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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 39. This is the beginning of the thread.
Posted by floatingbridge on July 18, 2011, at 9:34:00
I am experiencing a severe withdrawal from xanax. I was originally instructed to substitute with Valium, but I suspect underdosed. A three week taper didn't work :-/ though I tried it. Because I had/have been withdrawing from emsam, I haven't been able to tell what was what. I was tapering off from what had become a xanax 1.5-2.0mg daily total.
It's been a few weeks. I've become treatment avoidant and agoraphobic. When I look online, seems the sane thing to do is to taper more slowly on Valium or klonopin. I hate to restart a benzo, but it's been hellish and I think harmful.
I have read about tofranil as being helpful. Gabapentinin, too. Most other medical ammendments seem potentially
aggravating.Does anyone here have experience stabilizing this type of withdrawal
process?
Posted by Christ_empowered on July 18, 2011, at 10:04:32
In reply to ammending severe xanax withdrawal, posted by floatingbridge on July 18, 2011, at 9:34:00
This is a tough one. I would say get some Klonopin or Valium in and equivalent dose, but it seems like your prescriber(s) are under dosing you. Taurine and niacinamide, in addition to whatever dose of a longer-acting BZD you can get, would seem reasonable. Gabapentin and Depakote might help (I'd definitely take the gabapentin over the depakote).
There's a Xanax XR, but I don't know if that's used for these sorts of situations.
Sorry about your situation.
Posted by Phillipa on July 18, 2011, at 11:21:16
In reply to Re: ammending severe xanax withdrawal, posted by Christ_empowered on July 18, 2011, at 10:04:32
FB since you posted valium depressed you I'd go with the xanax and taper that. Just my opinion. Yes I know that valium is used in tapers. So the anxiety came back? Love Phillipa
Posted by jms600 on July 18, 2011, at 11:30:17
In reply to ammending severe xanax withdrawal, posted by floatingbridge on July 18, 2011, at 9:34:00
If you choose to go with a benzo and taper it, you're better off with Klonopin or Valium rather than Xanax or Ativan. Klonopin and Valium are long acting benzos and therefore theoretically easier to withdraw from.
Posted by floatingbridge on July 18, 2011, at 12:08:15
In reply to Re: ammending severe xanax withdrawal, posted by jms600 on July 18, 2011, at 11:30:17
Would it make symptoms like stuttering remit? I am concerned. I have never stuttered before.
Posted by sigismund on July 18, 2011, at 15:23:10
In reply to Re: ammending severe xanax withdrawal, posted by jms600 on July 18, 2011, at 11:30:17
A three week taper is unachievable. Take my experience. Around Easter I halved my Valium dose to 7.5mg/d and I haven't made any sustained progress since then.
Probably there is something to be said for the long action of Valium. It's not easier though, just smoother.
Gabapentin might help with sleep in small doses, but I worried about what I was letting myself in for.
Posted by Roslynn on July 18, 2011, at 16:18:30
In reply to ammending severe xanax withdrawal, posted by floatingbridge on July 18, 2011, at 9:34:00
Hi FB,
I'm sorry you are going through this..I wish I had some sort of solution for you.
Roslynn
Posted by zonked on July 18, 2011, at 18:50:52
In reply to ammending severe xanax withdrawal, posted by floatingbridge on July 18, 2011, at 9:34:00
Hi you, I suspect you're familiar with the ashton manual, if not, google it. I successfully tapered off Klonopin years ago using Valium substitution. If you decide to go off benzos, it's a good reference. I think yes, you may have underdosed, and you might want to restart the Valium and go slower. If not, why stop the benzos now if they're helping you? A slow, gradual taper is best if you really want off them. I wish you luck as always.
Posted by jono_in_adelaide on July 18, 2011, at 19:46:22
In reply to ammending severe xanax withdrawal, posted by floatingbridge on July 18, 2011, at 9:34:00
Start on Valium 15mg at bedtime for a week or two, till you feel stable then reduce by 2.5mg each week over 6 weeks.
Posted by jono_in_adelaide on July 18, 2011, at 19:52:44
In reply to Re: ammending severe xanax withdrawal, posted by jono_in_adelaide on July 18, 2011, at 19:46:22
You could also ask your doc for some hydroxyzine (atarax) to help with the anxiety, say 50mg three times a day.... mildly helpful, and non habit forming
Posted by Phillipa on July 18, 2011, at 20:17:58
In reply to Re: ammending severe xanax withdrawal » floatingbridge, posted by zonked on July 18, 2011, at 18:50:52
No idea what the stuttering is? I've not heard of this. I still say stay on the benzos as they were working. Love Phillipa
Posted by floatingbridge on July 18, 2011, at 21:35:52
In reply to ammending severe xanax withdrawal, posted by floatingbridge on July 18, 2011, at 9:34:00
Thanks for the practical advice. Anxiety was breaking through the Xanax. Last year I had trimmed it back to almost 0.25mg per day. So the escalation has been steady :-/
I guess I would take Valium and just slowly work down. I don't know. I don't get to write scripts. Not sure gabapentin would be okay after all because of a bad reaction to Lyrica.
