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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 26. This is the beginning of the thread.
Posted by Phillipa on September 12, 2012, at 12:55:13
Been discussing this with another. But when years ago started on benzos used to have them just lift the panic and felt great. But then about 7 years ago instead made me feel tired so quit taking during day and just take at night. So if this was tolerance wouldn't I need more? Or do I not need them anymore even though still have anxiety. Thanks Phillipa
Posted by Twinleaf on September 12, 2012, at 13:39:06
In reply to Benzo when changes from feel good to tired?, posted by Phillipa on September 12, 2012, at 12:55:13
Don't you think tolerance is likely? You could find out for sure by raising the dose for one or two times.
Posted by Phillipa on September 12, 2012, at 20:55:56
In reply to Re: Benzo when changes from feel good to tired? » Phillipa, posted by Twinleaf on September 12, 2012, at 13:39:06
No can't do this as then I'd be stuck as the doc never would prescribe higher doses. Phillipa
Posted by Twinleaf on September 13, 2012, at 5:50:44
In reply to Re: Benzo when changes from feel good to tired? » Twinleaf, posted by Phillipa on September 12, 2012, at 20:55:56
You are taking low doses, and have no history of abuse. I think it's very reasonable that you should be prescribed a dosage which helps with the anxiety you are presently having. From what you posted earlier, you have enough medication left over from your previous pdoc to raise the dosage one or two times to find the dosage at which you feel most comfortable and functional - probably just slightly higher. You have plenty of other choices of pdoc's and nurse practitioners to choose from who would be able to meet your needs much better than your present pdoc is.
Posted by phidippus on September 13, 2012, at 15:40:59
In reply to Benzo when changes from feel good to tired?, posted by Phillipa on September 12, 2012, at 12:55:13
What benzodiazapines are you taking?
If tolerance had built up, you would need more of the benzo in question.
Only you can decide if you need benzos anymore.
Eric
Posted by jono_in_adelaide on September 13, 2012, at 19:02:07
In reply to Re: Benzo when changes from feel good to tired? » Phillipa, posted by phidippus on September 13, 2012, at 15:40:59
Phillipa, if the doc wont allow an increase in your benzo dose, it might be worth thinking about adding on another med to take up the slack..... nortriptyline, mirtazepine, buspar, atarax
Posted by Phillipa on September 13, 2012, at 20:43:10
In reply to Re: Benzo when changes from feel good to tired?, posted by Twinleaf on September 13, 2012, at 5:50:44
I know do have a stash of benzos but if up the dose and find I need it no doc will prescribe the dose. Benzos are a no no here. They push antipsychotics and they are too strong for me. Before the internet I lowered or stopped a few doses and never thought of it and no side effects. Wonder if liver is filled to the brim with valium? The xanax I don't worry about as short half life. But couldn't they be stored in my fatty tissues? Phillipa
Posted by Twinleaf on September 13, 2012, at 22:32:49
In reply to Re: Benzo when changes from feel good to tired?, posted by Phillipa on September 13, 2012, at 20:43:10
I still think your goal is very reasonable. You really can't know how people will prescribe for you until you consult them. I think a competent nurse-practitioner would be very worth consulting. The only fact that you know for sure is your present pdoc is not going to make ANY changes, except to lower your present medications. From what you have told us here, he hasn't helped you at all. You really do deserve a competent person who is flexible and responsible and a good problem-solver -just as you are.
Posted by phidippus on September 13, 2012, at 22:35:52
In reply to Re: Benzo when changes from feel good to tired?, posted by Twinleaf on September 13, 2012, at 22:32:49
I agree.
Eric
Posted by jono_in_adelaide on September 13, 2012, at 22:37:19
In reply to Re: Benzo when changes from feel good to tired?, posted by Phillipa on September 13, 2012, at 20:43:10
I'm lucky, my doctor takes the pragmatic attitude that if Xanax is working, and the dose is being kept under control, then he's happy to keep prescribing it.
I hadnt thought about accumilation, I guess its worth exploring, maybe remind your doc of Valiums long half life, and see if you could change to (say) Xanax 1mg at night and 0.5mg in the morning.
I have a packet of 50 Xanax that I keep tucked away as an emergency life line.
