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Posted by Elizabeth on July 30, 2001, at 16:49:17
In reply to Attn: Elizabeth- Xanax or Ativan??, posted by terra miller on July 30, 2001, at 0:03:28
Hi. Can I ask how frequently you were taking the Ativan, and at what dose?
A problem that some people have with using benzodiazepines "as needed" is rebound anxiety symptoms. I don't know that Xanax would be any better. Klonopin is long-acting but takes longer to work, so it's not as well-suited to ad hoc use.
I'm not sure if I've answered your question, but I hope you at least got something useful out of this. < g >
-elizabeth
Posted by terra miller on July 30, 2001, at 23:54:31
In reply to Re: Xanax or Ativan?? » terra miller, posted by Elizabeth on July 30, 2001, at 16:49:17
> Hi. Can I ask how frequently you were taking the Ativan, and at what dose?
i've been off it now probably 3 weeks? (time kindof runs together for me sometimes *smile*) maybe a month?? at the most i was taking 1mg/2xdaily which is the level i quit from because it seemed to be only causing rebound and not helping the "real" anxiety when i needed it to. "when" it was doing what it was supposed to do/when it was supposed to do it, i took 1mg as needed. one time i took 2mg and that was reallllly nice *bigsmile*, but i only did that once for a totally major panic episode that 1mg wasn't touching.
> A problem that some people have with using benzodiazepines "as needed" is rebound anxiety symptoms.yep.
>I don't know that Xanax would be any better.
kind of what i thought, but i was wondering nonetheless.
>Klonopin is long-acting but takes longer to work, so it's not as well-suited to ad hoc use.
that's what i thought, too. i like the "as needed" effect better.
> I'm not sure if I've answered your question, but I hope you at least got something useful out of this. < g >i got a significant smile. i think "that" is useful! :-)
> -elizabethdo i just have to 'grin and bear it'???? thanks for your reply. feeling younger than you, -terra
Posted by terra miller on July 31, 2001, at 23:25:55
In reply to Re: Xanax or Ativan?? » Elizabeth, posted by terra miller on July 30, 2001, at 23:54:31
dear elizabeth,
two things: i have just "attempted" to read a thread here which has the hand-holding titles in it... i was drawn to it because of the DID in one of the titles. i didn't manage to read very far, however, so i have no idea what that thread is really about. i am now totally "fogged out." i think i'm having problems containing myself that i might actually be "understood" by another person who knows personally about the DID dx. in any case, i am totally "out of focus" right now. i wonder if you (you of course do not need to answer this if you aren't comfortable) are an Elizabeth who was a friend of mine on other boards?
on a practical basis: how in the heck does one with the DID dx. attempt to medicate in helpful ways "the body/brain?" specifically, i have been asking you about benzos. i am relying on alcohol medicinally these days. wish i could take a benzo without getting dependent or it not working or (grrrrr.... can't headache.......grrrr) anyway, should i even bother with meds?????? maybe i should just rely on "the ol'system" to take care of the panic on its own like it knows how to do instead of trying to "handle the panic on my own???" do you understand the "nature" of my questions????????
-help??? -terra
Posted by Elizabeth on August 1, 2001, at 14:22:31
In reply to Elizabeth: Please Read, posted by terra miller on July 31, 2001, at 23:25:55
> two things: i have just "attempted" to read a thread here which has the hand-holding titles in it... i was drawn to it because of the DID in one of the titles. i didn't manage to read very far, however, so i have no idea what that thread is really about.
It's pretty much devolved into random chattering. :-)
> i am now totally "fogged out." i think i'm having problems containing myself that i might actually be "understood" by another person who knows personally about the DID dx.
I wouldn't be that person.
> in any case, i am totally "out of focus" right now. i wonder if you (you of course do not need to answer this if you aren't comfortable) are an Elizabeth who was a friend of mine on other boards?
Umm. Not that I know of. Can you give me a hint?
> on a practical basis: how in the heck does one with the DID dx. attempt to medicate in helpful ways "the body/brain?"
I don't know. I think that there hasn't been much focus on pharmacotherapy of dissociative disorders. I've heard of people using various things, but I don't know how well they work.
