Posted by Honore on March 26, 2007, at 10:47:55
In reply to Re: just say what you need » med_empowered, posted by jealibeanz on March 26, 2007, at 4:58:01
hey, jealibean. I'm really in agreement with others here. It really would take a lot of pressure off your future dealing with your GP if you could just tell him the facts, without trying to get him to offer you things that you want, but are uncomfortable asking for. You have the right to ask-- he's not going to think worse of you. You have a long=-term solid trusting relationship with him-- and are a very reliable patient. I'm sure he wouldn't take it the wrong way.
Where I become concerned (and I do hope you realize it's concern, not blank negativity about long-term xanax; I use it myself longterm, at varying doses) is when you think about adding more than the 4 mg/day. The combination of 4 mg/day xanax plus at-need xanax xr strikes me as possibly placing you in that zone where you may, entirely innocently, start becoming more dependent on more then 4 mg/day than you realize.
It's important, I think personally (and this is me, I guess) that if you take drugs with some addictive potential, like xanax-- which you can fall prey to for entirely good reasons, ie dealing with anxiety-- that you monitor the dose level, and promise yourself never to go above a certain level. Also, that, if possible, you use less when it isn't absolutely necessary on certain days or at certain times. That alone can help to keep the dosage level down a bit.
I asked my pdoc , when he gave me xanax, about when you get into the danger zone for addiction. He said it's a problem when you take 4 mg a day, and that he wouldn't want to see me taking that much. That's why I'm concerned about you. I realize that you're using it for pervasive anxiety and really need it. But that doesn't mean it might not pose a threat long-term.
I know this isn't something you feel comfortable about, but I'm going to say it anyway. I do think you might want to begin to reconsider an AD, because you do suffer from depression along with the anxiety. That mix is hard to differentiate.
Cymbalta works a lot more on the noradrenergic system than Effexor at small doses, so it might help. I think it's a pretty good drug and it seems to be catching on a lot, too.
But also, an MAOI might really make a huge difference for you. I know you don't like the idea of ADs. But there' s no weight gain with Parnate or Emsam-- and they might make your need for xanax much more secondary and within what you would feel completely comfortable asking for.
I know it's a big jump, but why not at least give it some thought over the next period of time, as you try to figure out what's best?