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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 22 of 22. This is the beginning of the thread.
Posted by jealibeanz on May 14, 2006, at 13:41:25
I'm looking for a benzo to take daily. I'll probably need between 8-12 hours of general and social anxiety relief. I'm going to graduate school, so I don't want anything that will cloud my thinking or sedate me too much. I realize that they may all do this, but are any that are better than others? I've used generic Klonopin before, 1-2 mg daily, which was sedating, and slightly depressing. I now have .25 mg generic xanax, which is not too bad in terms of clouded thinknig, the dosage is pretty weak. Are Klonopin wafers better than others? Should I ask for brand name? What about Xanax XR, Ativan, or Valium?
Posted by bassman on May 14, 2006, at 19:52:52
In reply to Benzo with lowest side effect profile?, posted by jealibeanz on May 14, 2006, at 13:41:25
A good, if irreverent place to compare benzos is crazymeds.org. I'd get the brand name for starters, anyway. 1-2 mg klonopin is equivalent to 1-2 mg Xanax, so the 0.25 mg Xanax no doubt felt a bit light. I'll bet 0.5 mg Xanax would work well...but...different people like different benzos and I think the only way to find out what works for you, unfortunately, is to try them out. I'd try Valium and Ativan-there are people that post here that are really advocates of both. Ativan has the advantage of being painless in terms of withdrawal,in my experience, should you end up taking that much, that long. I wouldn't use the Xanax XR myself...it just doesn't seem to be as effective as Xanax ER, even though that doesn't make sense.
Posted by jealibeanz on May 14, 2006, at 21:50:11
In reply to Re: Benzo with lowest side effect profile?, posted by bassman on May 14, 2006, at 19:52:52
Well, if I were to take .5 mg xanax at a time, how much would I need to cover the entire day?
Posted by bassman on May 15, 2006, at 5:19:14
In reply to Re: Benzo with lowest side effect profile?, posted by jealibeanz on May 14, 2006, at 21:50:11
I took 0.5 mg twice a day for years and that worked well, but the "usual" dose is 0. 5 three times a day. Xanax has a short lifetime in the body, so some people have to take it 4 times a day. If you take it that much, every day, you will become dependent and have to taper off at some point, which might be unpleasant. You might look at Remedyfind.com and review what other people are taking in terms of dosage.
Posted by jealibeanz on May 15, 2006, at 9:34:41
In reply to Re: Benzo with lowest side effect profile?, posted by bassman on May 15, 2006, at 5:19:14
Yeah, this is such a baby dose. He prescibed it for panic. A .25 mg dosage of xanax will do absolutely nothing for panic.
Posted by bassman on May 15, 2006, at 9:47:38
In reply to Re: Benzo with lowest side effect profile?, posted by jealibeanz on May 15, 2006, at 9:34:41
For active, rationality-gone-out-the-window, oh-my-God-I'm-dying, chase cars and nip at their tires panic, it takes me 0.5-1 mg to de-train The Crazyland Express.
Posted by jealibeanz on May 15, 2006, at 10:28:49
In reply to Re: Benzo with lowest side effect profile?, posted by bassman on May 15, 2006, at 9:47:38
OK, this may be difficult to assess... if .25 mg xanax just mildly relaxes me, probaly .5 mg at a time would do the trick just for every day constant anxiety. How much would I need to last the entire day? What would be the equivalent in other drugs, such as Valium, Ativan, Klonopin, or Xanax XR?
Posted by bassman on May 15, 2006, at 10:58:48
In reply to Re: Benzo with lowest side effect profile?, posted by jealibeanz on May 15, 2006, at 10:28:49
Don't use XR!!! O.K., thanks, now I've gotten that out of my system.:>} Using the usal benzo equivalences (they're somewhere on this site, I've read), my wild-a$$ed guess is that you'd need 0. 5mg Xanax three times a day, or 3 mg Ativan a day, or 1.5 mg Klonopin, or 15 mg (?) of Valium. But it really is how it effects YOU. I've taken 20 mg Valium and not felt the least bit calmer nor sleepy-same thing with 1 mg Ativan. 0.5 mg Xanax XR makes me sleepy, but doesn't help with anxiety, in fact, it might make it worse. I have to take Klonopin in 0.25 mg doses because otherwise it depresses me. So as they like to put on this site, YMMV. Very true. I still recommed you try Klonopin or Valium before Xanax-because I think those two benzos work for a lot of people, just not me; also, you won't be taking the med 3-4 times a day, if that matters to you.
Posted by jealibeanz on May 15, 2006, at 13:18:35
In reply to Re: Benzo with lowest side effect profile?, posted by bassman on May 15, 2006, at 10:58:48
That seems about right. I know that taking 1 mg Klonopin makes me sleepy, 2 mg and I'm dead tired. But if 1.5 mg were spread out evenly throught an entire day, it should be sufficient. You don't like regular Xanax? I'm not sure I love it, it's, but I haven't taken much. The Klonpin has a depressive effect with me, especially at higher dosages. I know they can all do this, but it seems from what I've read that it's more common with Klonopin. Valium does seem highly regarded by most, after all, it's "mother's little helper."