Posted by jono_in_adelaide on September 13, 2012, at 22:42:40
In reply to Re: Benzo when changes from feel good to tired?, posted by jono_in_adelaide on September 13, 2012, at 22:37:19
And I agree with the others, you're dose is low, you have been stable on it for decades, if you now need a small dose increase or change of med, you should be given that change. Qualify of life for the patient should be what matters, not what the latest Op Ed peice in the British medical Journal had to say about benzos.
Is there any chance of finding another, more sympathetic psychiatrist, or even a family practitioner?
Posted by phidippus on September 13, 2012, at 22:55:08
In reply to Re: Benzo when changes from feel good to tired?, posted by Phillipa on September 13, 2012, at 20:43:10
Benzodiazepines: ones not metabolized by the liver (safe to use in liver failure)
LOT:
Lorazepam
Oxazepam
TemazepamIt would take a lot of benzos to enlarge the liver.
Benzodiazepines are fat soluble and do enter fatty tissues including the brain. But these tissues are in equilibrium with the blood, so that if the concentration in the blood is lower than that in fat, some will come out of the fat and re-enter the blood where it is metabolised and excreted. This will again lower the blood concentration, so more will leach out of the fat, and so on. So the body is more or less cleared, even of long half-life benzodiazepines, within 30 days. There is no evidence that benzodiazepines are "locked up" in tissues for years.
What benzodiazapines are you taking and what are their doses?
Eric
Posted by phidippus on September 13, 2012, at 22:57:52
In reply to Re: Benzo when changes from feel good to tired?, posted by Phillipa on September 13, 2012, at 20:43:10
Benzodiazepines are fat soluble and do enter fatty tissues including the brain. But these tissues are in equilibrium with the blood, so that if the concentration in the blood is lower than that in fat, some will come out of the fat and re-enter the blood where it is metabolised and excreted. This will again lower the blood concentration, so more will leach out of the fat, and so on. So the body is more or less cleared, even of long half-life benzodiazepines, within 30 days. There is no evidence that benzodiazepines are "locked up" in tissues for years.
Eric
Posted by Twinleaf on September 14, 2012, at 16:00:05
In reply to Re: Benzo when changes from feel good to tired?, posted by Twinleaf on September 13, 2012, at 22:32:49
Everyone who has posted about the issue you asked about agrees that you are a very responsible, low-dose benzo- taker. While after many, many years you are probably having slight tolerance issues, you are so clearly not addiction- prone. The relationship between you and your pdoc is probably making you feel like an addict; he probably thinks you are there because you are one. Keeping in mind how careful you are with medications, and being open to the possibility that a slight medication increase would improve your quality of life is a much more realistic and constructive way of looking at things.
There are about 30 psychopharmacologists in your area. Without changing doctors, why not get a consultation with several of them? I feel certain there are people who will trust you and work with you in a truly helpful fashion.
Posted by Phillipa on September 14, 2012, at 20:34:01
In reply to Re: Benzo when changes from feel good to tired? » Phillipa, posted by phidippus on September 13, 2012, at 22:55:08
7.5mg of generic valium & .5mg of xanax both once a day. Phillipa
Posted by phidippus on September 14, 2012, at 21:50:10
In reply to Re: Benzo when changes from feel good to tired? » phidippus, posted by Phillipa on September 14, 2012, at 20:34:01
How long have you been on these medications?
Eric
Posted by Twinleaf on September 15, 2012, at 19:55:48
In reply to Benzo when changes from feel good to tired?, posted by Phillipa on September 12, 2012, at 12:55:13
Phillipa, you started this thread by describing your current situation with your low-dose benzos, and asking the forum, generally, whether we thought your feelings were due to tolerance or to simply not needing them any longer.
I have a slight problem with the fact that you tend not to answer the thoughts/ suggestions which posters have gone to some trouble to give you. I certainly don't expect you to necessarily agree with me( or us) at all, but I guess I do expect you will give the people who have cared enough to post a respectful and thoughtful answer. You are the "expert" on you, and all of us have only partial knowledge and ideas about what might be best for you. But there is no getting around the fact that it is a let-down and disappointment to receive no answer of any kind.
