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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 17 of 17. This is the beginning of the thread.
Posted by med_empowered on October 13, 2005, at 13:07:00
OK...so, my anxiety has been bad lately, and I checked out a shrink. The verdict? I'm doing pretty well overall--he just think my anxiety is "holding me back significantly". Soo, he mentioned a benzo, told me to think it over, and we'll talk more next week. He's a bit older, and some of my acquaintances seem him, so I'm pretty sure he's good at benzo rx'ing--doesn't overprescribe, doesn't underprescribe, does tapers well, and will RX the best benzo for the situation (including valium) instead of only RXing Klonopin and occasionally Ativan. So..this leads me to wonder...what benzo is best? Since I've been on so many meds, he's been listening alot to my preferences, which is nice...I'm kind of thinking that maybe, at this point, Valium would be ideal. I don't want the mood-dampening properties of Klonopin, and I'd like something that lasts longer than Ativan...I guess Xanax is an option, but I'd rather something a little less intense. Tranxene is a no-no for me b/c of my previous depressive episodes. Librium...I like Librium, but the dosing is so tricky (anywhere from 50-200+mgs/day) and the side effects are more pronounced at effective doses than other meds, at least for me. On the other hand...I don't want to take a "real" mood-stabilizer, so taking Klonopin daily seems like it could help out with evening out my mood. *sigh* Any suggestions?
Posted by SLS on October 13, 2005, at 13:37:01
In reply to What benzo would you pick?, posted by med_empowered on October 13, 2005, at 13:07:00
Hi M_E
Have you thought to try Lyrica (pregabalin)? It might provide both anxiolytic and mood-stabilizing properties.
I doubt I could add anything to your understanding of BZDs. From your own words, though, it would seem that you lean towards Valium as a first choice based upon personal experience. I would let that be your guide. I have not tried Valium myself, so I cannot provide a comparison. However, I found Ativan to be helpful for anxiety and insomnia.
I guess a neuroleptic is out of the question?
- Scott
> OK...so, my anxiety has been bad lately, and I checked out a shrink. The verdict? I'm doing pretty well overall--he just think my anxiety is "holding me back significantly". Soo, he mentioned a benzo, told me to think it over, and we'll talk more next week. He's a bit older, and some of my acquaintances seem him, so I'm pretty sure he's good at benzo rx'ing--doesn't overprescribe, doesn't underprescribe, does tapers well, and will RX the best benzo for the situation (including valium) instead of only RXing Klonopin and occasionally Ativan. So..this leads me to wonder...what benzo is best? Since I've been on so many meds, he's been listening alot to my preferences, which is nice...I'm kind of thinking that maybe, at this point, Valium would be ideal. I don't want the mood-dampening properties of Klonopin, and I'd like something that lasts longer than Ativan...I guess Xanax is an option, but I'd rather something a little less intense. Tranxene is a no-no for me b/c of my previous depressive episodes. Librium...I like Librium, but the dosing is so tricky (anywhere from 50-200+mgs/day) and the side effects are more pronounced at effective doses than other meds, at least for me. On the other hand...I don't want to take a "real" mood-stabilizer, so taking Klonopin daily seems like it could help out with evening out my mood. *sigh* Any suggestions?
Posted by Declan on October 13, 2005, at 14:31:06
In reply to Re: What benzo would you pick? » med_empowered, posted by SLS on October 13, 2005, at 13:37:01
Hi Med E
What's the deal with Xanax extended release? Is there such a thing? Does it release in a good way? Do the special concerns about addiction apply to the extended release form?
That's a fairly high dose of Librium you mentioned, I could imagine that giving me cognitive issues.
Declan
Posted by maddy4 on October 13, 2005, at 14:40:56
In reply to Re: What benzo would you pick?, posted by Declan on October 13, 2005, at 14:31:06
i just started klonopin and it is really keeping my panic at bay. also have xanax as needed.
i would try the klonopin if i were you becasue it lasts longer than xanax and builds up in your system for an overall calm.
for me i wake up and take it (even though i am not paicky yet -i am taking it to get it built up in my system) then i take it again in the afternoon. havent needed a xan today.
or maybe you could try smthg like buspar.
