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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 14 to 38 of 38. Go back in thread:
Posted by jealibeanz on March 17, 2007, at 13:56:28
In reply to Re: Xanax XR is horrible!, posted by bassman on March 17, 2007, at 13:31:19
> I couldn't agree more. Xanax IR works very well for me and XR just makes me fatigued and has none of the antidepressant effect I think the IR has for me. But it does SOUND like a great idea-take a short half-life drug and put in a time-release formulation...
Absolutely. Sounds wonderful. If you have a patient who responds well to Xanax IR, and needs daily coverage, Xanax XR seems like the perfect option.
This isn't reality, at least in my case. I'm guessing that most people who stick with Xanax XR never tried anything else, so they don't know what they're missing, and they haven't had a medication, which their body is accustomed to, pulled away.
I don't know that this info really gets out to docs. I wasn't successful with Concerta or Ritalin LA either. My doc just looks at me like I'm the oddest case he's ever seen, since the drug companies claim these meds are long-lasting. I seem to be one of the few who just don't metabolize them properly. Controlled release does not work for me, but at least those gave me the initial burst.
Xanax XR is soooo different from Xanax. I wish my doctor would try these meds for himself, and then see what I'm talking about... or just take me word seriously. If it were working well, I wouldn't be complaining!
I really don't think he's trying to wean me off Xanax. If he were, I'd think he'd have the respect to tell me so, so we'd be working toward a goal... not inducing panic attacks and non-stop anxiety.
I'm about to tell him I'm going off all meds, because I'm frustrated. That would really mess me up. The panic has only developed in the past year, since I've been on Xanax. Plus, take away Lunesta, Provigil, Ritalin LA, Clarinex... I don't think I'd be terribly functional.
Posted by Phillipa on March 17, 2007, at 19:24:07
In reply to Re: Xanax XR is horrible!, posted by jealibeanz on March 17, 2007, at 13:56:28
Jelly guess what the long acting is starting to work it is just more subtle I notice things in me that I wasn't doing before. And we will get our money back as it was basically promised as it's a new store and they need the PR as its in a ritzey district. I've accomplished things I couldn't have done before . I think this is the plan a stable dose will build up slowly more like an ad. And he did say if I need short acting in between I could have it so right now I'm happy and down to zero on the ad's and no more valium either. A smart doc in my opinion especially sinced my anxiety is constant not just burts of panic which I had before menopause. Love Phillipa
Posted by jealibeanz on March 18, 2007, at 6:23:39
In reply to Re: Xanax XR is horrible! » jealibeanz, posted by Phillipa on March 17, 2007, at 19:24:07
> Jelly guess what the long acting is starting to work it is just more subtle I notice things in me that I wasn't doing before. And we will get our money back as it was basically promised as it's a new store and they need the PR as its in a ritzey district. I've accomplished things I couldn't have done before . I think this is the plan a stable dose will build up slowly more like an ad. And he did say if I need short acting in between I could have it so right now I'm happy and down to zero on the ad's and no more valium either. A smart doc in my opinion especially sinced my anxiety is constant not just burts of panic which I had before menopause. Love Phillipa
Oh good for you... probably because hadn't previously been taking Xanax.
Posted by Phillipa on March 18, 2007, at 20:08:40
In reply to Re: Xanax XR is horrible!, posted by jealibeanz on March 18, 2007, at 6:23:39
Ive taken it before the short acting and the long acting is just different. Think about it this dose is made for preferably 24 hours but my pdoc says twice a day is best. So the med is much weaker as it is slowly released. 2mg might have to stretch to 24 hours or l2. So don't expect a burst of relaxation like the fast release xanax. Love Phillipa ps has never been addictive to me. I've always gone off and on it with ease if only to go to a different benzo. I stopped 20mg of valium to 2.5mg last night. No side effects as a matter of fact slept even better. Love Pillipa
Posted by jealibeanz on March 18, 2007, at 20:14:28
In reply to Re: Xanax XR is horrible! » jealibeanz, posted by Phillipa on March 18, 2007, at 20:08:40
Yeah, definitely not burst of medication.
