![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 192 to 216 of 251. Go back in thread:
Posted by Sulpicia on June 23, 2001, at 23:06:20
In reply to Re: Addictive meds in general:Gdog, Gilbert JCB, posted by JCB on June 22, 2001, at 22:24:27
> JCB --
sorry about the tone and I didn't mean to challenge your credentials. It's unfair to expect perfection about such a complicated issue as addiction.
Now, granted that I'm unfamiliar with your patient population, it seems like the face of addiction is becoming more complex. People with chronic pain have long been plagued with addiction but one cannot simply withdraw them from opiates and substitute nsaids or massage: as medicine advances [some might use another verb] one of the costs is that many people survive major problems but live with chronic pain. If the pain is not relieved, and in some cases only opiates will do so, they will surely relapse. Many conditions are part of the self-medication-to-addiction/abuse dynamic, and these conditions MUST be treated if the patient is to have any hope of recovery or quality of life.
I take your point about meds being used as a crutch but please remember there is not one shred of research that demonstrates talk therapy without effective pharmacology has any efficacy whatsoever on disorders such as chronic severe depression, biopolar disorder, or ADHD -- I could probably think of more too.
And you know the cormorbity statistics as well as I do -- it is statistically impossible that the majority of your clients do not have one or more of these disorders.
Much like those recovering from eating disorders who must constantly face the substance they abuse, addiction treatment *needs* to accomodate the realities of psychiatric illness, and treat the patient accordingly. I don't envy you the complexity of your job.
Thanks for an interesting discussion.
And just for the record, benzo withdrawal is done inpatient because of the risk of seizures, which can be fatal, right??
S.
Posted by JCB on June 23, 2001, at 23:27:44
In reply to Re: Addictive meds in general:Gdog, Gilbert JCB » JCB, posted by Sulpicia on June 23, 2001, at 23:06:20
s.,
Yes, detox from benzos are done in the hospital because of the high risk of seizures. Its usually a long detox compared to alcohol as well, typically 2-4 weeks.
I certainly never meant to imply that talk therapies take the place of medication in treating disorders such as major depression, bi-polor, or ADHD. On the contrary, medication is the PRIMARY treatment for these above mentioned disorders. I do recall a study, however, that compared the efficacy of 3 types of treatment for major depressive disorder. One group received cognative-behavioral therapy alone, one group received anti-depressants only, and the other group received a combination of both. As I recall, all improved compared to the control group that received nothing. Big surprise :-) Interestingly enough, however, cognative-behavioral therapy in conjunction with anti-depressant therapy was shown to be superior to either cognative-behavioral or anti-depressant therapy alone. I think this shows that maximum benefit can be gained from a combination of both. I also suffer from dysthymic disorder (mild chronic depression) and was in therapy for months before I was put on anti-depressant medication. From my own experience, the counseling helped, but the medication changed my entire life (for the better of course)! I do, however, find the need for occasional "boosters" where I will see a counselor from time to time. So as you see, on many of these issues, my opinions come from my experiences as being both a mental health professional and a patient.
