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Dr. Bob is Robert Hsiung, MD,
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Posted by Joy on May 19, 2002, at 11:48:14
In reply to Benzo question for all users, posted by johnj on May 19, 2002, at 10:29:41
My vote goes to Xanax [Alazapram] which I use when needed [mostly for insomnia]; no depression here. My pdoc thinks Klonopin has depressive qualities while Xanax does not [according to him].
Joy
Posted by bubblegumchewer on May 19, 2002, at 12:18:12
In reply to Benzo question for all users, posted by johnj on May 19, 2002, at 10:29:41
I would be very careful of getting into regular use of benzos if I were you. A year ago I took the advice of people on this board (although I take total responsibility for my actions and I had my doctor's OK) and I took clonazepam 3x per day for four months, at which time I landed in the hospital for the first and hopefully only time in my life. The persistently recurrent panic attacks and sickness that I developed from tolerance to benzos was the worst nightmare that I can imagine a person going through. I was unable to eat anything or drink much of anything and had nearly constant adrenaline related symptoms such as raised hair, nausea, pacing, insomnia, panic attacks breaking into the little restless sleep I did get, all while being dulled and sedated, if you can imagine that. I thought I was going to die a miserable death. I wanted out but whether I took more benzos, stayed the same, or took less, my suffering increased in one way or another, whether it was adrenaline overload or the crushing depression caused by the continuation or increase of benzo. I could not function at all and checked into the hospital. Thankfully, I recovered after some time.
Someone may criticize my story as being "only my story," and that it is. I hope that you get into ongoing benzo use VERY carefully if you do at all. I felt ok for a few months and the onset of illness was subtle, but when it struck, it was horrible, and my life deteriorated day by day until I was incapacitated and not myself at all. I felt that I would never be myself again and I was only able to withdraw from the clonazepam under medical supervision, with nortriptyline, and a lot of misery.Be careful.
Posted by Rainee on May 19, 2002, at 12:32:04
In reply to Re: Benzo question for all users, posted by bubblegumchewer on May 19, 2002, at 12:18:12
I too had severe withrawl from benzos and was in the hospital for a month. You have to be VERY careful. it took me a good year to start to level out..I use xanax here and there but I have immense respect for the drugs.
Posted by JonW on May 19, 2002, at 12:38:33
In reply to Benzo question for all users, posted by johnj on May 19, 2002, at 10:29:41
I also vote for Xanax -- some people even say it has anti-depressant qualities. It really sucks that it has such a short half-life. Why can't we have the XR version?! Xanax seems to be the hardest drug to get off of after chronic use, though.
Jon
> I read that klonopin may cause behavorial disturbances. What does this mean? and has anybody experienced this? I am looking for a benzo that doesn't make me more depressed what have you used that helps with the anxiety, but doesn't cause additional depressive symptoms? Thanks.
> Johnj
Posted by JonW on May 19, 2002, at 12:48:26
In reply to Re: Benzo question for all users » johnj, posted by JonW on May 19, 2002, at 12:38:33
I concur with what others have said here about the benzos (in my case klonopin) being difficult to get off of. I've decided these drugs aren't for me on a chronic basis. However, if I took a benzo and it improved my quality of life to the extent that social phobia wasn't a problem, I'd take it even if it were a sure thing I could *never* get off the drug! As long as these drugs (or any drug for that matter) are legal, it's a personal decision and be aware of the facts and the risks.
Jon
Posted by IsoM on May 19, 2002, at 13:14:25
In reply to Benzo question for all users, posted by johnj on May 19, 2002, at 10:29:41
John, it's not so cut-&-dried as to say what benzo will work best for you. We're too individual. Alprazolam (Xanax) relaxes me wonderfully without sedation while lorazepam (Ativan) knocks me out. Yet many here will say the exact opposite happens for them.
My son took Rivitrol (Klonopin or clonazepam) for years with no adverse effects & no problems discontinuing it - no withdrawal. It worked very well for him without sedation. When I took it occasionally, I had no problems either.
