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Dr. Bob is Robert Hsiung, MD,
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Posted by jono_in_adelaide on August 14, 2012, at 1:07:40
In reply to Re: If two benzos no long work might a third? Differen, posted by jono_in_adelaide on August 14, 2012, at 1:03:33
Note that Ativan is shorter acting than Valium so you mgiht need to take it twice a day, say 2mg at night and 1mg in the morning?
Tranxene might be another alternative, between 15 and 22.5mg at bedtime.
You're already taking an SSRI arnt you? Which drug and which dose?
Posted by SLS on August 14, 2012, at 1:37:39
In reply to If two benzos no long work might a third? Differen, posted by Phillipa on August 13, 2012, at 12:34:47
Have you tried adding Neurontin or Lyrica? They might not completely get rid of the anxiety, but they could help.
Have you tried Paxil? Did it help? Did it hurt? For how long?
Which antipsychotics have you tried? What were the results of each one? They are not all alike.
If you want to change your life, you have to change the way you live. You have to do something different. Something needs to change. Insanity is often described as doing the same thing over and over again and expecting different results. I know this insanity well. These are insane illnesses.
You do, of course, have the whole rest of your life to try something different in order to feel better. How long does it make sense to wait, though?
Did you ever take Miltown (meprobamate)?
Phenergan (promethazine)?
- Scott
Posted by brynb on August 14, 2012, at 5:32:14
In reply to Re: If two benzos no long work might a third? Differen » brynb, posted by Phillipa on August 13, 2012, at 23:35:46
> Definitely have built up a tolerance. I'm taking 7.5mg of valium a day & .5mg of xanax a day both at night. I used to take higher doses and just cut down over the years as they used to perk me up and now just make me tired. Phillipa
Hi Phillipa,Tolerance to benzos builds up quickly (for most people). Is there a specific reason you take both at night? Perhaps try changing the dosing schedule. I'd take the Xanax (or as others suggested, Ativan) at night to help with sleep, and the longer-acting Valium during the day. It could help to split the Valium up as two doses (5mg in the morning and 5mg in the afternoon).
-b
Posted by Phillipa on August 14, 2012, at 19:07:05
In reply to Re: If two benzos no long work might a third? Differen, posted by jono_in_adelaide on August 14, 2012, at 1:07:40
50mg luvox and 2.5mg lexapro. The doc refuses to change meds or the doses of either as he's an addictions pdoc. Only two choices here for those with medicaire this one or a forensic pdoc. Phillipa
Posted by Phillipa on August 14, 2012, at 19:14:12
In reply to Re: If two benzos no long work might a third? Differen » Phillipa, posted by SLS on August 14, 2012, at 1:37:39
Paxil first ad ever at l0mg a day for over two years. Took three months to get used to it. Was when thyroid went. The doc at the time first gave lopressor at 25mg and then two weeks later paxil at l0mg. Also was taking .5mg of xanax two or three times a day.
Mephrobomate with valium 5mg three times a day was the first meds ever on that was at age 24.
Shame my pdoc retired as she would let me take whatever I wanted. This guy says you are OCD. Not willing to change any meds. Oh wait he lowered the xanax. Thankfully I have a stash of it so could continue on .5mg instead of the .25mg he prescribed. First time I asked for any scripts from him. When I ask what could I try he merely says continue on what you are on. Both docs said no to antipsychotics as I am not psychotic. Once took seroquel in hospital and next day I was taken off it as couldn't talk and almost fainted. Phillipa
Posted by SLS on August 14, 2012, at 19:37:10
In reply to Re: If two benzos no long work might a third? Differen » SLS, posted by Phillipa on August 14, 2012, at 19:14:12
> Paxil first ad ever at l0mg a day for over two years. Took three months to get used to it. Was when thyroid went. The doc at the time first gave lopressor at 25mg and then two weeks later paxil at l0mg. Also was taking .5mg of xanax two or three times a day.
>
> Mephrobomate with valium 5mg three times a day was the first meds ever on that was at age 24.
> Shame my pdoc retired as she would let me take whatever I wanted. This guy says you are OCD. Not willing to change any meds. Oh wait he lowered the xanax. Thankfully I have a stash of it so could continue on .5mg instead of the .25mg he prescribed. First time I asked for any scripts from him. When I ask what could I try he merely says continue on what you are on. Both docs said no to antipsychotics as I am not psychotic. Once took seroquel in hospital and next day I was taken off it as couldn't talk and almost fainted. Phillipa
I am sorry that you find yourself in such a predicament with your health care. Your doctor sucks. I know you have limited options. It must be hugely frustrating.
