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Dr. Bob is Robert Hsiung, MD,
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Posted by AnneL on March 25, 2001, at 0:43:03
I have been on Effexor 37.5 for one week now for depression and although frequently "jittery" during the day, have found it to be very helpful so far. Medication induced insomnia and anxiety at night are my main concerns and my doc suggested I take Xanax before going to sleep. I take 0.25 of Xanax about 1/2 hour before bed and find I drift off to sleep nicely, but at 1:30 AM I wake up every single night with extreme anxiety, heart racing, and say to myself, "No more Effexor!" because I get so scared. I have to take 0.5 mg. more of Xanax just to calm down! This scenario is repeated every night and takes about 30 minutes to calm down and get back to sleep. Is this a normal side effect of Effexor or am I experiencing a rebound of the Xanax taken before bed? As an experiment, I stopped the Effexor for one day and fell asleep last night without any Xanax but at 1:30 AM I woke up with the one of the worst panic attacks so far! The long and the short of it is that I am beginning to get phobic about going to sleep. My rationale is simple: If I don't go to sleep, I won't wake up with an anxiety attack! Of course, this is not practical. Any suggestions to help me manage? I really want to be able to work with this med because it is working on my depression.
Posted by Daveman on March 25, 2001, at 2:16:41
In reply to Effexor side effect or Xanax Rebound?, posted by AnneL on March 25, 2001, at 0:43:03
Anne:
What time are you taking the Xanax? It is a short-acting benzo, for me it lasted about 3-4 hours max. If you're taking it at, say, 9:00-10:00, you could be getting Xanax wearoff/rebound at 1:30 a.m. Also- did you have panic attacks before taking Xanax? That should give you a clue.
Dave
> I have been on Effexor 37.5 for one week now for depression and although frequently "jittery" during the day, have found it to be very helpful so far. Medication induced insomnia and anxiety at night are my main concerns and my doc suggested I take Xanax before going to sleep. I take 0.25 of Xanax about 1/2 hour before bed and find I drift off to sleep nicely, but at 1:30 AM I wake up every single night with extreme anxiety, heart racing, and say to myself, "No more Effexor!" because I get so scared. I have to take 0.5 mg. more of Xanax just to calm down! This scenario is repeated every night and takes about 30 minutes to calm down and get back to sleep. Is this a normal side effect of Effexor or am I experiencing a rebound of the Xanax taken before bed? As an experiment, I stopped the Effexor for one day and fell asleep last night without any Xanax but at 1:30 AM I woke up with the one of the worst panic attacks so far! The long and the short of it is that I am beginning to get phobic about going to sleep. My rationale is simple: If I don't go to sleep, I won't wake up with an anxiety attack! Of course, this is not practical. Any suggestions to help me manage? I really want to be able to work with this med because it is working on my depression.
Posted by JaneB on March 25, 2001, at 8:50:54
In reply to Effexor side effect or Xanax Rebound?, posted by AnneL on March 25, 2001, at 0:43:03
Were you sleeping through the night without frequent awakenings before you started meds?
Posted by AnneL on March 25, 2001, at 11:09:17
In reply to Re: Effexor side effect or Xanax Rebound? » AnneL, posted by Daveman on March 25, 2001, at 2:16:41
> Good Morning, Dave and Jane,
Thanks for responding. I had panic disorder between the ages of 18 and 19 which went away on its own, all attacks were during my sleep! That was 20 years ago and have been panic-free until I try any SSRI type meds or Effexor. I am doing beautifully on Effexor during the day, I have stopped crying and feel calmer. So you can imagine I am very motivated to make this work. I was taking Xanax at 9:00 or 9:30 PM and bam, panic at 1:30 AM and then more Xanax to calm down.