Whether a person would get "addicted" varies too. It seems to depend on your own physiology. I don't. But then I smoked a pack a day for 2 years & when I wanted to quit, I just did. Few people can do something like that. I strangely never felt addicted to tobacco like most. Benzos simply need to be treated with respect like all drugs should be.
Posted by Franz on May 19, 2002, at 15:47:42
In reply to Re: Benzo question for all users » johnj, posted by IsoM on May 19, 2002, at 13:14:25
Hello,
What happens if you take coffee to avoid benzodiazepine sedation during the day?. Does caffeine interfere with the anti-anxiety effect too?.
e.g. can I take a low dose Xanax with the morning coffee and still get the anti-anxiety effect with less sedation than without coffee?. I need to lessen anxiety but be fully alert.
Also, as alprazolam has a short life, will a morning dose only be not enough and cause a rebound of anxiety. I am thinking on using it for the more anxiety provoking times of the day and avoid regular use and dependance (if this is rational).
Thanks.
Franz
> John, it's not so cut-&-dried as to say what benzo will work best for you. We're too individual. Alprazolam (Xanax) relaxes me wonderfully without sedation while lorazepam (Ativan) knocks me out. Yet many here will say the exact opposite happens for them.
>
> My son took Rivitrol (Klonopin or clonazepam) for years with no adverse effects & no problems discontinuing it - no withdrawal. It worked very well for him without sedation. When I took it occasionally, I had no problems either.
>
> Whether a person would get "addicted" varies too. It seems to depend on your own physiology. I don't. But then I smoked a pack a day for 2 years & when I wanted to quit, I just did. Few people can do something like that. I strangely never felt addicted to tobacco like most. Benzos simply need to be treated with respect like all drugs should be.
Posted by Essence on May 19, 2002, at 17:09:43
In reply to Benzo question for all users, posted by johnj on May 19, 2002, at 10:29:41
Check out this site, it lists the behaviour problems associated with Clonazepam. Hope this helps. http://support4hope.com/medications/index.htm
Posted by katekite on May 19, 2002, at 17:22:56
In reply to Benzo question for all users, posted by johnj on May 19, 2002, at 10:29:41
Not sure what they meant by 'behavioral disturbance' but all the benzos have the potential to decrease inhibitions, just as alcohol can. For social anxiety etc this may be the desired effect.
However someone who is impulsive may tend to be more moody or angry or argumentative etc because they are not controlling themselves as well..... Wouldn't be likely to be an issue for someone who was not the impulsive type.
-------
RE coffee and benzos:
If you are to the point of taking benzos daily for anxiety then stay away from caffeine altogether -- if you feel sedated from the prescribed dose of benzo just take less.
Decaf will taste just as good as regular in a week or two.keep us posted.
kate
Posted by Squiggles on May 19, 2002, at 21:15:55
In reply to Benzo question for all users, posted by johnj on May 19, 2002, at 10:29:41
I have lengthy experience with this drug (15 yrs);
I found it almost imperceptible except for two
things:1. its interaction with lithium while I was
on XANAX caused severe dyspnea;2. the attempt to withdraw was indescribably
awful and very dangerous - i think i had a seizure;
But, if you are on it and stay on it - it's OK -
it is a good med. life benzo - side effects for
me (swollen ankles, fatigue, swollen face, some
dyspnea, gastro disturbance) but tolerable all
in all;Squiggles
Posted by omega man on May 19, 2002, at 22:02:29
In reply to Benzo question for all users, posted by johnj on May 19, 2002, at 10:29:41
Overconfidence..some downright sleaziness...I don't know which parts of the brain Benzos switch ...but I found myself well foul of the law..in bad company (lost people trying to have fun) ...I needed the confidence...but it went too far...
you start questioning yourself after you've been given a couple of beatings and you don't know why...
Posted by IsoM on May 20, 2002, at 1:04:00
In reply to Re: Benzo question for all users » IsoM, posted by Franz on May 19, 2002, at 15:47:42
> "What happens if you take coffee to avoid benzodiazepine sedation during the day?. Does caffeine interfere with the anti-anxiety effect too?."
