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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 15 of 15. This is the beginning of the thread.
Posted by Daveman on January 25, 2001, at 22:09:20
Hi All:
Am new to this board with a question about Xanax tolerance. I was prescribed (as interim therapy for depression/g.a.d/insomnia)xanax at .25 twice a day, then .50 at night (long term hope is Paxil but this takes time to become effective). The Xanax was at first quite effective but I have now, as I've learned is typical, developed tolerance to it. My question, while awaiting my doc's decision as to whether I should increase the Xanax, is whether tolerance is a continual cycle with Xanax or at some point does your body adjust to a particular therapeutic dose? I understand from research that doses up to 4mg per day are not uncommon for g.a.d., and even higher for panic disorders, but I do not wish to get into a continually escalating cycle, and am concerned about dependency at higher doses. Thanks for any helpful information.
Posted by Joy on January 26, 2001, at 8:40:26
In reply to Xanax tolerance, posted by Daveman on January 25, 2001, at 22:09:20
I have been taking .5 mg Xanax generic 30 minutes before bedtime for insomnia for about 3 months. I have not felt a need to increase my dose at all, but I can only speak for myself. .25 is a very mild dose, so I could see a possible adjustment a bit higher if checked out with your doc.
Joy> Hi All:
>
> Am new to this board with a question about Xanax tolerance. I was prescribed (as interim therapy for depression/g.a.d/insomnia)xanax at .25 twice a day, then .50 at night (long term hope is Paxil but this takes time to become effective). The Xanax was at first quite effective but I have now, as I've learned is typical, developed tolerance to it. My question, while awaiting my doc's decision as to whether I should increase the Xanax, is whether tolerance is a continual cycle with Xanax or at some point does your body adjust to a particular therapeutic dose? I understand from research that doses up to 4mg per day are not uncommon for g.a.d., and even higher for panic disorders, but I do not wish to get into a continually escalating cycle, and am concerned about dependency at higher doses. Thanks for any helpful information.
Posted by rogdog on January 26, 2001, at 17:54:15
In reply to Xanax tolerance, posted by Daveman on January 25, 2001, at 22:09:20
hey daveman! I have had similar experiences with xanax, I started on 1/4 mg three times a day...worked great! but then a couple of weeks go by and I need to double the dose, which didnt bother me much, 1 and a half mgs a day is not that much, but over the months I have had to increase my dose and now I am taking 4 mgs a day.. I dont like being "addicted" so to speek to a medicine like this but xanax is the only thing that helps me, so what do you do? good luck rogdog
Posted by JaneST on January 28, 2001, at 18:00:24
In reply to Xanax tolerance, posted by Daveman on January 25, 2001, at 22:09:20
D.~
Of course everyone is different...but my experience was that Xanax, though helpful for panic/anxiety/etc., was extremely addictive. It seems the therapeutic effect only lasted up to a few months or so and then the dose would have to be upped.
After a few years, I found myself telling doctors how much I was prescribed and they would look at me in disbelief...no one should be walking around at those levels. And let me tell you...weaning off the stuff was not a pretty picture...even though it was done over a long period of time...I never want to go through that again!
Now I'm taking Lorazepam (Ativan) and have successfully remained on the same dosage for 2 years...so my advice is to tread lightly here...and I'm rooting for the Paxil.
Best of Luck...
Jane
Posted by super on January 29, 2001, at 13:19:27
In reply to Re: Xanax tolerance » Daveman, posted by JaneST on January 28, 2001, at 18:00:24
Ideally, I've been told, Xanax should be taken "as needed." This way, (I guess) you won't develop a tolerance. If you need it all the time then it is probably best to find another drug, and you should probably find something else ASAP (before you are hooked on the Xanax). However, Xanax has been okay for me--nearly two years and I've never taken more than 2mg in a day, and I even stopped taking it completely for about a month. Personally, I never want to take more than 2mg because the higher the dose, the worse the withdrawal.
> D.~
>
> Of course everyone is different...but my experience was that Xanax, though helpful for panic/anxiety/etc., was extremely addictive. It seems the therapeutic effect only lasted up to a few months or so and then the dose would have to be upped.
>
> After a few years, I found myself telling doctors how much I was prescribed and they would look at me in disbelief...no one should be walking around at those levels. And let me tell you...weaning off the stuff was not a pretty picture...even though it was done over a long period of time...I never want to go through that again!
>
> Now I'm taking Lorazepam (Ativan) and have successfully remained on the same dosage for 2 years...so my advice is to tread lightly here...and I'm rooting for the Paxil.