Posted by bassman on May 15, 2006, at 14:16:58
In reply to Re: Benzo with lowest side effect profile?, posted by jealibeanz on May 15, 2006, at 13:18:35
No, I think "regular" Xanax (immediate release) is an excellent med and I get depressed by Klonopin, too. What I don't like is Xanax XR, which in theory is just regular Xanax in a time-released formulation. I had really high hopes for Xanax XR and I tried it and it just made me sleepy (unlike regular Xanax) and didn't help anxiety-wise. My guess is that if I had taken a higher dosage of XR, like 2-3 mg per day, it would have worked-but I didn't want to do that.
If you do decide to use "regular" Xanax, you probably will find you get a lot of relief from 0.5 mg 2-3 times a day. For many people, myself included, Xanax is the Panic Killer, unlike the other meds. I also find that it has a mild antidepressant effect-if I'm depressed and take Xanax, it yanks me out of the depression within an hour.
Posted by yxibow on May 16, 2006, at 16:51:30
In reply to Benzo with lowest side effect profile?, posted by jealibeanz on May 14, 2006, at 13:41:25
> I'm looking for a benzo to take daily. I'll probably need between 8-12 hours of general and social anxiety relief. I'm going to graduate school, so I don't want anything that will cloud my thinking or sedate me too much. I realize that they may all do this, but are any that are better than others? I've used generic Klonopin before, 1-2 mg daily, which was sedating, and slightly depressing. I now have .25 mg generic xanax, which is not too bad in terms of clouded thinknig, the dosage is pretty weak. Are Klonopin wafers better than others? Should I ask for brand name? What about Xanax XR, Ativan, or Valium?
They all are potential clouders of mental thinking and they all also increase response time (e.g. driving), but I wouldn't go down the Xanax road except as an emergency pill when you get really anxious as withdrawing from a 4x a day pill is daunting. PRN, as I mentioned in the previous sentence is a better use of Xanax.The whole brand name thing has been an argument at least two or three times recently here, and is unnecessary and expensive for no particular reason in my opinion especially if you are starting out on a regimen. What is important is a consistent generic, that is, from the same supplier, if one is to notice any difference, which some notice none even if they change suppliers.
A number of people here seem to have been depressed by Klonopin (clonazepam), I haven't by clonazepam, but some do. I would just used once (or twice) a day generic Valium (diazepam). Clonazepam has been consistently used for social anxiety disorder, so you can try that out too.. its half life unlike Valium which exceeds 24 hours in a typical dose, is about 16 hours in real life, so twice daily is usually necessary.
If you don't habituate, and most don't habituate (but you have to be prepared for that -- it is different from addiction, which is use of prescription medications for no purpose, rather habituation is escalation of dose over time), the "ahh" feeling and the sedation may decrease in time while the anxiolytic relief will persist -- you just wont notice a "kick". That is a typical reaction to a long term benzodiazepine, say 20-30mg of Valium.
just my 2c
-- Jay
Posted by jealibeanz on May 16, 2006, at 17:03:09
In reply to Re: Benzo with lowest side effect profile? » jealibeanz, posted by yxibow on May 16, 2006, at 16:51:30
So, you're saying daily benzo use is fine, just not daily Xanax in particular?
Posted by yxibow on May 17, 2006, at 0:43:18
In reply to Re: Benzo with lowest side effect profile?, posted by jealibeanz on May 16, 2006, at 17:03:09
> So, you're saying daily benzo use is fine, just not daily Xanax in particular?
Some swear by daily Xanax, but because of its short half life (as little as 4 hours), the serum level will be constantly going up and down during the day as one has to swallow around 4 doses a day.
For long term benzodiazepine treatment, the drugs with the longest half life have the best efficacy and generally the least likely to form habituation.
These would include Valium (24+ hours), Librium (chemically similar to Valium but hardly used today, it is very low potency and more unpredictable dosing), and Klonopin (16+ hours). Ativan comes in at around 12 hours, and is more suited like Xanax for immediacy of effect for acute breakthrough anxiety rather than long term use.
Posted by jealibeanz on May 17, 2006, at 4:17:28
In reply to Re: Benzo with lowest side effect profile? » jealibeanz, posted by yxibow on May 17, 2006, at 0:43:18
Are most pdocs at least somewhat open to daily use in those with chronic anxiety/dehabilitating social anxiety and depression?
Posted by bassman on May 17, 2006, at 5:19:59
In reply to Re: Benzo with lowest side effect profile? » jealibeanz, posted by yxibow on May 17, 2006, at 0:43:18
yxibow has obviously had a different experience with Xanax than I have. I took 0.5 mg twice a day for years and it worked exceptionally. I've taken as much as 4 mg/day. The "standard" dosing is 3 times a day. I do think it is the schedule with Xanax you get into, so if you take it 4 times a day for a few weeks, the Xanax will "remind" you 4 times a day that it is time for another dose. Some people find that annoying-and if you can get the same relief with a longer lasting benzo, it is more convenient. My experience with Ativan is that I can basically stop taking it in a two week taper with no withdrawal whatever, but then, Ativan, like Valium, seems to have no effect on me in terms of calming. There have been comments about feeling a relief (or a buzz of some kind, I guess, they are abused by some people) from some benzos, especially when first taking them. I've never experienced anything like that, either.
