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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 7 of 7. This is the beginning of the thread.
Posted by aquestioner on June 27, 2003, at 20:51:13
Since I've been looking around at different things used for anxiety, anger, stress and/or depression. Seems like "benzos" whatever those are..are helpful with stress/panic? When is Xanax prescribed and why is it so controversial? Does it make you sick, or lawsuits etc. I've read some posts,but there are so many!
Posted by eep on June 28, 2003, at 1:03:36
In reply to when is xanax prescribed?, posted by aquestioner on June 27, 2003, at 20:51:13
hey aquestioner.
> Seems like "benzos" whatever those are..are helpful with stress/panic? When is Xanax prescribed and why is it so controversial? Does it make you sick, or lawsuits etc. I've read some posts,but there are so many!
the benzodiazapine family of drugs are all highly addictive, hence the bad rep. xanax and ativan are two of the most commonly prescribed benzos, both used to treat anxiety and other related symptoms. however, i've read that quitting either is as bad as kicking heroin.
i take xanax when i need it - half of a .25mg if i'm feeling edgy. i also take it sparingly inspite of the fact that my doc seems to think that, "addiction," is not something i should worry about.. substance abuse has never been my thing. he, "recommends," that i take .25mgs 3-4 times a day, which makes me think he's out of his mind, but, whatever.
is the wellbutrin getting any less aggitating for you? have you thought of taking a (more sedating) ssri that won't make you edgy? i really like my paxil CR (25mg, pm) & wellbutrin SR (100mg, am) with an occasional xanax thing i've got going on. the paxil treats depression, anxiety and ocd while the wellbutrin kind of offsets the slight day time sedation from paxil and helps keep me in my clothes :).
hope all is well,
v.
Posted by Viridis on June 28, 2003, at 1:09:40
In reply to when is xanax prescribed?, posted by aquestioner on June 27, 2003, at 20:51:13
Xanax (alprazolam) is an excellent benzo for anxiety and seems to have antidepressant properties too. It was very widely prescribed until a few years ago, but it got a reputation for abuse (much like Valium in the 70s). Some people use it recreationally (although hardly ever those who really need it), so there's a street market for it, which really makes doctors nervous.
The big concern seems to be that it's short-acting, which (theoretically) means that people are more likely to pop increasing doses with increasing frequency as the effects wear off. So, many doctors who are willing to prescribe benzos prefer longer-acting ones, especially Klonopin (clonazepam), which is virtually imperceptible once you get used to it, and has almost no credible reputation for abuse.
It's a shame, because Xanax is great for fast relief from anxiety/panic. I have lots, and take it only when needed. A bit works well, any more makes me sleepy, so I have no incentive to abuse it. But it's the usual story -- since a few people have gotten into trouble with it (I know one such person), it's apparently monitored more closely than other drugs in the same class. My pdoc told me that asking for Xanax by name can sometimes be perceived as "drug-seeking behavior", and recommends use of the generic term alprazolam (of course, he knows that I have no interest in getting high on it).
People with genuine anxiety disorders rarely abuse benzos (benzodiazepines), but when these drugs appeared they were prescribed widely enough that some people found certain ones to be euphoriants, and that, coupled with the fact that they're now off-patent so not very profitable, has led to a backlash. This is supported by drug companies who would rather see expensive, still-under-patent drugs prescribed instead. And, there's an active anti-benzo lobby who have seized upon the small proportion of negative reactions to label these drugs "addictive" and "dangerous".
Sad, because used responsibly, these meds are very effective and safe, and have a proven record as the gold standards for anxiety disorders.
Posted by Viridis on June 28, 2003, at 2:22:16
In reply to Re: when is xanax prescribed?, posted by eep on June 28, 2003, at 1:03:36
There's no reliable evidence that benzodiazepines are addictive for the vast majority of patients -- this is simply a myth that's been thoroughly discredited by (among others) the World Health Organization. It's a very pervasive myth, though, that continues to be perpetuated by parties with a financial stake in the matter. Benzos are highly likely to induce medical dependency with long-term use, which is something very different -- this simply means that they must be discontinued slowly, like many other non-psychiatric drugs.
