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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 jono_in_adelaide on December 17, 2012, at 17:02:06
Still suffering anxiety, though the risperidone 1.5mg at night and Xanax 1mg twice a day is keeping it somewhat in check.
Saw doctor yesterday, we wound the Edronax back to 8mg/day (from 12mg per day which I had been taking for 4 weeks, asit hadnt made any improvement)
Next step is to push the Zoloft to 200mg/day for 6 weeks and see if that helps.
I have a script for Xanax 1mg three times a day, but have only been taking it twice a day because of my grey market risperidone, so have managed to stockpile 50 Xanax for a rainy day, and will have another 50 put by by the end of this six weeks.
If the Zoloft doesnt cut it, I'm going to ask about making regular risperidone a legitimate part of my treatment, rather that taking it in seceret and buying it from India - replace Zoloft with it, as Zoloft and the other SSRI's seem more or less inert to me. Other option will be to drop Zoloft and risperidone, and start mirtazapine
Posted by SLS on December 17, 2012, at 17:09:51
In reply to Anxiety redux redux, posted by jono_in_adelaide on December 17, 2012, at 17:02:06
I'm sure you'll get it right.
- Scott
Posted by Phillipa on December 17, 2012, at 17:53:45
In reply to Anxiety redux redux, posted by jono_in_adelaide on December 17, 2012, at 17:02:06
Jono got stockpile also. Same for rainy day. Go for it increase the xanax since it works for you. Endronax not familiar with. Will search it. Phillipa
Posted by Phillipa on December 17, 2012, at 18:03:08
In reply to Anxiety redux redux, posted by jono_in_adelaide on December 17, 2012, at 17:02:06
Don't know if you have visited this site crazy meds. Phillipa
Posted by jono_in_adelaide on December 17, 2012, at 20:56:26
In reply to Re: Anxiety redux redux » jono_in_adelaide, posted by Phillipa on December 17, 2012, at 18:03:08
I dont want to take 3mg a day of Xanax regularly, thats why I upped the risperidone by 0.5mg, to allow me to drop the Xanax back to twice a day - that way, I still have somwhere to go (an extra pill) on days when i am especialy bad
I dont think the higher dose Zoloft will work, but i have nothing to lose by trying. Next stop will be a psychiatrist (as last)
I'm tossing up wether to ask him about formalising the risperidone I'm taking, or dropping both the risperidone and the Zoloft, and adding mirtazapine.
Would be nice to reach a point where I could just take a benzo prn, but the way my anxiety is atm, thats a fair way off.
Posted by g_g_g_unit on December 17, 2012, at 21:33:41
In reply to Re: Anxiety redux redux, posted by jono_in_adelaide on December 17, 2012, at 20:56:26
Just had a question about Xanax, jono, since you seem rather experienced with it ..
Can it (and other benzos) have differing effects at different doses? I kept thinking I was crazy when I remembered Valium and clonazepam agitating me at lower doses (I've taken higher doses on one-off occasions, but for the purpose of sleep, and found them more calming), but for the past few days I've been noticed a mixture of sedation/cognitive impairment and increased agitation/alertness on 0.5mg of Xanax, within the space of a few hours. Taking a dose at dinner time will ensure my sleep is disrupted.
I upped to 1mg this morning and felt uncomfortable initially, but now am calmer and feel almost drunk/sedated. Should I persist with the 1mg dose? It's frustrating that the anxiolytic effect is accompanied by a lot of tiredness and impairment.
Posted by jono_in_adelaide on December 17, 2012, at 22:21:11
In reply to Re: xanax » jono_in_adelaide, posted by g_g_g_unit on December 17, 2012, at 21:33:41
To be honest, I'm not sure ggg, but where psychopharmacology is concerned, I wouldnt rule anything out.
A paradoxical reaction to benzos isnt that uncommon, maybe you get a paradoxical reaction at low doses, but the tranquilizing effect kicks in at higher doses?
If 1mg makes you feel better, then I'd use 1mg. The mental impairment will usualy pass off quite quickly, a few days to a week or so. Dont drive or drink alcohol till it has passed.
I'd perservere with 1mg for 2 weeks before deciding it isnt a goer - you have a serious illness, its worth putting up with some side effects to get it resolved.
If Xanax continues to make you feel groggy, it would be well worth trying Ativan and or Frisium, both of these benzos are reputed to be less sedating than average (though neither of them is on the PBS)
Posted by SLS on December 18, 2012, at 0:02:33
In reply to Re: xanax, posted by jono_in_adelaide on December 17, 2012, at 22:21:11
> If Xanax continues to make you feel groggy, it would be well worth trying Ativan and or Frisium...
