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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 10 of 10. This is the beginning of the thread.
Posted by GreyCow on February 3, 2004, at 19:53:32
I have been taking Xanax about 1 1/2 years (due to panic attacks in public presentations of large audiences).
I think I have abused the medication by taking it when I just wanted to feel calm (kind of like taking a warm bath and relaxing).
The problem is that as a result, my tolerance has gone from where I could take 2mg to get through a public presentation, to where I now am up to 8mg. Needless to say, this is a huge jump.
I didn't want to freak out my psychiatrist over this huge jump in tolerance, so I told him my tolerance only went up to 4mg. I asked him if it was possible to lower my tolerance back down to 2mg and he said yes. He said that the tolerance to xanax can be "reset".
So the question I forgot to ask him is how long should I stop taking xanax in order for my tolerance to drop back down to 2mg. Should I stop taking it for 3 months, 6 months, 1 year? Does anyone know or have any idea about lowering one's tolerance to Xanax?
Thanks in advance for any feedback.
Posted by Kon on February 3, 2004, at 20:43:41
In reply to Xanax and Lowering Tolerance, posted by GreyCow on February 3, 2004, at 19:53:32
> So the question I forgot to ask him is how long should I stop taking xanax in order for my tolerance to drop back down to 2mg. Should I stop taking it for 3 months, 6 months, 1 year? Does anyone know or have any idea about lowering one's tolerance to Xanax?
That's a good question. My guess is that it varies but I doubt it would take that long. I'll see if I can find any info. I use clonazepam for the exact same reason (public speaking). I do develop tolerance to sedating/hypnotic effects if I use it for a few days in a row. But if I take 2 weeks off, the sedation returns. So a 2-week wash-out period from clonazepam brings back the sedation. Tolerance to anti-anxiety effects hasn't developed much with over 1.5 years of as-needed use. I've never had to take more than 2.0 mg. It's surprising that tolerance to anti-anxiety effects has developed for yourself and others because I've come across research suggesting that (even with xanax) tolerance to anti-anxiety effects is quite rare. Do you take it regularly? I ask because some argue that occassional use may prevent tolerance from occuring (assuming you aren't concurrently taking other benzos).
Posted by Chairman_MAO on February 4, 2004, at 10:42:10
In reply to Xanax and Lowering Tolerance, posted by GreyCow on February 3, 2004, at 19:53:32
It is an extremely bad idea to escalate the dosage of a benzodiazepine if you really do need it to function. As the poster previous to me said, tolerance to the anxiolytic effecs of benzodiazepines is rare. Tolerance to the sedative/hypnotic effects develops rapidly if used often. If abused with a passion, you could easily be taking 40mg (10mg qid) alprazolam/day within several and not even be drowsy.
Please, take it from someone who's walked this path before: DO NOT ESCALATE THE DOSE. Be thankful for the fact that someone is even prescribing xanax for you long-term; many doctors won't.
It is not clear to me whether you are taking the xanax as-needed or continuously, but if you're taking it on an as-needed basis, 1 month without xanax should be enough to drop back down to 2mg. It might take much longer, though, and there is nothing you can do to speed up this process. 8mg of xanax is way more than anyone should have to take to get through a presentation; people with panic disorder can usually completely suppress panic attacks by taking no more than 10mg/day.
If you make presentations often, you may wish to consider starting on a low dose of an SSRI after you've gotten your xanax tolerance back to normal. If you can tolerate the side effects, this would allow you to be less psychologically dependent on xanax. Yeah, it's still relying on a drug, but SSRIs don't suppress anxiety completely at low doses so you can develop some non-med coping skills, too.
Best of luck.
Posted by GreyCow on February 5, 2004, at 13:06:20
In reply to Re: Xanax and Lowering Tolerance, posted by Chairman_MAO on February 4, 2004, at 10:42:10
Thanks for the advice. I'll try a month and see if my tolerance lowers as a result.
> It is an extremely bad idea to escalate the dosage of a benzodiazepine if you really do need it to function. As the poster previous to me said, tolerance to the anxiolytic effecs of benzodiazepines is rare. Tolerance to the sedative/hypnotic effects develops rapidly if used often. If abused with a passion, you could easily be taking 40mg (10mg qid) alprazolam/day within several and not even be drowsy.
>
> Please, take it from someone who's walked this path before: DO NOT ESCALATE THE DOSE. Be thankful for the fact that someone is even prescribing xanax for you long-term; many doctors won't.
>
> It is not clear to me whether you are taking the xanax as-needed or continuously, but if you're taking it on an as-needed basis, 1 month without xanax should be enough to drop back down to 2mg. It might take much longer, though, and there is nothing you can do to speed up this process. 8mg of xanax is way more than anyone should have to take to get through a presentation; people with panic disorder can usually completely suppress panic attacks by taking no more than 10mg/day.
>
> If you make presentations often, you may wish to consider starting on a low dose of an SSRI after you've gotten your xanax tolerance back to normal. If you can tolerate the side effects, this would allow you to be less psychologically dependent on xanax. Yeah, it's still relying on a drug, but SSRIs don't suppress anxiety completely at low doses so you can develop some non-med coping skills, too.
>
> Best of luck.
