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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 21 of 21. This is the beginning of the thread.
Posted by Tepiaca on November 1, 2002, at 12:07:47
Hi
Im currently taking .25mg of Alpralozam (Xanath)
and 4mg of Diazepam (Valium). Is it correct to take two benzos at the same time ?
They are helping me with my social phobia ,but I feel so depressed .
What can I do?
Posted by linkadge on November 1, 2002, at 15:46:07
In reply to Benzodiazepines and depression, posted by Tepiaca on November 1, 2002, at 12:07:47
It is possible that the Benzos are causing the
depression. Does it seem that the depression started as you began the benzos.Do you feel comfortable with the diagnosis of social phobia. Did you feel anxiety in other areas of life.
Is is possible that the socaial phobia was a component of underlying depression, which may
be better helped by an antidepressant.Another thing, some describe Valium to be more depressing than Xanax, you may try using only Xanax, (note - if this improves the case then you know that the problem is caused by the benzos)
Talk with your doctor about the alternatives to benzos. Some antidepressants are effective in treating S.P.
Linkadge
Posted by joy on November 1, 2002, at 17:14:34
In reply to Benzodiazepines and depression, posted by Tepiaca on November 1, 2002, at 12:07:47
I take Xanax for anxiety and insomnia. I took Prozac for depression, and used Xanax as needed. Benzos are wonderful for anxiety, but not for depression.
Posted by hiba on November 1, 2002, at 23:08:11
In reply to Benzodiazepines and depression, posted by Tepiaca on November 1, 2002, at 12:07:47
Hello Tepiaca,
Xanax (alprazolam)has a unique antidepressant action and it shouldn't be xanax which is causing depression. Valium can worsen pre-existing depression and sometimes itself causes depression. So in order to achieve a desirable effect you will have to increase the intake of Xanax and avoid valium completely. Talk with your doc. Xanax in moderate doses will cover up all those symptoms of depression. It is my experience.
HIBA
Posted by viridis on November 2, 2002, at 2:19:33
In reply to Benzodiazepines and depression, posted by Tepiaca on November 1, 2002, at 12:07:47
I think a lot of it comes down to the cause-and- effect relationship between anxiety and depression. As others here have suggested (Alan in particular, I think), some people seem to be anxious because they're depressed, others depressed because they're anxious.
For people in the first category, benzos may not be so great, and could increase depression (although as Hiba pointed out, there's some evidence that Xanax in particular actually has antidepressant properties). This group might be better off with ADs (or ADs plus benzos). For people whose depression is largely the result of anxiety, benzos can reduce depression greatly. I seem to fall into this category. So, you should try to figure out (ideally with your doctor's help) which category describes you better, while addressing the SP issues.
I do suspect, based on limited experience with Valium, that it could be an especially depression-inducing benzo. I don't like it at all, but I respond very well to Klonopin and Xanax, which help fight off anxiety and depression for me. I take both (mainly K, X occasionally) and combining them is no problem for me.
The ADs I've tried have had terrible side effects, increase anxiety, and don't seem to help much with depression, but I know people for whom Prozac, Paxil, Celexa etc. have had life-changing effects in terms of both anxiety and depression.
There are enough meds out there now that you're bound to find the one (or combination) that will work -- it may just take a while.
Posted by Kari on November 2, 2002, at 7:46:48
In reply to Anxiety vs. depression = chicken vs. egg » Tepiaca, posted by viridis on November 2, 2002, at 2:19:33
Klonopin can also cause depression in people from the first category, even in combo with an SSRI.
I took Klonopin with Luvox for a while and had to stop it since it worsened my depression and brought back panic attacks which the Luvox had stopped.
Posted by Ed O`Flaherty on November 2, 2002, at 12:19:18
In reply to Anxiety vs. depression = chicken vs. egg » Tepiaca, posted by viridis on November 2, 2002, at 2:19:33
Benzos are used for many reasons,mostly anxiety and insomnia.However in high doses they have an antidepressant effect.There is a high level of dependecy on them so one usually goes on an SSRI anti-depressant instead of using benzos for depression.A natural remedy which may help is omega-3 fish oil.Try 1 g daily of it-available cheap in Walmart.It is the total weight of the EPA and DHA,not the weight of the capsule itself that matters.
