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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 rjlockhart98 on August 13, 2005, at 12:58:30
I take 1mg of Clonazpeam (Klonopin) for panic 5 times daily.
Thats ALOT.
Klonopin sometimes depresses me, well actually it does.
Does Xanax work right away? klonopin takes some time to start working, up to 15min during a panic attack.
Just wanted to know why your doctor chose Xanax.
Posted by rjlockhart98 on August 13, 2005, at 13:05:13
In reply to Who here takes Xanax?, posted by rjlockhart98 on August 13, 2005, at 12:58:30
If you know me, well look up my older posts about having panic, well losing my mind. I went to mental wards, asking for brain scans for Schizophrenia. They refused, and said it wasnt needed.
Alot of times i have lurking thoughts that disturb me and cause panic attacks.
This is my current treatment for panic:
Klonopin 5mg daily
Prozac 20mg
Zyprexa 2.5mgI dont know how to say can i switch to Xanax, becuase i know what my doctor will say, your not own doctor.
I am still having panic attacks, well in the mornings.
Can someone give me some advice.
Posted by med_empowered on August 13, 2005, at 14:30:03
In reply to Who here takes Xanax?, posted by rjlockhart98 on August 13, 2005, at 12:58:30
xanax used to be *the* most popular benzo for a while...I think, overall, its still much more popular than Klonopin in terms of the number of prescriptions written. The deal with Xanax is that for a while, it seemed like a *really* good idea: it was short-acting and came on fast, so the idea was patients could use it for intense anxiety or to sleep without being sedated all day. The problem is that compared to the other benzos, Xanax is believed to be more "addictive". I don't know that I'd consider it addictive per se, but I did find it harder to withdraw from than Klonopin or Tranxene in terms of withdrawal effects...plus, if its taken in multiple doses, some people tend to get anxiety in between doses, which is kind of like a mini-withdrawal. So...there's been a move to go more for long-acting benzos with a slower onset, which is why Klonopin has become so popular lately (until relatively recently, Klonopin was used mostly as an anticonvulsant and only secondarily as an anti-anxiety medication). You doctors whole "you're not your own doctor" thing is kind of understandable, but it also indicates, I think, that your doctor prefers to RX with a minimum of input or questions from the patient. If Klonopin is depressing you, it probably is good idea to switch, but I think you might be better served by going to another long-acting benzo...your doctor will also prefer to maintain you on a long-acting benzo rather than risk having to do a more tricky withdrawal with Xanax. Tranxene is pretty good; its calming, but doesn't seem to cause or worsen depression. Librium is an under-used option that might also help. I believe you said you had already tried Ativan with minimal results, so I guess that's out. Valium would be the *classic* benzo option, but doctors don't like to RX it (it has a bad rep) and when they do, they tend to under-prescribe (at least in my experience). So....maybe a switch to Tranxene, with Ativan as an as-needed "extra" med ? Adding propranolol also helps people with anxiety sometimes, but it can cause/worsen depression (this is more common at the doses used for hypertension, but still possible at psychiatric doses). Good luck!
Posted by Nixon on August 13, 2005, at 20:18:51
In reply to Re: do you think i should switch to Alprazolam?, posted by rjlockhart98 on August 13, 2005, at 13:05:13
> If you know me, well look up my older posts about having panic, well losing my mind. I went to mental wards, asking for brain scans for Schizophrenia. They refused, and said it wasnt needed.
>
> Alot of times i have lurking thoughts that disturb me and cause panic attacks.
>
> This is my current treatment for panic:
> Klonopin 5mg daily
> Prozac 20mg
> Zyprexa 2.5mg
>
> I dont know how to say can i switch to Xanax, becuase i know what my doctor will say, your not own doctor.
>
> I am still having panic attacks, well in the mornings.
>
> Can someone give me some advice.If I were you I would consider adding an AED such as Depakote or Trileptal. It should clamp down on those thoughts and would definitely enhance the benzo effects.