>
> Best of Luck...
> Jane
Posted by Daveman on January 29, 2001, at 14:31:13
In reply to Re: Xanax tolerance » Daveman, posted by JaneST on January 28, 2001, at 18:00:24
> D.~
>
> Of course everyone is different...but my experience was that Xanax, though helpful for panic/anxiety/etc., was extremely addictive. It seems the therapeutic effect only lasted up to a few months or so and then the dose would have to be upped.
>
> After a few years, I found myself telling doctors how much I was prescribed and they would look at me in disbelief...no one should be walking around at those levels. And let me tell you...weaning off the stuff was not a pretty picture...even though it was done over a long period of time...I never want to go through that again!
>
> Now I'm taking Lorazepam (Ativan) and have successfully remained on the same dosage for 2 years...so my advice is to tread lightly here...and I'm rooting for the Paxil.
>
> Best of Luck...
> JaneHi Jane:
Your post has confirmed my worst fears about Xanax. But Ativan is a benzo also and there are other posts just as frightening about it. How high a dose of Xanax were you on before you began your taper? Have the docs explained why you had tolerance to one benzo but not another? I sure don't want to get trapped in an escalating cycle of dependency and addiction, but my current level of anxiety is completlely disabling. To say I am terrified of what seem like no good choices (unless the Paxil works, of which there is no sign yet)would be an understatement in the extreme.
D
Posted by super on January 29, 2001, at 15:40:49
In reply to Re: Xanax tolerance » JaneST, posted by Daveman on January 29, 2001, at 14:31:13
Hi Dave,
I take back what I said on my previous posting. If you are feeling that bad that you are disabled by your anxiety, I'd go ahead and take as much Xanax as you feel you need to function right now. You're on a small dose right now; even if you go to a higher dose, you can probably taper pretty easily once you get more stable.> > D.~
> >
> > Of course everyone is different...but my experience was that Xanax, though helpful for panic/anxiety/etc., was extremely addictive. It seems the therapeutic effect only lasted up to a few months or so and then the dose would have to be upped.
> >
> > After a few years, I found myself telling doctors how much I was prescribed and they would look at me in disbelief...no one should be walking around at those levels. And let me tell you...weaning off the stuff was not a pretty picture...even though it was done over a long period of time...I never want to go through that again!
> >
> > Now I'm taking Lorazepam (Ativan) and have successfully remained on the same dosage for 2 years...so my advice is to tread lightly here...and I'm rooting for the Paxil.
> >
> > Best of Luck...
> > Jane
>
> Hi Jane:
>
> Your post has confirmed my worst fears about Xanax. But Ativan is a benzo also and there are other posts just as frightening about it. How high a dose of Xanax were you on before you began your taper? Have the docs explained why you had tolerance to one benzo but not another? I sure don't want to get trapped in an escalating cycle of dependency and addiction, but my current level of anxiety is completlely disabling. To say I am terrified of what seem like no good choices (unless the Paxil works, of which there is no sign yet)would be an understatement in the extreme.
>
> D
Posted by JaneST on January 29, 2001, at 19:18:11
In reply to Re: Xanax tolerance » JaneST, posted by Daveman on January 29, 2001, at 14:31:13
D.~
Geez...it's been so long since I've thought about this...don't know if I know the answers but I'll give you my best guess. Though I hate to say this out loud, I got up to 20 (yes, twenty)mgs. of Xanax per day...guess you could say I was eating them like candy...honestly not to obtain a high or to deliberately knock me out...just to maintain. Literally, doctors didn't know how I was standing...very hard time in my life...post car wreck, pain, depression, surgery, overwhelming life with divorce looming....No one has said why I can maintain my current level of Ativan at 1mg per day...and have remained at that level for the past 2+ years. My guess is most of the above problems have been 'fixed'. I was on a lot of different meds at the same time I built up my Xanax tolerance so I don't know if that had anything to do with it or not. Good question.
I had not had addiction problems prior nor since...but I'm not counting nicotine :). Xanax is definitely not a drug you want to have to come down from...I did it over many months and maintained a 2mg dose for a few years after the big balloon.
So...I guess I didn't answer many of your direct questions but I hope my experience will simply help provide you with more information.
Oh! Additionally, while on the 2mg maintenance dose I was also on Nardil, evidently known for its' anti-anxiety agents as well. Can't think of anything else.
Hope it helps...let me know how you do....