Posted by Phillipa on September 15, 2012, at 20:40:32
In reply to Re: Benzo when changes from feel good to tired?, posted by Twinleaf on September 15, 2012, at 19:55:48
Usually a late posting as work at night on posting ebay and when done exhausted and go to bed. I cut down xanax in half last night. It was better. Soon will be hopefully almost off them. As for the lexapro going to let it go. Remain on luvox and see what happens. Sorry for late replies. But have to work to earn money. And online is how do it. Phillipa
Posted by Twinleaf on September 15, 2012, at 21:04:55
In reply to Re: Benzo when changes from feel good to tired? » Twinleaf, posted by Phillipa on September 15, 2012, at 20:40:32
What is the reason you have decided to go off of them after so many years? Do you or your doctor think they are harmful in some way? I would be concerned that by now your brain might be so accustomed to the medications that even going off a low dose might be very stressful and challenging. The initial dosage decrease is not nearly as hard as completely discontinuing.
Posted by Phillipa on September 15, 2012, at 21:16:18
In reply to Re: Benzo when changes from feel good to tired?, posted by Twinleaf on September 15, 2012, at 21:04:55
Not the doc me. Tired of meds. Might not discontinue all. Both lower doses at older ages are advised. Sure don't need a higher dose. Phillipa
Posted by SLS on September 15, 2012, at 23:29:02
In reply to Re: Benzo when changes from feel good to tired? » Twinleaf, posted by Phillipa on September 15, 2012, at 21:16:18
> Not the doc me. Tired of meds. Might not discontinue all. Both lower doses at older ages are advised. Sure don't need a higher dose. Phillipa
I don't know what you need. If you want to discontinue medication, will your doctor not help you to do that? Have you ever asked him for his help in doing that? If not, why not?
- Scott
Posted by Phillipa on September 16, 2012, at 10:03:54
In reply to Re: Benzo when changes from feel good to tired? » Phillipa, posted by SLS on September 15, 2012, at 23:29:02
I'm sick of doctors sick of medications, sick of feeling a different sick every day. I'm just old and each day a new pain. Now the neighbors want to know why I sit after a bike ride. It's the horrible back pain and lack of energy. Maybe it's old age and on the way out. But the fight is gone. I just try and make it through each day. I was such a fighter the poof is out of my sails. Phillipa
Posted by SLS on September 16, 2012, at 10:18:13
In reply to Re: Benzo when changes from feel good to tired? » SLS, posted by Phillipa on September 16, 2012, at 10:03:54
I can certainly understand what it is like to be depleted of emotional energy to fight with. I reached that point a year ago when I was convinced that I had run out of options. I had tried so hard to fight, but I had pretty much given up. I was demoralized, helpless, and hopeless. I pretty much didn't give a damn anymore.
I hope you find a place of peace.
- Scott
Posted by Twinleaf on September 16, 2012, at 11:13:13
In reply to Re: Benzo when changes from feel good to tired? » SLS, posted by Phillipa on September 16, 2012, at 10:03:54
The great majority of people in their 60's, 70's and beyond are enjoying life and finding that it still has meaning and is rewarding. A good proportion of those people are, or have, coped with very serious illness, and even the combination of advancing age and illness has not prevented them from enjoying what life has to offer.
As Scott implied, it is depression which is robbing you of the ability to enjoy life, and yet you do not consult any pharmacologists who might offer real help, nor will you seek out a psychotherapist for help with the interpersonal stresses you have. It is very sad for those of us who have gotten to know you over the years to see you come to such negative decisions. There are many constructive things you could do, which have helped many people, and have a very good chance of helping you. Hard as it is for us to accept, it clearly looks like you are not even going to try any of them.
Posted by jono_in_adelaide on September 16, 2012, at 17:58:40
In reply to Re: Benzo when changes from feel good to tired?, posted by Twinleaf on September 16, 2012, at 11:13:13
Phillpa, I would realy strongly encourage you to try adding mirtazepine (30mg at night0 or risperidone 1mg at night to your current meds (under doctors supervision of course) to see if they help with your anxiety and depression and ocd.
Re the long acting benzos, i hadnt thought of that, might be worth switching to say lorazepam 1mg twice a day - again, mention it to your doc, s/he might have forgotten as well
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