Yes, it can. Caffeine does help you stay alert, but has a *much* stronger effect physically than mentally for most. The amount to keep alert will probably leave you feeling jittery instead, negating much of the calming effect of a benzo.
> "e.g. can I take a low dose Xanax with the morning coffee and still get the anti-anxiety effect with less sedation than without coffee?. I need to lessen anxiety but be fully alert."
How much does the caffeine in one cup of coffee affect you? For most people, it's not that much & if you can normally have a morning coffee without feeling a little wired or jittery, I see no reason not to have it just 'cause you're taking Xanax. If you do feel wired with a morning coffee, do like katekite said & drink decaff.
> "Also, as alprazolam has a short life, will a morning dose only be not enough and cause a rebound of anxiety. I am thinking on using it for the more anxiety provoking times of the day and avoid regular use and dependance (if this is rational)."
I didn't notice a anxiety rebound myself when it wore off, but I found that my more anxious time was later in the early afternoon, so I saved my dose for that time. Another way of doing it may be to take a whole tablet in the morning & then mid-afternoon, take a half-tablet. I did that for a while before I tapered down & it worked well, keeping me calm throughout the day.
Posted by johnj on May 20, 2002, at 9:24:13
In reply to Re: Benzo answers for... » Franz, posted by IsoM on May 20, 2002, at 1:04:00
Hi,
I like the idea of xanax instead of a possible depression induced benzo like tranzene(which I take right now). The doc wants me to increase the dose of tranzene back to what I was about 2 years ago. It might prove to be a good move, but I do feel I get a little irritable and slightly more depressed when I take it. I hear xanax may have some antidepressant properties and I like the sound of that. I just don't know if it is ok to take xanax with another longer acting benzo. I also take some lithium and a TCA, both in low doses, so I don't know if it is ok or not. What have you taken in combination with the xanax? and do you still take it? Thanks for the help.
johnj
Posted by johnj on May 20, 2002, at 9:26:08
In reply to Re: Benzo answers for... » Franz, posted by IsoM on May 20, 2002, at 1:04:00
Thanks for the information. Has anyone taken xanax long term? How about in combination with a longer lasting benzo? I take lithium and a TCA and wonder if anybody else has taken xanax with such medications? Thank you.
johnj
Posted by Squiggles on May 20, 2002, at 10:50:11
In reply to Thanks all, and a few more questions, posted by johnj on May 20, 2002, at 9:26:08
Hi John,
Yes, I took XANAX (.25mg x 2 per day max) for
more than 10 years; as well as Klonopin and
Lithium (li 20+ years);The Xanax eventually produced debilitating
panic attacks (perhaps i reached tolerance);
and the combo with Klonopin, produced severe
dyspnea upon lithium ingestion (requiring
sitting on all fours to breathe every time
the two taken concurrently.All this pharmacological stuff is black magic
to me; however, I researched the X and got off;
thereby getting rid of all panic attacks.Squiggles.
p.s. also take Synthroid for lithium induced hypothyroidism.
Posted by Rathrbfishn on May 20, 2002, at 20:53:36
In reply to Thanks all, and a few more questions, posted by johnj on May 20, 2002, at 9:26:08
I have taken xanax in fairly high doses for years. Have little to no problems with it. I did use it with doxepin several years ago for a few months, along with xanax, but I have difficulties with the eventual enhancing effects of AD's. I take doxepin rarely now if I need a good nights sleep. I don't usually have a problem with doxepin's enhancing effect if I take it for a night or two due to insomnia. I am aware of many people who take long half life benzo's such as klonopin and tranxene as a daily maintenance dose and use xanax or ativan on a per need basis when faced with panic inducing situations, and need a fast acting anxiolitic.
As far as lithium, I tried it once when I was not using xanax or doxepin and found it turned me into a zombie, so I stopped it after 3 days.
I think the main thing about polytherapy is that you need to have a pdoc who is an expert, and has accurately diagnosed your condition.