I am not familiar with Frisium.
I find Ativan to be a very "clean" drug with respect to sedation and cognitive impairment. As I recall, Xanax produced some cognitive changes that I was uncomfortable with. I felt too "layed back" and groggy.
I believe that Xanax is more likely to produce paradoxical activation than is Ativan due to disinhibition.
Ativan had been very helpful to my 99 year old grandmother when she was in the hospital. Against my protests, they switched her to Xanax. I went so far as to lecture the charge nurse about behavioral disinhibition. The nurse said that she could only follow the orders left by the doctor. My grandmother became very agitatated after being given the first dose of Xanax. The nurse subsequently gave her more. My grandmother reacted to this second dose by becoming violent. It became necessary to attempt to place her in restraints. However, before they were able to do this, she ripped out her IV catheter and died. In the end, I believe she got what she wanted. In her mind, I am sure that she had chosen to die rather than to suffer more infirmity and hospitalizations. It was a suicide. I just wish it would have been a peaceful death.
What is the "PBS"?
- Scott
Posted by JONO_IN_ADELAIDE on December 18, 2012, at 0:40:11
In reply to Re: xanax » jono_in_adelaide, posted by SLS on December 18, 2012, at 0:02:33
PBS is Pharmacutical Benifits Scheme, the formulary of subsidised drugs avaliable under the national health insurance scheme. As far as benzos go, it subsidsises diazepam, oxazepam, temazepam, nitrazepam, clonazepam and alprazolam. If GG isnt working, he would get his scripts for these for $5 per month, if he got a script for Ativan, he would need to pay the full retail price him self (a quick goodle search shows it to be $22 for 50x1mg tabs at the big discount pharmacy chain.
Frisium is clobazm - its a 1,5 benzodiazepine - the manufacturers made a lot of that when it was first introduced, though not realy sure if its of any real significance , but it is reputed to be less sedating that some of the other benzos, and might be worth a shot. it also has a relatively long half life, so no rebound anxiety between doses
Posted by g_g_g_unit on December 18, 2012, at 3:47:48
In reply to Re: xanax, posted by jono_in_adelaide on December 17, 2012, at 22:21:11
> To be honest, I'm not sure ggg, but where psychopharmacology is concerned, I wouldnt rule anything out.
>
> A paradoxical reaction to benzos isnt that uncommon, maybe you get a paradoxical reaction at low doses, but the tranquilizing effect kicks in at higher doses?
>
> If 1mg makes you feel better, then I'd use 1mg. The mental impairment will usualy pass off quite quickly, a few days to a week or so. Dont drive or drink alcohol till it has passed.
>
> I'd perservere with 1mg for 2 weeks before deciding it isnt a goer - you have a serious illness, its worth putting up with some side effects to get it resolved.
>
> If Xanax continues to make you feel groggy, it would be well worth trying Ativan and or Frisium, both of these benzos are reputed to be less sedating than average (though neither of them is on the PBS)Thanks for the information. It's hard to tell if I feel better on 1mg, but I'm spending a bit too much time overanalyzing it. I noticed today that I get some signs of activation -- leg jiggling, clenched jaw, still very jumpy w/ noises like dog barking -- but that my head is a little clearer at least, albeit w/ some memory/focus issues. I'll just stick with 1mg for now and see what happens.
I should be dosing three times a day, but I feel so depressed that I'm sleeping from midnight until 12 or 1pm anyway, so I take one dose when I wake up and then another at dinner.
Posted by g_g_g_unit on December 18, 2012, at 8:14:04
In reply to Re: xanax, posted by JONO_IN_ADELAIDE on December 18, 2012, at 0:40:11
Are you taking Xanax b.i.d. or t.i.d., jono? What time do you take your last dose?
I take my second dose at 8pm or so, but regardless have been having difficulty falling asleep since starting 6 days ago (normally not an issue when depressed .. I'm a hypersomniac). Maybe it is still activating, since I'm up again at 2am now, though I feel a little calmer on 1mg I think.
Posted by jono_in_adelaide on December 18, 2012, at 18:39:12
In reply to Re: xanax + sleep.. jono, posted by g_g_g_unit on December 18, 2012, at 8:14:04
I'm taking 1mg twice a day most days, 1mg in the morning, and 1mg at 9pm (I go to bed at 10, because I'm up at 6 for work)
If I am having trouble sleepig, i take a 25mg Phenergan with the 9pm dose (otc antihistamine with strong sedative action, the combo of Xanax and Pheneragn gives a deep refreshing sleep.