Posted by viridis on November 2, 2002, at 12:51:19
In reply to Re: Anxiety vs. depression = chicken vs. egg » viridis, posted by Kari on November 2, 2002, at 7:46:48
Hi Kari,
Other people here have also reported increased depression with Klonopin, so clearly it's not for everyone. For me, the relief from intense anxiety and panic (and insomnia) that K provided greatly reduced the frequency and severity of depression and sharpened my thinking. I still had some "residual" depression, but it was much more manageable than pre-Klonopin. When I added a low dose of Adderall (I've also been diagnosed with mild to moderate ADD by two therapists and my current psychiatrist), that cleared up most of the remaining depression as well as helping with focus issues.
As I've mentioned, I can't seem to tolerate SSRIs or Wellbutrin at even the lowest doses, and the side effects don't disappear over time -- that's why I finally settled on benzos. But ADs are great meds for many people.
Posted by viridis on November 2, 2002, at 13:37:49
In reply to Re: Anxiety vs. depression = chicken vs. egg, posted by Ed O`Flaherty on November 2, 2002, at 12:19:18
Hi Ed,
I've been taking 3-4 g of fish oil/day for the last few months (total EPA about 1300-1500 mg, DHA about 700 -1000 mg), plus hempseed and flaxseed oil. I do think they help a bit with stability, although definitely Klonopin (and Adderall) have the main positive effects on my mental state. I've had no side effects with the oils, and if nothing else I figure they improve my overall health (e.g., cardiovascular). I've always been a big fish eater too, just because I like it. And, I've lost a bit of weight since starting fish oil, although it could just be coincidence.
I recognize the potential for dependency with benzos, but for me the benefits of Klonopin outweigh such risks. Luckily, I continue to do well with a relatively low dose (1 mg/day) and my pdoc says he's rarely had problems with patients discontinuing as long as it's done in a slow, supervised way. Plus, many ADs also have associated "discontinuation syndromes" that I gather can be quite serious for some people.
Posted by Ponder on November 2, 2002, at 16:24:21
In reply to Re: Anxiety vs. depression = chicken vs. egg » Ed O`Flaherty, posted by viridis on November 2, 2002, at 13:37:49
V.,
Do you take Klonipin and Adderall together? Is Adderall the same as Ritalin? If so, what is the rationale for taking a stimulant and sedative together? Thanks.
Posted by viridis on November 2, 2002, at 20:13:27
In reply to Klonipin and Adderall » viridis, posted by Ponder on November 2, 2002, at 16:24:21
Hi Ponder,
I do take the two together. Klonopin isn't a sedative (at least for me) except at higher doses. It's sometimes used as a temporary sleep aid, but I was prescribed it for anxiety and panic disorder, the most common uses. I also had severe episodes of depression that typically followed periods of especially high anxiety. It did make me a bit sleepy for the first week or two that I took it, but that went away quickly, along with my panic attacks and most of my anxiety and depression.
Adderall is a mixture of different amphetamine salts. Ritalin (methylphenidate) is a different drug that is chemically related to amphetamines and also acts as a stimulant. Both are best known for their use in people (especially children) with ADD, for whom instead of being stimulating these drugs allow better concentration and focus. I have ADD, so my psychiatrist added a small dose of Adderall to the Klonopin. It did exactly what it was supposed to, and actually has a calming effect for me at low doses. It also got rid of most of the depression that remained (although Klonopin had already alleviated much of that).
So, for me the two meds work very well together and help me feel normal.
Posted by FredPotter on November 3, 2002, at 13:53:00
In reply to Benzodiazepines and depression, posted by Tepiaca on November 1, 2002, at 12:07:47
I wouldn't expect 0.25 mg of Xanax per day to do *anything*. I think benzophobia has now caused doctors either not to prescribe benzos or to prescribe small ineffective doses.
However I've never found even large doses really effective for my kind of anxiety, which seems completely mixed with depression: neither comes first
Posted by Alan on November 3, 2002, at 16:11:17
In reply to Re: Benzodiazepines and depression » Tepiaca, posted by FredPotter on November 3, 2002, at 13:53:00
> I wouldn't expect 0.25 mg of Xanax per day to do *anything*. I think benzophobia has now caused doctors either not to prescribe benzos or to prescribe small ineffective doses.