Various newer antidepressants, especially Paxil and Effexor, are considered much more difficult to discontinue than benzos.
Posted by aquestioner on June 28, 2003, at 3:02:16
In reply to Re: when is xanax prescribed? » eep, posted by Viridis on June 28, 2003, at 2:22:16
Thank you, that all is very helpful. But if I can't ask for that help, what to do? I must find a new doc anyways, b/c mine is just terrible, so maybe I can start fresh. I was on 20-30mg of Paxil at bedtime and just loved it. Life was fine, never cried without reason, never wanted to punch anyone in the face, but gained wayyyy to much weight. Since then its been a lot a trial and disapointment. Sometimes I think I'd rather just go back on and gain weight...but my point is that getting off of the Paxil nearly killed me. It was so crazy, really, like commit myself crazy..yuck. Also, is there a type of doc that prescribes and does therapy? Is it better/worse to have all that in one doc?
Posted by Viridis on June 28, 2003, at 18:05:03
In reply to Re: when is xanax prescribed?, posted by aquestioner on June 28, 2003, at 3:02:16
I think there are some psychiatrists who also do therapy, but my impression (and others here can correct me if I'm wrong) is that psychiatrists tend to stick mainly to the medication side of things and therapists, of course, can't prescribe meds.
However, an approach that seems beneficial for many people is to see both a psychiatrist and a therapist. Sometimes (especially in larger cities) the two will share an office and may work as a team with a patient. I've never been in that situation; I've either had therapy (cognitive was best for me) or psychiatric treatment, not both at once.
The last two therapists I saw were helpful to a point; they helped me realize some self-defeating behavior patterns and personality characteristics that provided important insights. However, both wound up recommending that I see a psychiatrist and get appropriate medication for anxiety and depression. That's what's helped most, and I don't feel much of a need for therapy any more. But many people do both and benefit more than from either alone.
Returning to the Xanax question: you might be able to get a doctor to prescribe it, but even if you can't, for severe anxiety I'd really recommend you try Klonopin (clonazepam). It's another benzodiazepene, but doctors are much more comfortable with it because the risk of abuse is low and it has a longer half-life (= one dose usually works all day). When I said in my previous message that it was "imperceptible", I meant that I don't notice any side effects (beyond some mild initial ones). It's extremely effective for anxiety and depression (for me), and I haven't had to increase the dose at all since I started it two years ago.
In any case, it sounds like the first thing you need to do is find a psychiatrist (and maybe a therapist too) with whom you're comfortable. That really makes all the difference, and is worth the effort. On the medication side, there are so many meds available now that it's almost certain you'll find one or a combination that works -- you just need the right person to help you reach your goal.
Good luck!
Posted by waterlily on June 29, 2003, at 11:19:46
In reply to Xanax, therapists, psychiatrists etc. » aquestioner, posted by Viridis on June 28, 2003, at 18:05:03
I have both a psychiatrist and a psychologist and they work in the same practice. I gave them permission to talk with each other about my treatment. I know that my psychiatrist has done or currently does therapy, but I don't know what criteria he uses to choose which patients he refers to a psychologist and which patients he does the therapy himself. Psychiatrists are generally the experts on medications, where the psychologists are the experts on therapy. The team approach seems to work well. I find therapy to be useful, but the medication is what makes the most difference. I can usually tell when I've got problems that can be worked out by talking and when I really need to get with my psychiatrist to adjust the meds. My therapist is really good about warning me when she thinks I may be about to slip into depression so that I am not as surprised and distressed when it happens. I feel very fortunate to have such a caring and competent pair of professionals on my team.
Regarding meds, I take Wellbutrin SR 150 mg twice a day as my primary antidepressant and Effexor XR 150 mg once a day for anxiety. Additionally, I take Ativan .5 mg for insomnia and 'periodic limb movements in sleep' as well as any severe acute anxiety that I may experience (fortunately this is rare). My psychiatrist has been really good about prescribing Ativan when I need it.
This is the end of the thread.
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