My diagnosis is chronic panic/anxiety which explains the long term use of xanax. The occasional use of the sedating doxepin is for insomnia, not depression. I'm sorry, but I have no experience when adding lithium to this mix.
Posted by IsoM on May 21, 2002, at 0:54:28
In reply to Re: Benzo answers (IsoM), posted by johnj on May 20, 2002, at 9:24:13
John, the original pdoc I had was trained at the university in Edinburgh. He said it was at a time that many were still depending on Freudian ideas & the u. at Edinburgh was the best in the world at that time. I really trusted his judgement - he was a very sensible, intelligent, & understanding doctor.
He felt that Xanax was one of the best benzos for people who suffered with depression. I don't know if there's any new ones that have its AD effects like it. One of my sons has taken it occasionally only, while he was also taking a TCA & lithium, so the combo must be okay. I have taken Xanax regularly with TCAs in the past (imipramine & amoxepine) but haven't used lithium. I have no experience or information to give you about a combo of Xanax & another benzo. Still, I'm not sure it's a good idea - I think you'd get a potentiation of the effects - too sedating & even possibly dangerous.
My situation is very different now - the main source of my extraneous stress is gone so, while I may have a somewhat anxious personality, it's not much of a problem anymore. I rarely take Xanax now - more for unusual situations or root-canal work! I find that adrafinil while acting as a stim, is also very calming after the full effects of it kick in (about the 4 or 5 week point).
Posted by Squiggles on May 21, 2002, at 6:32:56
In reply to Re: Thanks all, and a few more questions » johnj, posted by Rathrbfishn on May 20, 2002, at 20:53:36
Hi Rathrbfishin,
I would be interested to know if your diazepam
dose was increased over the years; I stayed on
the same dose for some 10 years - I suspect THAT
was the problem - anyway, I got addicted to the
stuff even at that small dose and had inexplicable
panic and anxiety in between; not so with
Rivotril.Squiggles
Posted by Rathrbfishn on May 21, 2002, at 19:21:13
In reply to Re: Thanks all, and a few more questions, posted by Squiggles on May 21, 2002, at 6:32:56
Hi Squiggles
Yes my xanax dosage has increased since I started it in 85. That is the nature of a PAD disorder and xanax because of it's short half life.
Originally started at .5mgs, 4 times/day. By the end of the first year I was taking 4mgs/day. In 89 my pdoc increased the dosage to 6mgs/day. In 98 he gave me the option to take up to 8mgs/day if needed. The if needed part was because I was advancing in my work up the corporate ladder and often had to do public speaking, attend high level meetings, etc. I found that I would have some breakthrough panic in these new situations and that is just not an option I could tolerate when involved in these new responsibilities.
I usually stay at about 6mgs/day though.
With PAD and xanax you start at a low dose, allow your body to adust to the side effects, then continue to titrate up until the panic is under control. Since I only occasionally have depressive episodes, and the AD's don't work for me, xanax was the ticket. The medical evidence that xanax has mild anti-depressent properties is fairly well established.
You are probably right that you were not taking enough xanax. It's half life is about 4-6 hours. If you were only taking it 2 times/day you were probably getting rebound anxiety. For xanax to be effective, if your taking it daily, it is usually rx'd 3-4 times/day. Rebound anxiety is usually worse than the original anxiety that you started xanax for in the first place. However the klonopin, with it's much longer half life, should have taken care of that problem, but I guess not in your case.
I prefere to think of my use of xanax as a medical dependence rather than an addiction. Addiction has different characteristics associated with it than when taking a potentially addictive med for a properly diagnosed chronic illness. There is little doubt that it is a difficult drug to withdraw from at any dose after a long period of use, but the key is to do it slowly and under medical supervision. There is really not much difference for some in withdrawing from a benzo as any other psych drug, with the exception of a different set of symptoms. Just read all the posts about people having problems withdrawing from the ssri's.
Hope I've answered you question, I got off track a little.
