![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 14 of 14. This is the beginning of the thread.
Posted by Shell on September 11, 2006, at 17:36:14
I am currently taking the following:
37.5 mg Effexor (weaning off due to sexual side effects)
150 mg Wellbutrin
.25 mg Klonopin, twice a dayMy pdoc is about out of options for me. I am discontinuing the Effexor due to sexual side effects. Buspar did not help at all. The pdoc would like to try another antidepressant in addition to the Klonopin (and has gone through a very long list with me), but he tells me all of them have the same risk of sexual side effects as the Effexor– and some cause weight gain as well. The Klonopin does help, but he doesn’t want to increase it because of the potential for addiction.
He pretty much asked me for my ideas on what to try next. I have *no* idea at this point. The anxiety is quickly getting increasingly worse and I’m beginning to wonder if there are any alternatives that don’t have these side effects.
My only idea is to add or go back to Concerta – interestingly enough it is very calming, but my doctor thinks the anxiety is the main problem, not the ADD, and again, is concerned about addiction (though I took it for five years with no problems). Could the untreated ADD be worsening the anxiety – could there be a relationship?
Any ideas? The panic attacks are getting closer and closer together and I’m beginning to fall apart.
Posted by Phillipa on September 11, 2006, at 19:01:22
In reply to Please help me with medication ideas for ANXIETY!, posted by Shell on September 11, 2006, at 17:36:14
If you've taken it for five years and not incresed the dose. Why is he afraid of addiction? Makes no sense to me. Love Phillipa
Posted by fca on September 11, 2006, at 20:46:20
In reply to Please help me with medication ideas for ANXIETY!, posted by Shell on September 11, 2006, at 17:36:14
there is never enough information as to history and symptoms but here goes an alternative-The Wellbutrin is activating and may well increase anxiety. Are you on it to better manage the sexual side effects of effexor? Get off the Wellbutrin, wean yourself from the effexor while gradually switching to lexapro and stay on the klonopin at present levels with the option to occasionally increase it if you know there is a trigger for anxiety approaching. Also consider taking one .5mg a day rather than two .25mg, particularly if your anxiety is worse/better during certain times of the day. I do not know enought to comment about ADD. I second Phillipa's comments. Five years--whats the problem. Pragmatism should win out over theory and "what ifs".
Posted by tizza on September 12, 2006, at 2:07:25
In reply to Please help me with medication ideas for ANXIETY!, posted by Shell on September 11, 2006, at 17:36:14
I have found valium much better for anxiety that klonopin but everyone is different, if you do decide to swap to valium make sure that you subistute the proper equal dose using a benzo equivalency chart. Also valium has a much longer half life so you usually need to take it only once a day, and night time seems to be best for most people. good luck. Mood stablisers are also good for anxiety.
Posted by UgottaHaveHOPE on September 12, 2006, at 4:03:10
In reply to Re: Please help me with medication ideas for ANXIETY! » Shell, posted by tizza on September 12, 2006, at 2:07:25
I take 25mg of Seroquel and 1mg of Klonpin for anxiety. First of all, dont listen to your doc about Klonopin. I take less now than I did nine years ago. It just gets a bad wrap because of ppl who take it for recreational use.
Klonopin is an AP that is being prescribed in much smaller doses for anxiety (300-25mg). It feels like being shot with an elephant dart. It makes you real groggy and wipes out anxiety. The good thing is that you will know the first 2-3 days whether or not it will work, unlike the SSRIs. Good luck, Michael
Posted by linkadge on September 12, 2006, at 8:40:21
In reply to You might want to consider Seroquel, posted by UgottaHaveHOPE on September 12, 2006, at 4:03:10
>Klonopin is an AP that is being prescribed in >much smaller doses for anxiety (300-25mg). It >feels like being shot with an elephant dart. It >makes you real groggy and wipes out anxiety. The >good thing is that you will know the first 2->3days whether or not it will work, unlike the >
>SSRIs. Good luck, MichaelDid you mean seroquel ?
Linkadge
Posted by Crazy Horse on September 12, 2006, at 9:34:41
In reply to Please help me with medication ideas for ANXIETY!, posted by Shell on September 11, 2006, at 17:36:14
> I am currently taking the following:
> 37.5 mg Effexor (weaning off due to sexual side effects)
> 150 mg Wellbutrin
> .25 mg Klonopin, twice a day
>
> My pdoc is about out of options for me. I am discontinuing the Effexor due to sexual side effects. Buspar did not help at all. The pdoc would like to try another antidepressant in addition to the Klonopin (and has gone through a very long list with me), but he tells me all of them have the same risk of sexual side effects as the Effexor– and some cause weight gain as well. The Klonopin does help, but he doesn’t want to increase it because of the potential for addiction.
>
> He pretty much asked me for my ideas on what to try next. I have *no* idea at this point. The anxiety is quickly getting increasingly worse and I’m beginning to wonder if there are any alternatives that don’t have these side effects.