Posted by gilbert on June 24, 2001, at 10:35:36
In reply to Re: Addictive meds in general:Gdog, Gilbert JCB, posted by JCB on June 23, 2001, at 23:27:44
JCB,
I would agree with what you said in your previous post. I have been helped significantly witht talk therapy in areas like family dysfunction, self acceptance etc. I have been very dissapointed lately though to realize all the talk therapy in the world won't stop my panics. I went through these same feelings about AA when I realized it would not fix some things for me....was I to forever remain broken. I think the meds help but they are not without side effects. The xanax will make you tired and can give you a mild dose of depression. I am currently on low dose luvox trying to abait the xanax due to tremendous guilt and feelings of inferiority....especially around AA. I may have to accept xanax in my life as the only solution to the physiological symptoms of panic. I am very tired of trying to solve this problem with what ever technique or therapy is availed me. I have been wired this way since age 4 since my little brother died. I am not sure therapy can rewire circuits that entact or that old. I am now 42. You did mention that therpists and counselors etc. were not affiliated with AA. I know the literature and how it states it's non affilation mantra yet.......the therpay boom was a direct result of the popularity of treatment centers and in house counseling to be continued on outpatient basis. I have been around meetings since the late 70's. The therpay field has grown leaps and bounds as a direct result of affiliations to AA. Only since insurance companies getting greedieer has the pace slowed. The invention of AA was self supporting only in the first 30 years. The last 25 to 30 has seen the rise and fall of treatment centers, the rise and fall of pyschological phases...inner child issues, codependency issues, etc. Most of these offshoot industries especially therpy has been a direct result of treatment center mantra. Most people are referred to a therapist from a loving member in AA or Alanon. The therapist I see I always know someone in the lobby from meetings. The comingling of therapy and 12 step groups is furthered by lecture series at alano clubs, open talks, etc. Now don't get me wrong I think this is a good thing. The more help the merrier. But the days of AA as a self supporting institution have been gone since the late seventies boom of rehab centers.
P >S > I always thought we should visit Lois's grave on founders day. She stood by a man who couldn't hold down a job, brought drunken strangers home, chased other women even after sobriety, Did Bill even have a real job after getting sober? Lois must have made more coffee than Mrs. Folger.....I credit her with founding AA. If Bill didn't have her money, her home, her work ethic or her loyalty....me thinks AA would not be here.
Gil
Posted by JCB on June 24, 2001, at 11:35:30
In reply to Addictive meds in general, posted by JCB on June 22, 2001, at 0:58:18
Well, I may be wrong, but as mentioned at the beginning of every AA meeting I've attended, they claim to be self supporting and not allowed to be affiliated with any other organization. The treatment center where I work donates a room for the meetings to take place (we don't charge them rent). I realize that referals are made back and forth between treatment centers and AA, but unless something has changed that I'm not aware of, AA is NOT permitted to affiliate their name with any other organization or vica verca. Just an FYI.
Posted by gilbert on June 24, 2001, at 11:59:59
In reply to Re: Addictive meds in general, posted by JCB on June 24, 2001, at 11:35:30
JCB,
Thank you for the discussion even though we agree to disagree. You are proving my point in your last post. AA is not supposed to take donated time from any facility. This makes them supported by you and not self supporting. This was warned against in the early literature. They then owe you something. The meetings are supposed to fly on their own no matter how well intentioned the purpose. This is why the founders turned down Rockefeller's offer of money. This is how we get comingled with outside facilities. The favor is well meaning but the fellowship as a whole than becomes dependent on your facility to have that meeting. Would they exist if a fair market rent was charged. Does your treatment center use the meeting as a tool for their inpatient members......You see this is how the treatment centers all have worked. Now I don't know of any friend in AA who sees a therapist or counselor that was not a referral from another AA member. So their is alot of unintended comingling. Simply because it is read that AA ought to be self supporting does not make it true. The patients of your rehab cneter who pay or insurance companies who pay for their stay are footing the rent bill for that particular group,. This is definetly a tradition breaker.
Again this is starting to be like tennis but I do enjoy the debate
Thanks,
Gil
Posted by JCB on June 24, 2001, at 12:08:44
In reply to Re: Addictive meds in general, posted by gilbert on June 24, 2001, at 11:59:59
I never thought of it that way, but you're absolutely right. What else can I say :-) Thanks for enlightening me to this latent relationship.
Posted by Zo on June 24, 2001, at 15:55:33
In reply to mood disorders/klonopin,depakote,neurontin etc...., posted by paul on November 26, 1998, at 8:21:48
. . as depakote, or Klonopin. It is not addictive, or habit-forming, and while no med can be ruled out as having a negative effect on someone, Neurontin works for many conditions such as anxiety, TLE and pain by caliming the excitable GABA receptor sites. Altho it was hell to get on and ramp up, because of daytime fogginess, it has been nothing but beneficial to me, and is remarkably non-toxic. No comparison to other anticonvulsants, which can be nasty buggers.
