![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 40. This is the beginning of the thread.
Posted by Thrud on August 22, 2001, at 23:52:46
Hi all.
I have just ramped up to 6mg per day of Xanax for my PD (yes, a high dose for a big problem!)
I am feeling very tired, but I am not sure if it is from the Xanax or my anxious fatigue (when inadequately treated, I get hypersomnia and extremely tired with my PD). After approximately how long should it take for the sedative effects of Xanax to settle out?
Also, my libido is now shot as badly as when using the SSRIs. My pdoc said this *could* ease with time as part of the tolerance-dependence process. I have found someone else with a similar experience where his sexual function took 'months' to recover after going from Klonopin to 4mg per day Xanax. Anyone have any firsthand experience in this matter?
In general, why the f!ck does *anything* that helps my PD ends up destroying my libido? (Conversely, when I am unmedicated my libido is fantastic). I am desperately clinging to the hope that I can be panic free without being sex free as well!
On a lighter note, I can see that benzos really are muscle relaxants: for the first time since I was a kid I peed myself a little in bed! Ha Ha! Better a loosened urinary sphincter than the other one though!
Thrud
Posted by Elizabeth on August 23, 2001, at 11:29:30
In reply to Xanax and panic, experiences? , posted by Thrud on August 22, 2001, at 23:52:46
> I have just ramped up to 6mg per day of Xanax for my PD (yes, a high dose for a big problem!)
6 mg isn't so far-fetched. I'd probably need 6-8 mg/day if I were using it around-the-clock, too. Are you taking 1.5 mg q.i.d.?
> I am feeling very tired, but I am not sure if it is from the Xanax or my anxious fatigue (when inadequately treated, I get hypersomnia and extremely tired with my PD).
Xanax can make you tired when you first start it or when you increase the dose, but you should adjust to it pretty quickly. Personally, I never had that particular problem. I can take quite a bit of Xanax or other benzos without feeling sedated, although a lower dose (2 mg Xanax, e.g.) is usually all that is necessary to fend off a PA.
> After approximately how long should it take for the sedative effects of Xanax to settle out?
Different for different people, of course, but I'd give it a week at least.
> Also, my libido is now shot as badly as when using the SSRIs.
I think that might be a gender-related effect -- men and women might have opposite reactions. Are you M or F? ("Thrud" seems pretty neutral < g >, but I'm guessing you're a man.)
> I have found someone else with a similar experience where his sexual function took 'months' to recover after going from Klonopin to 4mg per day Xanax.
I guess that it would take a while. When people discontinue benzos after long-term use, there are EEG differences present a year afterwards, so there can be some sort of long-lived change resulting from chronic benzo use.
> In general, why the f!ck does *anything* that helps my PD ends up destroying my libido?
Sedation, maybe?
> (Conversely, when I am unmedicated my libido is fantastic).
Do you have atypical depression as well as PD, by any chance?
> I am desperately clinging to the hope that I can be panic free without being sex free as well!
Panic attacks don't exactly enhance the mood, yeah. :-)
-elizabeth
Posted by Thrud on August 23, 2001, at 20:03:21
In reply to Re: Xanax and panic, experiences? » Thrud, posted by Elizabeth on August 23, 2001, at 11:29:30
> 6 mg isn't so far-fetched. I'd probably need 6-8 mg/day if I were using it around-the-clock, too. Are you taking 1.5 mg q.i.d.?I'd like to, but that is too inconvenient. 2mg t.i.d.
>
> Xanax can make you tired when you first start it or when you increase the dose, but you should adjust to it pretty quickly. Personally, I never had that particular problem. I can take quite a bit of Xanax or other benzos without feeling sedated, although a lower dose (2 mg Xanax, e.g.) is usually all that is necessary to fend off a PA.That sort of dose would certainly fend off an isolated attack for me. Problem is that I am left with crippling levels of anxiety in betweeen attacks (status panicus?). So I must use it on an ongoing basis.
>
> > Also, my libido is now shot as badly as when using the SSRIs.
>
> I think that might be a gender-related effect -- men and women might have opposite reactions. Are you M or F? ("Thrud" seems pretty neutral < g >, but I'm guessing you're a man.)You are right. Would a sex change operation reverse this side effect? (I would have to become a lesbian though ;))
>
> > I have found someone else with a similar experience where his sexual function took 'months' to recover after going from Klonopin to 4mg per day Xanax.
>
> I guess that it would take a while. When people discontinue benzos after long-term use, there are EEG differences present a year afterwards, so there can be some sort of long-lived change resulting from chronic benzo use.Hopefully leading to a long-term libido recovery in my case.
(More likley, "add another piece of brain damage to the bar-b"!)
> > In general, why the f!ck does *anything* that helps my PD ends up destroying my libido?
>
> Sedation, maybe?Unfortunately not. Even activating, insomniac masters like Wellbutrin lead to Limp Bizkit.
> > (Conversely, when I am unmedicated my libido is fantastic).
>
> Do you have atypical depression as well as PD, by any chance?I don't *know* so, but I *think* so. I lack the mood reactivity and histironics associated with it, but definitely the leaden fatigue. If so, how can I augment my Xanax treatment to counter this?
> > I am desperately clinging to the hope that I can be panic free without being sex free as well!
>
> Panic attacks don't exactly enhance the mood, yeah. :-)For me, they don't even enhance the mood to live!
On something different, my pdoc says ECT is ineffective against PAD. Is this correct? I was very disappointed, since it was always a "big gun" I had up my sleeve.
Thrud
Posted by Thrud on August 23, 2001, at 20:54:24
In reply to Re: Xanax and panic, experiences? » Thrud, posted by Elizabeth on August 23, 2001, at 11:29:30
> > (Conversely, when I am unmedicated my libido is fantastic).
>
> Do you have atypical depression as well as PD, by any chance?I am absolutely intrigued that you made this link. When I am at my most anxious/depressed is when I have my *highest* libido, which flies in the face of the classic depression=no libido scenario.
Therefore, I ask you the Holy Grail question that no pdoc has successfully answered for me: is there a drug or group of drugs which will help the atypical depression/pd group WITHOUT killing the sex drive?
Thanking you in advance for divine insight.Thrud
Posted by Rick on August 24, 2001, at 1:32:59
In reply to Re: Xanax and panic, Elisabeth, more., posted by Thrud on August 23, 2001, at 20:54:24
You shouldn't be too quick to dump the Xanax without giving yourself time to adjust to the side effects, and perhaps even finding that you can lower the dosage without losing benefit.
While it varies greatly by individual, many find that Klonopin works a lot better as an ongoing treatment for panic than Xanax, and at lower equivalized doses with less fatigue. That's certainly true for loads of people who post here. It is longer acting and thus doesn't need to be taken as often. If you check Medline you'll see other benefits as well. If the Xanax doesn't work out, you should *definitely* give Klonopin a try. (It's the mainstay of my social phobia treatment. It actually *increases* my libido at a moderate dose, but I'm not sure that's typical.)
Getting back to short-acting benzos, some people respond better to Ativan than they do to Xanax.
Benzos are the gold standard for panic -- even if many docs remain benzophobic -- but there are other alternatives besides SSRI's.
