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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 8 of 8. This is the beginning of the thread.
Posted by banxious on August 22, 2002, at 23:10:29
Hello,
I posted a little while back about severe situational anxiety and wanting to try bromazepam (not available in US).I have since gotten a script for it and have been using it on and off. I thought the dose prescribed by my pdoc was a little high (6mg BID-TID prn), so I have been trying smaller doses with some success. I am really curious as to the degree of relief of anxiety I can really expect to receive from this drug, or any other benzo? Is it reasonable to expect true calm?
I will be leaving home for university for the first time shortly, that in combination with SP, GAD, depression in remission and mild inattentive ADD, needless to say I am feeling anxious -- its a lot for an 18 year old to deal with. Tonight I tried a full 6mg of bromazepam and still had these anxiety "surges", so I tried another 3mg about 75 min later. I feel a little calmer, but the anxiety is still there, is that what I should expect?
I have tried clonazepam 0.25-5mg BID prn. I switched to bromazepam because the clonazepam acted more like a heavy sedative than an anxiolytic.
My other meds are Remeron 30mg-60mg qhs, gabapentin 1200mg TID (for SP), Dexedrine 7.5-25mg/daily prn. Just finished a slow (4 month) taper of nortriptyline, 100mg-->0
Previously I have tried BuSpar 60mg/day, Effexor 225mg/day and fluoxetine 40mg QD, Parnate 10mg TID. All with little success. I've had some very occasional experience with Ativan, and I don't really care for it. I am concerned about dependence, tolerence, and interdose withdrawal associated with alprazolam.I am starting to wonder if maybe some Valium might be more effective?
Sorry abouot the long post, but I would appreciate any insights that more experienced people might offer.
Thanks,
Brian
Posted by Pattisun on August 23, 2002, at 1:48:00
In reply to Bromazepam and Other Benzos, posted by banxious on August 22, 2002, at 23:10:29
Wishing you all the best with your anxiety. I have used Klonopin successfully for seven years but now I feel I am suffering long-term effects of benzo use (or my psych. is wrong), so I am getting off.
But, I have Graves disease (hyper-thyroid) and that's when my panic attacks started. Have they checked your thyroid? (just curious).
Have you tried Cognitive Behavioral Therapy? It really, really, really helped me a lot. I would go into a room and do something to bring on a panic attack, and then work my way through it with the therapist(s).
Chin up and hope your future it bright,
Pattisun
Posted by Pattisun on August 23, 2002, at 1:52:43
In reply to Re: Bromazepam and Other Benzos, posted by Pattisun on August 23, 2002, at 1:48:00
I forgot to add, you CANNOT just keep taking pills to rid all your anxiety. You need to find other ways to help you deal with it.
I like the last part of an old Jane Fonda's Stress Reduction Workout video where she has you lay on the floor, deep breath, and tense then relax every inch of your body. It really helps. So does having a family member squeeze my fingers until they hurt and then I forget about my anxiety, so does having someone sit facing me on the floor and do deep breathing and stretching with me.
Experiment and find something to help you. I was just given this book to work with today:
"Anxiety of Phobia Workbook" by Ed Buorne, Ph.D.
:-)
Posted by jay on August 23, 2002, at 4:03:56
In reply to Re: one more thing, posted by Pattisun on August 23, 2002, at 1:52:43
Ok...I sort of understand what you are saying. I hope you understand I beg to differ. There is some (actually, a fair bit) evidence that taking consistent, long-term (indefinite) medication causes many of the important changes in many parts of our brain to deal with mental illness, and especially stress. As far as suffering long term effects of benzo use...I haven't seen much in the way of research on that. Used properly, they are one of the safest meds out there. It's been about 9 or 10 years for me using them regularly, and they have saved me when *nothing* else could..period. I *can* tell you of the long-term effects of untreated anxiety, besides major reduction in quality of life, is also possibly suicide. You can't get any worse then that.Would you ask someone with high blood pressure or congestive heart problems to just take their medications once in awhile? No, of course not....but your theory fits in here because as with those problems, you have to make some lifestyle changes also.
But, first things first...and that is the anxiety has to be brought down. If after so, and this can be determined by a person and a good doctor, other medications can be added to deal with both anxiety and anything from Bipolar disorder to depression. (Of all shades.)
Then, all of the books, the 're-learning', and changes can be utilized by a person who has been properly medicated, and feels somewhat well. "Proper" medication(s) may be hard as hell to find, but benzos are a good start. I think doctors are FAR too conservative with the half-dose, one-pill-at-a-time thing. Suicide is often (not always of course) the result of improperly or undertreated prescribing. I just doesn't seem the 'politically correct' thing to do, for a doctor to use all of the tools they have been given knowledge to use.
Sorry for my rambling...it's just my opinion. FWIW..
Jay
Posted by joy on August 23, 2002, at 8:37:53
In reply to Bromazepam and Other Benzos, posted by banxious on August 22, 2002, at 23:10:29
In my opinion alazopram [Xanax] has been best for panic and anxiety attacks. This med helped me greatly. I have changed my life around to have much less stress and now I don't get anxiety attacks, so don't need Xanax except for insomnia. These meds if used properly are first line drugs for panic and anxiety attacks. I take a smaller dose than my prescription, but can raise if I need it. I only take it at night now, cause I took it responsibly. Xanax is superior to Valium almost always. My pdoc felt Klonopin tended toward depression for some people and prescribed generic Xanax. It's inexpensive, has been around over 30 years, no side effects for me. Just my humble opinion...........good luck.