Posted by Squiggles on May 21, 2002, at 21:07:32
In reply to Re: Thanks all, and a few more questions, posted by Rathrbfishn on May 21, 2002, at 19:21:13
Rathrbfishn,
You not only answered my question, you
wrote a mini lecture on exactly how these
drugs should be dispensed and what happens
when their pharmaceutical properties are
not recognized.My Xanax was prescribed "as needed", but
over 10 years that "needed" inevitably became
greater; so the gaps turned into panic attacks,
about 3 a day, and worse and worse.I discovered this on the net. Getting off was
not that hard as I was on a low dose, and I got
a schedule from a supervisor at a hospital.About the Klonopin - a completely different story;
still don't understand why I couldn't do it.
Small dose (1.0mg max) over 10 yrs or more; tried
quitting over 1 and a half years, reaching
a stroke or seizure. I am at a loss to explain
what happened; i have even speculated that perhaps
there was an interplay with the lithium and the
lithium rose and gave me the stroke;I had to reinstate the full dose and then some;
in the interim, I had an itinary of withdrawals
that only someone trying this would believe.Anyway, I thank for your very thoughtful post,
and I certainly do not consider dependence on
a drug for a condition in the moral realm; you
may as well say that breathing air is something
you overdo every day; I don't want to get into
the linguistic aspects of the word "addiction" -
I think the only thing that matters with that
word is its physical aspects with respect to what
effect the drug has and its absence.cheers,
Squiggles
Posted by Rathrbfishn on May 21, 2002, at 22:47:25
In reply to Re: Thanks all, and a few more questions, posted by Squiggles on May 21, 2002, at 21:07:32
Hey Squiggles...what's up with this klonopin problem your having?
I know many people who have used it for PAD and had excellent results, using much higher doses than you are. But I personally was friends with a guy that was taking the same amount you were, 1mg/day, and he had all kinds of trouble with it. He simply could not get off it, even at that low dose. He eventually ended up in a rehab and I lost track of him.
I saw him struggle with it for almost a year. There was no mistaking his discomfort as he unsuccessfully tried to titrate down slowly on it.
I don't see many posts by people who have the difficulty you describe withdrawing from K and the problems this friend of mine had.
The reason I bring it up is because my pdoc sometimes mentions it as an alternative to xanax due to the short half life of xanax. But he always talks himself out of it, saying that one of it's side effects is that it is much more depressing than xanax.
I am very interested in the withdrawal problems you had with it, for the sake of gathering info on it. You mentioned that you thought you may have had a stroke or seizure problem with it. Those are two very different events and I am trying to figure out why you couldn't tell the difference. If you don't mind me asking, what were the symptoms you experienced that led you to believe you may have had one or the other? And to further the discussion, what, if any, other withdrawal problems did you have with it that were distinctly different than your xanax withdrawals. Granted, you were taking very low doses of xanax, but 1mg of K is not that much either.
Your situation with K has really perked my interest, because I have always remembered that friend of mine having so much trouble withdrawing from it, because I don't see much on the web about the problems you have had with it, and because I have given serious consideration to giving it a try. Even though my pdoc talks about the depressive qualities of it, he wouldn't hesitate to let me have a trial on it if I asked. When he does bring it up I alway tell him I've thought about it but am aware of the depressive qualities and would really rather stay with xanax because I know exactly how to take it, exactly when to take it based on how I'm feeling, and know that it works well for me. But I have one symptom that we have never really been able to solve and that is insomnia. My pdoc tells me that K would solve that problem. I do not use xanax to sleep, it actually has the opposite effect on me. If I take it at bedtime, I always end up getting out of bed and doing things. So I hope you can understand my interest in your experience with klonopin.
Hope I'm not intruding too much, but I'm am very interested.