If you're finding Xanax activiating, it likely isnt the drug for you. I seem to remember you did well on Valium in the past, why not switch back to that, or ask if you can try Ativan or Frisium?
Posted by Phillipa on December 18, 2012, at 19:32:05
In reply to Re: xanax + sleep.. jono, posted by jono_in_adelaide on December 18, 2012, at 18:39:12
When xanax worked well for me .25mg left me feeling normal. These were the days I worked and functioned fine. Phillipa
Posted by jono_in_adelaide on December 18, 2012, at 22:31:27
In reply to Re: xanax + sleep.. jono, posted by Phillipa on December 18, 2012, at 19:32:05
Thats what all the benzos I've tried do for me - they make me feel normal, no buzz, no swimming feeling, no craving for them - they just make me feel like normal
Posted by jono_in_adelaide on December 18, 2012, at 22:33:18
In reply to Re: xanax + sleep.. jono, posted by Phillipa on December 18, 2012, at 19:32:05
I wish a drug company could invent a relatively clean 5HT2A and C blocker, these leave me feeling calm and normal and arnt addictive, but all of the ones in common use have various other effcets (antihistaminic, anticholoinergic, sedative, etc)
Posted by SLS on December 19, 2012, at 6:03:54
In reply to Re: xanax + sleep.. jono, posted by jono_in_adelaide on December 18, 2012, at 22:33:18
> I wish a drug company could invent a relatively clean 5HT2A and C blocker
They already have. The drug I read about (I can't remember its designation) should take a few years to be submitted for approval. I believe it is being studied for schizophrenia to treat negative symptoms.
- Scott
Posted by jono_in_adelaide on December 19, 2012, at 16:48:36
In reply to Re: xanax + sleep.. jono » jono_in_adelaide, posted by SLS on December 19, 2012, at 6:03:54
Thanks Scott, I'll await that with interest.... I'm pretty sure the benifit i derive from the 1mg of risperidone I take is mainly 5HT2 rekated, at that dose it is reputed to have very little effect blocking the dopmaine receptors.
Doxepin would be great for me if it didnt have the potent H1 effect which lease to sedation and weight gain
Posted by SLS on December 19, 2012, at 16:54:04
In reply to Re: xanax + sleep.. jono...SLS, posted by jono_in_adelaide on December 19, 2012, at 16:48:36
A drug called ritanserin is a potent 5-HT2a/b/c antagonist. It was almost developed for marketing, but is now used only as a biological probe.
What happens when 5-HT2b receptors are blocked?
- Scott
Posted by SLS on December 19, 2012, at 17:33:28
In reply to Re: xanax + sleep.. jono...SLS » jono_in_adelaide, posted by SLS on December 19, 2012, at 16:54:04
> A drug called ritanserin is a potent 5-HT2a/b/c antagonist.
I am to be corrected (for now). I found a recent study of ritanserin that indicates it is a 5-HT2a/c receptor antagonist. I am guessing that this study does not consider ritanserin to block 5-HT2b receptors. I could have sworn that it was non-selective.
http://www.ncbi.nlm.nih.gov/pubmed/18801405
A friend of mine called ritanserin a great drug without an indication. The patent expired for ritanserin long ago, so I don't know who would be brave enough to develop it for marketing.
- Scott
Posted by jono_in_adelaide on December 19, 2012, at 19:15:53
In reply to Re: xanax + sleep.. jono...SLS, posted by SLS on December 19, 2012, at 17:33:28
"5-HT2B antagonists have previously been proposed as treatment for migraine headaches, and RS-127,445 was trialled in humans up to Phase I for this indication, but development was not continued.[24] More recent research has focused on possible application of 5-HT2B antagonists as treatments for chronic heart disease"
Posted by jono_in_adelaide on December 19, 2012, at 19:18:17
In reply to Re: xanax + sleep.. jono...SLS, posted by SLS on December 19, 2012, at 17:33:28
I guess I'll just keep taking my 1mg of risperidone for 5HT2A, 2c and HT7 blocking activity until somthing better comes along
The difference it made was amazing, i took a 1mg pill at bedtime, and work the next morning feeling calmer, less depressed, and with less negative intrusive thoughts.
And, buying it from India, its $3 for 100 tablets - best value around I recon!
This is the end of the thread.
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