I see a new shrink tomorrow. Just want to cover my bases. I have no idea what might get trotted out....
Thanks.
Posted by Phillipa on July 18, 2011, at 22:31:09
In reply to Re: ammending severe xanax withdrawal, posted by floatingbridge on July 18, 2011, at 21:35:52
FB you do? Hey finally!!!! Relief may be in sight!!! Phillipa
Posted by morgan miller on July 19, 2011, at 0:08:12
In reply to Re: ammending severe xanax withdrawal, posted by floatingbridge on July 18, 2011, at 21:35:52
FB, you may want to mention depakote to your psychiatrist.
You also might want to consider getting some supplements if you have the money-New Chapter Holy Basil supercritical softgels, Magnesium Gycinate, lithium orotate, melatonin, Taurine, GABA, Tryptophan, Valerian Root, and Lemon Balm. This is an arsenal that could help in you in during the withdrawal process.
So sorry you're going through this sh*t. Hang in there.
Morgan
Posted by jedi on July 19, 2011, at 1:00:31
In reply to Re: ammending severe xanax withdrawal, posted by floatingbridge on July 18, 2011, at 21:35:52
Good Luck FB,
I would be really careful about stopping the Xanax at the same time you are coming off Emsam. I just raised my clonazepam back up to 1mg from .5mg because of anxiety from a, hopefully short term, financial crisis. I'll take it back down to ZERO soon, but now is not the time for me. My guess would be the stuttering is more likely be related to the selegiline than the Xanax. Stuttering is thought to be related, at least in part, to dopamine hyperactivity in the brain. (http://www.ncbi.nlm.nih.gov/pubmed/15212606)
Good Luck and be Well - Things will be better soon,
Jedi
> Thanks for the practical advice. Anxiety was breaking through the Xanax. Last year I had trimmed it back to almost 0.25mg per day. So the escalation has been steady :-/
>
> I guess I would take Valium and just slowly work down. I don't know. I don't get to write scripts. Not sure gabapentin would be okay after all because of a bad reaction to Lyrica.
>
> I see a new shrink tomorrow. Just want to cover my bases. I have no idea what might get trotted out....
>
> Thanks.
Posted by floatingbridge on July 19, 2011, at 7:15:47
In reply to Re: ammending severe xanax withdrawal » floatingbridge, posted by jedi on July 19, 2011, at 1:00:31
Jedi, thanks. I had no idea. The stuttering came on with a panic attack and stayed. I assumed Xanax. Jeez. Two potential agents. This was not my idea at all. I would never have discontinued either, frankly, especially abruptly and simultaneously.
>Good Luck FB,
> I would be really careful about stopping the Xanax at the same time you are coming off Emsam. I just raised my clonazepam back up to 1mg from .5mg because of anxiety from a, hopefully short term, financial crisis. I'll take it back down to ZERO soon, but now is not the time for me. My guess would be the stuttering is more likely be related to the selegiline than the Xanax. Stuttering is thought to be related, at least in part, to dopamine hyperactivity in the brain. (http://www.ncbi.nlm.nih.gov/pubmed/15212606)
> Good Luck and be Well - Things will be better soon,
> Jedi
>
>
> > Thanks for the practical advice. Anxiety was breaking through the Xanax. Last year I had trimmed it back to almost 0.25mg per day. So the escalation has been steady :-/
> >
> > I guess I would take Valium and just slowly work down. I don't know. I don't get to write scripts. Not sure gabapentin would be okay after all because of a bad reaction to Lyrica.
> >
> > I see a new shrink tomorrow. Just want to cover my bases. I have no idea what might get trotted out....
> >
> > Thanks.
>
>
Posted by deepreason on July 19, 2011, at 17:45:31
In reply to Re: ammending severe xanax withdrawal, posted by floatingbridge on July 19, 2011, at 7:15:47
Bump your xanax back up to full dose just for 3 days. If the stuttering and other effects vanish then you know you've tapered too quick and you're in withdrawal. ie. time to slow it down.
I f there is no improvement then go back to where you were with the benzo's and suspect the emsam.
Posted by floatingbridge on July 19, 2011, at 18:27:03
In reply to ammending severe xanax withdrawal, posted by floatingbridge on July 18, 2011, at 9:34:00
It's Xanax xr. I needed to promise I would take it 2x daily whether I felt I needed it or not and maintain a steady, slightly increased dose. I had, apparently, been under-medicated.