Posted by Elizabeth on June 25, 2001, at 2:50:07
In reply to Addictive meds in general, posted by JCB on June 22, 2001, at 0:58:18
The term "addiction" is confusing. This is due, in part, to changing definitions. Twenty years ago, any drug that had a characteristic withdrawal syndrome was considered "addictive," and people who took such drugs (regardless of how they took them) were uniformly considered "drug addicts." It was a relatively simplistic and objective definition.
Today, "addiction" refers to the psychological disorder classified as "substance dependence" in DSM-IV. The tolerance/withdrawal syndrome is more properly identified as "pharmacologic dependence." It is not a disease, but a normal response to taking drugs for a long enough period of time. It is recognised that people who take drugs that have virtually no abuse potential (including many antidepressants) do often experience withdrawal symptoms if they discontinue the drug abruptly or miss a dose. This phenomenon, it is recognised, is not properly considered to be a drug addiction, and people who use antidepressants, anticonvulsants (including benzodiazepines), certain cardiac drugs, stimulants, glucocorticoids, opioids, etc., on a daily basis are not automatically classified as "drug addicts." It is understood that these drugs can and are used in a nonpathological way in the treatment of such conditions as depression, bipolar disorder, anxiety disorders, chronic pain, hypertension, tremor, attention deficit disorder, narcolepsy and some other sleep disorders, inflammatory conditions, autoimmune diseases, organ transplantation, etc.
The realisation that many classes of drugs thought to be virtually free of abuse potential -- such as SSRIs, tricyclics, MAOIs, centrally-acting alpha-adrenergic agonists, glucocorticoids, and anticonvulsants other than barbiturates and benzodiazepines -- can cause characteristic withdrawal syndromes and/or rebound symptoms is clinically important, because it is extremely important that these drugs be abruptly only in emergencies.
The distinction between true addiction and pharmacologic dependence is also important because "addiction" is such a loaded word today. Most people who take benzodiazepines for anxiety, stimulants for ADHD or narcolepsy, opioids for pain, etc., do *NOT* become drug addicts. Withdrawal symptoms are normal responses to discontinuation of these drugs, just as it should not surprise a pdoc (or other medical professional or counselor) if a person suffers withdrawal symptoms when he or she tries to stop taking Paxil or Effexor.
It is incorrect and misleading to label a person a "drug addict" based solely upon the manifestation of the substance-specific withdrawal syndrome upon discontinuation of the drug. Although most addicts do suffer withdrawal symptoms, there is much more to addiction than that.
Although I don't generally think that the DSM-IV definitions of mental disorders are very useful or precise, the definitions of substance dependence and substance abuse are worth careful examination -- *especially* by mental health professionals. A MHP who is unaware of the difference between true addiction and pharmacologic dependence runs the risk of placing people in "treatment" programs which will, at best, be of no benefit; indeed, the stigmatising label of "addict" may be harmful to these people in many cases.
It might be of interest that a standard medical school pharmacology textbook (Goodman & Gilman's _Pharmacological Basis of Therapeutics_) recommends doing away with the word "addiction" altogether because of its pejorative connotations and the confusion surrounding its meaning.
-elizabeth
Posted by Elizabeth on June 25, 2001, at 3:30:29
In reply to Re: Addictive meds in general, posted by gilbert on June 22, 2001, at 10:30:37
Gil,
Like you, most people taking doses within the accepted therapeutic range can taper off benzos without suffering significant withdrawal symptoms. With appropriately cautious tapering, seizures are almost unheard of. The discontinuation process often has to be an extremely slow one, though, especially with short-acting benzos such as Xanax or if the person has been taking the benzos for a very long time.