- Scott
Posted by phidippus on August 14, 2012, at 20:52:13
In reply to Re: If two benzos no long work might a third? Differen » Phillipa, posted by SLS on August 14, 2012, at 19:37:10
Atypical antipsychotics are recommmended by the APA as augmentaation for SSRIs in the treatmeent of OCD. Doesn't matter if your not psychotic.
Ericc
Posted by Phillipa on August 14, 2012, at 21:39:08
In reply to Re: If two benzos no long work might a third? » SLS, posted by phidippus on August 14, 2012, at 20:52:13
Eric I think it's contraindicated in a person in 60's as I am. Phillipa
Posted by phidippus on August 14, 2012, at 21:47:46
In reply to Re: If two benzos no long work might a third? » phidippus, posted by Phillipa on August 14, 2012, at 21:39:08
I doubt that. ITs not that different from other benzodiazapines. Why would you thinkk it contraindicated in the elderly?
Eric
Posted by jono_in_adelaiDE on August 14, 2012, at 22:44:17
In reply to Re: If two benzos no long work might a third? » Phillipa, posted by phidippus on August 14, 2012, at 21:47:46
Ask the doc about Tranxene, 22,5mg at bedtime, along with your current antidepressants.
Posted by herpills on August 15, 2012, at 5:41:09
In reply to Re: If two benzos no long work might a third? Differen » jono_in_adelaide, posted by Phillipa on August 14, 2012, at 19:07:05
> 50mg luvox and 2.5mg lexapro. The doc refuses to change meds or the doses of either as he's an addictions pdoc. Only two choices here for those with medicaire this one or a forensic pdoc. Phillipa
Why would you want to see a doc who refuses to make med changes if you are not feeling well?
Posted by SLS on August 15, 2012, at 6:08:51
In reply to Re: If two benzos no long work might a third? » phidippus, posted by Phillipa on August 14, 2012, at 21:39:08
> Eric I think it's contraindicated in a person in 60's as I am. Phillipa
Did your doctor tell you this?
I'll have to look into it, but I was under the impression that APs were associated with increased fatalities in the elderly, but only when they are used to treat Alzheimers Dementia. There is an increased risk of developing TD with APs when they are used to treat older folks, but this might be an artifact of the length of time spent in treatment. I'm not sure.
How did you respond to Buspar (buspirone)?
- Scott
Posted by SLS on August 15, 2012, at 6:24:38
In reply to Re: If two benzos no long work might a third?, posted by jono_in_adelaiDE on August 14, 2012, at 22:44:17
> Ask the doc about Tranxene, 22,5mg at bedtime, along with your current antidepressants.
That's an interesting choice. What are your reasons for suggesting it?
If Tranxene (clorazepate) is effective as a hypnotic, perhaps the Xanax can be reserved for administration during the day as a mood-elevating anxiolytic. Considering the complexity of Phillipa's pattern of response to treatment, using three BZDs might not be such a bad thing. Such a treatment would be unusual, but I don't think it is indefensible.
It might be more appropriate to add Seroquel for sleep and use the Xanax during the day.
- Scott
Posted by phidippus on August 15, 2012, at 8:34:28
In reply to Re: If two benzos no long work might a third? » jono_in_adelaiDE, posted by SLS on August 15, 2012, at 6:24:38
She couldn't tolerate Seroquel.
Eric
Posted by SLS on August 15, 2012, at 9:04:21
In reply to Re: If two benzos no long work might a third? » SLS, posted by phidippus on August 15, 2012, at 8:34:28
> She couldn't tolerate Seroquel.
>
> EricOops.
I hope you're having a good day. Mine's okay so far.
- Scott
Posted by phidippus on August 15, 2012, at 9:30:21
In reply to Re: If two benzos no long work might a third? » phidippus, posted by SLS on August 15, 2012, at 9:04:21
Just replying to personal ads, lol. Having a great time here.