> specifically, i have been asking you about benzos. i am relying on alcohol medicinally these days. wish i could take a benzo without getting dependent or it not working or (grrrrr.... can't headache.......grrrr) anyway, should i even bother with meds??????
I don't have enough information to make any reasonable judgment about that.
I'm confused about one thing in particular: you said you become tolerant to/dependent on benzos, but this doesn't happen with alcohol???
> maybe i should just rely on "the ol'system" to take care of the panic on its own like it knows how to do instead of trying to "handle the panic on my own???" do you understand the "nature" of my questions????????
I think so. Can you say more about what you mean by panic?
-elizabeth
Posted by terra miller on August 2, 2001, at 18:02:33
In reply to to Terra, posted by Elizabeth on August 1, 2001, at 14:22:31
to elizabeth-
> I wouldn't be that person.
*smile* i knew i should have read the whole thread. (remembering that game called "telephone" we played as kids.....)
> I'm confused about one thing in particular: you said you become tolerant to/dependent on benzos, but this doesn't happen with alcohol???
yes. i know; it doesn't make logical sense.>
> > maybe i should just rely on "the ol'system" to take care of the panic on its own like it knows how to do instead of trying to "handle the panic on my own???" do you understand the "nature" of my questions????????
>
> I think so. Can you say more about what you mean by panic?sure. for me there are two levels of anxiety. the first level might be from a flashback or memory or whatever, but i am able to talk myself through it or occupy myself and assure myself of my current surroundings/time; if i work hard enough i can push through this level of anxiety without taking anything. the second level of anxiety is more like frantic- bouncing off the walls- no way to calm myself down- panic. this level benefits from ativan/something. it is often brought on by a difficult flashback or memory that i didn't have any idea was there. ie: the greater the shock value the worse the panic.
so, for me, i am not anxious consistently. i'm certain my "fight or flight" is always on, though. i am always aware; it takes days to settle into a night of restful sleep, etc. i have just adapted. i still feel mentally sharp (most of the time *smile*) and i'm certain my body will be the first to weaken from being "on" all the time. the wellbutrin has helped in that sense- it's like adding "STP" to the fuel of your car's engine to make it run more efficiently. but, from time to time i get knocked off my feet and that's when i find medication beneficial for panic that's short term; and if dealing with a new flashback is particularly distressing it might mean i have to use sleep medication after a week or so because i've thrown my body off cycle (again) from not sleeping (the hypervigilance thing). this is probably why long-term-anxiety reducing-attempts/meds have not helped me but just made me feel very drugged. when necessary i want to retry the ativan, but don't want to have to do two weeks of withdrawals again just for one attempted dose when needed. grrrrr.
-terra
Posted by Elizabeth on August 3, 2001, at 0:08:45
In reply to Reply » Elizabeth, posted by terra miller on August 2, 2001, at 18:02:33
> > I'm confused about one thing in particular: you said you become tolerant to/dependent on benzos, but this doesn't happen with alcohol???
>
> yes. i know; it doesn't make logical sense.Well, I can't use antihistaminic drugs (such as tricyclics, neuroleptics, trazodone, Remeron, etc. as well as things like Benadryl and Atarax) for chronic insomnia because I become tolerant every few days. So I can believe that you might have different experiences with tolerance compared to most people. Still -- are you sure you're not increasing your alcohol intake? How often are you drinking?
> so, for me, i am not anxious consistently. i'm certain my "fight or flight" is always on, though.
Does the phrase "exaggerated startle response" seem to fit? That's very common for people suffering from posttraumatic stress.
> when necessary i want to retry the ativan, but don't want to have to do two weeks of withdrawals again just for one attempted dose when needed. grrrrr.
How often were you taking Ativan?
