![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 11 of 11. This is the beginning of the thread.
Posted by gingersnap on July 21, 2003, at 22:28:24
Hi All,
I've been on 50 mg Zoloft for the last 7 months. It certainly stabilizes my mood swings/tears/anger etc.
But once in a while, like today, something will just 'trigger' me and my anger will sky rocket and then I'll start crying - and I can't control it. My Dr. had prescribed Xanax to try if I wanted the next time I had a 'trigger' episode.
So today I took a 0.25 mg Xanax for the first time. Since I was at work and not sure what to expect, I locked myself in the office, laid down and cried a bit and then I decided to do some no-brainer work.
The urge to cry went away but I wasn't happy or high or sleep or spacey. So I guessed it work.
But how does it work?
Do any of you take it just for periodic episodes? How long does it take til it 'kicks-in'? Then how/what do you feel?
I may or may not take another tonight although I feel ok. I'm afraid I'll wake up in the middle of the night and start going over the trigger event over/over in my head.
I've tried upping the zoloft but it affects my sleep. I am also adding Enada NADH ( and 100 mg B complex and 400 mg no-flush Niacin (B3) to my supplements but I haven't seen any obvious positive effects after 1 week).
thanks,
-gs
Posted by Viridis on July 22, 2003, at 0:30:31
In reply to how does xanax work?, posted by gingersnap on July 21, 2003, at 22:28:24
You can certainly take Xanax on an as-needed basis -- most doctors prefer this, since it has a reputation for inducing dependency with regular use. It should act very quickly. It's not like most antidepressants, which can take weeks to show an effect -- generally it works almost immediately. One trick if you want the fastest relief is to dissolve the pill under your tongue (if you can tolerate the bitter taste; it doesn't bother me but some people hate it).
The main thing to watch out for is that it can make you sleepy and/or uncoordinated if you only use it occasionally, a concern if you're driving etc. For me, this is very dose-dependent, and there's a fine line between the amount that calms my anxiety and that which makes me drowsy. I haven't noticed any "high" with it, although it tends to improve my mood.
Xanax is a short-acting benzodiazepine and typically wears off after 3-4 hours. Another one to consider for longer relief is Klonopin (clonazepam) -- I find it great for anxiety, and it lasts all day. It can also be taken on an as-needed basis. Different people have different responses to benzodiazepines; I do very well with Klonopin and/or Xanax, but don't like Valium at all. Generally these are very effective, flexible drugs if used properly, and they have a long record of safety.
Posted by KellyD on July 22, 2003, at 9:09:32
In reply to how does xanax work?, posted by gingersnap on July 21, 2003, at 22:28:24
In the most simplest of explanations, most of these types of meds work by acting on some chemical brain systems to decrease their "excitablilty". Through those actions, it calms down the "fight or flight" response that gets overactivated in anxiety and panic states. There are those here who can really explain it, but that's my understanding and simple seems to work better for me to figure it all out.
Posted by Viridis on July 23, 2003, at 1:50:40
In reply to Me - Simple Mind, Simple Concepts, posted by KellyD on July 22, 2003, at 9:09:32
What you said is right -- just to be a bit more technical, benzos enhance the effect of the neurotransmitter GABA on certain brain cells that send out "warning" messages to other brain and nerve cells. GABA is sort of a "brake" that stops these cells from being overactive and continuously sending out inappropriate signals that cause an anxiety response.
In non-anxious people, there's the right amount of GABA at the receptors to keep things even most of the time, but other chemicals can override this in a real emergency situation, or during times of intense stress. In anxious types (and some epileptics), the balance is thrown off and the cells become overactive (partly because the effects of the other, activating chemicals aren't held in check).
GABA has to bind to a receptor on the outside of the cell to exert its effects, and if not enough of it reaches this target, the cells aren't slowed down appropriately -- this can be due to not enough GABA, faulty receptors, too few receptors, etc.
Benzos bind to a different part of the GABA receptor than GABA itself, and make the receptor more "attractive" to whatever GABA is present, thus producing a calming effect. Really, they're just creating a set of conditions like that in the brains of people who are naturally mellow.
Posted by gingersnap on July 23, 2003, at 7:39:47
In reply to Re: how does xanax work? » gingersnap, posted by Viridis on July 22, 2003, at 0:30:31
thanks!!!
Posted by gingersnap on July 23, 2003, at 9:08:29
In reply to Re: Me - Simple Mind, Simple Concepts » KellyD, posted by Viridis on July 23, 2003, at 1:50:40
> What you said is right -- just to be a bit more technical, benzos enhance the effect of the neurotransmitter GABA on certain brain cells that send out "warning" messages to other brain and nerve cells. GABA is sort of a "brake" that stops these cells from being overactive and continuously sending out inappropriate signals that cause an anxiety response.