Last night I convinced myself to take 1 mg. of Klonopin instead of the short-acting Xanax. I took it at 12 midnight and slept soundly and peacefully during the night. I certainly don't want to become potentially addicted to benzos, but this is the first time in my life that I can actually hang in there with AD's. What do you think? Will this panic eventually subside? Or do you think a non-benzo sleeper may help? Between being phobic about going to sleep and the insomnia side-effects of Effexor, I could stay awake all night. . . I appreciate any input. Anne
Posted by Daveman on March 25, 2001, at 12:36:36
In reply to Re: Effexor side effect or Xanax Rebound? » Daveman, posted by AnneL on March 25, 2001, at 11:09:17
Anne,
Sounds to me like it was Xanax rebound. Klonopin is much longer lasting than Xanax and for me it was very sedating as well. I had no problem getting off, but was only on it a short time. My understanding is that all benzos create physical dependency if taken over long periods, so if you're going to take one continuously for more than a few weeks at a time, you have to come off slowly and will probably have withdrawal symptoms (the longer you take it and the higher the dose, the worse the withdrawal).
You might want to check into augmenting your AD with low-dose Remeron or Trazodone. Both are anti-depressants with sedating qualities, and if they work would allow you to back off your benzo. Good luck!
Dave
> > Good Morning, Dave and Jane,
> Thanks for responding. I had panic disorder between the ages of 18 and 19 which went away on its own, all attacks were during my sleep! That was 20 years ago and have been panic-free until I try any SSRI type meds or Effexor. I am doing beautifully on Effexor during the day, I have stopped crying and feel calmer. So you can imagine I am very motivated to make this work. I was taking Xanax at 9:00 or 9:30 PM and bam, panic at 1:30 AM and then more Xanax to calm down.
> Last night I convinced myself to take 1 mg. of Klonopin instead of the short-acting Xanax. I took it at 12 midnight and slept soundly and peacefully during the night. I certainly don't want to become potentially addicted to benzos, but this is the first time in my life that I can actually hang in there with AD's. What do you think? Will this panic eventually subside? Or do you think a non-benzo sleeper may help? Between being phobic about going to sleep and the insomnia side-effects of Effexor, I could stay awake all night. . . I appreciate any input. Anne
Posted by AnneL on March 25, 2001, at 16:58:58
In reply to Re: Effexor side effect or Xanax Rebound? » AnneL, posted by Daveman on March 25, 2001, at 12:36:36
>Dave,
I think you hit the nail on the head. I see my pdoc this week and will discuss alternatives to Klonopin. I've read up on Remeron, but no little about trazadone. Have you tried either? What was your experience? Thanks, Anne
Posted by Daveman on March 26, 2001, at 2:56:11
In reply to Re: Effexor side effect or Xanax Rebound?, posted by AnneL on March 25, 2001, at 16:58:58
Anne,
I've tried both. I could not take trazodone bacause it caused heart palpitations for me, which precipitated a panic episode (my father died of a heart attack). I understand this is not a terribly common side effect, so I wouldn't assume you'd get the same thing (my bad luck)
Remeron-now there's a story. First night I took it at midnight, was in bed thinking "I wonder if this will work". Next thing I knew it was 11:00 the next morning. Seriously! Remeron is extremely sedating the first few nights you take it, particularly in low doses, 15 mg. or less (for most people, Remeron gets less sedating the larger the dose- sounds ridiculous but it's true). Remeron is what allowed me to taper off Klonopin completely. Unfortunately, I've now been on it for about 6 weeks, and it does not do much to sedate me anymore. Again, for some, the sedation never wears off, but for me it did. My docs don't want to give me any other sleeping med right now, so I'm trying "natural" remedies (chamomile tea, GABA, valerian, Kava, and OTC stuff (Unisom, dramamine) with decidedly mixed results. I still have the klonopin for occasional use to break an insomnia cycle, but I've been getting enough sleep (barely) and my panic is well blocked by the Celexa I'm on, so haven't taken Klonopin in about 5 weeks (but I'm not afraid to take it occasionally in small doses).
