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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 34 to 58 of 58. Go back in thread:
Posted by saint james on December 5, 1999, at 13:36:27
In reply to Re: social anxiety - benzos , posted by Louise on December 5, 1999, at 8:03:29
> James,
>
> Just as I suspected ... you've never tried Klonopin, nor have you withdrawn from it. Geez, I'm not trying to pick a fight, but why would a pdoc give a patient a stronger benzo like Klonopin to help with withdrawal from XanaxJames here....
All I can say is that using a longer acting benzo to get off of a shorter one is a common practice that is well excepted. It also makes sense to me. Take a look at Bob's tips and tricks section or else where on the net about benzo dependence.
I too am not trying to fight. I have no problem with agreeing to disagree and I am always intrested in other peoples views.
j
Posted by doug on December 5, 1999, at 15:54:12
In reply to Re: social anxiety - benzos , posted by Louise on December 5, 1999, at 8:03:29
>I've taken Xanax for 3 years and I've yet to experience the "euphoria" that you describe
Louise,
I have been prescribed Xanax to take for social phobia for anticipated situations : weddings, presentations, etc. and have found that a 1.25 mg dose about an hr. before the situation/event definitely does give me a slightly euphoric/relaxing, take the edge off type of feeling that almost totally alleviates the stress and nervousness that would have normally accompanied these type situations. I suspect there is a dosage level that would produce these effects in you (of course I'm just speaking only from my experience).
Doug
Posted by Adam on December 5, 1999, at 16:52:51
In reply to Re: social anxiety - benzos , posted by doug on December 5, 1999, at 15:54:12
Benzos are useful.
One good reason: It's one of the few things I (and other's like me) could take in
combination with an MAOI to treat anxiety and insomnia simultaneously.As for abuse potential, lorazepam makes me feel wonderful. I unabeshedly admit that
I love it. I have the same bottle of lor. that I had when I was discharged from the
hospital in Jan. of this year. Half of the pills are still there. Despite its appeal
I feel no compulsion to use it. I suspect the same is true of many others.
Posted by doug on December 5, 1999, at 17:11:58
In reply to Re: social anxiety - benzos , posted by Adam on December 5, 1999, at 16:52:51
Yes I'm the same way. I rarely use the Xanax. Maybe once a month, because the anticipated events for which I use it are infrequent. I have never thought of taking it for just the euphoric feeling because of the addiction potential and potential for needing more and more to produce the same effect. My quest is to find a medication I can take daily which can work for the unanticipated situations which occur much more frequently.
Posted by Louise on December 5, 1999, at 17:54:44
In reply to Re: social anxiety - benzos , posted by doug on December 5, 1999, at 15:54:12
Doug,
I'm aware of the relaxing effect of Xanax, but I'd hardly describe it as "euphoria", although 1.25 mg. is a lot to take all at once. I also had that same relaxing feeling when I took Klonopin too, so I think it's the benzo effect, not the Xanax effect.
Louise
> >I've taken Xanax for 3 years and I've yet to experience the "euphoria" that you describe
> Louise,
> I have been prescribed Xanax to take for social phobia for anticipated situations : weddings, presentations, etc. and have found that a 1.25 mg dose about an hr. before the situation/event definitely does give me a slightly euphoric/relaxing, take the edge off type of feeling that almost totally alleviates the stress and nervousness that would have normally accompanied these type situations. I suspect there is a dosage level that would produce these effects in you (of course I'm just speaking only from my experience).
> Doug
Posted by Louise on December 5, 1999, at 18:03:57
In reply to Re: social anxiety - benzos , posted by saint james on December 5, 1999, at 13:36:27
James,
I've heard of pdocs giving patients Valium to wean off of Klonopin, but I've never heard of giving Klonopin to wean off of Xanax. Since I've taken both meds, when you've tried Klonopin and have successfully withdrawn from it, then please come back and tell me about your experience. Until then, I've nothing further to say on this subject.
Louise
> > James,
> >
> > Just as I suspected ... you've never tried Klonopin, nor have you withdrawn from it. Geez, I'm not trying to pick a fight, but why would a pdoc give a patient a stronger benzo like Klonopin to help with withdrawal from Xanax
>
> James here....
>
> All I can say is that using a longer acting benzo to get off of a shorter one is a common practice that is well excepted. It also makes sense to me. Take a look at Bob's tips and tricks section or else where on the net about benzo dependence.
