Posted by Fred23 on November 17, 2008, at 19:27:24
A few years ago, I had posed questions about my situation with high blood pressure, where I felt that stress and anxiety were a factor, and how to go about getting my GP to add anti-anxiety med(s) to the hypertension med(s).
He reluctantly tried Ativan, but after a few months wanted a psychiatrist to ratify its use. The one chosen seemed to be more used to getting psychopaths off the street, rather than dealing with nervous disorders, so nixed the idea. He wanted the try what the GP originally wanted, a SSRI. (I did get the the diagnosis of General Axiety Disorder.)
This was just after all that bad press about them getting those black box warnings, and the climate here was very anti-SSRI and pro-benzo.
In the meanwhile, many things happened, including being unemployed, and not having insurance to enable looking for another doctor.
After finally finding work, and getting insurance, I did find another doctor, who had more success in treating the high blood pressure. About the time to get a renewal for the hypertension med, due to a changing work situation, I started having panic attacks, at work, which had never happened to me before. The GP gave me three weeks of 10 mg Lexapro samples.
From the very first dose, things did get better. But, just a few days before the followup appointment, another dramatic change happened in the work environment, and the panic attacks started all over again. The GP said we could either increase the Lexapro dosage, or add something to it. Since I had already been reading about the treatments, and was aware that panic needs more of an SSRI than depression does, I went with the 20 mg of Lexapro, which he wrote out a formal prescription.
The 20 mg up from 10 mg started the cycle of side effects all over again, but after they settled, the intense morning situations still caused those heart pounding periods, so at the next followup he agreed to add a benzo to the mix, but preferably on a "prn" basis. Since I suggested Klonopin over Xanax, he actually wrote the presciption out for a period as long as the renewed Lexapro.
The Klonopin amount was written as 0.5 mg per day as needed, but he advised, and what I would do anyway, was to break them in half, and only take 0.25 mg, and not every day. (I am using the name brand, not the generic.)
In the meanwhile, I found that using SSRIs as the first line treatment for Panic Disorder, that due to the agitation (from the "activation"), the panic will likely get worse before it gets better. I had deliberately not wanted a benzo during the adjustment period, so that I could see what the SSRI by itself would do, to know if a benzo was needed to make up the difference. It may be that I need a few more weeks at the 20 mg of Lexapro to fully kick in, but I need to be able to function also, without appearin gto be a nervous wreck.
If I take the 0.25 mg of Klonopin in the morning, with the other meds, on Monday, Tuesday, and Wednesday, the long half-life seems to cover Thursday and Friday. So my question is, I take it for three days in a row, then skip it for four days, will each week start "fresh" so that its use is essentially "prn," or will I start developing a tolerance (habituation)?
poster:Fred23
thread:863674
URL: http://www.dr-bob.org/babble/20081114/msgs/863674.html