The reversible (no food restrictions) MAOI moclobemide has shown success in many panic disorder studies (with and without comorbid depression). It has about the lowest incidence of sexual dysfunction of all the AD's.
Serzone, while having a somewhat lower success rate for panic than the SSRI's, works very well for many people. It has a very low incidence of drug-induced sexual dysfuntion (I take it with the Klonopin with no problems in that regard), but at the highest doses it can have a sexually inhibiting effect in some. Many people find it quite sedating, although some don't. You just never know...
I've heard a few reports of Remeron efficacy in panic. It has a lower incidence of sexual dysfuntion than SSRI's, but not as low as Serzone. It tends to be even more sedating than Serzone, and has a reputation for inducing weight gain.
On the OTC front, some panic specialists find that Taurine supplementation is all that is needed for some patients. (Taurine is an amino acid, one of the ingredients in Red Bull -- not that I'm suggesting you use Red Bull!)
Finally, several Israeli studies found that mega-doses of Inositol (a B vitamin) work as well as SSRI's in panic (and OCD), without side effects. See Medline.
Good luck, and please read the following article on panic, which was posted here a couple months ago by another individual. It's fabulous information (much of it applicable to *any* anxiety disorder), even though I do disagree with the author on a couple of points. It points out how benzos are generally most efective longterm in PD, yet high-powered pharmaceutical company marketing, and benzophobia in the medical community cause PD sufferers to end up with (usually) inferior and side-effect-laden SSRI treatment instead.
http://bearpaw8.tripod.com/pd.html
Rick
> > > (Conversely, when I am unmedicated my libido is fantastic).
> >
> > Do you have atypical depression as well as PD, by any chance?
>
> I am absolutely intrigued that you made this link. When I am at my most anxious/depressed is when I have my *highest* libido, which flies in the face of the classic depression=no libido scenario.
> Therefore, I ask you the Holy Grail question that no pdoc has successfully answered for me: is there a drug or group of drugs which will help the atypical depression/pd group WITHOUT killing the sex drive?
> Thanking you in advance for divine insight.
>
> Thrud
>
Posted by Thrud on August 24, 2001, at 2:30:28
In reply to Re: Xanax and panic, Elisabeth, more. » Thrud, posted by Rick on August 24, 2001, at 1:32:59
> You shouldn't be too quick to dump the Xanax without giving yourself time to adjust to the side effects, and perhaps even finding that you can lower the dosage without losing benefit.
True. Could you give me some idea how long I should wait? Especially with regards to the sexual dysfunction effects I am getting with Xanax.
> While it varies greatly by individual, many find that Klonopin works a lot better as an ongoing treatment for panic than Xanax, and at lower equivalized doses with less fatigue. That's certainly true for loads of people who post here. It is longer acting and thus doesn't need to be taken as often. If you check Medline you'll see other benefits as well.
Please excuse my naivite. Is that Medline.com or something?
If the Xanax doesn't work out, you should *definitely* give Klonopin a try. (It's the mainstay of my social phobia treatment. It actually *increases* my libido at a moderate dose, but I'm not sure that's typical.)
I have read about that effect. That would be awesome! At the moment my pdoc is firmly focused on Xanax because of it's antidepressant properties. However, if I could be panic free, have an unaffected libido and not feel like sleeping all day, there would be NO depression, I guarrantee that!
> Getting back to short-acting benzos, some people respond better to Ativan than they do to Xanax.I've heard it called a "watered down" version: less side effects but less powerful. Is this a widely held view?
> Benzos are the gold standard for panic -- even if many docs remain benzophobic -- but there are other alternatives besides SSRI's.I am lucky I have a pdoc who believes in benzos: at least he's willing to give them a try!
> The reversible (no food restrictions) MAOI moclobemide has shown success in many panic disorder studies (with and without comorbid depression). It has about the lowest incidence of sexual dysfunction of all the AD's.
Used it ages ago (for a about a year). Not very good for my panic, still left me with some significant sexual dysfunction. (getting the idea I am a hardcase ???)
> Serzone, while having a somewhat lower success rate for panic than the SSRI's, works very well for many people. It has a very low incidence of drug-induced sexual dysfuntion (I take it with the Klonopin with no problems in that regard), but at the highest doses it can have a sexually inhibiting effect in some. Many people find it quite sedating, although some don't. You just never know...Tried that too. Once it gave me significant sexual dysfunction, I ditched it!
> I've heard a few reports of Remeron efficacy in panic. It has a lower incidence of sexual dysfuntion than SSRI's, but not as low as Serzone. It tends to be even more sedating than Serzone, and has a reputation for inducing weight gain.I found all the above to be true. However, if it did not give me sexual syfunction I would have persisted with it.
> On the OTC front, some panic specialists find that Taurine supplementation is all that is needed for some patients. (Taurine is an amino acid, one of the ingredients in Red Bull -- not that I'm suggesting you use Red Bull!)
>
What Taurine about co-morbid depression?
> Finally, several Israeli studies found that mega-doses of Inositol (a B vitamin) work as well as SSRI's in panic (and OCD), without side effects. See Medline.I am very interested in this stuff. I think I will buy some and see what happens.
> Good luck, and please read the following article on panic, which was posted here a couple months ago by another individual. It's fabulous information (much of it applicable to *any* anxiety disorder), even though I do disagree with the author on a couple of points. It points out how benzos are generally most efective longterm in PD, yet high-powered pharmaceutical company marketing, and benzophobia in the medical community cause PD sufferers to end up with (usually) inferior and side-effect-laden SSRI treatment instead.
>
> http://bearpaw8.tripod.com/pd.htmlI have read it and was extremely impressed. After reading it I virtually demanded my pdoc try me on Xanax! Before that we were experiementing with the mega$$$$ Lamictal.
After being on 3mg Xanax/day for about 2 weeks I am now up to 6mg/day. These are my problems so far:
1) very significsant lack of libido
2) depressed
3) always sleeping
4) poor co-ordination (I don't like to drive at the moment)On the plus side:
1) My anxiety sympotms are way down and panic non existentAny indication how long I must endure before the "bad" list before it subsides? I am under the impression that as part of the tolerance-dependence process the bad list tends to subside.
Any personal experiences from yourself or aquaintances on this "running in" period would be most greatly appreciate it.I really appreciate the time you took to consider my case. I hope you respond and eeducte me some more!
Thrud
Posted by Elizabeth on August 24, 2001, at 12:39:32
In reply to Re: Xanax and panic, experiences? Elizabeth, posted by Thrud on August 23, 2001, at 20:03:21
> > Are you taking 1.5 mg q.i.d.?
>
> I'd like to, but that is too inconvenient. 2mg t.i.d.That works okay for you? I would think you'd wake up early in the morning feeling jittery.
> That sort of dose would certainly fend off an isolated attack for me. Problem is that I am left with crippling levels of anxiety in betweeen attacks (status panicus?). So I must use it on an ongoing basis.
Anticipatory anxiety, or general anxiety?
It probably would do me some good to take Xanax or Klonopin or Ativan or something around the clock, too. Klonopin is a little less potent than Xanax; Ativan is about half as potent (i.e., the effective dose of Ativan will be about twice the effective dose of Xanax).
> > I think that might be a gender-related effect -- men and women might have opposite reactions. Are you M or F? ("Thrud" seems pretty neutral < g >, but I'm guessing you're a man.)