Eric
Posted by Phillipa on August 15, 2012, at 20:16:06
In reply to Re: If two benzos no long work might a third? Differen » Phillipa, posted by herpills on August 15, 2012, at 5:41:09
I am 66 retired and insurance is medicaire and United Health Care supplement paid for by me. So on a limited income how? Only pdoc and he's supposed to be good is a cash only doc $250.00 initial visit. And his practice is full. He left a one of the only multiple doc practices here there are two and went on his own. Wonder if the fact that when first year I moved here saw one of them and heard from pdoc now as he would fall asleep during patient visits that he has nacolepsy. Evidently Charlotte area of NC is the pitts for pdoc and therapists also. Google doc and see what your find. Maybe someone knows a better search. Because of this I stayed with old doc til she retired 6 hours away. But she was always willing to change meds. Phillipa
Posted by Beckett on August 15, 2012, at 20:26:02
In reply to Re: If two benzos no long work might a third? Differen » herpills, posted by Phillipa on August 15, 2012, at 20:16:06
Maybe try the forensic pdoc. Mine speciilaizes in forensics. He's just a regular pdoc to me. Actually, he's very sharp.
Posted by Phillipa on August 15, 2012, at 23:33:28
In reply to Re: If two benzos no long work might a third? Differen » Phillipa, posted by Beckett on August 15, 2012, at 20:26:02
I may have to after deal with a problem tomorrow. P
Posted by Twinleaf on August 16, 2012, at 17:27:15
In reply to Re: If two benzos no long work might a third? Differen » Beckett, posted by Phillipa on August 15, 2012, at 23:33:28
It just seems very unhelpful to have a psychopharmacologist who is not willing to make any medication changes. It would be very reasonable for him to increase the benzo dosage temporarily when you are under unusual stress. What about consulting the other pdoc you mentioned, or trying to find someone more helpful in a neighboring city?
Posted by jono_in_adelaide on August 16, 2012, at 20:04:12
In reply to Re: If two benzos no long work might a third? » jono_in_adelaiDE, posted by SLS on August 15, 2012, at 6:24:38
I suggested chlorazepate because it is long acting, so should cover philipa for a full 24 hours on one dose, it is an effective hypnotic which produces a calming effect throughout the following day, and also i was suggesting a modest dose increase on what she is taking now.
Tranxene is also well tolorated and Phillipa has had issues tolorating meds before, and there is some suggestion that chlorazepate is one of the lesser addictive benzos.
She could still keep a few 0.5mg Xanax on hand for emergencies.
Posted by Phillipa on August 16, 2012, at 21:11:43
In reply to Your pdoc..., posted by Twinleaf on August 16, 2012, at 17:27:15
Oh it is it's totally ridiculous. Since this is the biggest city. Surrounding areas even less. At one time a therapist when asking said "for some reason psych never took off here". Thankfully I have stockpiled a lot of bottles of xanax. I did this when the old pdoc wanted to help me save money and would prescribe lmg tabs of xanax. This dope says .25. So am currently taking the .5mg of xanax. Raleigh Is closest large city. Rest are tiny cities. Medical care is in Charlotte. Phillipa
Posted by jono_in_adelaide on August 19, 2012, at 20:26:03
In reply to Re: Your pdoc... » Twinleaf, posted by Phillipa on August 16, 2012, at 21:11:43
Hi Phillipa
if you cant get the doc to alter your benzos, it might be worth asking if you can try Remeron....15mg at night for 4 nights, then 30mg at night
As well as being an antidepressant, it has potent antianxiety effects (5HT2A andC) - it would certainly be worth a shot.
It releives anxirty through the same mechanism as the atypical antipsychotics without some of their downsides
Posted by Phillipa on August 20, 2012, at 19:04:28
In reply to Re: Your pdoc..., posted by jono_in_adelaide on August 19, 2012, at 20:26:03
Jono at one time took 15mg of remeron with benzos and did nothing. Took for a month and didn't take anymore. Thanks for the suggestion. Phillipa
Posted by jono_in_adelaide on August 20, 2012, at 19:23:14
In reply to Re: Your pdoc... » jono_in_adelaide, posted by Phillipa on August 20, 2012, at 19:04:28
Ah, ok. 15mg is a pretty low dose, 30mg is more usual.
Definatly ask your doc if you can try Tranxene, between 22.5 and 30mg at bedtime.
Alternative might be Ativan 1mg twice a day, or Klonopin or any of the other benzos, or even just a dose increase in what you're curently on - you're on a pretty low dose, you could easily go to 10 or 15mg of Valium
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