-elizabeth
Posted by terra miller on August 3, 2001, at 13:04:10
In reply to Re: Reply » terra miller, posted by Elizabeth on August 3, 2001, at 0:08:45
> Well, I can't use antihistaminic drugs (such as tricyclics, neuroleptics, trazodone, Remeron, etc. as well as things like Benadryl and Atarax) for chronic insomnia because I become tolerant every few days.yes, i have had that response to trazodone and ambien as well. i rotated for a while and that was somewhat beneficial. kind of like tricking my body or something. in fact, that still works and i suppose that's actually what i am still doing. sometimes sleep on my own, maybe chamomile tea, trazodone, ambien, alcohol, whatever. (you understand, not every night like that.... just whenever... that probably is descriptive of two months actually... more nights on my own than using something)
>Still -- are you sure you're not increasing your alcohol intake? How often are you drinking?
there is no pattern. i can go weeks without drinking a thing and actually feeling a form of aversion. i can have a week when i drink three times a week, a glass of wine. that's probably accurate. every day is different for me.
> Does the phrase "exaggerated startle response" seem to fit? That's very common for people suffering from posttraumatic stress.
oh, clearly. very clearly. life with PTSD...
> > when necessary i want to retry the ativan, but don't want to have to do two weeks of withdrawals again just for one attempted dose when needed. grrrrr.
>
> How often were you taking Ativan?hmmm, at the peak i probably went 2 months taking it every day, 2 times a day, 1mg at a time. then i quit cold turkey. i've been off it a month now???
-terra
Posted by Elizabeth on August 4, 2001, at 22:05:50
In reply to Re: Reply » Elizabeth, posted by terra miller on August 3, 2001, at 13:04:10
> > Well, I can't use antihistaminic drugs (such as tricyclics, neuroleptics, trazodone, Remeron, etc. as well as things like Benadryl and Atarax) for chronic insomnia because I become tolerant every few days.
>
> yes, i have had that response to trazodone and ambien as well.Ambien is the one thing that's continued working for me. What I've found is that while it only "knocks you out" when you first start taking it, it continues to facilitate sleep for a long time afterwards.
> i rotated for a while and that was somewhat beneficial. kind of like tricking my body or something.
I actually think it's a pretty good idea (although I'm not too keen on using alcohol as a sleep aid). It's important to have a stable sleep-wake pattern. One thing that worked well for me was taking Cylert (a long-acting stimulant) in the morning and Ambien or a benzo at night.
> there is no pattern. i can go weeks without drinking a thing and actually feeling a form of aversion. i can have a week when i drink three times a week, a glass of wine. that's probably accurate. every day is different for me.
It might help you to have a routine. Sleeping is much easier if you are going to bed at about the same time every day and waking up at about the same time every day.
> hmmm, at the peak i probably went 2 months taking it every day, 2 times a day, 1mg at a time. then i quit cold turkey. i've been off it a month now???
Do you really think that if you used it intermittently, as needed, you would still have to go through withdrawal? ("Intermittently" means perhaps taking it once every few days, not every day.)
That hasn't been my experience with Xanax (which I've been using as-needed for years). Actually I've never experienced benzo withdrawal.
-elizabeth
Posted by terra miller on August 5, 2001, at 23:31:46
In reply to Re: Reply » terra miller, posted by Elizabeth on August 4, 2001, at 22:05:50
> Ambien is the one thing that's continued working for me. What I've found is that while it only "knocks you out" when you first start taking it, it continues to facilitate sleep for a long time afterwards.
can you explain what you mean by "facilitates sleep for a long time afterwards."???? does that mean it regulates your sleep cycle for days afterwards, or are you referring to that particular night's sleep???
> > i rotated for a while and that was somewhat beneficial. kind of like tricking my body or something.
>
> I actually think it's a pretty good idea (although I'm not too keen on using alcohol as a sleep aid).you know, i'm not either. i don't for the life of me understand why alcohol works. i don't want it to work and intellectually i don't think it's a good idea. i don't get it, elizabeth. grrrr.
>It's important to have a stable sleep-wake pattern.
no matter when i get off to sleep, i wake at the same time (because i agree that sleeping in only makes it worse) and i do not let myself nap either for same reason. i can't believe how little sleep i'm living on. (how long can one person be so hypervigilant??? now i'm getting agitated just writing! grrrr.)
>One thing that worked well for me was taking Cylert (a long-acting stimulant) in the morning...
I have not heard of Cylert. Can you tell me more about it. Also, would not the same effect occur with Wellbutrin, I wonder? Curious.
> It might help you to have a routine. Sleeping is much easier if you are going to bed at about the same time every day and waking up at about the same time every day.