Posted by Phillipa on August 14, 2005, at 12:42:33
In reply to Re: Who here takes Xanax?, posted by med_empowered on August 13, 2005, at 14:30:03
Hey Med! I usually don't post during the day. But I'm with Matt. My anxiety is skyhigh. I'm prescribed l5mg of valium and it does help with sleep. But with all the other stuff in my life going on I've taken 20mg at night which means I'll run out. What do you consider a resonable dose of valium. I'm really getting scared. I don't have the knowledge base the rest of you do. I read what you all take and can't figure out how you all learn to combine the meds you do. Please answer. Or better yet you can always Babble me. Fondly, Phillipa
Posted by med_empowered on August 14, 2005, at 16:13:07
In reply to Re: Who here takes Xanax?, posted by Phillipa on August 14, 2005, at 12:42:33
Hey Phillipa! I'm sorry you're having a rough time lately; it happens to us all, so please don't give up hope. :-) I would have babble mailed you, but its not working on my computer so i thought i'd post here. Dosing benzos is kind of tricky...when valium first came out, the standard dosing regimine was 10mgs, 3-4 times daily (this is for anxiety..I don't know they dosed out for other disorders). The 4X daily was designed to help with anxiety and sleep, so it was probably the most popular set up. With all the benzo backlash, the big problem is that docs either don't prescribe benzos (they buy all that valley of the dolls crap about valium ruining lives, blah blah blah...honestly, they should know better) OR they underprescribe, which may be worse (not only do you get inadequate anxiety relief, you also have to deal with withdrawal when you go off.) Unless you have other problems--severe depression or a respiratory problem like emphysema-- or you take other sedating medications, especially stuff like tricyclic antidepressant or some antipsychotics,or you're an alcoholic, there's probably not a really good reason *not* to increase your dose of valium or RX a higher dose of a more potent benzodiazepene. When Librium, the first benzo, came out, it was known as "the drug that tames tigers"; they really did give it to agitated tigers at a zoo (I think San Diego zoo). You certainly wouldn't want to be "tamed," but I'm sure some relief would be *much* appreciated. Some studies I've seen have used massive benzodiazpene doses--several hundred mgs/Librium, for instance--in those with severe anxiety...there are also some studies using very high-dose diazepam (400mgs+) for severe problems such as Schizophrenia, with some pretty good results. So...benzos have a reall wide "therapeutic index"...unless you have other problems/conditions, toxicity really isnt an issue, and a good doctor would monitor for stuff like impaired cognition/drug-induced depression **anytime** a benzo is prescribed, so upping your benzo a bit shouldn't be too much of a problem...if it is, the problem is your doc, not you. By the way...some docs RX antipsychotics to help with anxiety (back in the day, they used Stelazine; now the atypicals are more popular). Based on my own experience, I'd seriously recommend **against** doing this, although adding a mood-stabilizer (keppra, lamictal, trileptal would be my top picks) might offer some benefit. Good luck!
Posted by ed_uk on August 14, 2005, at 16:56:57
In reply to hey phillipa!, posted by med_empowered on August 14, 2005, at 16:13:07
Hi Med,
Thank you for supporting Phillipa :-)
Kind regards
~ed
Posted by Phillipa on August 14, 2005, at 18:38:58
In reply to Re: hey phillipa! » med_empowered, posted by ed_uk on August 14, 2005, at 16:56:57
Hi Med, Thanks so much for replying. Even Ed said a starting dose of 30mg would probably be better, but I figured that if l5mg worked miracles years ago it would again. I really feel nothing from it where's that ahhh I'm relaxed? And I totally agree about not using drugs like seroquel as they once tried them and I was a zombie. Now the question is can I convince my pdoc? Last time I was there she wanted to know if I wanted xanax. I said no. I've been on this med and it stopped working . Thanks again. Fondly, Phillipa
Posted by ed_uk on August 15, 2005, at 4:01:52
In reply to Yes Thanks Med_Empowered One More Thing, posted by Phillipa on August 14, 2005, at 18:38:58
Hi!
>Even Ed said a starting dose of 30mg would probably be better....
I suggested the high dose because you'd been on long term treatment with clonazepam.
~ed xxx
Posted by Phillipa on August 15, 2005, at 18:27:45
In reply to Re: Yes Thanks Med_Empowered One More Thing » Phillipa, posted by ed_uk on August 15, 2005, at 4:01:52
Well then I must be an addict as klonopin didn't relax me just made me feel stupid! Love PJ O
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