Posted by AtlantaRunner on February 6, 2004, at 18:00:12
In reply to Re: Xanax and Lowering Tolerance, posted by Kon on February 3, 2004, at 20:43:41
> > So the question I forgot to ask him is how long should I stop taking xanax in order for my tolerance to drop back down to 2mg. Should I stop taking it for 3 months, 6 months, 1 year? Does anyone know or have any idea about lowering one's tolerance to Xanax?
>
> That's a good question. My guess is that it varies but I doubt it would take that long. I'll see if I can find any info. I use clonazepam for the exact same reason (public speaking). I do develop tolerance to sedating/hypnotic effects if I use it for a few days in a row. But if I take 2 weeks off, the sedation returns. So a 2-week wash-out period from clonazepam brings back the sedation. Tolerance to anti-anxiety effects hasn't developed much with over 1.5 years of as-needed use. I've never had to take more than 2.0 mg. It's surprising that tolerance to anti-anxiety effects has developed for yourself and others because I've come across research suggesting that (even with xanax) tolerance to anti-anxiety effects is quite rare. Do you take it regularly? I ask because some argue that occassional use may prevent tolerance from occuring (assuming you aren't concurrently taking other benzos).
>I'm so surprised by this conversation. I have pretty extreme GAD and have been on Xanax in combination with Lexapro for a year and a half. I have never taken more than 1 mg in a day. My prescription is for .25 mg up to 4x a day - and that (120 per month) lasts me generally 6-10 weeks. I had no idea people took and could tolerate such high dosages!
Posted by GreyCow on February 10, 2004, at 0:14:04
In reply to Re: Xanax and Lowering Tolerance, posted by AtlantaRunner on February 6, 2004, at 18:00:12
Yeah, unfortunately, one can tolerate the high doseages. I'm not sure how it happened, but it came on gradually. There was a time when I took 3mg and I almost fell asleep in the meeting (that I might have had to speek in).
Eventually 3mg became the normal amount and then over time, I didn't feel anything on 3mg. The same scenerio with 4mg, then 5mg, then I seemed to jump up to 7mg, then I quit just recently when I hit 8mg.
Sometimes I would take like 6mg at once in the afternoon and it would make the rest of the day at work seem to float by. I was able to do routine, redundant type work and it gave me a kind of relaxed high to just sit and stare at my monitor as I did the tasks. I think back now and it was kind of euphoric in the feeling.
I think that euphoria is what made me continue to keep taking it and try more each time. I still haven't taken any since I posted this thread and really haven't had a craving for them.
Reason I stopped is that I'd rather not taken them and have the security blanket of knowing I can take them for an emergency meeting or oral presentation, rather than continue to take them and build a tolerance that will not allow me to use them in those emergency situations.
-Grey Cow
Posted by delna on February 10, 2004, at 4:40:54
In reply to Re: Xanax and Lowering Tolerance, posted by AtlantaRunner on February 6, 2004, at 18:00:12
> >
>
> I'm so surprised by this conversation. I have pretty extreme GAD and have been on Xanax in combination with Lexapro for a year and a half. I have never taken more than 1 mg in a day. My prescription is for .25 mg up to 4x a day - and that (120 per month) lasts me generally 6-10 weeks. I had no idea people took and could tolerate such high dosages!
>I am also really surprised that such high doses are taken. I went up to 5mg a day and my pdoc was horrified. i was just popping them whenever I had anxiety. After a while if i didnt take any my anxiety came back worse. it came to the stage that my anxiety escalted to psychotic levels and i was put in hospital to withdraw.
Posted by GreyCow on February 10, 2004, at 14:13:15
In reply to Re: Xanax and Lowering Tolerance, posted by delna on February 10, 2004, at 4:40:54
>After a while if i didnt take any my anxiety came back worse. it came to the stage that my anxiety escalted to psychotic levels and i was put in hospital to withdraw.
>Wow, I'm sorry to hear that it got to this point. Your story makes me feel better about quitting now before it would have gotten to the point of me having withdrawls. I'm sorry to hear you had to go through those withdrawls.
Posted by dysphoricpaul on February 11, 2004, at 21:40:30
In reply to Re: Xanax and Lowering Tolerance, posted by GreyCow on February 10, 2004, at 14:13:15
I have been taking xanax on and off for panic attacks for about a year now. It's odd, sometimes .5mg does the trick, sometimes I need upwards of 2mg. I can't figure out why. The dose factor dosen't seem dependant on the severity of my panic attcks / anxeity, just sometimes a little works and sometimes alot is needed. Anyone have anyone have any clues as to why?
Posted by Joy on February 13, 2004, at 13:32:45
In reply to Re: Xanax and Lowering Tolerance, posted by dysphoricpaul on February 11, 2004, at 21:40:30
I take .5 Xanax at night time. My sister-in-law needs 2 mgs. for anxiety. It's something to do with enzymes according to her doctor. My husband and I have different reactions to same mgs. of medication. I think the least dose that is effective for any med is probably the best. I've been on Xanax a few years and stopped once for a couple of months. I don't go up on my dose. I am careful about benzos; just enough and no more. Also, a less stressful lifestyle has calmed down my anxiety. I think we are all different. My tolerance as not lowered.
Joy
This is the end of the thread.
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