I wake same time. I fall asleep whenever I can override the hypervigilance. Honestly, Elizabeth, it is extremely annoying.
> Do you really think that if you used it intermittently, as needed, you would still have to go through withdrawal? ("Intermittently" means perhaps taking it once every few days, not every day.)
I'm afraid to start again, since I went through withdrawals last time I attempted the "as needed" approach.
> That hasn't been my experience with Xanax (which I've been using as-needed for years). Actually I've never experienced benzo withdrawal.Do you think I just am prone to it? I have been in bed thinking and really think that the benzos really are the way to go for me, considering the variety of anxiety I am dealing with (occasional). I think I only need short term/acting types. I'm just afraid. What difference is there between xanax and ativan from what you notice? (I "do" know that I've found ativan frustrating in the past because it takes too long to get in my system.... usually an hour.... which is far into whatever is making me anxious. I've always wished to have xanax instead, because I've heard that it acts faster.)
On another note: what do you know about Sonota for sleep??? I see pdoc on Friday, and have been wondering about asking for scripts for both xanax and sonata. Opinions? Sonata can be taken in the middle of the night, yes? That is "SO" my issue.
-terra
Posted by Elizabeth on August 6, 2001, at 12:02:06
In reply to sleep stuff » Elizabeth, posted by terra miller on August 5, 2001, at 23:31:46
> can you explain what you mean by "facilitates sleep for a long time afterwards."????
Sure. I mean that when I first started taking Ambien, it was actively sedating; although it didn't continue to "knock me out" after I'd been taking it a while, I was still able to rely on it to help me get to sleep and stay asleep for as long as I continued taking it each night (as long as 18 months).
> you know, i'm not either. i don't for the life of me understand why alcohol works. i don't want it to work and intellectually i don't think it's a good idea.
It's a CNS depressant; at a high enough dose, it will make anyone drowsy, whether they want it to or not. However, it also tends to cause rebound insomnia -- awakening in the middle of the night when it wears off.
> I have not heard of Cylert. Can you tell me more about it. Also, would not the same effect occur with Wellbutrin, I wonder? Curious.
Cylert (pemoline) is a relatively mild stimulant used mainly for ADHD.
Wellbutrin is certainly activating, but its effect doesn't last as long as Cylert's (so you might find yourself crashing in the afternoon). It might be worth a try, though; I'd recommend Wellbutrin SR, the sustained-release formulation.
[re Ativan[
> I'm afraid to start again, since I went through withdrawals last time I attempted the "as needed" approach.How often were you using it?
> Do you think I just am prone to it?
That's possible.
> What difference is there between xanax and ativan from what you notice?
Not much. Xanax is a little more potent (i.e., the effective dose will be lower than the effective dose of Ativan); Ativan lasts a little longer.
> (I "do" know that I've found ativan frustrating in the past because it takes too long to get in my system.... usually an hour.... which is far into whatever is making me anxious.
Have you tried dissolving it under your tongue rather than swallowing it?
> On another note: what do you know about Sonota for sleep???
Yes. It's very short-acting. It works best for people who wake up in the middle of the night and have trouble getting back to sleep.
-elizabeth
Posted by terra miller on August 6, 2001, at 12:55:26
In reply to Re: sleep stuff » terra miller, posted by Elizabeth on August 6, 2001, at 12:02:06
> Wellbutrin is certainly activating, but its effect doesn't last as long as Cylert's (so you might find yourself crashing in the afternoon). It might be worth a try, though; >
I've been taking the i.r. version and liking it for months now. (i do not take it too late in the day.)
> Re: ativan: How often were you using it?
at peak: 1mg 2x/day
> re: diff. btn. xanax & ativan: Xanax is a little more potent (i.e., the effective dose will be lower than the effective dose of Ativan); Ativan lasts a little longer.
i don't need it to last long. i just need the help at the beginning.
> Have you tried dissolving it under your tongue rather than swallowing it?
yes, i was "resorting" to dissolving it under my tongue and found it to work much quicker than just swallowing it. still, it lacked the "kick" i needed to calm the panic (i'm not referring to that "benzo-feeling" but rather to feeling an edge in taking control of an out-of-control feeling/situation.)