I've encountered 12-steppers who express the sort of attitude you mention, that the use of benzodiazepines (or even, sometimes, of antidepressants!) jeopardises the sobriety of a recovering addict. Although addiction history should be considered, my own opinion is that alcoholism and other addictions should *never* be seen as absolute contraindications for the use of benzos in the treatment of anxiety disorders.
Although people who are currently abusing other drugs are the most likely to abuse prescribed benzos (otherwise, abuse is almost unheard of), many people originally *became* addicts (alcoholics in particular) when they realised that they could use drugs to "self-medicate" lifelong anxiety disorders. Denying these people BZDs may actually put them at *increased* risk of relapse. Such patients should be carefully monitored, of course, but benzos are extremely safe and effective for anxiety, while alcohol carries all sorts of health risks as well as the general risk of addiction associated with unmonitored self-medication.
SSRIs have been touted for anxiety disorders, but many anxiety patients find the side effects *very* hard to tolerate. Benzos, in contrast, are almost invariably well-tolerated. Personally I have never experienced any adverse side effects from my intermittent use of benzos or for the month or so that I took Klonopin daily.)
> I also have never wanted to take them to get high in fact I don't feel high at all from taking them...they just get rid of the panics and make me feel normal.
Same here. I have a hard time believing that *anyone* would find benzos a "high." I suspect that, more often, people who use unprescribed benzos are using them to stave off withdrawal symptoms from other drugs such as heroin and alcohol.
> Even though tolerance may appear after the initial dose most people can maintenace dose with the same amount year after year.
Tolerance to the anxiolytic effects is the exception, not the rule, with benzos. (People do grow tolerant to side effects like sedation, dizziness, and appetite stimulation, though.)
> I will tell you all drugs cause dependence at some level.
Yes, this is just what I was getting at ("physical" or "pharmacologic" dependence). Unfortunately, even many mental health professionals do not understand the difference. As a result, many non-drug-abusing anxiety patients are pressured to stop taking benzos, and some are even pushed into "rehab" programs where they don't belong at all!
> Even blood pressure drug removal causes rebound.
Very true. Clonidine, an antihypertensive often used for ADD-associated hyperactivity, is particularly notorious for this (something which child psychiatrists too often fail to mention to the parents!). People who take glucocorticoids (cortisol-like steroids such as prednisone, dexamethasone, etc.) can suffer severe, even fatal, withdrawal reactions if the drug is suddenly discontinued. And benzos and barbiturates aren't the only anticonvulsants that can cause rebound seizures; all anticonvulsants have this potential (which makes me rather concerned about the extremely liberal use of these drugs in off-label conditions).
> I have never thought wow why don't I take a bunch of xanax and go hang out downtown and party. They just don't feel or work that way. I have been able to take xanax and do things I was always afraid to do ....
I know exactly what you mean; buprenorphine is similar for me. When used responsibly, these two drugs (which generally have low potentials for abuse anyway) are, as you say, life-savers. There are many people out there like us who can function on a day-to-day basis because of these medications.
-elizabeth
Posted by Annabelle on June 25, 2001, at 5:37:57
In reply to Re: Addictive meds » JCB, posted by Elizabeth on June 25, 2001, at 2:50:07
> The term "addiction" is confusing. This is due, in part, to changing definitions. Twenty years ago, any drug that had a characteristic withdrawal syndrome was considered "addictive," and people who took such drugs (regardless of how they took them) were uniformly considered "drug addicts." It was a relatively simplistic and objective definition.
Thank you for your voice of WISDOM. I think I mentioned this, but my Dad, who is 91 does not want to take any sleeping meds, even though he has a life-long history of sleep problems (which my brother and I seem to have also)because he does not want to become ADDICTED! Dad also suffers from life long depression. In the 40s and 50s whenever he had some Benezedrine he felt better. He begged the family MD to let him have some 'only for when he felt 'lousey and down'', but that was looked upon as ADDICTIVE. He was born before the days of AntiD's, but if the doctors had let him have small doses of Benezedrine, I believe it would have made a great difference in his life, and our entire family.