Posted by jealibeanz on May 17, 2006, at 5:52:41
In reply to Re: Benzo with lowest side effect profile? » yxibow, posted by bassman on May 17, 2006, at 5:19:59
Why do they all have slightly different effects? Do they work on different receptors, like SSRI's do with serotonin? Is there any place I can read about this?
Posted by bassman on May 17, 2006, at 6:06:37
In reply to Re: Benzo with lowest side effect profile?, posted by jealibeanz on May 17, 2006, at 5:52:41
My opinion is not to bother reading about benzos...it really doesn't matter what someone believes the mechanism to be (I don't think you'll be a better person by reading about GABA). From this string, I think it is evident that different people are affected by different benzos in different ways. Some people think Valium and Klonopin are great. Some people are depressed by Klonopin, but others can take 2-3 mg. Some people are calmed by 2 mg Valium; some feel no effect at 20-30 mg. Some people can stop benzos any time they want to; some need a long period of taper. Several posts back, I suggested the Easter Egg Hunt approach to meds, namely, try them and see what works best for you. Klonopin and Valium would be the most convenient choices, followed by Ativan, etc. and probably last, Xanax.
No one can predict what benzo will work best for you-you have to try them and find out. If there were a single best benzo, just like if there were a single best antidepressant, we'd all be taking it.
Hummmm...which muddies the waters-sorry, I can't remember-have you thought of using and AD instead?
Posted by jealibeanz on May 17, 2006, at 6:12:11
In reply to Re: Benzo with lowest side effect profile?, posted by bassman on May 17, 2006, at 6:06:37
I've used Paxil, Buspar, Wellbutrin, and Effexor. I couldn't tolerate side effects. If Klonopin causes depression and fatigue, is it likely that others will too? I'd like to consider EMSAM, but am not sure what the doc will think. I don't understand how MAOI's help with anxiety anyhow.
Posted by bassman on May 17, 2006, at 7:22:50
In reply to Re: Benzo with lowest side effect profile?, posted by jealibeanz on May 17, 2006, at 6:12:11
Not in my experience. I'm depressed by Klonopin if the dose is over 0.75 mg/day, but I'm actual "undepressed" by Xanax, neither depressed nor undepressed by Ativan, and Valium doesn't effect me at all in terms of depression, unless I go to sleep, and then I wake up feeling like Hell. Back to "try them".
I had an awful time with AD side effects until I started them at VERY low doses, like Paxil I started at 2.5 mg, Prozac at 5 mg, etc. That works.
Posted by jealibeanz on May 17, 2006, at 8:05:05
In reply to Re: Benzo with lowest side effect profile?, posted by bassman on May 17, 2006, at 7:22:50
Well, one of my major complaints, which is the main theme of any of my posts, is uncontrollable weight gain from the meds. It's become my number one factor in stopping or choosing medications, since I haven't found a great deal of relief from them anyway. The weight gain was the largest side effect. Others were bare apparent.
Posted by bassman on May 17, 2006, at 11:57:56
In reply to Re: Benzo with lowest side effect profile?, posted by jealibeanz on May 17, 2006, at 8:05:05
Little emotional relief and the stress and depression of weight gain. No wonder. Bummer.
Posted by yxibow on May 18, 2006, at 0:08:14
In reply to Re: Benzo with lowest side effect profile? » yxibow, posted by bassman on May 17, 2006, at 5:19:59
> yxibow has obviously had a different experience with Xanax than I have. I took 0.5 mg twice a day for years and it worked exceptionally. I've taken as much as 4 mg/day. The "standard" dosing is 3 times a day. I do think it is the schedule with Xanax you get into, so if you take it 4 times a day for a few weeks, the Xanax will "remind" you 4 times a day that it is time for another dose. Some people find that annoying-and if you can get the same relief with a longer lasting benzo, it is more convenient. My experience with Ativan is that I can basically stop taking it in a two week taper with no withdrawal whatever, but then, Ativan, like Valium, seems to have no effect on me in terms of calming. There have been comments about feeling a relief (or a buzz of some kind, I guess, they are abused by some people) from some benzos, especially when first taking them. I've never experienced anything like that, either.
It's not an abuse buzz typically -- when it first hits your transmitters, a benzodiazepine with a high potential for a "buzz", usually those with the shortest half life, which includes Halcion, Restoril, Xanax, Ativan, etc. can cause a feeling of relief which has nothing whatsoever to do with abuse -- its just transmitters that have never been hit. As the use of those medications continue and one doesn't habituate which is more likely with short half life benzodiazepines, the buzz dissappears but the anxiolytic relief continues
This is the end of the thread.
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