I don't feel much therapeutic benefit at all though.
Posted by Phillipa on March 18, 2007, at 22:58:26
In reply to Re: Xanax XR is horrible!, posted by jealibeanz on March 18, 2007, at 20:14:28
Jelly what mg? Mine is 3 twice a day. Love Phillipa
Posted by jealibeanz on March 19, 2007, at 4:17:54
In reply to Re: Xanax XR is horrible! » jealibeanz, posted by Phillipa on March 18, 2007, at 22:58:26
I'm taking 3mg Xanax XR once a day.
So you take 6 mg total? Is this your first experience taking a daily benzo, without an AD?
I'm surprised you can handle this much. Are you really sedated? Were you taking Valium before this? I know you mentioned Luvox.
Posted by jealibeanz on March 19, 2007, at 4:27:36
In reply to Re: Xanax XR is horrible! » jealibeanz, posted by Phillipa on March 18, 2007, at 22:58:26
> Jelly what mg? Mine is 3 twice a day. Love Phillipa
That's much more than me. I don't really want my doctor to increase the dose if I call and tell him it's not helping. You can tell whether or not a drug will work. I like very little about this one.
He'd probably increase it to 2 x 2mg Xanax XR. This is why I am not requesting that it be increased. I'm stating that it does not make any difference in my anxiety, whether I take it or not.
I actually have taken 2 x 3mg Xanax XR. Did it help? Ehh... it made me sleep, which is partially what I was going for since I slept little the night before.
I've increased it another time while I was out all day. I can't say that I liked it. I was maybe a little drowsy and less anxious, but it's just not right for me. I think I would need 6mg a day for any real effect. That may freak my doctor out.
I'm going to make a poster for him that says Xanax does not equal Xanax XR!
I was fine at 4 mg Xanax. 4 mg Xanax XR is ineffective.
Posted by sukarno on March 19, 2007, at 14:30:16
In reply to Re: Xanax XR is horrible! » Phillipa, posted by jealibeanz on March 19, 2007, at 4:27:36
"I stopped 20mg of valium to 2.5mg last night. No side effects"
Valium has a very long half-life and tends to build up in the fat cells. Withdrawal might not be noticeable for 5 days after abrupt discontinuation. Then again, you are taking Xanax now so that should cover for it.
I just reduced my Valium from 17mg/day to 15mg/day (5mg TID) and was fine for 5 days and then woke up yesterday feeling hot and also in a cold sweat..my head felt like a TV camera. hehhehheh... no fun at all though. It wasn't major withdrawal, but I guess since I've been on Valium or other benzo equivalents for the past 16 years, my body is so used to it that any slight reduction results in some chaos a few days later.
I'll probably have to reduce by 0.5 to 1mg per month to be able to get off this stuff.
I wish I had Xanax XR where I live. In theory it should work well, but I can see how for some it might not be very good, since the level will never reach as high a point as immediate-release. However, immediate-release Xanax has been associated with interdose anxiety (anxiety between doses) because it is so short-acting. I used to get panic attacks between doses, especially at night. Night terrors were the worst part of it.
Posted by Phillipa on March 19, 2007, at 19:35:59
In reply to Re: Xanax XR is horrible!, posted by sukarno on March 19, 2007, at 14:30:16
Same here and believe it or not forgot to take lunesta 3mg with it last night and still had a nightmare so it isn't that med. I'm glad I forgot it what better way to find out? Don't get me wrong I still have anxiety but am doing more. I think the 30years of immediate benzos this long acting will take getting used to . Love Phillipa
Posted by Phillipa on March 19, 2007, at 20:05:11
In reply to Re: Xanax XR is horrible! » Phillipa, posted by jealibeanz on March 19, 2007, at 4:27:36
Jelly yes six and in the past I've been on much higher benzo doses. Valium, klonopin, chloral hydrate, short acting xanax, ativan. And no more luvox and as I said in another thread forgot the lunesta last night and slept fine. And I am not sedated at all. Love Phillipa ps I have always since day one had a high tolerance to benzos and low to antidepressants. This new pdoc says no ad's for me and that the thyroid is the culprit and getting in contact with the endo as I have some strange auto antibody that gives me Graves(high) and hasimotos( low) at the same time. Love Phillipa
Posted by jealibeanz on March 20, 2007, at 4:14:43
In reply to Re: Xanax XR is horrible! » jealibeanz, posted by Phillipa on March 19, 2007, at 20:05:11
I thought you mentioned both Hashimoto's and Grave's disease before. I just glanced over it, since that made no sense to me, I figured I was remembering them incorrectly.