>
> I too am not trying to fight. I have no problem with agreeing to disagree and I am always intrested in other peoples views.
>
> j
Posted by GS on December 5, 1999, at 19:12:40
In reply to Re: social anxiety - benzos - to James, posted by Louise on December 5, 1999, at 18:03:57
> > James here....
> >
> > All I can say is that using a longer acting benzo to get off of a shorter one is a common practice that is well excepted. It also makes sense to me. Take a look at Bob's tips and tricks section or else where on the net about benzo dependence.
*************************************************
This is the standard form of easing withdrawl from the shorter acting benzos...to take longer acting ones to slow the exit of this type of medicine...a time honored practice and good sound medicine. If there are doctors prescribing Valium to get off of klonopin, they've either got it backwards, are just plain wrong (doctors are occasionally), or are trying to accomplish something else altogether - other than what is being described here.
GS
**************************************************
Posted by Louise on December 5, 1999, at 19:32:17
In reply to Re: social anxiety - benzos - to James and Louise, posted by GS on December 5, 1999, at 19:12:40
GS,
Here's the best info on the net about getting off benzos. I did it, my pdoc recommends it, Dr. Shipko of the PDI recommends it, and it's the best way to withdraw from benzos (Xanax included) because it works. Take care.
http://lexington-on-line.com/naf_xanax.html
Louise
*************************************************
> This is the standard form of easing withdrawl from the shorter acting benzos...to take longer acting ones to slow the exit of this type of medicine...a time honored practice and good sound medicine. If there are doctors prescribing Valium to get off of klonopin, they've either got it backwards, are just plain wrong (doctors are occasionally), or are trying to accomplish something else altogether - other than what is being described here.
> GS
> **************************************************
Posted by Phil on December 5, 1999, at 20:13:41
In reply to Re: social anxiety - benzos - to Anybody, posted by Louise on December 5, 1999, at 19:32:17
Louise,
If you do a search on PubMed..Xanax withdrawal, you may see that there are tons of abstracts supporting the use of Clonazepam to withdraw from Xanax.
Not trying to heat up the battle here. Just pointing out some research suggesting that saint james is right.Phil
Posted by Louise on December 5, 1999, at 20:21:33
In reply to Re: social anxiety - benzos - to Anybody, posted by Phil on December 5, 1999, at 20:13:41
Phil,
I think having taken both meds that I'm a little better qualified than James to give advice on this subject. And I've done quite a bit of research on this, too. However, I agree to disagree. Peace.
Louise
> Louise,
>
> If you do a search on PubMed..Xanax withdrawal, you may see that there are tons of abstracts supporting the use of Clonazepam to withdraw from Xanax.
> Not trying to heat up the battle here. Just pointing out some research suggesting that saint james is right.
>
> Phil
Posted by GS on December 5, 1999, at 21:00:28
In reply to Re: social anxiety - benzos - to Anybody, posted by Louise on December 5, 1999, at 20:21:33
> Phil,
>
> I think having taken both meds that I'm a little better qualified than James to give advice on this subject. And I've done quite a bit of research on this, too. However, I agree to disagree. Peace.
>
> Louise
>
>
> > Louise,
> >
> > If you do a search on PubMed..Xanax withdrawal, you may see that there are tons of abstracts supporting the use of Clonazepam to withdraw from Xanax.
> > Not trying to heat up the battle here. Just pointing out some research suggesting that saint james is right.
> >
> > Phil
**************************************************
There really isn't any disagreement here as I see it. Very gradual withdrawl is the answer whether it be done purely as Louise's reference article discusses or by way of using a longer half-life benzo to accomplish the same task.
Perhaps what Louise is trying to tell us is that the specific benzo klonopin (for whatever reason) didn't make her feel well in withdrawl like the other benzo - xanax - so she decided to withdraw purely with that xanax. Makes sense.
I know that I don't feel as well on other benzos that I've tried and slow withdrawl has been a little more severe feeling than with the same slow withdrawl process using lorazepam for instance (my benzo of choice).
GS
**************************************************
Posted by Elizabeth on December 6, 1999, at 1:14:00
In reply to Re: social anxiety - benzos , posted by Louise on December 5, 1999, at 17:54:44
> I'm aware of the relaxing effect of Xanax, but I'd hardly describe it as "euphoria", although 1.25 mg. is a lot to take all at once.