Posted by bubblegumchewer on May 22, 2002, at 9:17:01
In reply to Re: Thanks all, and a few more questions » Squiggles, posted by Rathrbfishn on May 21, 2002, at 22:47:25
I don't mean to be a buttinsky, but if you haven't already read my post above, you might want to do so. I had problems with klonopin; I can tell you the whole grueling story if you want, but the very short form is in my post from a few days ago, up near the top of the thread. If you have any specific questions I'd be glad to answer them. Sorry if I spelled your name wrong. ;o)
Posted by Ponder on May 22, 2002, at 9:25:13
In reply to Re: Thanks all, and a few more questions » Squiggles, posted by Rathrbfishn on May 21, 2002, at 22:47:25
Someone on the board recommended using Ativan sublingually for faster onset. Wanted to thank that person. This technique has been VERY useful as I tend not to take it until I needed it 20 minutes ago. The quicker onset is great.
Posted by Squiggles on May 22, 2002, at 12:21:03
In reply to Re: Thanks all, and a few more questions » Squiggles, posted by Rathrbfishn on May 21, 2002, at 22:47:25
Hi,
I think K is fine as long as you stay on - like
all drugs if you look at the mono. you will see
the side effects.The first incident of it being a "weird" drug,
was when I forgot to take my dose once, and felt
a "stroke" like electric and paralyzing sensation
down one arm; i also fell asleep and woke up
feeling very strange; i was not myself for a month
even though I continued taking it.The second memorable time that I had trouble with
it was when it started interfering with the lithium-
i would get the dyspnea i mentioned; very severe but
as i was on Xanax at that time, I wonder if it was
just not respiratory depression.The third big odyssey on K was trying to withdraw -
something I should never have done and I don;t believe
my doctor really wanted to; but being the very
compassionate person he is, he lets me try things.Anyway, in the process of using the chunk-0-meter
and trying to withdraw, i experience many severe
withdrawal symptoms - motor, neuronal, and especially
gastro - which never really stopped; the worst
was the stroke at 0.125 mg (it was a hot summer and
possibly it was li overdose or displacement - i know
bupkin about pharmacology). I have described it before;
it felt like cords, or moving snakes or eels down the
back of head spine area (not to worry i had that
the year before still in w/d and an emergency doc
said "myoclonic seizure" - not the real thing; but
this time they travelled all the way up and started
to move faster around the head like an electric storm;
and the POW - felt as if an axe hit the back centre of
my head.After that I was quite sick for a month - very sick;
dizzy, could not walk straight, sweats, falling asleep
without even knowing it, erratic sleep cycles, and
extreme head pain to the point of not being able
to place my head on the pillow. I can't remeber
everything. I just don't know what happened. My
husband freaked and reinstated me and my doc. permitted
me to take the dose at which a comfort level could be
reached.That's my story. BTW I had to go up a bit after
that incident and from 1.0mg K - now take 1.250 mg
K.I am sort of glad you have a friend who knows about
K - it is very hard to believe that such a small dose
can do this. Unless there are other factors, but
your friend does not take lithium. I personally think
that K is different and that if taken for a very long
time actually changes the brain chemistry maybe even
structure - much like alcohol.So, if you take it, I would suggest you stay on it
or choose another. I know that most psychopharmacologists
swear that all the benzos are the same, but I swear
there is something different about clonazepam and only
the creator of it knows for sure. Sort of like
the Coca Cola formula.:-)
Squiggles
Posted by Elizabeth on May 22, 2002, at 15:08:24
In reply to Benzo question for all users, posted by johnj on May 19, 2002, at 10:29:41
> I read that klonopin may cause behavorial disturbances. What does this mean? and has anybody experienced this? I am looking for a benzo that doesn't make me more depressed what have you used that helps with the anxiety, but doesn't cause additional depressive symptoms?
Hi John. As katekite says, "behavioral disturbances" usually have to do with disinhibition. This can manifest as aggression and even violence. This is rare -- I think it's much more common with alcohol -- but it can happen. It's been suggested that people with certain disorders are especially vulnerable to this kind of reaction. Any benzo can cause it; Xanax and Valium have been implicated in a number of cases, but that probably has to do with their popularity rather than an increased tendency to cause loss of control or disinhibition.
As for depression, Xanax is usually considered the benzo of choice for people who've become depressed on other benzos. It's even thought to be an antidepressant by itself, in high doses. But as always, YMMV.
-elizabeth
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