Love,
Jane
Posted by Daveman on January 29, 2001, at 23:14:28
In reply to Re: Xanax tolerance » Daveman, posted by JaneST on January 29, 2001, at 19:18:11
> D.~
> Geez...it's been so long since I've thought about this...don't know if I know the answers but I'll give you my best guess. Though I hate to say this out loud, I got up to 20 (yes, twenty)mgs. of Xanax per day...guess you could say I was eating them like candy...honestly not to obtain a high or to deliberately knock me out...just to maintain. Literally, doctors didn't know how I was standing...very hard time in my life...post car wreck, pain, depression, surgery, overwhelming life with divorce looming....
>
> No one has said why I can maintain my current level of Ativan at 1mg per day...and have remained at that level for the past 2+ years. My guess is most of the above problems have been 'fixed'. I was on a lot of different meds at the same time I built up my Xanax tolerance so I don't know if that had anything to do with it or not. Good question.
>
> I had not had addiction problems prior nor since...but I'm not counting nicotine :). Xanax is definitely not a drug you want to have to come down from...I did it over many months and maintained a 2mg dose for a few years after the big balloon.
>
> So...I guess I didn't answer many of your direct questions but I hope my experience will simply help provide you with more information.
>
> Oh! Additionally, while on the 2mg maintenance dose I was also on Nardil, evidently known for its' anti-anxiety agents as well. Can't think of anything else.
>
> Hope it helps...let me know how you do....
>
> Love,
> JaneJane:
I want to thank you so much for taking the time to respond to me. Even if you weren't able to directly answer my questions the support is very meaningful. I'm determined under all circumstances not to exceed 4mg xanax in any day no matter how bad my anxiety gets (that's the recommended dose in the PDR for general anxiety disorder). Right now I'm still not even at 2mg per day so hopefully other, less addictive, solutions will be found for me before then.
I was curious about one more thing (if you don't mind:)) You mentioned Nardil. That is a medication my doc has referred to as a "last gasp" measure because it is an MAO Inhibitor which inteacts negatively with many common types of foods and medicines. Did you find it helped you, particularly if you had insomnia (a big-time problem of mine)? Did you find it hard to avoid all the complications? Sorry to keep "pumping you" for info but you have been very kind and helpful so far.
D
Posted by JaneST on February 3, 2001, at 20:30:03
In reply to Re: Xanax tolerance » JaneST, posted by Daveman on January 29, 2001, at 23:14:28
D~
Sorry...meant to get back to you sooner. Nardil saved my life. Yes, there can be complications...I memorized my food list and before Anyone prescribed an anti-biotic or ANYTHING, I had them double check to see if it would be contraindicated with the Nardil. I guess I became hyper-vigilante...but when you have high anxiety anyway, that's not really so hard, is it? :)I remained on Nardil for a little over 5 years. I never had an episode or problem with an interaction. Insomnia has never really been one of my problems, however, I learned early on that I should only take Nardil at night...not daytime...because it was too sedating for me.
Sadly, it pooped out on me about 2+ years ago and until about 4 months ago, I remained in search of that speeding bullet...something that would give me a break from the black pit. Though I tried just about everything else, nothing has achieved that success. Eventually, I decided that most of the AD's I was trying were contributing to my depression. So, 4 months ago I chose to stop everything but my Ativan...and I feel surprisingly 'normal'. I have my moments but then I remind myself whatever was making me feel disheartened or bummed out was normal...just a blip on the screen and I'm doing ok.
A few weeks ago I went to an MD for my annual physical and recited the litany of AD's I had tried, mentioning my success with Nardil...he said, "hmmm, I rely only on psychiatrists to prescribe that." And I truly believe it requires quite a courageous one at that. I don't know if they are so concerned about the side-effects or the potential legal issues...or what...but you sound like the kind of person to be responsible enough for yourself.
Hope this has given you some insight. Let me know how it goes.
Love,
Jane
Posted by Jackster on February 4, 2001, at 0:25:27
In reply to Re: Xanax tolerance » Daveman, posted by JaneST on February 3, 2001, at 20:30:03
Hi
I've been on Xanax for the last 6 weeks whilst waiting for the Paxil to kick in too. But in my case i was on Paxil 40mg for 3 years for agoraphobia with PA and it worked wonderfully. I decided to come down off it slowly, but then the PA's started coming back. When I went back up to the full dose it didn't work as well anymore. After trying many different AD's (Celexa, Imipramine, Prozac) I ended up having the worst PA's of my life (brought on by the starting too higher dose of Prozac I think). I got put on Xanax 1mg x 3 a day which helped me heaps. This is not an uncommon dose for Panic disorder. The Doc seemed to think that addiction wasn't a danger until after about 3 months. If I'm not doing anything stressful at night, I don't take my last dose until just before bedtime which helps me sleep. I'm seeing the PDoc next week - would have been back on the Paxil for 7 weeks so time to reduce the Xanax and see how I go. Wish me luck. Anyone got recommendations about the speed of tapering off Xanax?