For the record, I take 2mg of Xanax p.r.n. to halt a panic attack. Also have the option of taking less for general anxiety. I've had the same bottle of 15 2mg tabs for 5 months, I think there are about 10 left.
Posted by Louise on December 6, 1999, at 17:44:56
In reply to benzo doses (was Re: social anxiety - benzos), posted by Elizabeth on December 6, 1999, at 1:14:00
Elizabeth,
If I took that much Xanax all at once I'd be terribly drowsy (if not asleep), but I'm glad that works for you. I tried taking Xanax PRN, but I developed severe anxiety and agoraphobia.
By the time a panic situation were to develop, it would be too late for me to take Xanax. My pdoc advised that because of an embalance in my brain, Xanax only works for me when I have a steady amount built up in my system. Although I take Xanax everyday, I have reduced my daily dose from 3 mg. to 2 mg. per day by taking glutamine and taurine supplements. Since I can't take Klonopin, I'm considering changing to Ativan, although someone suggested to me on another Board that Ativan is not as strong as Xanax, even though they believe it is more sedating.
Louise
> > I'm aware of the relaxing effect of Xanax, but I'd hardly describe it as "euphoria", although 1.25 mg. is a lot to take all at once.
>
> For the record, I take 2mg of Xanax p.r.n. to halt a panic attack. Also have the option of taking less for general anxiety. I've had the same bottle of 15 2mg tabs for 5 months, I think there are about 10 left.
Posted by Elizabeth on December 6, 1999, at 20:03:43
In reply to Re: benzo doses (was Re: social anxiety - benzos), posted by Louise on December 6, 1999, at 17:44:56
> If I took that much Xanax all at once I'd be terribly drowsy (if not asleep), but I'm glad that works for you.
Here's the interesting part: it's sedating for me too, *except* when I am having or about to have a panic attack.
> I tried taking Xanax PRN, but I developed severe anxiety and agoraphobia.
I have to take an antidepressant with it, yeah (no agoraphobia though).
> By the time a panic situation were to develop, it would be too late for me to take Xanax.
I have "auras" (much like epileptic auras) that begin a while before a panic attack. Xanax seems to kick in within a half hour.
> My pdoc advised that because of an embalance in my brain, Xanax only works for me when I have a steady amount built up in my system. Although I take Xanax everyday, I have reduced my daily dose from 3 mg. to 2 mg. per day by taking glutamine and taurine supplements.
That's interesting; I should read up more on amino acids.
> Since I can't take Klonopin, I'm considering changing to Ativan, although someone suggested to me on another Board that Ativan is not as strong as Xanax, even though they believe it is more sedating.
It's not as *potent* - you'd need a higher dose - but I don't see any reason it wouldn't work. It's a bit longer-lasting and doesn't have the awful taste (so if you need it right away you can take it sublingually).
Posted by Louise on December 6, 1999, at 22:06:14
In reply to Re: benzo doses, posted by Elizabeth on December 6, 1999, at 20:03:43
> Here's the interesting part: it's sedating for me too, *except* when I am having or about to have a panic attack.
Yeah, I can understand that. Unfortunately, I don't get any warnings like you do. You're lucky in that way since you can take the Xanax PRN.
> I have to take an antidepressant with it, yeah (no agoraphobia though).
Unfortunately I'm unable to take A/Ds. I've been trying Effexor XR for GAD, but I've developed a terrible ringing in my ears and nausea, so I guess another A/D bites the dust. I had such high hopes for this drug since it's an SNRI not an SSRI.
> I have "auras" (much like epileptic auras) that begin a while before a panic attack. Xanax seems to kick in within a half hour.
You're lucky that way. I get GAD which on occasion has triggered a panic attack, but much more likely just turns into agoraphobia, which in some ways is even worse.
> That's interesting; I should read up more on amino acids.
They've helped me a lot, along with other natural remedies, but they aren't miracle cures. I'm hoping one day some other med will come along that works well on the GABA receptors without the problems of the benzos or the side effects of the A/Ds.
> It's not as *potent* - you'd need a higher dose - but I don't see any reason it wouldn't work. It's a bit longer-lasting and doesn't have the awful taste (so if you need it right away you can take it sublingually).
