored and condescended to! She says that she will recommend that I go back on Paxil. I will NOT go back on Paxil, as I will not endure the weight gain (and the chemical lobotomy effect) again .
>
> I am feeling GREAT with the Xanax! Totally normal, totally healed, but am going to have SSRI's (or maybe Effexor - I REFUSE that one) shoved up my butt again. What should I do? I live in L.A., (and am insured by Kaiser). Is there any other place I can go to get a sympathetic, professional ear? Luckily, a friend of a friend is a psychiatrist (and can write me a prescription HA HA HA)... I know now that I will be seen by the docs at Kaiser as incorrible, recalcitrant, and just looking for a fix...
>
> AAAAAHHHHH! Benzos WORK for me! I feel NORMAL, not drugged out, and not gaining weight! I'm functioning! How dare they ignore that!
>
> Sorry for my anger, but I am just boiling.
>
> Please advise,
> Daniel
poster:Rick
thread:83210
URL: http://www.dr-bob.org/babble/20011104/msgs/83300.html