Have you actually been diagnosed with both?
So, since they are both autoimmune diseases, Hashimoto's is when the thyroid destroys itself, Grave's causes the body to mimic hyperthyroism. It's like the tissue you have is hyper, but being eaten away by the Hashimoto's. Right?
Posted by Phillipa on March 20, 2007, at 10:10:28
In reply to Re: Xanax XR is horrible! » Phillipa, posted by jealibeanz on March 20, 2007, at 4:14:43
Yes the autoimmune hasimotos eats its own flesh as it sees it as an intruder the Graves is hyper usually they destroy Graves with radioactive isotobes. I am totally confused. Love Phillipa ps I have no idea how it's treated.
Posted by jealibeanz on March 20, 2007, at 10:25:34
In reply to Re: Xanax XR is horrible! » jealibeanz, posted by Phillipa on March 20, 2007, at 10:10:28
> Yes the autoimmune hasimotos eats its own flesh as it sees it as an intruder the Graves is hyper usually they destroy Graves with radioactive isotobes. I am totally confused. Love Phillipa ps I have no idea how it's treated.
I could be wrong, but I think just "regular hyperthyroid" is treated by a thyroidectomy. It may be the same with Hasimoto's. There are some drugs that can be tried (I have nooo clue what they are.), but I think they aren't very effective, and removing the thyroid is usually the best option.
You have a very unusual case. You need a verrrry good and experienced specialist. The typical endocrinologist is not going to know how to treat this. Make sure you get the best care possible.
Posted by Phillipa on March 20, 2007, at 19:29:49
In reply to Re: Xanax XR is horrible!, posted by jealibeanz on March 20, 2007, at 10:25:34
Jelly don't I ever know it. I am trying my hardest to get the best. Now when I see this new pdoc we will see if the endo made good on his word and contacted him. I do trust this new pdoc. Something about his calmness and always has time for you and the fact that the PHD recommended him for being good with meds. Oh let's not forget the lymes. I truly am complicated. Love Phillipa thanks for caring.
Posted by jealibeanz on March 23, 2007, at 13:11:10
In reply to Re: Xanax XR is horrible! » jealibeanz, posted by Phillipa on March 20, 2007, at 19:29:49
> Jelly don't I ever know it. I am trying my hardest to get the best. Now when I see this new pdoc we will see if the endo made good on his word and contacted him. I do trust this new pdoc. Something about his calmness and always has time for you and the fact that the PHD recommended him for being good with meds. Oh let's not forget the lymes. I truly am complicated. Love Phillipa thanks for caring.
Are you doing OK with the XR now? I still haven't spoken to my doctor about it.
I wonder what his reaction will be when I tell him it's not helping and I want to stop. I don't really want to increase the dose. You can get a feel for whether or not a drug will work. I don't have that feeling with Xanax XR. I think taking more would just making me into a sleepy zombie.
I hope he doesn't suggest Klonopin. I never liked it. It made me uncoordinated and groggy and dulled at even .25 mg. That was the first benzo he ever gave me. 1 mg b.i.d.!
Haha, I have noo idea why he gave me such a high starting dose. When I began Xanax I started at .25 mg t.i.d. Maybe I seemed much more anxious years ago... haha, well I was, at least when talking to him, because I didn't know him very well and was scared to death about talking about medications and anxiety.
I hope he doesn't just let me stop either. Even though I think the XR does nothing, it's probably better than no drug at all. I don't think I've tried a day without it. I don't think I want to. Haha, but that's basically what I'm proposing to him. Ohhh god... he may know me well enough to think that's not a wonderful idea at the moment. I'm not saying my anxiety went away, I'm just saying the XR isn't so great. If I'm on 3 mg XR and I have anxiety, I'd definitely be a nut unmedicated.
