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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 7 of 7. This is the beginning of the thread.
Posted by numbster on October 25, 2004, at 1:57:34
Hi, my doctor is reluctant to continue to prescribe me xanax for my social anxiety, but I find that it is the only thing I have tried that helps. I believe my doctors fear is two-fold: first, the fear of abuse, and second, the belief that the drug is useless over the long term because tolerance is inevitable. I think I can try to convince her I won't abuse it, so my biggest problem is convincing her that while tolerance does develop, it levels off. I say that because I have been on xanax before in the past for long periods, and while I did develop tolerance, it seemed to level off.
Anyway, the point of this post is that I'm looking for some factual data or studies that I can show my doctor that will back up my claim on the tolerance issue (or if the studies show the opposite, I'd like to read those too). Does anyone know of any articles or studies that I could print out that pertain to this?
any help is greatly appreciated, thanks!
Posted by ed_uk on October 25, 2004, at 9:34:58
In reply to Xanax and tolerance: studies available?, posted by numbster on October 25, 2004, at 1:57:34
Hi!
Here is a list of studies posted by Elizabeth in 2001, you can find the abstracts on pubmed and print them out to show your pdoc....J Clin Psychopharmacol 1998 Dec;18(6 Suppl 2):12S-18S. Panic disorder: long-term pharmacotherapy and discontinuation. Rickels K, Schweizer E.
Neuropsychopharmacology 1995 Apr;12(2):147-57. Benzodiazepine sensitivity in panic disorder: effects of chronic alprazolam treatment. Cowley DS, Roy-Byrne PP, Radant A, Ritchie JC, Greenblatt DJ, Nemeroff CB, Hommer DW.
Arch Gen Psychiatry 1993 Jan;50(1):51-60. Maintenance drug treatment of panic disorder. I. Results of a prospective, placebo-controlled comparison of alprazolam and imipramine. Schweizer E, Rickels K, Weiss S, Zavodnick S.
Int Clin Psychopharmacol 1993 Summer;8(2):115-8. Three-year follow-up of patients with panic disorder after short-term treatment with alprazolam and imipramine. Lepola UM, Rimon RH, Riekkinen PJ.
J Psychiatr Res 1993;27 Suppl 1:127-42. Maintenance drug therapy of panic disorder. Curtis GC, Massana J, Udina C, Ayuso JL, Cassano GB, Perugi G.
J Clin Psychopharmacol 1992 Oct;12(5):352-4. Discontinuation of alprazolam after long-term treatment of panic-related disorders. DuPont RL, Swinson RP, Ballenger JC, Burrows GD, Noyes R, Rubin RT, Rifkin A, Pecknold JC.
Arch Gen Psychiatry 1989 Nov;46(11):993-9. Clinical and medication outcome after short-term alprazolam and behavioral group treatment in panic disorder. 2.5 year naturalistic follow-up study. Nagy LM, Krystal JH, Woods SW, Charney DS.
Acta Psychiatr Scand Suppl 1987;335:39-46. Pharmacology of the benzodiazepines; with special emphasis on alprazolam. Soderpalm B.
Hope this helps.......
Ed
Posted by steve12 on October 25, 2004, at 21:30:25
In reply to Re: Xanax and tolerance: studies available?, posted by ed_uk on October 25, 2004, at 9:34:58
All sponsored by the drug companies, right? The truth is that Xanax will always be addictive b/c of its short half-life (which the XR version doesn't solve). That's a fundamental of pharmacology. The real issue is, whether dependence is *justified* given the improvemnt in your symptoms.
> Hi!
> Here is a list of studies posted by Elizabeth in 2001, you can find the abstracts on pubmed and print them out to show your pdoc....
>
> J Clin Psychopharmacol 1998 Dec;18(6 Suppl 2):12S-18S. Panic disorder: long-term pharmacotherapy and discontinuation. Rickels K, Schweizer E.
>
> Neuropsychopharmacology 1995 Apr;12(2):147-57. Benzodiazepine sensitivity in panic disorder: effects of chronic alprazolam treatment. Cowley DS, Roy-Byrne PP, Radant A, Ritchie JC, Greenblatt DJ, Nemeroff CB, Hommer DW.
>
> Arch Gen Psychiatry 1993 Jan;50(1):51-60. Maintenance drug treatment of panic disorder. I. Results of a prospective, placebo-controlled comparison of alprazolam and imipramine. Schweizer E, Rickels K, Weiss S, Zavodnick S.
>
> Int Clin Psychopharmacol 1993 Summer;8(2):115-8. Three-year follow-up of patients with panic disorder after short-term treatment with alprazolam and imipramine. Lepola UM, Rimon RH, Riekkinen PJ.