Annie
Posted by Elizabeth on June 25, 2001, at 6:01:08
In reply to NEURONTIN is not in the same class. . ., posted by Zo on June 24, 2001, at 15:55:33
> . . as depakote, or Klonopin. It is not addictive, or habit-forming, and while no med can be ruled out as having a negative effect on someone, Neurontin works for many conditions such as anxiety, TLE and pain by caliming the excitable GABA receptor sites.
GABA is an *inhibitory* (not excitatory) neurotransmitter, so drugs that activate GABA receptors, inhibit the metabolism of GABA (e.g., Nardil and vigabatrin), block the GABA transporter (e.g., tiagabine), or potentiate the effects of endogenous GABA (e.g., benzodiazepines), cause *decreased* firing and CNS depression (*not* the same thing as "depressed mood"). This is thought to be the basis for their efficacy in the treatment of seizures, anxiety, and mania.
Neurontin's molecular structure resembles that of GABA, so it was natural for researchers to hypothesise that it might produce its effects through GABA-ergic actions. Last I checked, though, nobody had been able to figure out what the stuff does. It is not a GABA-A agonist or a promotor of GABA release. Some research suggests that it may be an agonist at certain GABA-B receptors, however. Another possibility is that it increases GABA activity and/or decreases glutamate activity via enzyme induction. It does seem to alter GABA turnover, a property shared by some other anxiolytic drugs.
Interestingly, I found that Neurontin actually *felt* sort of like Xanax, although it was not as effective for panic disorder. (I probably didn't try a high enough dose; since I didn't have problems with sedation, I've considered giving it another try.) It's not clear whether Neurontin is as effective for anxiety as the benzos are, but there are some studies and anecdotal reports suggesting that it may be worth trying for sufferers of anxiety or mixed anxiety/mood disorders.
> Altho it was hell to get on and ramp up, because of daytime fogginess, it has been nothing but beneficial to me, and is remarkably non-toxic. No comparison to other anticonvulsants, which can be nasty buggers.
Lamictal, which has gained some popularity as an antidepressant-anticonvulsant for people with bipolar-spectrum disorders, is also pretty much free of side effects (and usually isn't sedating the way that Neurontin can be for some people). Lamictal might be a better first choice for people whose problems are more associated with depression or mood swings, while Neurontin may be preferable for those with major anxiety disorders.
-elizabeth
Posted by gilbert on June 25, 2001, at 20:00:18
In reply to Re: Neurontin » Zo, posted by Elizabeth on June 25, 2001, at 6:01:08
Hi Elizabeth..........welcome back,
I have found xanax to have less side effects and to be more stable for panic than nerontin. I know some are getting good effetcs fromnerontin though.Gil.
Posted by Elizabeth on June 27, 2001, at 6:00:12
In reply to welcome back, posted by gilbert on June 25, 2001, at 20:00:18
> Hi Elizabeth..........welcome back,
Hi to you. I'm glad to be back.
> I have found xanax to have less side effects and to be more stable for panic than nerontin. I know some are getting good effetcs fromnerontin though.
That's about what I would expect. I don't have very frequent attacks (since I take ADs), and Neurontin seemed to do some good. It ended up not being worth it because it didn't help with the depression (the real tough problem for me) and I was getting the munchies a lot on it. (I had a real problem with weight gain on Nardil and don't want to repeat that.)
-elizabeth
Posted by Zo on June 28, 2001, at 1:46:20
In reply to Re: Neurontin » Zo, posted by Elizabeth on June 25, 2001, at 6:01:08
> Lamictal, which has gained some popularity as an antidepressant-anticonvulsant for people with bipolar-spectrum disorders, is also pretty much free of side effects (and usually isn't sedating the way that Neurontin can be for some people). Lamictal might be a better first choice for people whose problems are more associated with depression or mood swings, while Neurontin may be preferable for those with major anxiety disorders.