Xanax is very bitter. I'm going to ask my pdoc to switch me over to Ativan ... at least for a while. My pdoc is pro-Xanax because he says it's better for panic, but he says Ativan is better for your liver.
Louise
Posted by Elizabeth on December 7, 1999, at 12:12:00
In reply to Re: benzo doses, posted by Louise on December 6, 1999, at 22:06:14
> Unfortunately I'm unable to take A/Ds. I've been trying Effexor XR for GAD, but I've developed a terrible ringing in my ears and nausea, so I guess another A/D bites the dust. I had such high hopes for this drug since it's an SNRI not an SSRI.
I wonder what causes the tinnitus. That is weird.
> You're lucky that way. I get GAD which on occasion has triggered a panic attack, but much more likely just turns into agoraphobia, which in some ways is even worse.
Oh, I agree totally - I think agoraphobia is probably the most debilitating of the anxiety disorders.
> They've helped me a lot, along with other natural remedies, but they aren't miracle cures. I'm hoping one day some other med will come along that works well on the GABA receptors without the problems of the benzos or the side effects of the A/Ds.
Some of the anticonvulsants do, FWIW. Gabitril, e.g., is a GABA reuptake inhibitor. Also, I don't recall if you've tried MAOIs, but Nardil (or one of its metabolites) inhibits GABA transaminase.
> Xanax is very bitter. I'm going to ask my pdoc to switch me over to Ativan ... at least for a while. My pdoc is pro-Xanax because he says it's better for panic, but he says Ativan is better for your liver.
That's true, yeah. And yes, Xanax tastes *gross*!
Posted by Louise on December 7, 1999, at 18:18:45
In reply to Re: benzo doses, posted by Elizabeth on December 7, 1999, at 12:12:00
Elizabeth,
I wish I knew why I have so many problems with all of the meds; it's quite frustrating. My ears are still ringing, so I've finally given up on the Effexor XR. The ringing should stop ... hopefully soon.
Do they both work well on anxiety and panic? I know that Nardil works on panic, but I've also heard about the problems with weight gain. That's just what I need ... to trade one problem for another. I don't know which would be worse -- to be panic and anxiety free, or to remain agoraphobic because I feel too fat to leave the house!
Louise
>I wonder what causes the tinnitus. That is weird.
> Some of the anticonvulsants do, FWIW. Gabitril, e.g., is a GABA reuptake inhibitor. Also, I don't recall if you've tried MAOIs, but Nardil (or one of its metabolites) inhibits GABA transaminase.
Posted by Elizabeth on December 7, 1999, at 22:48:36
In reply to Re: benzo doses, posted by Louise on December 7, 1999, at 18:18:45
> Do they both work well on anxiety and panic?
Err, point of confusion: both of what?
Posted by Louise on December 8, 1999, at 20:19:44
In reply to Re: benzo doses, posted by Elizabeth on December 7, 1999, at 22:48:36
Your message: "Some of the anticonvulsants do, FWIW. Gabitril, e.g., is a GABA reuptake inhibitor. Also, I don't recall if you've tried MAOIs, but Nardil (or one of its metabolites) inhibits GABA transaminase."
> > Do they both work well on anxiety and panic?
>
> Err, point of confusion: both of what?
Posted by DC on December 9, 1999, at 2:27:26
In reply to social anxiety-HELP!!!, posted by Mark on November 27, 1999, at 1:47:01
Okay you guys are getting old news. Klonipan, Nardil, Marplan, Paxil, blah blah. Yes, we all know about them. Here's a new one: it's called Pregabalin, it's related to Neurontin, and its going to be tested at Yale for Social Phobia. Why doesn't somebody get some of this stuff and try it. Then tell me about it. The only other new thing is Reboxetrine which supposedly helps with motivation and hence gets people out of the house where they can start socializing. Something like that.
Posted by Noa on December 9, 1999, at 6:29:48
In reply to Re: social anxiety-HELP!!!, posted by DC on December 9, 1999, at 2:27:26
DC, you don't say in your post why YOU can't get some and try it. Fill us in.
Posted by Elizabeth on December 9, 1999, at 23:04:47
In reply to Re: benzo doses, posted by Louise on December 8, 1999, at 20:19:44
> Your message: "Some of the anticonvulsants do, FWIW. Gabitril, e.g., is a GABA reuptake inhibitor. Also, I don't recall if you've tried MAOIs, but Nardil (or one of its metabolites) inhibits GABA transaminase."