Sorry to have rambled on. Hope some of this was of use. Give either or both of them a try, if for nothing else to help get you out of the benzo habit. It's not good to rely on a benzo regularly for sleep, the benzos disrupt your sleep cycle. Ambien, a non-benzo which interacts more selectively with the benzo receptor sites in your brain, is actually much less disruptive of your natural sleep cycle- unfortunately it has little anti-anxiety properties (there I go rambling again- over and out:)
Dave
> >Dave,
>
> I think you hit the nail on the head. I see my pdoc this week and will discuss alternatives to Klonopin. I've read up on Remeron, but no little about trazadone. Have you tried either? What was your experience? Thanks, Anne
Posted by AnneL on March 26, 2001, at 14:50:59
In reply to Re: Effexor side effect or Xanax Rebound? » AnneL, posted by Daveman on March 26, 2001, at 2:56:11
> Thanks, Dave! I appreciate the in-depth answer to my questions. I do have a few more if you don't mind? I have only been on Xanax and/or Klonopin for a total of 2 weeks now. I would have assumed that no taper was necessary with the short time span, however, not taking any benzo for one night did cause a major attack. So therefore, can I assume that I have developed some dependence on the benzos even after a relatively short time? If I start on low-dose Remeron, do I need to take the Klonopin in the same 1 mg. dose concurrently or would that be dangerous? In other words, how do I get off one to the other? It really seems like 2 weeks on relatively low-dose benzos should not have created any withdrawl symptoms, maybe I'am wrong. Thanks, Anne.
Posted by AnneL on March 26, 2001, at 17:56:45
In reply to Re: Effexor side effect or Xanax Rebound? » AnneL, posted by Daveman on March 26, 2001, at 2:56:11
>Hi Dave,
Thank you for sharing your thoughts on Remeron and Trazadone. All you have to say is heart palpitations and I think I'll save that for last! (I know everyone is different. . .) My question is do you think I need to taper off the Klonopin if I have only been on benzos for two weeks now. The reason why I even ask this, is that the one night I didn't take either Effexor or Xanax, that's when I had a monstrous panic attack and of course had no other recourse but to take Xanax in the wee hours of the morning. How do I taper off one med and begin, lets say on Remeron? Any help would be greatly appreciated. By the way, I slept well again last night on my Klonopin 1 mg. regimen and seem to be doing very well on the low dose Effexor. Thanks in advance. Anne :)
Posted by Daveman on March 27, 2001, at 1:43:56
In reply to Re: Effexor side effect or Xanax Rebound?, posted by AnneL on March 26, 2001, at 17:56:45
Hi Anne:
First of all, I'm not an expert, I can only share my experiences and what I've learned though this unexpected trip I've taken through depression, panic and insomnia. If you have a good pdoc (I do), you should discuss these issues with him/her.
My experience was that after being on Xanax 6 weeks, I was beginning to develop interdose rebound anxiety. This I'm sure was largely due to the short half-life of Xanax (half-life is different from the length of its primary effect- half-life is the time it takes for half of the med to leave your system completely). Xanax has a half life of 6-19 hours. Basically, when the half-life ends, you lose any assistance the drug is giving you.
Klonopin, by contrast, has a much longer half-life, 19-60 hours. I found that I could take as little as one dose a day at bedtime and it completely covered all Xanax withdrawal symptoms.
You say you've only been on the benzos two weeks. Everyone is different, and I suppose it is theoretically possible for you to have developed a dependency. However, according to what my docs have told me, and what I've read, it is highly unlikely. I found it very easy to taper off at 8 weeks. Also, it does not appear your doses have been very high.
If your doc approves, you might try taking Remeron instead of Klonopin one night and see if you have any rebound symptoms the following day. I'd bet you won't. If you do, you'll have to taper down, but if the Remeron is working that should not be a problem.
I wouldn't assume you have a dependency because of what happened with Xanax. Xanax is a particular drug which some people just can't take due to it's "whoosh" in and out of your system and its short half life. It has to be taken quite frequently to maintain constant blood levels. It is a very effective drug for panic disorder, but is very tricky for other patients. I'd bet with the short time you've been on Klonopin you can get off with little difficulty, but again I urge you to work with your doc on this.
Good luck and keep us posted!
Dave
> >Hi Dave,
> Thank you for sharing your thoughts on Remeron and Trazadone. All you have to say is heart palpitations and I think I'll save that for last! (I know everyone is different. . .) My question is do you think I need to taper off the Klonopin if I have only been on benzos for two weeks now. The reason why I even ask this, is that the one night I didn't take either Effexor or Xanax, that's when I had a monstrous panic attack and of course had no other recourse but to take Xanax in the wee hours of the morning. How do I taper off one med and begin, lets say on Remeron? Any help would be greatly appreciated. By the way, I slept well again last night on my Klonopin 1 mg. regimen and seem to be doing very well on the low dose Effexor. Thanks in advance. Anne :)
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