Posted by Phillipa on March 23, 2007, at 20:08:47
In reply to Re: Xanax XR is horrible!, posted by jealibeanz on March 23, 2007, at 13:11:10
Jelly saw him yesterday he took me off the xanax long acting and instead gave me 2mg of ativen four times a day. I had two pills left of the long acting so first dose of ativan will be bedtime tonight Wish me luck cause as you I started years ago on .25 of xanax regular four times a day. By all rights I should be a walking zombie on this with the lunesta. And he said the dizzyness and nightmares were probably from the discontinuing of the ad. And then the endo still hadn't contacted him he firmly believes my problem is physical since the thyroid started this merry-go-round so sent to a friend internist across the street appointment next Friday and the internist is part of the big practice of all specialties this Mecklenburgmedicalgroup.com so he should be able to get in touch with him. He is in a different location. You can google this by adding the www. Love Phllipa
Posted by jealibeanz on March 24, 2007, at 5:01:07
In reply to Re: Xanax XR is horrible! » jealibeanz, posted by Phillipa on March 23, 2007, at 20:08:47
> Jelly saw him yesterday he took me off the xanax long acting and instead gave me 2mg of ativen four times a day. I had two pills left of the long acting so first dose of ativan will be bedtime tonight Wish me luck cause as you I started years ago on .25 of xanax regular four times a day. By all rights I should be a walking zombie on this with the lunesta. And he said the dizzyness and nightmares were probably from the discontinuing of the ad. And then the endo still hadn't contacted him he firmly believes my problem is physical since the thyroid started this merry-go-round so sent to a friend internist across the street appointment next Friday and the internist is part of the big practice of all specialties this Mecklenburgmedicalgroup.com so he should be able to get in touch with him. He is in a different location. You can google this by adding the www. Love Phllipa
It's good that your pdoc sent you to another specialist. You need someone who is accountable and can be reached.What was the reason for taking you off Xanax XR? I thought you were doing well with it. Did this change?
Why the change to Ativan? Have you been on it before?
Do you think the Xanax XR made you tired or groggy? I'm pretty sure it's doing that to me, much more so than regular Xanax. I just want to take naps all the time. I didn't need to before. If I had the time, I could take an afternoon nap, and be fine the rest of the day. But with the XR, I'm just very groggy and slow. (I shouldn't be tired with the 400 mg Provigil and 60 mg Ritalin LA.)
It almost does feel a bit like Klonopin, which made me uncoordinated, sleepy, cloudy, depressed. The XR does not have the antidepressant effects that regular does. It may be depressing, I'm not sure, but that's how Klonopin was... your mood just slowly sinks, and you don't always attribute the decline to the medication.
Ughh... I want off of this drug and back on to something that works. I don't know what my doc's intentions were. Maybe he's trying to ween me off benzos. Is that common to switch someone on to a longer-acting med to get off? I would have thought he'd tell me of this plan, but maybe he didn't purposely, as to not upset me, and let things play out.
Or, I might just be reading in to this too much. That's easy to do when you not happy with the situation. My doctor isn't a person who tries to mess with you just to have power or control. He's not a secretive person. I know he's just trying to help, but I don't know if that's coming in the form of him believing I should try to stop Xanax, or that he really thought that I'd like Xanax XR because of it's consistency.
I'm not liking this at all.
Posted by Honore on March 24, 2007, at 12:39:29
In reply to Re: Xanax XR is horrible! » Phillipa, posted by jealibeanz on March 24, 2007, at 5:01:07
Thought you might be interested in this, jealibeanz. Probably you think it doesn't apply to you, but it could explain why the xanax XR doesn't help right now.
Also why the XR might be better for you, in the long run, if you stick with it and your brain adapt to a different rhythm of release, possibly by making more GABA itself.
It's admirable that you're sticking with it this long, given how difficult it's been. But you may experience a change in your adjustment to it soon; I hope so.
That might help in general.:
This is from a pdoc's blog on blogspot. I'll look for the url.