>
> You are right. Would a sex change operation reverse this side effect? (I would have to become a lesbian though ;))I think there are differences that aren't taken care of by transsexual surgery and hormone therapy. :-) I guessed that you're a guy because it seems like sedatives tend to have that effect on men but not on women (if anything, they have the reverse effect on women).
> > > In general, why the f!ck does *anything* that helps my PD ends up destroying my libido?
> >
> > Sedation, maybe?
>
> Unfortunately not. Even activating, insomniac masters like Wellbutrin lead to Limp Bizkit.Wellbutrin helped with panic disorder??? That's weird.
> > Do you have atypical depression as well as PD, by any chance?
>
> I don't *know* so, but I *think* so. I lack the mood reactivity and histironics associated with it, but definitely the leaden fatigue. If so, how can I augment my Xanax treatment to counter this?MAOIs (Parnate in particular) and amphetamine are the obvious things that come to mind. Yes, amphetamine sometimes helps with anxiety (!). (I don't think that histrionics or moodiness is necessarily associated with atypical depression, BTW.) The reason it came to mind was because you said your libido is greatest when you are the most anxious-depressed. That seems to be common in atypical depression.
Anyway, your drug responses seem to be pretty unusual, so I hesitate to try to predict what might work for you.
> > Panic attacks don't exactly enhance the mood, yeah. :-)
>
> For me, they don't even enhance the mood to live!I understand. Panic + depression is not a healthy combo.
> On something different, my pdoc says ECT is ineffective against PAD. Is this correct?
Yes, I think so.
BTW, you can search Medline at http://www.ncbi.nlm.nih.gov/PubMed/
-elizabeth
Posted by Rick on August 24, 2001, at 16:23:30
In reply to Re: Xanax and panic, Rick, posted by Thrud on August 24, 2001, at 2:30:28
> > You shouldn't be too quick to dump the Xanax without giving yourself time to adjust to the side effects, and perhaps even finding that you can lower the dosage without losing benefit.
>
> True. Could you give me some idea how long I should wait? Especially with regards to the sexual dysfunction effects I am getting with Xanax.I’d try to give it a minimum four weeks to see if there’s any sign of improvement in the side effects.
Forgive me if you’ve already addressed this earlier in thread, but when you were on Remeron did you try augmentation strategies to restore sexual function? I recently read a study of augmentation with Wellbutrin (as I recall) that showed no significant restoration of sexual function vs. placebo. They both "worked" in something like 30% of the subjects. But augmenation to restore sexual function has helped many – and even where it might be a placebo effect, who cares so long as it helps. There have been many reports of success with low-dose Wellbutrin augmentation, BuSpar, OTC Yohobimide (sp) (but avoid if you have high blood pressure), Ginkgo, Viagra, dopamine agonists, and many more. While these agents are usually used to reverse *AD* sexual function, I know they’ve helped people with SD induced by other kinds of meds as well.
When I took a low doses (so no food restrictions) of the MAOI-B selegiline (aka Eldepryl, deprenyl, Junex (sp), etc) with Klonopin (and nothing else except a beta blocker), it actually led to *too much* sexual stimulation (+ cognitive enhancement). Selegiline is well known as a strong libido and performance enhancer. But it is very stimulating overall, in a way that mildly reduced my social phobia benefits (unlike $$$Provigil/Alertec/modafinil). But in retrospect and based on what I’ve heard since , only *very* tiny doses are needed for steady-state stimulation...as little as 2.5mg three times a week. My own “low dose” of seligiline was 5-10 mg/day, so in retrospect maybe I could’ve had the benefits without added anxiety if I had taken less. I’d definitely keep Selegiline augmentation (not solo!!!!!) in mind as something to consider if benzo sexual dysfunstion remains – but don’t use it with an AD!
> Used it [moclobemide] ages ago (for a about a year). Not very good for my panic, still left me with some significant sexual dysfunction. (getting the idea I am a hardcase ???)
No pun intended, right? I might not be quite as prone to that side effect as you, but after six weeks of Nardil, I was completely anorgasmic until three weeks after I discontinued it. I was naive about psychotropics back then, and that side effect sure threw me for a loop! High dose Neurontin also gave me problems, but nothing like Nardil.
>
> > On the OTC front, some panic specialists find that Taurine supplementation is all that is needed for some patients. (Taurine is an amino acid, one of the ingredients in Red Bull -- not that I'm suggesting you use Red Bull!)
> >
> What Taurine about co-morbid depression?Frankly, this sure wouldn’t be my fisrt choice anyway. But as you mentioned in your post, perhaps treating the panic, without adding sexual dysfunction, just might alleviate your depression. Even if it didn’t, you might be able to take a low enough dose of an AD to avoid the sexual dysfunction.
>
>
> > Finally, several Israeli studies found that mega-doses of Inositol (a B vitamin) work as well as SSRI's in panic (and OCD), without side effects. See Medline.
>
> I am very interested in this stuff. I think I will buy some and see what happens.
>Yes, may be worth a try, but be prepared to down a lot of capsules, or to buy the powdered form to mix with liquids. The studies of Inositol use 12-18g/day, and the OTC capsules usually top out at 500 mg. I’ve seen a few 1000 mg capsules advertised on the net.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11386498&dopt=Abstract
> Any indication how long I must endure before the "bad" list before it subsides? I am under the impression that as part of the tolerance-dependence process the bad list tends to subside.
> Any personal experiences from yourself or aquaintances on this "running in" period would be most greatly appreciate it.Definitely, tolerance usually develops to the side effects. Maybe not always 100% tolerance, but pretty close in most cases. Changing the regimen, even at the same daily dose, can definitely have an effect. As long as I never take more than one dose of Klonopin in a four hour period, there is no fatigue. But if I take two doses closer together -- even small ones -- it will make me a little sleepy. BTW, The few times I've taken it at bedtime (long ago), I would always wake up groggy and actually be MORE prone to anxiety for the next 24 hrs.
I’m not sure our reactions are similar. The first benzo I took for my severe social phobia was as-needed Xanax. I didn't like it -- made me feel like I had been hit over the head with a hammer -- but perhaps I would have adjusted had I taken it ongoing. After two years, I have a bunch left that I intended to use for insomnia. But since I started taking regular Klonopin (almost always *before* 3 pm), I've almost forgotten what insomnia is.
I started Klonopin at 3 mg for the social phobia (sometimes I had near-panic attacks and one or two full blown – but not panic disorder). It wasn’t long that I found out that less actually worked better for me, and eliminated most of the modest fatigue I had had at 3 mg. Most of the fatigue was gone within weeks. But it takes longer for lots of people! Again, give it a min four weeks, and perhaps carefully experiment with reducing the dose a bit, with your doctor’s approval. (As you know, the longer you’ve been on it – especially for a short-acting benzo like Xanax – the more gradually you have to taper off. Some people don’t have this problem, especially if they don’t go down to zero, but many do, especially when starting with a high dose and after having been on the med for a month or two.) BTW, whicle I need to once again acknowledge that stats do not equal individuals, the mfr of Klonopin found no increased benefit in panic disorder for 3mg/day vs. 2mg.