>< sonata > Yes. It's very short-acting. It works best for people who wake up in the middle of the night and have trouble getting back to sleep.
hmmm. that would be me. i can get to sleep usually. occasionally i can't and then ambien works fine. it's waking up and waking up and waking up that's most of the problem. any sonata- sideeffects issues you know about?
thanks. -terra
Posted by Elizabeth on August 7, 2001, at 8:38:24
In reply to Re: sleep stuff » Elizabeth, posted by terra miller on August 6, 2001, at 12:55:26
> > Re: ativan: How often were you using it?
>
> at peak: 1mg 2x/dayAhh. That's more than intermittent use, if you were using it on a daily basis for any significant length of time.
> i don't need it to last long. i just need the help at the beginning.
Then Xanax might be better for you.
> hmmm. that would be me. i can get to sleep usually. occasionally i can't and then ambien works fine. it's waking up and waking up and waking up that's most of the problem. any sonata- sideeffects issues you know about?
Probably similar to Ambien. (Personally, I find that Ambien is short-acting enough; when I wake up in the middle of the night, I just take Ambien.)
-elizabeth
Posted by paxvox on August 7, 2001, at 12:02:17
In reply to sleep stuff » Elizabeth, posted by terra miller on August 5, 2001, at 23:31:46
>
> On another note: what do you know about Sonota for sleep??? I see pdoc on Friday, and have been wondering about asking for scripts for both xanax and sonata. Opinions? Sonata can be taken in the middle of the night, yes? That is "SO" my issue.
>
> -terraGonna jump in here before I read the follow-ups.
Sonata is OK, with an *. It does put you out, but you will wake up in 4-5 hours, generally having trouble getting back to sleep. Due to its short half life (1 hour) the med is rapidly metabolized. It can cause daytime anxiety, nervousness and can set off a panic attack (my personal experinces). However, you CAN take it in middle of the night to get back to sleep, or if you have been trying to get to sleep and you just can't. I took one last night at 12:45, and slept fine until 5:39, which is about the time (5:45) my alarm is set to. Perhaps that is its best use. I do not think it will help taken chronically, and may potentiate the negative effects that I had with it. Ambien worked a bit better for me, and kept me asleep longer, but my Pdoc took me off of it starting with my first visit to him 4 years ago. Alcohol does not help you in the sleep battle. True, it lets you GET to sleep, but it interfers with deep sleep, and thus sleep quality. When I quit drinking entirely, my sleep actually improved quite a bit. Benzos, however, are life savers for sleep problems as long as you don't increase the dose on your own. You may develop a tolerance to one benzo, but they are chemically different enought that you can switch to another one.
Posted by terra miller on August 8, 2001, at 12:01:02
In reply to Re: sleep stuff » terra miller, posted by Elizabeth on August 7, 2001, at 8:38:24
> ativan- at peak: 1mg 2x/day
>
> Ahh. That's more than intermittent use, if you were using it on a daily basis for any significant length of time.it was that way for 2 months. otherwise it was as needed. i got stuck for 2 months and couldn't get off. then did the cold-turkey thing.
> hmmm. that would be me. i can get to sleep usually. occasionally i can't and then ambien works fine. it's waking up and waking up and waking up that's most of the problem. any sonata- sideeffects issues you know about?
>
> Probably similar to Ambien. (Personally, I find that Ambien is short-acting enough; when I wake up in the middle of the night, I just take Ambien.)Really????? If I take Ambien in the middle of the night I am grogged for 8 hours until it gets out of my system. I may be awake, but I feel drugged. That's why I can't take it in the middle of the night. How do you get away with it? (smile)
-terra
Posted by terra miller on August 8, 2001, at 12:04:07
In reply to Re: sleep stuff » terra miller, posted by paxvox on August 7, 2001, at 12:02:17
thanks for "jumping in" (smile)
it could be that my pdoc has not ever suggested sonata because i have panic/anxiety issues????
and about benzos: do you actually switch back and forth and if yes, then how/what do you do? i've not heard of this, or maybe i just don't remember. (got 3 hours last night, but still plugging right along!) :-)
-terra
Posted by Elizabeth on August 9, 2001, at 10:14:27
In reply to Re: sleep stuff » terra miller, posted by paxvox on August 7, 2001, at 12:02:17
> You may develop a tolerance to one benzo, but they are chemically different enought that you can switch to another one.
