Posted by sukarno on April 13, 2005, at 21:02:52
In reply to Re: Doing ok now » sukarno, posted by ed_uk on April 13, 2005, at 8:50:35
Thanks for the post. :) I've tried about 15 medications: Imipramine, nortriptyline, desipramine, trazodone, fluoxetine (Prozac), paroxetine (Paxil/Seroxat), sertraline (Zoloft/Lustral), buspirone (BuSpar), clorazepate (Tranxene), diazepam (Valium), lorazepam (Ativan), alprazolam (Xanax), clonazepam (Klonopin/Rivotril), oxazepam (Serax..was given it in ER once), venlafaxine (Effexor) and hydroxyzine (Atarax/Vistaril).
I was diagnosed in 1988 when I was 16 and prescribed imipramine 25mg in November '88. It was quite sedating and made me feel weak the first few days..along with some increased blood pressure and tachycardia (90bpm).
My psychiatrist recommended taking up some exercise, so I did that and my resting heart rate dropped to an average of 60bpm, sometimes lower.
I was in good shape then and my grades went back up to 4.0 in high school and I worked part-time too. The problem with my heart started about 1 month later and felt like "skipped beats" and then I woke up one night with a rapid pulse of 120bpm and palpitations/irregular heart action and my face felt flushed. My father called up the psychiatrist and she told me she wouldn't prescribe imipramine again.
She then prescribed nortriptyline 25mg. I was ok on that for a few months and put up with the "skipped beats" and finally decided to taper off it. When I quit nortriptyline my panic did not return for at least 10 days, but when it did resume it was back to the classic 3 to 5 a day as it was prior to diagosis and medication.
I did notice in the 18 months preceding my first panic attack, that I felt a lack of motivation and ambition, lowered sense of self-esteem but nothing major. My grades did suffer and dropped to below 3.0. I began to drink more caffeinated beverages to help increase my attention and focus on school and resorted to caffeine pills at one point.I certainly hope that caffeine wasn't responsible for my current problems. Perhaps it set it off earlier than it would have, had I not been taking caffeine.
I could tolerate large doses of caffeine without any palpitations or anxiety prior to panic disorder. However, after panic disorder struck me, I no longer had a tolerance to caffeine and even 1/2 cup of coffee would trigger heart palpitations.
I saw another psychiatrist in 1989 who tried Prozac since it was quite new and he thought it might work. I took it for 3 days at 20mg/day and on day 3 I was walking to school and suddenly felt as if my body was on fire along with the worst anxiety I had ever experienced in my life. I immediately went to the school nurse and called my psychiatrist who then asked me if I'd heard of Valium or Xanax, because that was what he was going to try next. I did try Xanax and felt it didn't last long enough to keep the anxiety away at 0.5mg 3x/day and also gave me some vertigo a few times which was unpleasant. Valium worked excellently, but it also made me quite sleepy in class, so I complained to him about it and he took me off it.He then tried BuSpar (buspirone) and it had no effect whatsoever on my anxiety, even after taking it for a while. I tried trazodone (Desyrel) 50mg and it made me very sleepy and the dry mouth I experienced with it along with feeling quite drugged was not something I liked, so I quit taking that.
Later on I tried desipramine (Norpramin) in 1990 but it made me feel faint all of the time. I couldn't tolerate the side effects. It was different than the other tricyclics in that it wasn't sedating and caused more orthostatic hypotension. My psychiatrist wasn't too understanding of the suffering I was experiencing from desipramine and I just decided to stop taking it.
In the fall of 1990 I had seen a GP at my college who gave me BuSpar again and it gave me side effects such as dizziness/mild vertigo, palpitations and diarrhea after about 1 week. I told the GP about this and he handed me some free samples of Tranxene (clorazepate) saying, "I don't like to prescribe this to college students.". He really had no choice though as I didn't respond well to other medications.
Tranxene took effect quickly and I felt so relieved: no more palpitations or anxiety or apprehension. I could sleep well and felt like a huge burden was lifted from me, however, it did cause me to sleep quite deeply and caused a few paradoxical reactions a few times. It certainly wasn't good for my studies.
I remained on Tranxene for the next 10 years and only briefly tried other SSRIs.I had tried 1/2 tablet of Paxil/Seroxat and I ended up going to the ER with severe panic attacks.