>
> J Psychiatr Res 1993;27 Suppl 1:127-42. Maintenance drug therapy of panic disorder. Curtis GC, Massana J, Udina C, Ayuso JL, Cassano GB, Perugi G.
>
> J Clin Psychopharmacol 1992 Oct;12(5):352-4. Discontinuation of alprazolam after long-term treatment of panic-related disorders. DuPont RL, Swinson RP, Ballenger JC, Burrows GD, Noyes R, Rubin RT, Rifkin A, Pecknold JC.
>
> Arch Gen Psychiatry 1989 Nov;46(11):993-9. Clinical and medication outcome after short-term alprazolam and behavioral group treatment in panic disorder. 2.5 year naturalistic follow-up study. Nagy LM, Krystal JH, Woods SW, Charney DS.
>
> Acta Psychiatr Scand Suppl 1987;335:39-46. Pharmacology of the benzodiazepines; with special emphasis on alprazolam. Soderpalm B.
>
> Hope this helps.......
> Ed
>
Posted by numbster on October 25, 2004, at 23:36:05
In reply to Re: Xanax and tolerance: studies available?, posted by steve12 on October 25, 2004, at 21:30:25
> All sponsored by the drug companies, right? The truth is that Xanax will always be addictive b/c of its short half-life (which the XR version doesn't solve). That's a fundamental of pharmacology. The real issue is, whether dependence is *justified* given the improvemnt in your symptoms.
>
To me the real issue isn't if dependence is justified... Even the SSRI's cause physical dependence, just try discontinuing one of those suddenly. Not as dramatic withdrawal symptoms as xanax perhaps, but many have some pretty bad withdrawal symptoms. In any case, I think you misunderstood my post, because what I was getting at was if the tolerance one develops for xanax levels off at some point, or if it continues until a given xanax dose has little or no effect. Obviously different people will have different experiences which is why I was looking for studies.
Posted by jboud24 on October 26, 2004, at 3:02:49
In reply to Re: Xanax and tolerance: studies available?, posted by numbster on October 25, 2004, at 23:36:05
Xanax began to lose effectiveness for me. I was up to 5mgs / day. I think you'll find find that all benzo's will lose some of their anti-anxiety effect over time due to tolerance, despite what the stugies say. That has been my experience with xanax and ativan anyway. And no I don't mean they'll lose their sedative or hypnotic effect. They will retain some of that anti-anxiety effect, just like they'll retain some of their sedative effect, but this will wean with time. I'd say just pick one and go for it.
Justin
Posted by steve12 on October 26, 2004, at 7:37:47
In reply to Re: Xanax and tolerance: studies available?, posted by numbster on October 25, 2004, at 23:36:05
That's not true. SSRI's do not cause dependence. Yes discontinuation syndrome is a real issue, but it is not the same as dependence (how many people are forging scripts to get them?) Tolerance and abuse are different animals when it comes to xanax -- abuse is possible, tolerance is guarenteed. Abuse typically occurs if the it is not taken as prescribed (taking all 3 doses at once). As to effectiveness, that's an ideopathic result, but I know of few doctors who would consider xanax as a long-term solution for anxiety unless one is totally disabled by it.
>
> To me the real issue isn't if dependence is justified... Even the SSRI's cause physical dependence, just try discontinuing one of those suddenly. Not as dramatic withdrawal symptoms as xanax perhaps, but many have some pretty bad withdrawal symptoms. In any case, I think you misunderstood my post, because what I was getting at was if the tolerance one develops for xanax levels off at some point, or if it continues until a given xanax dose has little or no effect. Obviously different people will have different experiences which is why I was looking for studies.
Posted by jboud24 on October 26, 2004, at 12:43:42
In reply to Re: Xanax and tolerance: studies available?, posted by steve12 on October 26, 2004, at 7:37:47
I disagree. The doctors are very quick to call it discontinuation syndrome, but I have witnessed drug-seeking behavior for an SSRI, speciffically Lexapro, from an old drug-dealer I used to hang with. He asked me every month if I could spare any Lexapro or if he could buy some off me. He apparently immensely enjoyed the effects of SSRI's. He would pay me like $60 for a half a months worth of pills. And he told me specifically that he liked the feeling it gave him.
It is rediculous to think that psychological addiction cannot occur to SSRI's, this CAN and DOES happen to almost every known psychoactive drug in the pharmacoepia. If you want to call the physical withdrawal a 'discontinuation syndrome', then more power to you. God knows that's all you'll hear the doctors tell you.
Just look at the statement that they put under anti-depressants in the packaging: "Although studies in x animal has shown that this drug has no potential for abuse, it is unknown as to the extent a CNS active drug will be abused or diverted after it is released on the market.
This is the end of the thread.
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