I'm sure this is old territory to you, but:
-- Do you drink much? Benzos essentially double
the impact of alcohol, and more than a modest
amount of booze can easily worsen depression
even if it makes you feel better initially.
-- I was long skeptical that caffeine could
have any significant effect on my SP, but
I cut way back I found I had fewer "blips" in
the effectiveness of the weekends. I still
drink full-strength coffee and full-strength
Coke on weekends, though.You may have already tried these suggestions, but you should go to the full-search page on this site, and you’ll come up with tons of personal experiences. Or just browse. And post again if you don’t get more responses to this. Also, if you haven’t already done so, visit and/or post and/or search through Usenet, especially alt.anxiety.panic. (You can do this all free through http://groups.google.com )
Rick
Posted by Rick on August 24, 2001, at 16:36:20
In reply to Re: Xanax and panic, Rick » Thrud, posted by Rick on August 24, 2001, at 16:23:30
I found a few typos after posting, but this one in particular may have been confusing. Corrected version:
-- I was long skeptical that caffeine could
have any significant effect on my SP, but
when I cut way back I found I had fewer "blips" in the effectiveness of the meds. I still
drink full-strength coffee and full-strength
Coke on weekends, though.
Posted by Thrud on August 24, 2001, at 18:34:06
In reply to Re: Xanax and panic, experiences? » Thrud, posted by Elizabeth on August 24, 2001, at 12:39:32
> > > Are you taking 1.5 mg q.i.d.?
> >
> > I'd like to, but that is too inconvenient. 2mg t.i.d.
>
> That works okay for you? I would think you'd wake up early in the morning feeling jittery.I do. But you know, after being on so *many* drugs that make me feel like a sloth in the morning I actually don't mind the heightened morning activation (as much).
Problem is that I am left with crippling levels of anxiety in betweeen attacks (status panicus?). So I must use it on an ongoing basis.
>
> Anticipatory anxiety, or general anxiety?General. I've had so many PAs that there is very little anticipatory fear left. Like those old escape tests using dogs: after they get shocked enough instead of trying to escape they just lie down and cop it sweet (welcome to my world! I think I'll change my name to Learned Helplessness!)
> It probably would do me some good to take Xanax or Klonopin or Ativan or something around the clock, too. Klonopin is a little less potent than Xanax; Ativan is about half as potent (i.e., the effective dose of Ativan will be about twice the effective dose of Xanax).Did you notice much of an antidepressant effect with Xanax? I do, but it is not really very strong or activating (not enough to counteract the AD depression). The antidepressant effect is why, at the moment, my pdoc is sticking firmly with Xanax.
> I think there are differences that aren't taken care of by transsexual surgery and hormone therapy. :-) I guessed that you're a guy because it seems like sedatives tend to have that effect on men but not on women (if anything, they have the reverse effect on women).
Hmmm. Maybe I should peddle some of my stuff as 'Viagranax' ;)
>
> > > > In general, why the f!ck does *anything* that helps my PD ends up destroying my libido?
> > >
> > > Sedation, maybe?
> >
> > Unfortunately not. Even activating, insomniac masters like Wellbutrin lead to Limp Bizkit.
>
> Wellbutrin helped with panic disorder??? That's weird.It didn't. I was using it as an adjunct to try and counter the sexual dysfunction of serzone(!). It made sex, mood, everything worse!
>
> > > Do you have atypical depression as well as PD, by any chance?
> >
> > I don't *know* so, but I *think* so. I lack the mood reactivity and histironics associated with it, but definitely the leaden fatigue. If so, how can I augment my Xanax treatment to counter this?
>
> MAOIs (Parnate in particular) and amphetamine are the obvious things that come to mind. Yes, amphetamine sometimes helps with anxiety (!). (I don't think that histrionics or moodiness is necessarily associated with atypical depression, BTW.) The reason it came to mind was because you said your libido is greatest when you are the most anxious-depressed. That seems to be common in atypical depression.With the exception of the amphetamines, I believe your suggestions would induce sexual dysfunction (the viscious cycle begins again).
> Anyway, your drug responses seem to be pretty unusual,
(that's an understatement!)
>so I hesitate to try to predict what might work for you.Have you tried inositol by chance? I have come across one or two studies suggesting it is better against panic and depression than prozac. Since it is not a patentable material, I do not expect to find much more about it.
After more than 10 years of this merry-go-round I am tempted to adopt a "Darth Maul" costume, accept my bitterness and wreak revenge on an innocent world! I guess why I am saying this is that I have spent a decade trying to both feel well *and* save my sexual function. Comes a time you've gotta let go. Know what I mean?
> BTW, you can search Medline at http://www.ncbi.nlm.nih.gov/PubMed/
>
> -elizabethThanks.
Thrud
Posted by Thrud on August 25, 2001, at 2:42:09
In reply to Re: Xanax and panic, experiences? » Thrud, posted by Elizabeth on August 24, 2001, at 12:39:32
> > > Do you have atypical depression as well as PD, by any chance?
More Qs (sorry!)
How can one distinguish the hypersomnia and fatigue associated with atypical depression with what I've heard called "nervous fatigue".
Apparently in nervous fatigue your energy levels are supposed to return when the panic stops. If this is true, how long after the panic has been treated could I expect my energy to return? If it does not return, how do I differentiate this aspect of atypical depression with the sedative effect of Xanax?Thanks!
Thrud
Posted by Thrud on August 25, 2001, at 3:26:30
In reply to Re: Xanax and panic, Rick » Thrud, posted by Rick on August 24, 2001, at 16:23:30
Hi Rick.
Please let me thank you for your excellent and encouraging posting. Unfortunately for you, since you were so helpful I am afraid I must "pick your brain" a bit more! (I apologize beforehand.)
> Forgive me if you’ve already addressed this earlier in thread, but when you were on Remeron did you try augmentation strategies to restore sexual function? I recently read a study of augmentation with Wellbutrin (as I recall) that showed no significant restoration of sexual function vs. placebo. They both "worked" in something like 30% of the subjects.I have tried these as augmentaion therapies and they both further *reduced* my sexual function!
So did Gingko and L-Tyrosine! Viagra is okay for erection but does nothing for my desire or sensation (takes away the 'sponteneity' of sex as well).
The one you mention that I have not tried but has me interested is deprenyl. I am sceptical though because it is supposed to work by increasing dopamine...like Wellbutrin: and that failed.Still, I am very interested when you say....
> When I took a low doses (so no food restrictions) of the MAOI-B selegiline (aka Eldepryl, deprenyl, Junex (sp), etc) with Klonopin (and nothing else except a beta blocker), it actually led to *too much* sexual stimulation (+ cognitive enhancement). Selegiline is well known as a strong libido and performance enhancer.
.....this sounds great....
>But it is very stimulating overall, in a way that mildly reduced my social phobia benefits.
This is my fear: sexual dysfunction from benzos needs deprenyl. Nervousness from deprenyl needs more benzos etc ect...
Only one way to find out though!>as little as 2.5mg three times a week. My own “low dose” of seligiline was 5-10 mg/day, so in retrospect maybe I could’ve had the benefits without added anxiety if I had taken less. I’d definitely keep Selegiline augmentation (not solo!!!!!) in mind as something to consider if benzo sexual dysfunstion remains – but don’t use it with an AD!