I also tried a low dose of Zoloft/Lustral and felt a tingling sensation all over, so I quit that too.
I asked for Effexor and my psychiatrist prescribed 25mg (the lowest dose). I took only 1/4 tablet and a few hours later my pulse was up to 90bpm and I had difficulty sleeping. I also developed a severe headache and pressure in the head, so I went to have my blood pressure checked and it was marginally high (150/95).
I told him I'd never take it again, yet he didn't seem to think it was a big deal...either that, or he didn't want to believe it. So he tried to get me on Klonopin/Rivotril along with another SSRI, but I refused that. I had tried Klonopin once years ago and it was far too sedating for me. For some odd reason he didn't like prescribing Valium, but didn't tell me why.
When it comes to benzos, I have found that Valium and Tranxene were quite similar. Actually Tranxene is one of Valium's active metabolites. :)
However, the advantage of Valium is that, according to the British National Formulary or BNF, it is the fastest acting BZD due to his high lipid solubility. It would take effect within 7 minutes, so it was useful in the event I felt a panic attack coming on.Xanax is slower to take effect..about 20-30 minutes. I found Xanax to produce dysarthria (trouble speaking at times) and more cognitive deficits, but less sedation.
Valium produced more muscle relaxation, no dysarthria and was heavily sedating, but not as bad as Klonopin/Rivotril.
Ativan (lorazepam) produced dysarthria and hypersalivation along with some nasty cognitive effects such as a sense of amnesia. I couldn't tell when I was on Ativan or withdrawing from it. hehheh. It just made my mind so fuzzy that I thought I was going to lose my mind totally... well, it wasn't _that_ bad, but I see it as more of a sleeping pill than a daytime anxiolytic.
Overall, Valium was an excellent medication. The only problem I had with it was elevation of my liver enzymes. Other than that I liked it. Tranxene was similar but took about 15 minutes to take effect, but when it did take effect it felt identical to Valium.
Xanax just seems like a different drug. It lacks the muscle relaxant effects of Valium and muscle relaxation is very useful for me in controlling my GAD (Generalised Anxiety Disorder) which then prevents my panic attacks from occuring. Valium is also, like Tranxene, *very* easy to taper. I could taper 20mg/day (5mg 4x/day) down to 12.5mg/day in 3 weeks without any problems, except an increase in my asthma attacks.
I've also found hydroxyzine (Atarax/Vistaril), a sedating antihistamine, to be useful as needed for anxiety and it is also doesn't produce dependence, although it can produce tolerance when taken regularly.
If I had to label a benzo as being "addictive"..and that is a highly charged word often taking out of context these days, I would say Ativan is the worst offender because it had a lot of cognitive effects (to me that was unpleasant, but perhaps others like that and abuse it for that feeling).
Otherwise I've never escalated the dose of any BZD I've ever taken. I've found myself wanting to lower the dose over time.
I would prefer Valium above all other benzos (or Tranxene..it is similar), but I'm afraid of developing high liver enzymes again.
Have you had your liver enzymes checked? My GGT (Gamma GT) was 205 and ALT was 78 on Valium. Three liver function tests taken over a 2 month period confirmed the same results. That's the only thing keeping me off Valium and why I asked for Xanax. Xanax is very short-acting and much easier on the liver, although I have read in the BNF and other books that Serax (oxazepam) is the easiest on it.
But on Valium I could still think. You'll develop a tolerance for it when you take it 3 or 4 times a day, but it was still effective at preventing the panic attacks. The cognitive effects I did feel from Valium only occurred during the beginning of treatment.
Everyone is different though and might react differently. :)
I think more doctors should use Valium whenever possible since it is tried and true and also easy to discontinue relative to other BZDs. In my opinion, the high-potency BZDs should only be used as a last resort when conventional BZDs fail.
I'm originally from the USA, but lived in Malaysia from 2001-2003 and Indonesia since then. Psychiatrists were very professional in Malaysia.
Here in Indonesia they are ok too, but Malaysia was much more organised about everything and all prescriptions were accounted for by the government. Indonesia is a bit lax on controlled substances. :)
Have you tried Ativan? What benzos have you tried so far?
Thanks for taking the time to read this post! :)
Paul
poster:sukarno
thread:474445
URL: http://www.dr-bob.org/babble/20050413/msgs/483919.html