>What these drugs have in common, and what Bipolar, TLE (which I have) and certain other conditions have in common, and what Neurontin seems to "de-excite" is the interest effect of Kindling. It has also been of significant, life-changing help with my CFS / muscle pain / Stage 4 sleep.
Lamactil, interestingly, did not "feel" the same way at all, subjectively, and I never was able to find a good dose. . . for me, it wasn't tolerable.
Neurontin *can*, despite what you may have heard, be taken all at bed. Taken this way, I have no sedation during the day. . and have no break-thru pain or TLE.
Zo
Posted by Annabelle on June 28, 2001, at 8:40:32
In reply to Re: Neurontin, posted by Zo on June 28, 2001, at 1:46:20
> >
It has also been of significant, life-changing help with my CFS / muscle pain / Stage 4 sleep.
>
Taken this way, I have no sedation during the day. . and have no break-thru pain or TLE.Zo....read this with interest as I have chronic muscle spasm in Trap, and occassional muscle pain all over. I have been taking Klonopin and recently Neurontin. Did Neurontin work with your muscle pain?? What dose??? Neurontin worked with my pain for a couple of months. Actually this spasm has been getting worse and the only thing that will calm it down is Klonopin. So...I only take .5, but it makes me so tired. I need to call my prescribing Psych Nurse to see what else I can do. My Neuroligist is scheduling a visit to the Pain Clinic for perhaps a Botox shot, but that could take months.
AM I REPEATING MYSELF???? I think I babbled all of this stuff before, BUT I am interested in hearing from anyone with muscle pain.
Annie
Posted by Zo on June 28, 2001, at 19:27:36
In reply to Re: Neurontin » Zo, posted by Annabelle on June 28, 2001, at 8:40:32
No exaggeration, Neurontin took care of my muscle pain and spasms, of 18-year duration (CFS.)
What dose are you on? I was on Neurontin-L, and while I maxxed out at 900 mg, and am now down to 600 at bed, there were people with severe FM pain taking in the 2,000-3,000 range.
Zo
Posted by Annabelle on June 28, 2001, at 19:50:49
In reply to Re: Neurontin » Zo, posted by Annabelle on June 28, 2001, at 8:40:32
Zo, Wow, that is a high dose. The pain just stinks doesn't it? And you suffered with it for 18 years???.... I am only on 600 in the a.m. and 600 in the p.m. So I might try all at once at night and see if that works. Everything was working for a while, but with age and more wear and tear on the crooked old neck no wonder it is getting worse.
Thanks for all your help... I really appreciate your input to this 'babble'.
Annie
Posted by Lorraine on June 28, 2001, at 20:14:22
In reply to Re: Neurontin, posted by Annabelle on June 28, 2001, at 19:50:49
I'm not the expert on these things, but I think I remember reading here that with Neurontin the body cannot use more than 600mg at a time--hence the split dose.
Posted by Alan on June 28, 2001, at 23:56:22
In reply to Re: Addictive meds, posted by Annabelle on June 25, 2001, at 5:37:57
Thank you for your wonderful insights regarding benzos and "addiction". You have the talents of a writer AND a doc kind of rolled into one. It's so refreshing. Are you either? I'm kind of new here and enjoy your insights and command of the science too.
What is your take on those that suffer chronic anxiety disorders and have been on a benzo to treat for periods of perhaps 10 or more years?
Do you feel that long term constant treatment with no escalation has any downside, even if there are no plans to discontinue and efficacy has been proven?Also, have you ever heard of mediating the effect of fluctuating levels of a shorter acting benzo through the use of acheiving a steady state (lower) dose of Neurontin? How would this make sense - or not - in light of complaints of interdose withdrawls?