>
> > > Do they both work well on anxiety and panic?Nardil definitely does, on general anxiety and panic. I don't know that Gabitril has been tried for anxiety.
Posted by DC on December 11, 1999, at 6:49:13
In reply to social anxiety-HELP!!!, posted by Mark on November 27, 1999, at 1:47:01
I'm wondering if anyone knows what neurochemical effects MAOI's have and which of these is the most likely reason they are effective. I know Nardil inhibits MAO and that this effects levels of serotonin and dopamine and I know it has some effect on GABA levels. Seems like Nardil is a rather "dirty" drug, unlike say Prozac which pretty much just works on Serotonin. Since Nardil works on all these different neurochemicals, it's hard to know what exactly is responsible for its effectiveness. Or perhaps the good result comes from the synergy of these different effects.
Does Nardil work on Gaba the same way Benzos do? Or does it operate more like some of the anticonvulsants like Depakote, Neurontin, etc. The reason I'm wondering is because I've heard that a new drug called pregabalin might be effective for social phobia.
Posted by Louise on December 11, 1999, at 11:56:25
In reply to Why does Nardil help social phobia?, posted by DC on December 11, 1999, at 6:49:13
DC,
If you haven't seen it, there's a thread way down below called "Nardil and GABA" that might answer your question.
Louise
> I'm wondering if anyone knows what neurochemical effects MAOI's have and which of these is the most likely reason they are effective. I know Nardil inhibits MAO and that this effects levels of serotonin and dopamine and I know it has some effect on GABA levels. Seems like Nardil is a rather "dirty" drug, unlike say Prozac which pretty much just works on Serotonin. Since Nardil works on all these different neurochemicals, it's hard to know what exactly is responsible for its effectiveness. Or perhaps the good result comes from the synergy of these different effects.
>
> Does Nardil work on Gaba the same way Benzos do? Or does it operate more like some of the anticonvulsants like Depakote, Neurontin, etc. The reason I'm wondering is because I've heard that a new drug called pregabalin might be effective for social phobia.
Posted by Jon21 on September 25, 2003, at 14:18:54
In reply to My social anxiety, posted by jb on November 29, 1999, at 12:29:00
Hi,I have had social anxiety and depressive episodes since I was 14 and am still looking for a tolerable and effective treatment regimen.
Clonazepam (Klonopin, Rivotril)has been by far the most effective drug for SA - I felt an almost 100% remisson in the early days (I've been taking approx. 4mg daily for 18 months).
I returned to college last month after a year out and found my concentration was too poor to cope with the demands of intensive study. I reluctantly decided that a reduction in clonazepam was necessary. I'm now down to 2mg after 1 month tapering (a little too fast I know, but I need my concentration back ASAP).
[BTW clonazepam isn't licenced for anxiety here in the UK, but somehow I managed to convince a locum doctor to prescribe it and other doctors have repeated my prescription ever since!]I've taken the benzo's:
Lorazepam - very good, but not disinhibiting like clonazepam; diazepam - not good, just made me very drowsy; and alprazolam (Xanax) - which seemed to have no effect on me at all!
Also, I've been on:
ALL the SSRI's - I'm extremely sensitive to them, I could only tolerate citalopram, which kept depression at bay, but did not help with social anxiety.
Effexor - terrible time getting on it, and withdrawal worse than benzo's; Mirtazapine, Trazodone and Dothiepin (a TCA). Most recently I tried moclobemide (a RIMA), which gave me an energy boost during the first two weeks then faded away, I was taking 600mg. No Side effects (except aggravated insomnia initially), but it seems, no effect either :-(
After a washout of two weeks I was ready to try tranylcypromine (Parnate), only to find when I handed the prescription in at the pharmacy Parnate is temporarily (or possibly permanently) unavailable for reasons unknown. Are any other Brits also having this problem? I read about a problem with the Nardil supply in the US recently, but not Parnate.
So I'm given the choice: Nardil or Marplan, or go back to moclobemide (*NOT* an option). From what I've read about Nardil, I want to stay well away from it for as long as possible.
Very little seems to have been written about Marplan, but from what I *CAN* find there's nothing bad, and some quite reassuring experiences regarding its tolerability and efficiency in SA.Does anyone have any more info on these topics, thanks?
This is the end of the thread.
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