>
> However I've never found even large doses really effective for my kind of anxiety, which seems completely mixed with depression: neither comes first
===========================================
I would agree.If your case was DX'd as an anxiety disorder, MAOI's would be an alternative to Bzd's.
Best,
Alan
Posted by Anna Laura on November 4, 2002, at 2:02:59
In reply to Re: Benzodiazepines and depression » FredPotter, posted by Alan on November 3, 2002, at 16:11:17
> > I wouldn't expect 0.25 mg of Xanax per day to do *anything*. I think benzophobia has now caused doctors either not to prescribe benzos or to prescribe small ineffective doses.
> >
> > However I've never found even large doses really effective for my kind of anxiety, which seems completely mixed with depression: neither comes first
> ===========================================
>
>
> I would agree.
>
> If your case was DX'd as an anxiety disorder, MAOI's would be an alternative to Bzd's.
>
> Best,
>
> Alan
>
GAD and bipolar II seem to be intertwined according to some pdoc.
Some kind of GAD or depressive anxiety might respond to mood stabilizers:http://www.psycheducation.org/depression/Anxiety.htm
Posted by Tepiaca on November 4, 2002, at 11:14:24
In reply to Re: Benzodiazepines and depression: bipolar?, posted by Anna Laura on November 4, 2002, at 2:02:59
Hi , I have increase my dose from .25 to .75 of Xanath , I feel just a little change , but most of the time im so afraid of people.Do you think I should take higher doses? What is the highest dose
of Xanath? . I dont care If I become addict to this medicine , I want this fear to go away because I cant have a normal life and if I have to take 10mg of Xanath to be a normal person then I would do it. What is the problem if you become addict to this drug?
Posted by viridis on November 4, 2002, at 13:27:23
In reply to Re: Benzodiazepines and depression, posted by Tepiaca on November 4, 2002, at 11:14:24
I think the best dose is the one that works for you -- benzos are very hard to overdose on (unless you mix them with alcohol). Some people take several mg of Xanax a day with no problems. Anything over 0.5 mg makes me sleepy, but I only take it occasionally (I do take Klonopin every day though). Maybe you could work with your doctor to move up to a dose that's most effective. There seems to be a pretty wide range, depending on the individual.
Most people with anxiety disorders are unlikely to become "addicted" to benzos -- the proper use of the term addiction refers to a situation in which you keep using the drug and/or increasing doses despite negative consequences (e.g., smoking is an addiction, people can become addicted to heroin, seeking it out despite serious physical and lifestyle consequences, etc.). So, using a benzo responsibly because it's effective for your condition isn't "addiction", any more than using insulin for diabetes would be considered addiction. Of course, there are some people who enjoy the effects of benzos and do genuinely become addicted, but this is rare for people using them to treat anxiety disorders.
The bigger concern is medical dependency, which means that your brain changes in such a way that you need the drug to function normally, and if it's discontinued suddenly, you experience serious effects. The degree to which this happens with benzos is debatable and varies among individuals, but there's little doubt that they have a high potential for dependency (as do most antidepressants). My pdoc and many others report that serious benzo withdrawal can usually be avoided by gradually decreasing the dose, under the supervision of a doctor. Some pdocs feel that short-acting benzos like Xanax have a higher potential for dependency than longer-acting ones such as Klonopin, but this also seems to be debatable.
If Xanax is the only thing that seems effective for your anxiety, then I would talk to your doctor about finding a dose that works. If it continues to work, allows you to live a normal life, and doesn't cause you problems, I think it's worth the risk of dependency (although others may disagree).
Posted by FredPotter on November 4, 2002, at 13:42:24
In reply to Re: Benzodiazepines and depression » Tepiaca, posted by viridis on November 4, 2002, at 13:27:23
Well said Viridis I agree with everything you say
Posted by Tepiaca on November 5, 2002, at 15:50:15
In reply to Re: Benzodiazepines and depression » viridis, posted by FredPotter on November 4, 2002, at 13:42:24
Thank you virids , for all the things that you
told me, I did not Know most of them .It seems
that you are very well informated about all these
things.
I want to tell you ,that my first election with
benzos was Clonazepam , but I took only for one
week , and I felt so depressed .