After 10 years of ADs for panic disorder, I have learned to HATE them with a vengence. Compared to ADs, the side effects of benzos are like the morning dew (and since I must always take meds, addiction does not scare me)
>I've almost forgotten what insomnia is.At the moment the antianxiety effects of Xanax don't last all the way through to morning and I wake up a bit jittery. Still, before that happens I sleep like a baby: unlike the nightmare sleep while on ADs: vivid dreams, racing thoughts, constant waking, waking up "fogged"..
At least now I wake up a bit jittery, but fresh and clear headed. First good night's sleep in 10 years.
>found no increased benefit in panic disorder for 3mg/day vs. 2mg.Yes I read that on the Roche site. Very interesting.
> I'm sure this is old territory to you, but:
> -- Do you drink much?only socially
Benzos essentially double
> the impact of alcohol,Found out that one already!
> You may have already tried these suggestions, but you should go to the full-search page on this site, and you’ll come up with tons of personal experiences. Or just browse. And post again if you don’t get more responses to this. Also, if you haven’t already done so, visit and/or post and/or search through Usenet, especially alt.anxiety.panic. (You can do this all free through http://groups.google.com )
I will do this, espescially for the million dollar question: If I wait long enough, *will* my libido return when on benzos??????
Could I ask you a big favor? If you are firmly "enmeshed" in any of these groups, could you ask the million dollar question on my behalf and let me know the result? I have found that being a newbie often leads to being ignored, probably from asking questions that have been asked a zillion times before.
Many, many thanks.
Thrud
Posted by Rick on August 26, 2001, at 0:25:33
In reply to Re: Xanax and panic, Elisabeth, more. » Thrud, posted by Rick on August 24, 2001, at 1:32:59
>Please let me thank you for your excellent and encouraging posting. Unfortunately for you, since you were so helpful I am afraid I must "pick your brain" a bit more! (I apologize beforehand.)
Happy to oblige, but I think the “pickin’s” may be getting slim.
> > Forgive me if you’ve already addressed this earlier in thread, but when you were on Remeron did you try augmentation strategies to restore sexual function? I recently read a study of augmentation with Wellbutrin (as I recall) that showed no significant restoration of sexual function vs. placebo. They both "worked" in something like 30% of the subjects.
>I have tried these as augmentaion therapies and they both further *reduced* my sexual function!
>So did Gingko and L-Tyrosine! Viagra is okay for erection but does nothing for my desire or sensation (takes away the 'sponteneity' of sex as well).
>The one you mention that I have not tried but has me interested is deprenyl. I am sceptical though because it is supposed to work by increasing dopamine...like Wellbutrin: and that failed.
Despite the dopamine-connection to smoking and Wellbutrin’s double-role as Zyban, WB’s mechanism of action is pretty fuzzy. It’s now thought that noradrenergic effects, unknown effects, or both, account for more of Wellbutrin’s efficacy than dopaminergic actions. Insofar as dopamine reuptake inhibition, it’s been shown that this doesn’t occur much, if at all, at the dosages prescribed for depression (and of course doses used for augmentation are even lower).
Nonetheless, I had assumed, perhaps incorrectly, that dopamine underlied the anxiety Wellbutrin added back when used it to augment a Klonopin/Celexa combo. Maybe that bothersome effect would’ve subsided had I given it more time. As usual, based on what others have posted here, Wellbutrin-worsened anxiety goes away for some people but not others.
The reason for augmenting Klonopin+Celexa with WB was to fight fatigue/apathy and improve sexual function. It helped mildly on the zone-out problems, but didn’t make a difference sexually. But I didn’t give it a fair trial, because it was adding back anxiety and I didn’t really care for Celexa much anyway. (That’s when I added Serzone+Provigil to the K that's still going strong after 15 months.)
The short WB trial, plus the fact that I took it with a sedating and sexual-dysfunction-inducing AD, means there’s no way for me do make a direct firsthand comparison with selegiline. (Remember, I was taking selegiline with 2-3 mg Klonopin, which has never produced sexual dysfunction for me.) But the selegiline was such a potent sexual activator that my guess is you’d have a much better shot at reducing or eliminating benzo-induced sexual dysunction augmenting with very-low-dose selegiline, than you had trying to reverse AD-induced sexual side effects with WB.> > You may have already tried these suggestions, but you should go to the full-search page on this site, and you’ll come up with tons of personal experiences. Or just browse. And post again if you don’t get more responses to this. Also, if you haven’t already done so, visit and/or post and/or search through Usenet, especially alt.anxiety.panic. (You can do this all free through http://groups.google.com )
>I will do this, espescially for the million dollar question: If I wait long enough, *will* my libido return when on benzos??????
>Could I ask you a big favor? If you are firmly "enmeshed" in any of these groups, could you ask the million dollar question on my behalf and let me know the result? I have found that being a newbie often leads to being ignored, probably from asking questions that have been asked a zillion times before.
Actually I’m anything but “enmeshed” in Usenet! I’ve only posted to the newsgroups a handful of times. I’ve ususally ended up there when doing searches for a specific topic. For that matter, I wouldn’t call myself a “regular” on Psycho-Babble, either. I tend to post a lot for a week or two at a time, and then don’t visit again for up to a couple months, unless I receive one of those automatic e-mail notifications that a thread of interest has had some new activity. If you’re concerned about anonymity, set up a free e-mail address with, say, Yahoo, then register free with Google Groups (link above), use that to post o Usenet via the web, and then cancel the email account.
Rick
Posted by Thrud on August 26, 2001, at 7:07:13
In reply to Re: Xanax and panic, Elisabeth, more. » Rick, posted by Rick on August 26, 2001, at 0:25:33
Posted by Elizabeth on August 26, 2001, at 9:47:27
In reply to Re: Xanax and panic, experiences?-Elizabeth, posted by Thrud on August 24, 2001, at 18:34:06
> > > 2mg t.i.d.
> >
> > That works okay for you? I would think you'd wake up early in the morning feeling jittery.
>
> I do. But you know, after being on so *many* drugs that make me feel like a sloth in the morning I actually don't mind the heightened morning activation (as much).It doesn't sound pleasant to me regardless -- I would really hate feeling like I was being yanked back and forth between extremes of agitation and sedation.
> > Anticipatory anxiety, or general anxiety?
>
> General. I've had so many PAs that there is very little anticipatory fear left. Like those old escape tests using dogs: after they get shocked enough instead of trying to escape they just lie down and cop it sweet (welcome to my world! I think I'll change my name to Learned Helplessness!)Generalised anxiety + spontaneous panic attacks is a more common combo than people realise, I think.
Just getting a diagnosis and finding a treatment that worked virtually eliminated my anticipatory anxiety. You know? It was like, wow, there's a name for this and it's treatable. PAD has been much easier for me to deal with than depression (it started a lot later, too).
> Did you notice much of an antidepressant effect with Xanax?
I only ever took Xanax in isolated doses (when I notice that a panic attack is coming). I don't find Xanax or other benzos mood-elevating in a single dose, and Klonopin (which I've been taking at 4 mg/day for about 2 weeks because desipramine doesn't work as well for PAD as Parnate did) doesn't seem to be much of an AD, either. (Xanax is supposed to be a better AD than the other benzos, anyway, except for adinazolam of course.)