Posted by med_empowered on October 13, 2005, at 15:37:24
In reply to Re: What benzo would you pick?, posted by maddy4 on October 13, 2005, at 14:40:56
hey! Thanks for the input. I've done Buspar up to 45mgs (15mgs 3X daily); it was OK, but it pooped out...plus, it gave me headaches, and I still got the more intense, panic-attack type episodes so...it wasn't all that impressive. Neuroleptics are **definitely** out of the question; I get akathisia and "neuroleptic-induced dysphoria" at low doses...plus, it just seems like overkill to me; the problem is anxiety, not mania or psychosis...so why bother with a neuroleptic? I also don't want to deal with all the metabolic stuff. I did mention a pretty high Librium dose...that was when I was at my absolute **worst**; Librium really isn't great for high-intensity anxiety, but my doc at the time liked it, so the dose went unusually high...I got similar results from 2-3mgs of Klonopin, so that just goes to show how weak librium is (for me at least). Valium appeals to me because it seems to **only** relive anxiety; Ativan and Klonopin are both used for mania, bipolar maintenance, and schizoaffective disorder; Tranxene causes depression, Xanax has a bad reputation, and Librium makes me stupid. I just like the idea of something I can take now and then for anxiety that will work only on anxiety w/o affecting anything else. But then again..I've never taken valium.
Posted by sdb on October 13, 2005, at 17:21:26
In reply to Re: What benzo would you pick?, posted by med_empowered on October 13, 2005, at 15:37:24
prazepam is a very good benzo alternative (long-lasting, no sedation, also good for SP and depression, no muscle relaxation if desired, slow resorption thus flat plasma levels of n-demethyl-metabolites), effective in dosages of 40mg normally according to studies (40mg equals 75mg clomipramine slowRel. without the dirty sideeffects because of dirty pharmacology of tryciclics) and a test of myself (unfortunately 20mg tablet is the highest sold->does not make sense, only fill the purse of the drug manufacturer). I stopped it and I am on/off benzo, mostly clonazepam because of mood-stabilizing properties.
kind regards
sdb
Posted by sdb on October 13, 2005, at 17:47:51
In reply to Re: What benzo would you pick?, posted by sdb on October 13, 2005, at 17:21:26
bye the way, ketazolam is a very good alternative for diazepam. It causes less drowsiness than diazepam and can be taken once daily. I suppose that the antidepressant properties of prazepam is caused by some minor metabolites after first-pass in liver. Unfortunately these metabolites dont have a so long half-life. Because there is no diazepam there is no muscle relaxation and drowsiness but it does the same at the end, transforming in same not so potent active metabolites.
The decision of choosing a benzo depends on your needs sp, muscle spastic, gad, panic
Posted by UgottaHaveHope on October 13, 2005, at 23:03:37
In reply to What benzo would you pick?, posted by med_empowered on October 13, 2005, at 13:07:00
SEROQUEL. It has been a miracle drug for my GAD. First out of 40 meds over eight years to smack that rage of anxious energy and racing mind.
I would take it 25 mg, or even cut that in half. I'm telling you, this is a miracle drug for anxiety.
Posted by krybrahaha78 on October 14, 2005, at 1:42:49
In reply to Re: What benzo would you pick?, posted by sdb on October 13, 2005, at 17:47:51
Tranxene is by far the best benzo in my opinion...
Posted by sdb on October 14, 2005, at 6:42:23
In reply to Re: The clear winner is .., posted by UgottaHaveHope on October 13, 2005, at 23:03:37
25mg daily seems to be a very low dosage. Do you take it once a day or in splitted dosages? Does it work only for GAD for you?
I have taken moodstabilizers and it knocked me out even at a low dosage, perhaps I should try a very, very low dosage.
Its interesting how people react so differently to all these drugs.
kind regards
sdb
Posted by sdb on October 14, 2005, at 8:33:26
In reply to Re: The clear winner is .. UgottaHaveHope, posted by sdb on October 14, 2005, at 6:42:23
Does somebody have experience with Xanax Xr?
I have heard that for many people Xanax Xr is totally different and only sedating compared with the common Xanax, without the anxiolytic, euphoric effect and it does not last for the whole day.