>
> My only idea is to add or go back to Concerta – interestingly enough it is very calming, but my doctor thinks the anxiety is the main problem, not the ADD, and again, is concerned about addiction (though I took it for five years with no problems). Could the untreated ADD be worsening the anxiety – could there be a relationship?
>
> Any ideas? The panic attacks are getting closer and closer together and I’m beginning to fall apart.
>That's a very low dose of Klonopin. Maybe .50 mgs. b.i.d. would suffice. I take 1 mg. of Klonopin b.i.d. and it works beautifully.
-Monte
Posted by Talbot on September 12, 2006, at 10:05:19
In reply to Re: Please help me with medication ideas for ANXIETY! » Shell, posted by Crazy Horse on September 12, 2006, at 9:34:41
I agree with Crazy Horse...you may want to raise your Klonopin levels. I started at .5 b.i.d., and have since been upped to 1mg t.i.d. over about a 2 month period. I function "normally" in that I'm not sedated or "zombified", although sometimes I can get by on 2mg of Klonopin. I also take Ativan .5 mg as needed, as well as Wellbutrin SR 100 mg b.i.d. The Wellbutrin is activating, but does not seem to incite panic attacks or the like, and does a wonderful job of controlling my depression.
Best of luck!!
Posted by UgottaHaveHope on September 12, 2006, at 16:05:53
In reply to Re: You might want to consider Seroquel » UgottaHaveHOPE, posted by linkadge on September 12, 2006, at 8:40:21
YES, GOOD CATCH LINK, I MEANT SEROQUEL INSTEAD OF KLONOPIN. THANKS!
> >Klonopin is an AP that is being prescribed in >much smaller doses for anxiety (300-25mg). It >feels like being shot with an elephant dart. It >makes you real groggy and wipes out anxiety. The >good thing is that you will know the first 2->3days whether or not it will work, unlike the >
> >SSRIs. Good luck, Michael
>
> Did you mean seroquel ?
>
>
> Linkadge
Posted by Jelly on September 12, 2006, at 16:33:27
In reply to Re: Please help me with medication ideas for ANXIE, posted by fca on September 11, 2006, at 20:46:20
> there is never enough information as to history and symptoms but here goes an alternative-The Wellbutrin is activating and may well increase anxiety. Are you on it to better manage the sexual side effects of effexor? Get off the Wellbutrin, wean yourself from the effexor while gradually switching to lexapro and stay on the klonopin at present levels with the option to occasionally increase it if you know there is a trigger for anxiety approaching. Also consider taking one .5mg a day rather than two .25mg, particularly if your anxiety is worse/better during certain times of the day. I do not know enought to comment about ADD. I second Phillipa's comments. Five years--whats the problem. Pragmatism should win out over theory and "what ifs".
The one .5 Klonopin a day is a good idea.
That's really what I've been doing. I hold out until about mid-morning and take it then. It seems to work better than the .25 mg twice a day...but by the end of the day, I'm pretty useless.Is Lexapro an SSRI? Does it have less incidence of sexual side effects? I've not heard much about it.
Posted by Jelly on September 12, 2006, at 16:36:53
In reply to Re: Please help me with medication ideas for ANXIETY!, posted by Talbot on September 12, 2006, at 10:05:19
I don't know about raising the Klonopin. I have no problems with it, but he tells me that long-term it is not a good solution because of the potential for addiction. I'm just so frustrated that there is medication out there that will help, but this fear of addiction (both with the Klonopin and the Concerta) seem to mean that they just aren't seriously considered.
Posted by Colleen D. on September 12, 2006, at 19:58:46
In reply to Please help me with medication ideas for ANXIETY!, posted by Shell on September 11, 2006, at 17:36:14
I am BACK on Effexor after a period on Lexapro. Effexor works well for me and I take 1.25mg of clonazepam with it daily. The sexual side effects are worth it for me because it works so well. When I was on Lexapro, I had NO sexual side effects. It may be worth a try along with your clonazepam.
Good luck!
Colleen
Posted by Galennt on September 17, 2006, at 20:02:53
In reply to Please help me with medication ideas for ANXIETY!, posted by Shell on September 11, 2006, at 17:36:14
Shell,
Your Effexor dose is very low. Was it helping? Because Effexor sexual side effects often moderate at a higher dose and over time.
Switching gears, the MAOs, especially Nardil, often help with anxiety.
gt
Posted by annesand on September 18, 2006, at 15:06:42
In reply to Re: Please help me with medication ideas for ANXIETY!, posted by Colleen D. on September 12, 2006, at 19:58:46
I've tried just about every SSRI there is, and had sexual side effects with all but Lexapro.
And for what it's worth, Wellbutrin made me incredibly anxious.
Good luck,
Anne
This is the end of the thread.
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.