> I do, but it is not really very strong or activating (not enough to counteract the AD depression). The antidepressant effect is why, at the moment, my pdoc is sticking firmly with Xanax.
That makes sense to me. I'm glad he's not a benzophobe.
> > I think there are differences that aren't taken care of by transsexual surgery and hormone therapy. :-) I guessed that you're a guy because it seems like sedatives tend to have that effect on men but not on women (if anything, they have the reverse effect on women).
>
> Hmmm. Maybe I should peddle some of my stuff as 'Viagranax' ;)I feel really dense, like there's a joke that I'm not getting. (Explain?)
> > Wellbutrin helped with panic disorder??? That's weird.
>
> It didn't.Okay, that's a relief. (My entire world view was crashing. < g >)
> I was using it as an adjunct to try and counter the sexual dysfunction of serzone(!). It made sex, mood, everything worse!
That's pretty scary -- it seems like all different sorts of ADs do that to you. Have you ever tried a stimulant, like Ritalin, Adderall, Dexedrine, Cylert, or Provigil?
Wellbutrin was icky for me. It made my depression worse -- I was anxious and constantly ruminating, I was waking up in the middle of the night feeling miserable more often and it was harder to get back to sleep, I was on edge and easily startled, I stopped eating altogether.
> With the exception of the amphetamines, I believe your suggestions would induce sexual dysfunction (the viscious cycle begins again).
That's why I thought Parnate would be the MAOI for you to try. Selegiline is tricky and can cause agitation, but Nardil and Marplan seem to cause more sexual problems than the other MAOIs do.
It would be interesting to see how the combination of a stimulant and Xanax would work.
> Have you tried inositol by chance? I have come across one or two studies suggesting it is better against panic and depression than prozac. Since it is not a patentable material, I do not expect to find much more about it.
I've heard good things about it. I never tried it myself.
> After more than 10 years of this merry-go-round I am tempted to adopt a "Darth Maul" costume, accept my bitterness and wreak revenge on an innocent world!
< giggle fit >
> I guess why I am saying this is that I have spent a decade trying to both feel well *and* save my sexual function. Comes a time you've gotta let go. Know what I mean?
Yes, I sure do.
> How can one distinguish the hypersomnia and fatigue associated with atypical depression with what I've heard called "nervous fatigue".
Good question. I don't know. Panic and anxiety are so common in atypical depression that it's really questionable whether there is a difference.
> Apparently in nervous fatigue your energy levels are supposed to return when the panic stops. If this is true, how long after the panic has been treated could I expect my energy to return?
I don't know.
> If it does not return, how do I differentiate this aspect of atypical depression with the sedative effect of Xanax?
Well, think about whether you felt tired before you were taking Xanax.
-elizabeth
Posted by Thrud on August 26, 2001, at 21:37:23
In reply to Re: Xanax and panic, experiences? » Thrud, posted by Elizabeth on August 26, 2001, at 9:47:27
> Just getting a diagnosis and finding a treatment that worked virtually eliminated my anticipatory anxiety. You know? It was like, wow, there's a name for this and it's treatable. PAD has been much easier for me to deal with than depression (it started a lot later, too).
I was the reverse. I suffered very strong "agitated" sort of anxiety for at least 6 months before the PAs started. It was after "they" began, started spiralling up in frequency until I was having many per day that my atypical depression started. When I first crawled to a shrinks office he suspected possible epilepsy. When the EEG came back normal he diagnosed panic and put me on some tricyclic (doxepin I think). It was almost as bad as nothing. And so the 11 year struggle began..
The point I am making is that I was probably diagnosed correctly right from the start but no AD ever fully suppressed the attacks and corresponding anticipatory anxiety. The depression, on the other hand, responded quickly and very easily. I think only psychological depression remains: not regaining sexual function. Only two types of med have treated PAD adequately for me:Lamictal (only AED-mood stabilizer I've ever tried). Unfortunately gave me sexual dyfunction w/cognitive difficulties (word recall) and high levels of residual anxiety (but no attacks). Still needed some Xanax.
Xanax (only benzo I've ever tried). At 6mg per day, STRONG sexual dysfunction (cognitive problems again, word recall + attention). Bad ataxia (stumbling like drunk).
(BTW the worst cognitive problems I ever had was with Effexor XR. I was angry and embarassed for years with that)>Klonopin (which I've been taking at 4 mg/day for about 2 weeks because desipramine doesn't work as well for PAD as Parnate did) doesn't seem to be much of an AD, either. (Xanax is supposed to be a better AD than the other benzos, anyway, except for adinazolam of course.)
Any cognitive difficulties with the 4mg/day Klonopin? If yes, were they transient?
What is adinazolam? I am going to look it up...
How do benzos exert an antidepressant effect? I thought that the GABA system was rather independent from the HT-NE-DA chain?
> > I do, but it is not really very strong or activating (not enough to counteract the AD depression). The antidepressant effect is why, at the moment, my pdoc is sticking firmly with Xanax.
>
> That makes sense to me. I'm glad he's not a benzophobe.So am I. He is fairly old (late 60s I am guessing)and been practicing for a long time. His clinical experience goes strongly against a lot of the 'fad' stuff like anti-benzo crusades, so he chooses experience over fads.
> > > I think there are differences that aren't taken care of by transsexual surgery and hormone therapy. :-) I guessed that you're a guy because it seems like sedatives tend to have that effect on men but not on women (if anything, they have the reverse effect on women).
> >
> > Hmmm. Maybe I should peddle some of my stuff as 'Viagranax' ;)
>
> I feel really dense, like there's a joke that I'm not getting. (Explain?)Dumb joke: Viagranax as in Xanax, the "Viagra" for women. (even though viagra is obviously not an aphrodisiac, that is the public perception)
> That's pretty scary -- it seems like all different sorts of ADs do that to you. Have you ever tried a stimulant, like Ritalin, Adderall, Dexedrine, Cylert, or Provigil?No. That is another possible avenue. I read somewhere that opiates (or is it opioids) have been used against PAD. Have you heard of this? My google searches aren't turning up much. Maybe you know the pros and cons of these drugs?
>
> Wellbutrin was icky for me. It made my depression worse -- I was anxious and constantly ruminating, I was waking up in the middle of the night feeling miserable more often and it was harder to get back to sleep, I was on edge and easily startled, I stopped eating altogether.I fully understand. I could not sleep, full stop. The slightest sound would wake me. One thing I will say for benzos: *great* nights sleep without feeling drugged out when you wake up.
> That's why I thought Parnate would be the MAOI for you to try. Selegiline is tricky and can cause agitation.If you look up Selegiline on rxlist.com sexual dysfunction appears *everywhere* as a side effect! I do not know why so many people claim it has prosexual properties.
As for Parnate, as soon as I read the side-effect profile I got flashbacks of the bad old days of TCAs and SSRIs: I am never going down that path again.
> It would be interesting to see how the combination of a stimulant and Xanax would work.Yes, I will definitely discuss this with my pdoc.
> > Have you tried inositol by chance? I have come across one or two studies suggesting it is better against panic and depression than prozac. Since it is not a patentable material, I do not expect to find much more about it.
>
> I've heard good things about it. I never tried it myself.'Heard' as in published literature or anecdotally?