"This is in response to JW's question below about the "rules" docs use about prescribing Xanax/alprazolam. Not all docs feel this way, but here's how I think about it. Of course, I am not suggesting that, if you are taking this anti-anxiety drug, you should stop it. I'M NOT. Talk to your doctor if you have concerns.
The half-life for Xanax is short... on the order of 6-20 hours. Halcion is the only similar sedative that has a shorter half-life (and that one has even more problems). Thus, it doesn't stick around long. It is also quite lipophilic, meaning that it quickly gets into the brain. So, it has a quick on, quick off way of working. Sounds great, right?
The quicker a drug works, especially one which makes you feel good in some way, the more addicting it is, as the cause (taking it) and effect (feeling it) are close in time, making it very reinforcing. This is fine if you just take it on those rare anxious moments where you need something to get through it. However, since it works so quickly, many folks start taking it more and more often, until it gets to the point that they are taking it daily. Then they start taking it as soon as they feel it wear off. Before you know it, you are taking it 3-4 times per day. Now, that's not the big problem.
The big problem is all because of your brain's laziness. See, your brain makes it's own natural Xanax-like substance, called GABA. GABA works by inhibiting the brain's natural tendency to speed up. It's like a brake pedal, where the accelerator is stuck in the pedal-to-the-metal mode. GABA keeps your brain from over-working. Xanax (and other sedatives, and alcohol) works by acting like GABA in the brain (sort of). If you start taking it daily, your brain starts thinking "I guess I don't need to make so much GABA because this Xanax stuff is here, so I'll only make 20% of what I usually make." It takes a week or more for your brain to stop making the GABA (which is why just a few days on Xanax won't lead to much trouble), and a week or more for it to start making it again when you stop taking the Xanax.
Here's where the trouble begins. If Xanax wears off in just a few hours, but it takes a week for your brain's natural Xanax to kick back in, what happens in the interim? Withdrawal. What does that feel like? It feels like a panic attack, but worse. High blood pressure, rapid heart beat, tremors, confusion, delirium, hallucinations, seizures. What do folks do when they feel a panic attack coming on? Take another Xanax."
Honore
Posted by jealibeanz on March 24, 2007, at 13:36:20
In reply to Re: Xanax XR is horrible!, posted by Honore on March 24, 2007, at 12:39:29
Thanks for the article. It definitely makes me think a little about my situation.
I don't deny that I "like" the feeling of Xanax. It does provide anxiety relief, which I'm in need of with my GAD. I don't feel euphoric. Not at all. Just brings me to what I consider normal and gives me some help, which allows me to live a higher quality life.
I didn't start taking it for panic, it's for constent GAD, so I've always taken it 3-4 times a day. I never had that "more, more, more" feeling, because I was used to taking it every few hours and always stuck to taking it as prescribed. I agree that it is good for a situation with very high anxiety and you want fairly immediate relief. So it helps, but I see where the worry about that agument for a learned helplessness comes in.
From the article, it seems that the only benefit from Xanax XR, rather than Xanax IR, is that you get away from feeling like you "need" the medication when anxiety sets is. Ideally, you'd take the XR in the AM and be covered for the day.
I don't think there would be any benefit from the XR in terms of GABA production by the brain, but I'm not sure.
So, I'm stuck with the dilemma that so many benzo users have to face. Do you take a medication that relieves anxiety, with the risk that you will have a difficult time discontinuing the med? Or do you live a crippled life with anxiety?
It's a tough decision. It's not completely mine, obviously, since I'm not the one with the DEA license and prescription pad.
I'd have anxiety if I never took the medication. I'd have anxiety if I took it and then went off. This isn't something that I think will go away.
Too bad nobody thinks of SSRI's in this same fashion. It's not looked down upon in the medical world for someone to stay on an SSRI indefinitely for GAD, since stopping the med would mean that anxiety would return. SSRI's can cause the brain to produce fewer neurotransmitters after extended use, just like benzo's.
I don't know what to think or do right now. Feel bad about taking medication? Suck it up and keep taking one that doesn't help me? Ask for regular Xanax? Be "strong" and go med-free?