I took once a small dosage of Xanax Xr and it seemed only to be sedating.
Does somebody prefer Xanax Xr to Klonopin?
Posted by kerria on October 14, 2005, at 9:49:21
In reply to What benzo would you pick?, posted by med_empowered on October 13, 2005, at 13:07:00
Hi med_empowered,
In the past four years i have taken Ativan, Klonopin and Valium.
Valium is the one that is best or me. i've a LOT of trouble with side effects of meds and negative effects.
Ativan got me into trouble, i took more than supposed to because of anxiety and ran out always at the end of month- dr was upset, said it was dangerous to stop suddenly like that and put me on Valium because it was longerlasting. i tried Klonopin first because it supposed to also stop rapid switching (have DID) but it wasn't good for me, i couldn't switch as needed to work and live my life.
Valium is one that works well for anxiety- the only drawback is sedation but i used to take a lot- 10 mg in AM and 15 mg in PM and it wasn't too sedating- now it is because i take oxycontin for pain control and i just take as needed.Valium is good because it works for anxiety only and doesn't have weird side effects- just sedation, which is good at night.
hey,
nice to meet you,
kerria
Posted by SLS on October 14, 2005, at 10:13:07
In reply to Re: The clear winner is .., posted by UgottaHaveHope on October 13, 2005, at 23:03:37
> SEROQUEL. It has been a miracle drug for my GAD. First out of 40 meds over eight years to smack that rage of anxious energy and racing mind.
>
> I would take it 25 mg, or even cut that in half. I'm telling you, this is a miracle drug for anxiety.That's what I was thinking.
- Scott
Posted by ed_uk on October 14, 2005, at 16:04:01
In reply to What benzo would you pick?, posted by med_empowered on October 13, 2005, at 13:07:00
Well, if I had to take a benzo I'd probably take Valium - because most UK pdocs view Valium as the benzo of first choice.
~ed
Posted by UgottaHaveHope on October 14, 2005, at 18:58:18
In reply to Re: The clear winner is .. UgottaHaveHope, posted by sdb on October 14, 2005, at 6:42:23
i take it once a day, just before bed. i would recommend starting on 25 mg, and judge over the next few weeks whether you need more or less. someone in here said they take it in 7.5 mg. ive taken as high as 100mg, and actually felt less groggy on that than i did when with 25.
but yes, to make a long story short, every med affects everyone differently. i assure you seroquel will calm you down, but you will have to test for the dosage.
and yes, whatever chemical makes you race with anxiety, it nails, i mean, it nails it! Seroquel is a gift from God. now i will say it makes me groggy throughout the day, which i hate, but i hate anxiety more. it is worth it to me.
one last thing about seroquel: you will feel its effects only minutes after you take it, but it will take 2-3 weeks for your body to get used to it. for example, my mouth was very dry for 2-3 weeks, now its not.
Posted by Franz on October 16, 2005, at 4:49:41
In reply to Xanax Xr - effective and similar to normal X.., posted by sdb on October 14, 2005, at 8:33:26
> Does somebody have experience with Xanax Xr?
>
> I have heard that for many people Xanax Xr is totally different and only sedating compared with the common Xanax, without the anxiolytic, euphoric effect and it does not last for the whole day.It is not so mood elevating but I do not think it is not anxiolytic, it is still the same drug!
I read that an xr 0.5mg will have a peak of ~0.25mg. So, don´t expect the same effect from same mg.
Maybe for the whole day it takes a higher dose or repeated.
>
> I took once a small dosage of Xanax Xr and it seemed only to be sedating.You mean 0.5mg?. You can´t split them or do they come in less than that?.
>
> Does somebody prefer Xanax Xr to Klonopin?I think xanax xr is better on mood than Klonopin, but I am not sure/have not tried it enough.
Posted by HeadShrinker on October 18, 2005, at 10:39:23
In reply to What benzo would you pick?, posted by med_empowered on October 13, 2005, at 13:07:00
Forgive me for not directly answering your question, but are you taking anything else for anxiety? The "right" benzo is nice, but it's generally less effective than an antidepressant.
This is the end of the thread.
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