Jackie
Posted by Daveman on February 4, 2001, at 1:48:35
In reply to Re: Xanax tolerance, posted by Jackster on February 4, 2001, at 0:25:27
> Hi
>
> I've been on Xanax for the last 6 weeks whilst waiting for the Paxil to kick in too. But in my case i was on Paxil 40mg for 3 years for agoraphobia with PA and it worked wonderfully. I decided to come down off it slowly, but then the PA's started coming back. When I went back up to the full dose it didn't work as well anymore. After trying many different AD's (Celexa, Imipramine, Prozac) I ended up having the worst PA's of my life (brought on by the starting too higher dose of Prozac I think). I got put on Xanax 1mg x 3 a day which helped me heaps. This is not an uncommon dose for Panic disorder. The Doc seemed to think that addiction wasn't a danger until after about 3 months. If I'm not doing anything stressful at night, I don't take my last dose until just before bedtime which helps me sleep. I'm seeing the PDoc next week - would have been back on the Paxil for 7 weeks so time to reduce the Xanax and see how I go. Wish me luck. Anyone got recommendations about the speed of tapering off Xanax?
>
> JackieHi Jackie:
Here's a link to a good article about Xanax and panic attacks, with specific information about tapering:
http://lexington-on-line.com/naf_xanax.html
I've been on Xanax (still haven't gone above 1.5 mg. per day) waiting for Paxil now for 28 days, still no real help from the Paxil. It now appears my sleep anxiety problem has settled into an obsession (I've battled OCD in various forms before) so it still looks like Paxil or some SSRI is what I need, though the wait is interminable! Question- my doc has mentioned Serzone as a possible alternative if Paxil fails. Anybody out there got any info on that medication?
Daveman
Posted by Greg A. on February 5, 2001, at 16:17:54
In reply to Re: Xanax tolerance » Jackster, posted by Daveman on February 4, 2001, at 1:48:35
This dredges up not so fond memories of my recent past . . . I took Xanax for almost seven years, prescribed by my GP for anxiety and depression. When the drug was first introduced, it was touted as less addictive than other benzodiazepines and also possessed of some AD properties.
I peaked at around 12 mgs per day and then weaned myself down to around 6 or so. I always had the container of little orange pills with me, because about every 2 hours or so, the need was there.
Long story short . . . it took a year of slowly cutting back (and replacing the Xanax with Paxil) until I was off. Even then I would have these rebound episodes where the withdrawal symptoms would return for no apparent reason.
Xanax is widely prescribed, I think because it has such a rapid and effective onset. I have since used Clonazepam periodically and it seems much longer acting but in a milder way.
The pdoc I was seeing was really good about tapering me off Xanax. I was afraid he was just going to take my pills away and give me the AD's. Instead he told me I could stay on Xanax for as long as I felt it necessary - as long as I attempted to gradually reduce the dose. He told me up front he expected it would take a year. The actual tapering consisted of initial reductions of 0.5 mgs at biweekly intervals. Near the end of the year, however, I was chipping the pills into little fragments . . .
Don't know if this info is of any use but I pass it along since you asked.
Posted by SLS on February 5, 2001, at 17:04:54
In reply to Re: Xanax tolerance, posted by Jackster on February 4, 2001, at 0:25:27
Hi Jackie.
If Paxil does not help as much as it used to, perhaps adding Buspar or possibly pindolol would help. I would look into Buspar first. Perhaps you can use pindolol or propanolol (beta-blocker) as needed at the beginning of a panic attack.
Just a few guesses - I have no personal experience with this situation.
Good luck.
- Scott
Posted by baxwing on February 10, 2001, at 18:51:33
In reply to Re: Xanax tolerance, posted by Greg A. on February 5, 2001, at 16:17:54
Whatever you do don't quit abrubtly...I had a depression/anxiety/panic attack episode that was close to being the worst I have ever felt in my life...not knowing it was the withdrawal that helped trigger it.
This is the end of the thread.
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