I've got to say, this isn't a fun disorder. Most other medical conditions are just treated. You don't question it. Just treat it properly to relieve symptoms or to help rid of pathology. Anxiety meds only treat symptoms, so I suppose this is why they are looked upon as the easy way out.
I don't mean for this post to be negative. Just me thinking out loud and being torn between options.
Posted by Phillipa on March 24, 2007, at 19:24:09
In reply to Re: Xanax XR is horrible! » Phillipa, posted by jealibeanz on March 24, 2007, at 5:01:07
Jelly he switched me as it is very expensive and he wanted to save me money. He said he even might go back to the valium. And yes I've taken ativan before. Last night I doubled the night time dose and then took less during the day. No it doesn't make me groggy. Hey after 30years it's part of of life forever. I am doing the CBT and want to work again. I've weaned almost off it before so can do it again. When the time is right. As he still thinks it's my thyroid. Love Phillipa
Posted by jealibeanz on March 25, 2007, at 3:17:31
In reply to Re: Xanax XR is horrible! » jealibeanz, posted by Phillipa on March 24, 2007, at 19:24:09
> Jelly he switched me as it is very expensive and he wanted to save me money. He said he even might go back to the valium. And yes I've taken ativan before. Last night I doubled the night time dose and then took less during the day. No it doesn't make me groggy. Hey after 30years it's part of of life forever. I am doing the CBT and want to work again. I've weaned almost off it before so can do it again. When the time is right. As he still thinks it's my thyroid. Love Phillipa
Well switched because of cost makes sense. It's very expensive without insurance. The only reason I can afford to use brand name drugs is because I have wonderful health insurance and prescription coverage ($3 = generic, $5 = brand). I wonder why he thought to put you on such an expensive med in the first place if cost is an issue.I'm glad you found something that works.
You shouldn't be so worried about your thyroid. Leave that up to your doctors. You can't treat it yourself.
That being said, that doesn't mean that you don't have anxiety. You still do, even if you thyroid is the sole or partial cause. A lot of people with depression or anxiety have other health problems the cause or add to mental illness. It's not abnormal.
Posted by jealibeanz on March 25, 2007, at 4:18:14
In reply to Re: Xanax XR is horrible! » jealibeanz, posted by Phillipa on March 24, 2007, at 19:24:09
I was thinking about possible solutions to my medication problems. I wonder if anyone ever takes both Xanax XR and Xanax daily. Although I don't feel like Xanax XR does anything for me, it probably does. Maybe I could take 1-2 mg Xanax XR daily plus 2-3mg Xanax daily. That way, I have a stable baseline, with the addition of a medication that I believe helps with my anixety.
Of course I will not ask for that. I'm trying to be a good patient and not freak out my doctor by asking for controlled medications.
Posted by Phillipa on March 25, 2007, at 18:48:25
In reply to Re: Xanax XR is horrible!, posted by jealibeanz on March 25, 2007, at 4:18:14
Jelly this pdoc was going to do that until the cost thing came up. See I have medicaire and none of their plans cover benzos. So it's not uncommon to take both. And no the only thing the benzos are doing is letting me sleep. Better than nothing I guess. And I have to keep on the docs as the endo has yet to contact my pdoc who is very angry about it. So another reason to see the internist he likes and knows across the street. Love Phillipa
Posted by jealibeanz on March 25, 2007, at 19:13:43
In reply to Re: Xanax XR is horrible! » jealibeanz, posted by Phillipa on March 25, 2007, at 18:48:25
> Jelly this pdoc was going to do that until the cost thing came up. See I have medicaire and none of their plans cover benzos. So it's not uncommon to take both. And no the only thing the benzos are doing is letting me sleep. Better than nothing I guess. And I have to keep on the docs as the endo has yet to contact my pdoc who is very angry about it. So another reason to see the internist he likes and knows across the street. Love Phillipa
Oh yes, I do remember you saying that he'd be willing to give you a script for Xanax IR on top of the XR if it wasn't enough. It seems like a logical thing to try.
This is the end of the thread.
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