Joy
Posted by banxious on August 23, 2002, at 15:52:08
In reply to Re: one more thing..Bromazepam... » Pattisun, posted by jay on August 23, 2002, at 4:03:56
Hi,
Thanks for everyone's responses so far. I have been in CBT with a great psychologist for more than a year now, so I am not "running" to meds as the only answer.Also, its not a panic attack, just a sharp increase in a constantly present anxiety over events that are fast approaching.
What I would really like to know is whether or not I can really expect a calm from the drugs?
As a pharm. tech I see people who have become so dependent on alprazolam that I am scared of trying it.
So, I am especially interested in people's personal experiences with Valium.
Thanks, Brian
Posted by Pattisun on August 23, 2002, at 15:54:24
In reply to Re: one more thing..Bromazepam... » Pattisun, posted by jay on August 23, 2002, at 4:03:56
Hey Jay,
I wasn't trying to say he should not take his anti-anxiety medication. If it were not for my Klonopin I would have not been able to LIVE, I am CERTAIN of that!!
I just meant that even with the medication's help that he should also work on some other avenues to help. At least for me my anxiety disorder is so bad that I needed both cognitive therapy and medication. And, since suffering with this since 1995 I find I still need help and have started in therapy again.
And, I am confused about the long term benzo use, I am having such a rough time withdrawing from the benzo (doctor's order) my husband had to be woken up about 2 a.m. this morning because I was sure I needed to go to the hospital because my chest pains were so bad. It was anxiety and it is crippling.
But even with an SSRI and Klonopin and cognitive therapy, etc. I usually end up with at least one ambulance ride per year to the ER because they are sure I am in heart failure. Anxiety is an evil, scary demon and it takes lots of resources to fight it!
Okay, now I'm rambling.... :-)
Patti
>
> Ok...I sort of understand what you are saying. I hope you understand I beg to differ. There is some (actually, a fair bit) evidence that taking consistent, long-term (indefinite) medication causes many of the important changes in many parts of our brain to deal with mental illness, and especially stress. As far as suffering long term effects of benzo use...I haven't seen much in the way of research on that. Used properly, they are one of the safest meds out there. It's been about 9 or 10 years for me using them regularly, and they have saved me when *nothing* else could..period. I *can* tell you of the long-term effects of untreated anxiety, besides major reduction in quality of life, is also possibly suicide. You can't get any worse then that.
>
> Would you ask someone with high blood pressure or congestive heart problems to just take their medications once in awhile? No, of course not....but your theory fits in here because as with those problems, you have to make some lifestyle changes also.
>
> But, first things first...and that is the anxiety has to be brought down. If after so, and this can be determined by a person and a good doctor, other medications can be added to deal with both anxiety and anything from Bipolar disorder to depression. (Of all shades.)
>
> Then, all of the books, the 're-learning', and changes can be utilized by a person who has been properly medicated, and feels somewhat well. "Proper" medication(s) may be hard as hell to find, but benzos are a good start. I think doctors are FAR too conservative with the half-dose, one-pill-at-a-time thing. Suicide is often (not always of course) the result of improperly or undertreated prescribing. I just doesn't seem the 'politically correct' thing to do, for a doctor to use all of the tools they have been given knowledge to use.
>
> Sorry for my rambling...it's just my opinion. FWIW..
>
> Jay
>
Posted by alan on August 25, 2002, at 10:25:37
In reply to Bromazepam and Other Benzos, posted by banxious on August 22, 2002, at 23:10:29
I am concerned about dependence, tolerence, and interdose withdrawal associated with alprazolam.
>
--------------------------------------------
I have taken bzds for 20 years off and on and have understood that withdrawl is more easilly accomplished than one would be led to believe - especially if you augment with longer acting bzds to help with the tapering process.You may want to read:
http://panicdisorder.about.com/library/weekly/aa031997.htm
Perhaps this will help relieve your concerns about xanax - probably the most effective anxiolytic for many.
The anticipatory anxiety that you are experiencing is completely natural - I have the same symptoms as do most anxiety sufferers.
Why are you on all of the other medications? All for anxiety disorder? Bzd monotherapy is a common alternative to all of these medications at once if you want to have an alternative that will have less side effects.
All reports show that the panic and anxiety population do not abuse or experience suddenly spiraling dosages but rather, a time to let the drowsy start-up side effect abate after a week or two, find a non-arbitrary doseage level, and stick with it. They will either decrease their dosage over time as water seeking its own level or if their anxiety disorder fluctuates, trace the slight increase or decrease in their symptoms.
This "interdose withdrawls" phenomenon is simply the medication not being kept at a contant or steady-state level with regular dosing. One can stabilise one's self once they get the hang of when to dose and with how much...sometimes it is earlier than planned, sometimes later.
I've used it with great success and know many that do. In fact, the main complaints come from those that aren't using it properly, were misdiagnosed and were misprescribed, or simply not given proper instructions how to use the medication...or there were other complicating circumstances that were attributeed to the drug (drug interactions, confusion of improper time periods between dosages as being caused by the medication, etc.).
That isn't to say that there are not the occasional bad reaction to the drugs in this class (and everyone responds differently to each of them) but there are no more bad reactions to this drug than to any other psychotropic.
At least one is given a way out of the drug with the forewarning of it's tolerance/withdrawl effect - unlike the ssri's, etc, where drug co's have deliberately witheld information about the phenomenon with AD's as it's now coming to light.
Alan
Alan
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