Looking forward to hearing from you!
Best,
Alan
Posted by Alan on June 29, 2001, at 0:00:07
In reply to Re: Addictive meds }} Elizabeth, posted by Alan on June 28, 2001, at 23:56:22
Sorry for asking but,
How does one get the "TO" abbreviation that looks like }} ? What key do you hit?
Thanks,
Alan
Posted by Elizabeth on June 30, 2001, at 0:02:55
In reply to Re: Addictive meds }} Elizabeth, posted by Alan on June 28, 2001, at 23:56:22
Alan,
Thank you for your compliments. They are much appreciated.
> What is your take on those that suffer chronic anxiety disorders and have been on a benzo to treat for periods of perhaps 10 or more years?
> Do you feel that long term constant treatment with no escalation has any downside, even if there are no plans to discontinue and efficacy has been proven?No. Some people do develop (or perhaps, come to notice) cognitive problems with long-term benzo use, and in this case it may be better to taper off the benzo gradually. The scenario you've described is not uncommon, and there is no good reason for going off a drug that continues to work and is well tolerated, especially when going off it has the potential to be seriously disruptive (and discontinuing benzos, especially after long-term use, can be very disruptive, not only because withdrawal symptoms are to be expected, but also simply because the anxiety disorder will return).
> Also, have you ever heard of mediating the effect of fluctuating levels of a shorter acting benzo through the use of acheiving a steady state (lower) dose of Neurontin? How would this make sense - or not - in light of complaints of interdose withdrawls?
I would think it would make sense to switch to a longer-acting benzo. Klonopin and Tranxene are my favourites. Neurontin is relatively short-acting itself.
BTW, to get " > > Elizabeth" in the title of your reply, just check the "add name of previous poster" box under the Subject: line.
best,
-elizabeth
Posted by Alan on June 30, 2001, at 1:00:55
In reply to Re: Addictive meds » Alan, posted by Elizabeth on June 30, 2001, at 0:02:55
> Alan,
>
> Thank you for your compliments. They are much appreciated.
>
> > What is your take on those that suffer chronic anxiety disorders and have been on a benzo to treat for periods of perhaps 10 or more years?
> > Do you feel that long term constant treatment with no escalation has any downside, even if there are no plans to discontinue and efficacy has been proven?
>
> No. Some people do develop (or perhaps, come to notice) cognitive problems with long-term benzo use, and in this case it may be better to taper off the benzo gradually. The scenario you've described is not uncommon, and there is no good reason for going off a drug that continues to work and is well tolerated, especially when going off it has the potential to be seriously disruptive (and discontinuing benzos, especially after long-term use, can be very disruptive, not only because withdrawal symptoms are to be expected, but also simply because the anxiety disorder will return).
>
> > Also, have you ever heard of mediating the effect of fluctuating levels of a shorter acting benzo through the use of acheiving a steady state (lower) dose of Neurontin? How would this make sense - or not - in light of complaints of interdose withdrawls?
>
> I would think it would make sense to switch to a longer-acting benzo. Klonopin and Tranxene are my favourites. Neurontin is relatively short-acting itself.
>
> BTW, to get " > > Elizabeth" in the title of your reply, just check the "add name of previous poster" box under the Subject: line.
>
> best,
> -elizabeth
*******************************************
Thanks elizabeth -The partial problem is that the shorter acting Ativan is needed at about 5 MGS on only 3 - 4 days per week for performance anxiety (eves.)while the other days it would be too much.
To keep from being overmedicated on the other days, only 3 MGS are needed. This is where the Nurontin comes in to mediate.
The klon. is too long acting and causes clumsiness anyway at the dosage to be effective in my kind of work and I would feel terribly hung over at the dosage for "off" days compared to "on" days.
It's kind of a special social anxiety subcatagory that I have not been able to treat any other way.
