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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 angier29 on November 18, 2010, at 19:53:00
I'll try to be succinct. My first problem (started 9 years ago) was insomnia and moderate-severe anxiety near sleep time. The first med I was prescribed was .5mg xanax before sleep. Worked well for a few months; doc then switched me to Remeron/Trazodone, I tolerated that change without a problem. Eventually a combination of Remeron/Effexor was agreed to and it got me through college (although effexor was useless and cutting every morning class for 4 years is what actually helped). After graduation I didn't work a lot, and my sleeping got worse. Doc was happy to add Ambien to the Remeron, in fact for a while he was allowing me 20mgs instead of the normal 10mgs. Ambien was awesome at first, now it's just something that I take 10-15mgs.
About 2 years ago, I started working part time at a community college. Working regularly, I wanted a safety net of anti-anxiety medications and my doc agreed to .5mg xanax bid. For the last year, I had a pretty good streak going. I was using about 30% of my rx'd xanax, 85% of my ambien and I was poised to land a nice full time gig at the college. Unfortunately, things didn't work out with the job and this triggered a bout of pretty severe anxiety/insomnia that I have not been able to get a handle on for the last 6 weeks.
I went to the doc and said I felt like I needed more xanax because I was having anxiety every waking hour and sleeping under 3 hours a night. His reaction was pretty extreme and negative. He said he hated Xanax, wants me back on effexor/zoloft whatever other SSRI that has NEVER helped my anxiety/insomnia, but that he's open to switching me over to klonopin.
So, these are my concerns. I know what to expect from xanax. I know that .5 calms me for 4-6 hours, 1mg gets the job done if I'm having moderate on the verge of servere anxiety, 1.5mg for emergencies and 2mg for defcon 1 anxiety (my current rx is 1mg a day, but i have about a 50 mg safety net). I fear that he will want to make a clean switch to the klon and underdose me with it. I also fear that the drug will be weaker and my anxiety will break through because I will no longer have a xanax backup option. However, I do think my main issue now is interdose/psychologically induced anxiety and klonopin sounds like a better option at the right dose. How do I approach this with my doc? He seems like a schizo about benzos; one month he's giving me 20mgs ambien, next he's having a fit about raising xanax to .5 tid. I really need to stabilize this situation because I obsess over every last detail of this thing.
Thanks for reading.
Posted by Phillipa on November 18, 2010, at 21:50:33
In reply to Potential switch from xanax to klonopin, worried, posted by angier29 on November 18, 2010, at 19:53:00
Sorry you are having so many problems. I too have always benefited from benzos 40 years on them now but seems the older I get the less I need. Klonopin for some can be depressing have you or he discussed valium. Was the only one out when I suffered first panic attack. It worked and was med free for quite a while. Til thyroid went. So I ask have you had your thyroid levels checked? Can can anxiety/depression. Good luck. Have you considered a second opinion? Phillipa
Posted by angier29 on November 19, 2010, at 22:24:50
In reply to Re: Potential switch from xanax to klonopin, worried » angier29, posted by Phillipa on November 18, 2010, at 21:50:33
> Sorry you are having so many problems. I too have always benefited from benzos 40 years on them now but seems the older I get the less I need. Klonopin for some can be depressing have you or he discussed valium. Was the only one out when I suffered first panic attack. It worked and was med free for quite a while. Til thyroid went. So I ask have you had your thyroid levels checked? Can can anxiety/depression. Good luck. Have you considered a second opinion? Phillipa
I've been physically fit/healthy for all of my life (29 now), so I don't want to indulge any borderline hypochondria about other causes; plus without insurance I don't really have the option of doing a lot of tests. Last full medical I had came back with a clean bill about 2 and a half years ago.
I'd get a second opinion about my meds if I knew how to find a psych who wasn't a benzo-phobe. I don't have anything that I would identify as depression - I just feel miserable when I'm anxious and haven't slept. If I've slept and don't feel anxiety then my mood is fine. At least, this has been the pattern for the last decade. It's just that this last event has triggered anxiety about my medications and I feel helpless because the doc is getting on his soapbox.
Again, I'd be happy to try klonopin or valium, but I fear I will psychologically undermine the drug if I perceive it as being less effective than the xanax and especially if I perceive my psych as being stingy with the dose. I can't imagine .5mg bid klonopin will be more therapeutic for me than .5mg bid xanax at this point.
Saying all this, if klonopin works and I can make a smooth transition, it's probably a better med for me because I don't have severe heart racing panic attacks (for which xanax would be best I guess); I'm currently having this restless miserable feeling and restless thoughts and anticipation anxiety about sleeping poorly that's lasting more or less all day except for 4-5 hours around 2pm when I take .5mg xanax.
Posted by Joe Schmoe on November 24, 2010, at 16:09:37
In reply to Re: Potential switch from xanax to klonopin, worried, posted by angier29 on November 19, 2010, at 22:24:50
I took xanax long ago when I was being weaned onto imipramine. It was a brutal experience due to how quickly and nastily it wore off. I always had to carry some in my pocket in case I needed to take some at work. I was afraid to ever be without it.
I have been on clonazepam for almost ten years now and it is a thousand times better. It builds up over days, I take it on a schedule, when I get up and before I go to bed, I don't feel it wear off.
Everyone is different but I think you will be much happier on klonopin than xanax. No more roller coaster rides of anxiety. Just don't confuse xanax withdrawals with a lack of efficacy of klonopin. Coming off xanax will produce its own anxiety symptoms that may make you think the clonazepam isn't working.
I don't know how the dosages compare but again klonopin has a long half life and builds up over 5 days to a plateau level so don't judge it on the first or second day like you would with xanax. And allow for the fact that your anxiety level may increase just from discontinuing xanax, temporarily.
Posted by Phillipa on November 24, 2010, at 20:01:28
In reply to Re: Potential switch from xanax to klonopin, worried, posted by Joe Schmoe on November 24, 2010, at 16:09:37
Sometimes it increases but I've usually been able to just switch benzos. But we are all so different. Also think it depends on the doseages of the meds. Phillipa
Posted by FluffMama on November 28, 2010, at 23:35:19
In reply to Potential switch from xanax to klonopin, worried, posted by angier29 on November 18, 2010, at 19:53:00
Here are my two cents worth. Tell your doctor that you realize this is NOT going to be part of your permanent treatment plan (bring a piece of paper with you that has a treatment plan you have typed out), but that you are unwilling to switch to alternative medications at this time since the switch will only add to your distress, and you need to go with what is familiar.
You need stability right now, you know what works, and I also like to remind myself and all of us that doctors work for US. OUR insurance writes their checks. Don't ask him/her for Xanax. TELL them what you are willing to do or not do. Most will back down if they see you have a plan, because they are uncomfortable prescribing Xanax long-term, but seeing that you do plan on switching to the drug they are recommending at a future date calms them down. Xanax is a nasty drug because of the rebound anxiety that occurs so quickly in response to leaving the body. Clonopin is a good med, but it does cause depression in some (myself included).
Posted by KathrynLex on December 2, 2010, at 16:03:14
In reply to Re: Potential switch from xanax to klonopin, worried, posted by angier29 on November 19, 2010, at 22:24:50
angier29, I don't know if you're following this thread anymore but if you are I want to wish you luck. Xanax is a wonderful medication and it worked wonders for me. I had an equal amount of success with Klonopin. Of course everyone is different but I felt that Klonopin did the trick, It works like Xanax but without the feeling of being heavily sedated.
This is the end of the thread.
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