> > After more than 10 years of this merry-go-round I am tempted to adopt a "Darth Maul" costume, accept my bitterness and wreak revenge on an innocent world!
>
> < giggle fit >Yes, and Jar-Jar Binks will be the first to take a double-bladed light sabre to the head...
Thrud
Posted by gilbert on August 26, 2001, at 23:41:41
In reply to Re: Xanax and panic, experiences?-Elizabeth, posted by Thrud on August 26, 2001, at 21:37:23
Thrud,
I take xanax and have tried klonopin, the klonopin made Mr. Happy very sad although I have to admit that I felt like a million bucks otherwise. The long half life on the klonopin was wonderfullllll. I take xanax and at higher doses it can have negative sexual effects mostly lethargy but those do seem to wear off. My sex drive kind of comes and goes...I am a bunny one week and a turtle the next., but the ssris obliterated my sexual capabilities completely. I take 1.5 to 2 mg per day......you may find after being on it a long time the dose may actually be effective lower. I have been able to reduce my dosage and find it works more effectively taken regularly. I also am able to get 12 to 24 hour runs out of doses without too much rebound although I here that is unusual. Elizabeth knows of the study on benzos and sex it seems that klonopin is one of the few benzos causing impotence....which it did to me. But everyone is so different alot op folks on this board have been helped by klonopin in the sex area....hope this helps.
Gil
Posted by SalArmy4me on August 27, 2001, at 0:02:28
In reply to thrud and xanax and sex, posted by gilbert on August 26, 2001, at 23:41:41
Practice Guideline for the Treatment of Patients With Panic Disorder. American Journal of Psychiatry. 155(5S) Supplement:1-34, May 1998:
c. Bupropion
Bupropion has been found to be effective in the treatment of depression. Proposed mechanisms of action include dopaminergic and noradrenergic agonist effects. Although there have been several small clinical trials using bupropion for patients with panic disorder, there is general consensus that it is not effective in alleviating either the somatic or psychological symptoms of panic attacks. It may have a role as an adjunctive treatment for patients with panic disorder who suffer sexual dysfunction as a side effect of other antidepressant medications, but it nevertheless may be potentially "overenergizing" for this specific patient group [160].
Posted by Thrud on August 27, 2001, at 2:43:17
In reply to Re: thrud and xanax and sex » gilbert, posted by SalArmy4me on August 27, 2001, at 0:02:28
> Practice Guideline for the Treatment of Patients With Panic Disorder. American Journal of Psychiatry. 155(5S) Supplement:1-34, May 1998:
>
> c. Bupropion
> Bupropion has been found to be effective in the treatment of depression. Proposed mechanisms of action include dopaminergic and noradrenergic agonist effects. Although there have been several small clinical trials using bupropion for patients with panic disorder, there is general consensus that it is not effective in alleviating either the somatic or psychological symptoms of panic attacks. It may have a role as an adjunctive treatment for patients with panic disorder who suffer sexual dysfunction as a side effect of other antidepressant medications, but it nevertheless may be potentially "overenergizing" for this specific patient group [160].Hi Sal.
Buproprion actualy *inhibited* my sexual response as well! I used it for a hellish period of monotherapy to properly test it out. Once it was certain it was not going to be of help in the sex department I kicked the packet for a field goal!
Thrud
Posted by Thrud on August 27, 2001, at 2:58:50
In reply to thrud and xanax and sex, posted by gilbert on August 26, 2001, at 23:41:41
Hi Gil!
> Thrud,
I take xanax and at higher doses it can have negative sexual effects mostly lethargy but those do seem to wear off. My sex drive kind of comes and goes...I am a bunny one week and a turtle the next., but the ssris obliterated my sexual capabilities completely. I take 1.5 to 2 mg per day......you may find after being on it a long time the dose may actually be effective lower.Were you on Xanax at the same time as an SSRI or other known "offender". If not, how long before Mr Happy became happy again? Did he return to his normal happy self or was there a residual "sadness"?
I am on 6mg per day and feel like an impotent, stupid drunk. But I am fairly relaxed (comfortably numb?)
>Elizabeth knows of the study on benzos and sex it seems that klonopin is one of the few benzos causing impotence....which it did to me.Was that the Vietnam Vet study? I think I read it. How long did you stick with the Klonopin? There was no Mr Happy improvement over that time?
>But everyone is so different alot op folks on this board have been helped by klonopin in the sex area....hope this helps.
Yes my archive searches show this to be true. I just don't understand! My pdoc wants me to stick to Xanax because of it's antidepressant effect, although he and I both understand that my depression has a direct psychological cause: medication induced impotence.
Thanks for your help Gil.
Thrud
Posted by Thrud on August 27, 2001, at 3:04:04
In reply to Re: Xanax and panic, Elisabeth, more. » Rick, posted by Rick on August 26, 2001, at 0:25:33
Hi Rick.
I just joined the alt.panic.something? group.
How the heck are you supposed to extract useful info from that rambling mess???!!!
Most of it seems to be idle chit-chat. From what I've seen, nothng like Babble-land!
Anyway, I've posted my usual pleading "please help" question and I'll see what I get.BTW, is there a search engine there so I can cut through the crap?
Thanks again Rick
Posted by Thrud on August 27, 2001, at 3:08:50
In reply to Re: thrud and xanax and sex » gilbert, posted by SalArmy4me on August 27, 2001, at 0:02:28
Congratulations on your success with Moclobemide. I hope it is everything you have been looking for.
We are all here looking for that magic pill, not to get "high" but to be *normal* again. I hope it does it for you and doesn't poop out or something.
(I was actually on it for a year or so. It was not very successful for PAD. Like the USS Enterprise I still boldy go...)
Thrud
Posted by gilbert on August 27, 2001, at 20:55:22
In reply to Re: BTW Sal...., posted by Thrud on August 27, 2001, at 3:08:50
Thrud,
I actually found the xanax to improved my sex drive while on an ssri which is probably not average. I am off ssris and find xanax does have a nice anti panic effect and helps my ruminating thoughts and gives me a little boost as well. I think at first I was too sedated to care about sex but I would guess after about a month I noticed my interest returned to almost normal.....when I say almost I mean sometimes I will still take a little longer to finish but the it still feels pretty darn good. How long have you been off ssris....it took me a long time after being on prozac to regain my orgasmic function.....could be some ssri residue adding to the xanax problem.
Now about the klonopin I did not give it a fair try because I was so sick of not being sexual by the time I got to the konopin on drugs to try I had no patience for any more sex problem.....some have waited it out and regained function.....you just gotta try and see. Also most panic patients are very sensitive to med side effects and are also very suggestible emotionally to side effects so make sure what you have is truly a physical manifestation of a chemical side effect and not a pyshcological manifestation of an unwanted side effect.
Good Luck,
Gil
Posted by Rick on August 28, 2001, at 1:03:44
In reply to Re: Rick: alt.panic, posted by Thrud on August 27, 2001, at 3:04:04
> Hi Rick.
>
> I just joined the alt.panic.something? group.
>
> How the heck are you supposed to extract useful info from that rambling mess???!!!
> Most of it seems to be idle chit-chat. From what I've seen, nothng like Babble-land!