Now Im taking the Xanath , but Im also taking an+
antidepressant Wellbutrin. Do you think I should
try again with Clonazepam to diminish the risk of
the depence , now that Im taking an antidepressan
By the way Do you know any antidepressant that do no cause lost of sex drive?
Thank you
Posted by FredPotter on November 5, 2002, at 17:24:30
In reply to Re: Benzodiazepines and depressionviridis, posted by Tepiaca on November 5, 2002, at 15:50:15
I don't find the tricyclic antidepressants (TCAs)interfere with sex, but the SSRIs I've tried do. But TCAs have anti-cholinergic side effects instead (dry mouth + I'm not sure what else). I've always found the side effects of SSRIs worse. At the moment I'm on the TCA Nortriptyline (Pamelor)
Posted by viridis on November 6, 2002, at 3:57:43
In reply to Re: Benzodiazepines and depressionviridis, posted by Tepiaca on November 5, 2002, at 15:50:15
Hi Tepiaca,
I'm not sure if Xanax really is more likely to produce dependency than Klonopin, but the idea that benzos with short half-lives (like Xanax) are most likely to do so seems pretty widespread. If you can, why not try Klonopin with the Wellbutrin and see how you react? Wellbutrin is often very activating, so maybe the two together could work well for you. But if Xanax helps you more, I'd stick with it. Again, this is something to discuss with your doctor.
I've taken K and WB together, but for me, the WB was mainly irritating, and didn't help with my remaining depression, whereas Adderall, an amphetamine mixture, has been very helpful (but I take that primarily for ADD). WB alone (without K) was intolerable, causing me severe anxiety and various side effects. It can be a good antidepressant for some, but is notorious for increasing anxiety. On the positive side, WB rarely has sexual side effects and is sometimes used to offset the sexual side effects of other antidepressants. It had no sexual side effects for me, just lots of others that I couldn't stand.
Antidepressants that are especially well known for sexual side effects are the SSRIs (selective serotonin reuptake inhibitors -- Prozac, Paxil, Zoloft, Celexa, Luvox, etc.), and Effexor, which has SSRI-like effects and also affects norepinephrine reuptake. I haven't taken all of these, but Prozac and especially Zoloft were terrible for me in terms of side effects, including near-complete loss of libido. My psychiatrist estimates that sexual side effects from SSRIs occur in at least 60% of patients. But, others do very well with them.
Another antidepressant that some people here recommend is Remeron (mirtazipine). I've never taken it (although many others on this board could comment). Apparently, it rarely has sexual side effects, but is known for causing weight gain in some people. Then there's Serzone (Nefazodone), which works well for some people and (apparently) can reduce agitation. Again, I'm sure others here could comment.
There are lots of possibilities, and even though it may take time, you're very likely to find a medication strategy that will work for you. The nice thing about benzos is that they can help to stabilize you quickly, and you'll know how you react quite soon, whereas most of the antidepressants can take weeks or longer to be effective. If you can tolerate Wellbutrin, I'd give it a reasonable trial (a few weeks) and maybe see how Xanax vs. Klonopin work together with it. If it doesn't work, then I'd try some of the other antidepressants, under a doctor's supervision.
Having the benzos available can be a great help during the adjustment periods for ADs, and you may find (like I did) that benzos are the drugs that provide primary relief. If Xanax is most helpful for you, then I'd keep it on hand in case the other treatments don't work or cause intolerable side effects. It can be a great help to have something available that you know will calm you down, and you might find after trying various ADs that benzos are a better alternative for you.
Remember that most of the ADs can cause dependency, sometimes worse than that caused by benzos. If you have a serious mental condition and find a medication that treats it, there's a good chance that you'll become dependent on it. But I still think that this is better than being anxious and/or depressed most of the time.
Posted by Tepiaca on November 8, 2002, at 12:14:22
In reply to Re: Benzodiazepines and depressionviridis » Tepiaca, posted by viridis on November 6, 2002, at 3:57:43
Hi guys .
It happened again , now the Xanat has caused me
a big depression , suicidal thougths , no matter
that im taking wellbutrin . Can I be allergic to
the benzos or something like that? Shoul I try
with another benzo?
Help
Tepiaca
This is the end of the thread.
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