Are there any other ways to treat under these special circumstances that I've outlined or do you think the idea of a mood stabiliser is as good as any that might come to mind?
Best,
Alan (a fellow Chicagoan!)
Thanks for the tip thing.
Posted by Lorraine on June 30, 2001, at 11:09:31
In reply to Re: Addictive meds » Elizabeth, posted by Alan on June 30, 2001, at 1:00:55
>
> Thanks elizabeth -
>
> The partial problem is that the shorter acting Ativan is needed at about 5 MGS on only 3 - 4 days per week for performance anxiety (eves.)while the other days it would be too much.
>
> To keep from being overmedicated on the other days, only 3 MGS are needed. This is where the Nurontin comes in to mediate.
>
> The klon. is too long acting and causes clumsiness anyway at the dosage to be effective in my kind of work and I would feel terribly hung over at the dosage for "off" days compared to "on" days.
>
> It's kind of a special social anxiety subcatagory that I have not been able to treat any other way.
>
> Are there any other ways to treat under these special circumstances that I've outlined or do you think the idea of a mood stabiliser is as good as any that might come to mind?
*********************************************
What about beta blockers, Alan? I think that performers use these a lot for performance anxiety.
Posted by Alan on June 30, 2001, at 15:05:49
In reply to Re: Addictive meds, posted by Lorraine on June 30, 2001, at 11:09:31
> >
> > Thanks elizabeth -
> >
> > The partial problem is that the shorter acting Ativan is needed at about 5 MGS on only 3 - 4 days per week for performance anxiety (eves.)while the other days it would be too much.
> >
> > To keep from being overmedicated on the other days, only 3 MGS are needed. This is where the Nurontin comes in to mediate.
> >
> > The klon. is too long acting and causes clumsiness anyway at the dosage to be effective in my kind of work and I would feel terribly hung over at the dosage for "off" days compared to "on" days.
> >
> > It's kind of a special social anxiety subcatagory that I have not been able to treat any other way.
> >
> > Are there any other ways to treat under these special circumstances that I've outlined or do you think the idea of a mood stabiliser is as good as any that might come to mind?
> *********************************************
> What about beta blockers, Alan? I think that performers use these a lot for performance anxiety.
*******************************************
Yes, I do use them but they only take care of some of the physiological symptoms and not the psychological ones. Thanks for the good suggestion though!Best,
Alan
Posted by Elizabeth on June 30, 2001, at 17:47:37
In reply to Re: Addictive meds » Elizabeth, posted by Alan on June 30, 2001, at 1:00:55
> The partial problem is that the shorter acting Ativan is needed at about 5 MGS on only 3 - 4 days per week for performance anxiety (eves.)while the other days it would be too much.
>
> To keep from being overmedicated on the other days, only 3 MGS are needed. This is where the Nurontin comes in to mediate.Huh. So it doesn't work to just take the Ativan as needed -- 5 mg on the days you need that much, 3 mg on the other days? I can see how that could cause some ups and downs -- Ativan is pretty short-acting.
The Neurontin idea might be worth a try. It's kind of short-acting too. I've heard of some people taking the entire dose at bedtime, but I don't know how well that would work for your purposes. My other thought would be to use a small dose of a long-acting benzo (Klonopin, Tranxene) -- not enough to cause sedation, ataxia, or other unwanted side effects -- in the "background," and take the Ativan on top of that as needed. That might smooth things out.
> It's kind of a special social anxiety subcatagory that I have not been able to treat any other way.
Can you tell me more about that? Have you tried antidepressants? That might seem like overkill, but some of them (phenelzine especially) can be extremely effective for social anxiety, especially if you take benzos along with them.
> Alan (a fellow Chicagoan!)
Oops, didn't mean to mislead. I'm afraid I'm not from Chicago: I was recommending it as a place to find good doctors in the Midwest. Our own Dr. Bob, for example. < g >
best,
-elizabeth
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