I'm surprised to hear this. Benzos do cause cross-tolerance (and similarly, switching to a different benzo can prevent withdrawal symptoms).
-e
Posted by Elizabeth on August 9, 2001, at 10:16:05
In reply to Re: sleep stuff » Elizabeth, posted by terra miller on August 8, 2001, at 12:01:02
> it was that way for 2 months. otherwise it was as needed. i got stuck for 2 months and couldn't get off. then did the cold-turkey thing.
If you were taking Ativan on a daily basis for two months, I'm not surprised that you got withdrawal symptoms when you stopped.
> Really????? If I take Ambien in the middle of the night I am grogged for 8 hours until it gets out of my system. I may be awake, but I feel drugged. That's why I can't take it in the middle of the night. How do you get away with it? (smile)
Probably just individual variations in metabolism.
-elizabeth
Posted by paxvox on August 9, 2001, at 11:15:30
In reply to Re: sleep stuff » paxvox, posted by Elizabeth on August 9, 2001, at 10:14:27
> > You may develop a tolerance to one benzo, but they are chemically different enought that you can switch to another one.
>
> I'm surprised to hear this. Benzos do cause cross-tolerance (and similarly, switching to a different benzo can prevent withdrawal symptoms).
>
> -eI didn't say that they didn't "cross tolerate", however, they are diffent enough in degrees such as half-life, etc where one can be used to maintain the effects of another where the subject has becomer tolerant to that specific chemical formula.
Posted by paxvox on August 9, 2001, at 11:28:40
In reply to Re: sleep stuff » paxvox, posted by terra miller on August 8, 2001, at 12:04:07
> thanks for "jumping in" (smile)
>
> it could be that my pdoc has not ever suggested sonata because i have panic/anxiety issues????
>
> and about benzos: do you actually switch back and forth and if yes, then how/what do you do? i've not heard of this, or maybe i just don't remember. (got 3 hours last night, but still plugging right along!) :-)Sonata can cause the anxiety problems. Yes, I have flip-flopped different benzos (yes, it works for ME) without having to increase the relative dosage (see Dr. Bob's benzo equivalence graph). I went to my GP yesterday to try to rule out some physical caualities for my sleep pattern. I've been playing this game for 10 years now, I have tried many things. I would be happy to recount my particular experiences if you would be interested.
>
> -terra
Posted by terra miller on August 9, 2001, at 14:47:48
In reply to Re: sleep stuff » terra miller, posted by paxvox on August 9, 2001, at 11:28:40
saw my pdoc today and came home with a scrip for xanax. never used it before, and my pdoc did not want to let me use it. but from what i can gather, it seems to be the best and only option for that sudden-onset panic on occasion. he prescribed the scored .5mg tablets so i can play with the dosage +/-.
as far as sleep, 15mg ambien put me out for the whole night last night (had forgotten what it feels like to be out for that long... it actually was kind of weird because i'm just used to always being awake).... so i'm just going to use that on occasion (ie: once a week probably) which is when it's most likely to be beneficial for me. other than the occasional ambien or xanax, i think "toughing it out" for now seems to be the way to go.
-terra
Posted by Elizabeth on August 9, 2001, at 16:47:27
In reply to Re: sleep stuff » Elizabeth, posted by paxvox on August 9, 2001, at 11:15:30
> I didn't say that they didn't "cross tolerate", however, they are diffent enough in degrees such as half-life, etc where one can be used to maintain the effects of another where the subject has becomer tolerant to that specific chemical formula.
I wouldn't expect that to happen. A person who's tolerant to Valium will also be tolerant to Serax, for example. In this case, taking the equivalent dose of Serax would prevent withdrawal symptoms, and taking a higher dose than the equivalent one would produce a positive effect. The minor variations in the chemical structures of various benzodiazepines don't make a difference here; their pharmacodynamics are the same, and that's what matters.
Partial cross-tolerance does occur with other classes of drugs that have related, but not identical, mechanisms (such as alcohol or barbiturates).