> Anyway, I've posted my usual pleading "please help" question and I'll see what I get.
>
> BTW, is there a search engine there so I can cut through the crap?
>
> Thanks again RickDid you try searching at http://groups.google.com/ ?
This is a recently-added service of google.com that searches through several years of newsgroup posts. You don't even have to choose a specific group. Just enter several keywords in the search box, such as xanax and "sexual dysfunction" (i.e., use quotes to make it a string).
When you get your 40,000 results, it will show you the groups that use the terms the most, which will certainly include alt.anxiety-panic. If you want to narrow things down, you can then click on the link to that group to open a reverse-chronological listing of threads on the NG. Then you can re-enter the search terms, but this time click the radio button that says "search only in alt.anxiety-panic." to get a narrower list of postings that might be relevant. Etc. Always be sure to select "view entire thread." Yes, there's a lot of junk, but there may be some good stuff in there. I believe some regular Psycho-Babblers post frequently to alt.anxiety-panic, too.
I spent a few minutes nosing around like that myself and did find some people who complained of sexual dysfunction with Xanax. But frankly, the responses were usually along the lines of "Xanax never causes that, must be related to something else." The latter part of that statement is sometimes true, of course (something alluded to in gibert's last post), even if Xanax *can* cause SD for some, esp at high doses. Why don't you just try to wait it out a at least a few weeks more, and do see if maybe you could cut back a little with your doc's approval.
(I know, easier said than done!)
If that or some of the other ideas don't work, I'd still look into low-dose stimulant augmentation. If you do, there have been so many experiences in Babble-Land alone of sexual stimulation from selegiline that I really think you should consider it.
BTW, I looked for sexual dysfunction in the RXlist monograph for selegiline, too. It made me wonder if you and I were looking at the same site, given that you say you saw sexual dysfunction plastered all over the place. I only saw it once, and was listed in the laundry-list, who-knows-what-really-caused-it section that tends to include everything from hangnails to change of political affiliation. (Which is NOT to say that some people don't occasionally have very atypical reactions, as you know.) The Medscape monograph for selegiline (they try to stay very up to date) listed a "mere" 25 or so "less common" adverse effects for selegiline, and sexual dysfunction didn't make the cut. By the way, I think some of the references to "personality changes" etc. might have referred to elderly Parkinson's patients who had an unusual and maybe inappropriately-expressed increase in libido.
Hey, didja ever notice that the side-effects list for antidepressants always include depression?
If you live in a large metro, I wonder if you could find a psych who specializes in sexual disorders (even if your reaction IS all or mainly drug-induced). Not to *replace* your current guy, who sounds like a good one, but just to see if they might have any ideas for putting a grin back on Mr. Happy's face. Or maybe an endocrinologist? I believe certain hormonal/endocrine profiles could make one more susceptible. (As you can see, I'm just tossing out ideas at this point, some of which may or may not make sense.) If you're overweight or out of shape, maybe diet and exercise could help as well, either directly, or indirectly through anti-anxiety benefits that allow you to get by on less Xanax. (I'm certainly not implyng that that very-fit people aren't prone to sexual side effects, too.)
Rick
Posted by Thrud on August 28, 2001, at 6:38:42
In reply to Re: Rick: alt.panic(Caution: REAL babbling within), posted by Rick on August 28, 2001, at 1:03:44
Hi Rick
> Did you try searching at http://groups.google.com/ ?
Yes. Now I feel like a total retard since it was so obvious! (I think I'll blame it on the Xanax)
> I spent a few minutes nosing around like that myself and did find some people who complained of sexual dysfunction with Xanax. But frankly, the responses were usually along the lines of "Xanax never causes that, must be related to something else."Yes. That is exactly what I found out too. Problem is that very few used Xanax as monotherapy and those who did used it at low, PRN doses. Makes the culprit difficult to determine.
>The latter part of that statement is sometimes true, of course (something alluded to in gibert's last post), even if Xanax *can* cause SD for some, esp at high doses. Why don't you just try to wait it out a at least a few weeks more, and do see if maybe you could cut back a little with your doc's approval.
>
> (I know, easier said than done!)My pdoc said that he typically has PAD patients on initially high doses to first eliminate the panic and any other anxiety then over 18 months to 2 years the dose is slowly tapered down to very low or nothing. However, he acknowledges that my condition is chronic and very powerful, very likely requiring lifelong medication at an unknown final, "stable" dose. Will it be high enough to effect Mr Willy? Who knows.
BTW I am sticking it out until my pdoc says otherwise. The SD is very depressing, but in other respects the side effects of Xanax are simply bliss compared to ADs.
> If that or some of the other ideas don't work, I'd still look into low-dose stimulant augmentation. If you do, there have been so many experiences in Babble-Land alone of sexual stimulation from selegiline that I really think you should consider it.I see my pdoc in three weeks. Just today I mailed him a letter with some literature I pulled off the net asking him to consider selegine augmentation (at less than 10mg per day). Should be an interesting session. I also sent him information on inositol.
> BTW, I looked for sexual dysfunction in the RXlist monograph for selegiline, too. It made me wonder if you and I were looking at the same site, given that you say you saw sexual dysfunction plastered all over the place.
My apologies. I checked it again and I must have been looking at a different drug. "transient anorgasmia" and "lack of penile sensation" was reported by an unknown number of people out of a sample >900 and *only* at doses >10mg/day. Again, I will blame my oversight on Xanax (lovely scapegoat)
>
> Hey, didja ever notice that the side-effects list for antidepressants always include depression?Yes! And anxiety for anxiolytics! The way my body seems to work, if I were in a trial for aphrodisiacs they would probably have to note impotence as a potential side effect!
>
> If you live in a large metro, I wonder if you could find a psych who specializes in sexual disorders (even if your reaction IS all or mainly drug-induced). Not to *replace* your current guy, who sounds like a good one, but just to see if they might have any ideas for putting a grin back on Mr. Happy's face.In my letter I did ask him to consult his "peers" on their clinical experience with Xanax and SD.
>Or maybe an endocrinologist? I believe certain hormonal/endocrine profiles could make one more susceptible.
Possibly. The problem is that when I am not on medication I am actually *hypersexual*! (but full blown "status panicus" as well!) Nevertheless, I will bring up this point with him. My thyroid tests were normal but this is the only set of hormones I have had tested.
>(As you can see, I'm just tossing out ideas at this point, some of which may or may not make sense.)
Please continue. You have been extremely helpful.
>If you're overweight or out of shape, maybe diet and exercise could help as well, either directly, or indirectly through anti-anxiety benefits that allow you to get by on less Xanax. (I'm certainly not implyng that that very-fit people aren't prone to sexual side effects, too.)
I play rugby regularly and am pretty fit. There is no doubting that *rigorous* excercise is an excellent antidepressant/relaxant. Unfortunately, my underlying condition is way too severe to use fitness alone.
From my discussions with you and Elizabeth and Gil I think the potential combo of Xanax plus a stimulant like selegiline could be a very promising one.
Stimulant plus depressant: Sort of like Dr Dolittle's fictitious two-headed beast, the "pushme-pullyou"! I hope it doesn't rip my brain apart. It will be discussed at my next pdoc session. In the meantime, if you feel like downloading any further info, please do.Thrud
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