>
> In non-anxious people, there's the right amount of GABA at the receptors to keep things even most of the time, but other chemicals can override this in a real emergency situation, or during times of intense stress. In anxious types (and some epileptics), the balance is thrown off and the cells become overactive (partly because the effects of the other, activating chemicals aren't held in check).
>
> GABA has to bind to a receptor on the outside of the cell to exert its effects, and if not enough of it reaches this target, the cells aren't slowed down appropriately -- this can be due to not enough GABA, faulty receptors, too few receptors, etc.
>
> Benzos bind to a different part of the GABA receptor than GABA itself, and make the receptor more "attractive" to whatever GABA is present, thus producing a calming effect. Really, they're just creating a set of conditions like that in the brains of people who are naturally mellow.Thanks,
So can you take GABA? Is there something more natural than XANAX that will increase GABA levels? Can you have too much GABA ?
Posted by KellyD on July 23, 2003, at 11:50:51
In reply to Xanax/GABA, posted by gingersnap on July 23, 2003, at 9:08:29
Just an opinion, I would think if that worked, a lot of us wouldn't need the meds use. You can get products that are called GABA. I think the problem is the blood brain barrier issue, not everything (quite alot actually) you ingest in your body makes it to the brain for any sort of results. Just my opinion, maybe taking it has been a great thing for some. I'll keep on my very dependable Klonopin.
Posted by Viridis on July 23, 2003, at 23:49:42
In reply to Xanax/GABA, posted by gingersnap on July 23, 2003, at 9:08:29
As far as I know (and KellyD already pointed this out) GABA doesn't cross the "blood-brain barrier" easily. The brain is very selective about what it allows in, and although it needs a regular blood supply, it screens out many chemicals that are present in blood (including most of the GABA you might swallow). So, taking GABA supplements isn't likely to help much (I've tried some and they had no effect).
There is a drug out there called Picamilon (it's been discussed here a bit) which fuses GABA to nicotinic acid, and this supposedly allows it past the barrier. It's not a prescription med in the U.S., and Dr. Bob is uneasy about people giving out source info. I've tried it, and it does seem to have a mild calming effect, but really (for me) it isn't nearly as effective as benzos.
The other thing to keep in mind is that it's unlikely to be as simple as lacking GABA itself -- most brains have plenty; the key is whether the receptors on key brain cells can bind it effectively. No matter how much GABA is present, if you don't have enough receptors, or they're faulty somehow, not enough GABA will bind. This is where benzos come in -- they attach to a different part of the GABA receptor protein and change its "shape" so that it can attract more GABA. And for many people (like me), they seem to do this very well.
Of course, all of this is greatly oversimplified; there are lots of other neurotransmitters and receptors involved, and it all comes down to achieving a balance between appropriate regulation of excitatory cells, and not shutting down their activity completely (after all, anxiety serves a purpose if there's a genuine emergency).
Earlier tranquilizers like barbituates tread a fine line between keeping people calm at the right dose or shutting things (like breathing!) down completely at a slightly-too-high dose. Benzos are vastly safer (unless combined with alcohol etc.) and at worst are likely to make you sleepy. Many people take the same dose for years with no problem. The main downside is that your brain gets used to them, and if you decide to stop, generally you have to lower the dose very gradually to allow your brain to readjust. But this is no different from most of the antidepressants etc. that are currently in vogue for anxiety. These often cause more side effects than benzos and also require gradual tapering to avoid withdrawal symptoms. When someone has problems coming off a still-patented antidepressant, the drug companies call it "withdrawal syndrome", and when someone has difficulty discontinuing an inexpensive, generic benzo they often call it "addiction" (which is really something different altogether).
Posted by McPac on July 23, 2003, at 23:50:15
In reply to But does the brain know ?, posted by KellyD on July 23, 2003, at 11:50:51
Might Klonopin work for a dysphoric, pissed-off temperment?
Thanks!
Posted by KellyD on July 24, 2003, at 6:00:19
In reply to Re: But does the brain know ?, posted by McPac on July 23, 2003, at 23:50:15
> Might Klonopin work for a dysphoric, pissed-off temperment?
> Thanks!McPac,
Don't really know the answer to that one. I do have a thought that anxiety disorders are underappreciated for a "stand alone" diagnosis and tend to get thought of as comorbid with depressive states - which is true for some, but not all. I think their impact and effects, person to person, are also "overlooked". Klonopin isn't, of itself, a mood lifter for me - except for the fact of treating my anxiety symptoms makes Kelly a happier person. Klonopin did work for me when other trials of AD's did not. So, again, really don't have a good answer for you.
Posted by Viridis on July 24, 2003, at 14:30:59
In reply to Re: But does the brain know ?, posted by McPac on July 23, 2003, at 23:50:15
It might -- I guess it depends on the underlying cause and your particular response. Klonopin certainly improved my mood, although I didn't have the kind of anger you're describing. It didn't make me euphoric, just less stressed-out, and better able to see things clearly and get things done without worrying constantly.
I'd say try it and see!
This is the end of the thread.
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.