-elizabeth
Posted by Daveman on August 9, 2001, at 23:11:23
In reply to Re: sleep stuff » paxvox, posted by Elizabeth on August 9, 2001, at 16:47:27
I think it depends what is meant by "cross-tolerant". If you are talking about the principal mechanism, probably so. But each benzo has a different chemical profile and thus different side effects. Thus, some experts utilize a valium-substitution method to wean off Xanax- not only does it cover withdrawal symptoms and have a longer half life, but is a much stronger hypnotic and can thus help with the insomnia that comes with benzo withdrawal.
Of course, panic disorder patients report staying on the same doses of Xanax or klonopin for years without developing tolerance to the anti-panic effects (as opposed to the sedation). YMMV.
Dave
Posted by paxvox on August 10, 2001, at 8:24:51
In reply to well, it depends....:) » Elizabeth, posted by Daveman on August 9, 2001, at 23:11:23
.
>
> Of course, panic disorder patients report staying on the same doses of Xanax or klonopin for years without developing tolerance to the anti-panic effects (as opposed to the sedation). YMMV.
>
> Dave
Well, Dave, that's been my opion with the Benzos. I have taken Klonopin for as long as two years w/o having to up my dosing, and have been taking Tranzene now for about two years, again w/o increasing dose. My problem is that my Pdoc seems to want to wean me off the Benzo every two years or so, and try to substitute it with another med, usually off-lable application of an anti-seizure med like Topamax, Neurontin and now Depakote. All these have a whole lot higher potential for adverse effects than the benzos. My point: why fix it if it aint broken? I never told my Pdoc that the benzos had lost their effects as either anxiolytics, to take edge off the Wellbutrin or as a sleep inducer. True, the half-lives of the different benzos affect how well they work for specific conditions. I think she was missing my point.
Posted by Elizabeth on August 10, 2001, at 15:25:31
In reply to well, it depends....:) » Elizabeth, posted by Daveman on August 9, 2001, at 23:11:23
> I think it depends what is meant by "cross-tolerant."
Pharmacodynamic tolerance to one benzo will result in tolerance to other benzos. As you say, the principal mechanism.
> But each benzo has a different chemical profile and thus different side effects.
For the most part, it's not easy to predict the side effects of different benzos. For some people, Valium is more sedating than a supposedly "equivalent" dose of Xanax. For others the reverse is true. (I've taken as much as 40 mg of Valium -- with no tolerance -- and didn't feel a thing.)
> Thus, some experts utilize a valium-substitution method to wean off Xanax- not only does it cover withdrawal symptoms and have a longer half life, but is a much stronger hypnotic and can thus help with the insomnia that comes with benzo withdrawal.
Again, the sedative effects of benzos are highly variable from individual to individual. Valium isn't the best choice for substitution in benzo discontinuation; despite its relatively long elimination half-life, its action lasts only a few hours because of distribution factors. Klonopin and Tranxene are probably the longest-lived benzos.
> Of course, panic disorder patients report staying on the same doses of Xanax or klonopin for years without developing tolerance to the anti-panic effects (as opposed to the sedation). YMMV.
That's not just patient report; it's a pretty well established fact. Some people say they became tolerant to the antipanic effects of benzos, but that seems to be the exception rather than the rule.
-e
Posted by Daveman on August 13, 2001, at 23:20:21
In reply to benzo stuff » Daveman, posted by Elizabeth on August 10, 2001, at 15:25:31
>
> > Of course, panic disorder patients report staying on the same doses of Xanax or klonopin for years without developing tolerance to the anti-panic effects (as opposed to the sedation). YMMV.
>
> That's not just patient report; it's a pretty well established fact. Some people say they became tolerant to the antipanic effects of benzos, but that seems to be the exception rather than the rule.
>
> -eNo disagreement here:)
BTW, tho I always say YMMV (your mileage may vary), the valium substitution method is well accepted. That's not to say Klonopin doesn't work also, since I used Klonopin to wean off Xanax. But for those with long-term use who need to go especially slowly, Valium is preferred because, as a low-potency benzo (1 mg. Xanax= 10 mg. Valium), the dose reductions can be much smaller, particularly toward the end of a taper.
Dave
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