It was acknowledged that once benzodiazepine is introduced into treatment, it's difficult to return to a medically naive state. It's not a perfect world, and I was advised to stop fighting medication--that to reap any benefits, I needed to accept treatment. He also seemed to understand those benzodiazepine conversion tables.
Interestingly, he said proper Valium tapers were not the norm because (speculation) because Valium was misunderstood and had bad press.
He also said Luvox might have been more helpful to me in
my snri/ssri treatment course. He observed it was unique among the category but seemed to have gotten marginalized (possibly due to a simultaneous appearance of zoloft). No one had ever mentioned Luvox to me. My first
pharmaceutical treatment was zoloft.It's Emsam again. He's willing to bump my dose into upper
ranges if need be. And keep me sleeping.Thanks for the support and practical advice!
Posted by Phillipa on July 19, 2011, at 19:50:57
In reply to Re: ammending severe xanax withdrawal, posted by floatingbridge on July 19, 2011, at 18:27:03
FB You are just like me in underdosing. Fear of addiction. Sounds like a winner this time finally. Interested in his luvox also. Congrats Phillipa
Posted by floatingbridge on July 19, 2011, at 20:37:11
In reply to Re: ammending severe xanax withdrawal, posted by deepreason on July 19, 2011, at 17:45:31
Thanks for thinking about this. I will watch this, and if observe anything, I'll contact this doctor. It was not good to stop two meds at once. This doctor has concerns (as do I) about starting two meds at once as well. It is tough to be in crisis and be observant. Thanks for your observation.
> Bump your xanax back up to full dose just for 3 days. If the stuttering and other effects vanish then you know you've tapered too quick and you're in withdrawal. ie. time to slow it down.
>
> I f there is no improvement then go back to where you were with the benzo's and suspect the emsam.
Posted by Phillipa on July 19, 2011, at 21:40:54
In reply to Re: ammending severe xanax withdrawal » deepreason, posted by floatingbridge on July 19, 2011, at 20:37:11
In a way to me it's not like starting two meds at same time as took them both together before. Restarting to me Love Phillipa
Posted by morgan miller on July 19, 2011, at 23:30:54
In reply to Re: ammending severe xanax withdrawal, posted by floatingbridge on July 19, 2011, at 18:27:03
One reason why Luvox did not do as well as Zoloft is simply because it did not fit as many people's needs as Zoloft did. It also appears to usually have a worse side effect profile, of course this does not apply to everyone. Luvox is not typically a "feel good" drug, but it can be extremely effective in treating OCD and certain types of anxiety. It is now believed that Luvox may actually be more of a sigma 1 agonist than an SSRI, which would explain it's effectiveness in OCD and psychotic disorders.
Luvox might be a good idea. If you try it, I really hope it gives you a good amount of relief.
Posted by hyperfocus on July 20, 2011, at 0:28:28
In reply to ammending severe xanax withdrawal, posted by floatingbridge on July 18, 2011, at 9:34:00
I'm pretty sure the stuttering is the Xanax withdrawal. Years ago when I ran out of Ativan for a few days, I developed this spasm on the right side of my mouth. My speech was uncontrollably slurred, all I could do was lay down, and I'll never forget my aunt looking at me like I was a crack addict.
The truth is no matter how you do it, withdrawing from benzos is hard-going. It's a full-time thing: you shouldn't be withdrawing from another drug at the same time. It took me several months to withdraw completely from an average dose of Klonopin I was on for a few years. Three weeks is way WAY too fast for 2mg of Xanax.
My strategy is stay on the same agent but just reduce by the absolutely smallest increment. Take a .25mg and cut it into halves. So you'd be decreasing in .125mg increments - starting from 2mg would be 1.875mg, 1.75mg, and so on. Then you have to figure out how much time your body needs to adjust to the lower dose. If after a week you're ok, go to to the next increment. At this rate it will take you a month to go from 2mg to 1.5mg. To me this is like the absolute fastest you can taper - your body will probably need more time. The slower you go the better your chances of minimizing rebound anxiety and having to restart the taper, which is what you have to do now.
I think it's a good idea to restart the EMSAM - I feel like if you responded to the EMSAM you should try to find an agent that combats the insomnia. But one thing at a time. Is there any particular reason you have to come off the Xanax now?
Hang in there fb, you're not alone in this. I and pretty much everybody here has walked the same path you're walking - and we survived. You will too. Never doubt human resiliency.
Posted by floatingbridge on July 20, 2011, at 10:58:57
In reply to Re: ammending severe xanax withdrawal » floatingbridge, posted by hyperfocus on July 20, 2011, at 0:28:28
The short version is I had a private gp who decided I was addicted and had 'dependency' issues. Since I have fibromyalgia, I am very chemically sensitive. This doctor is very new in her AA recovery and runs the big detox center in my area. (She had overcome her own addictions to her own scripts a few years back.). Once she said 'dependent' that was it. My pdoc/ therapist stopped listening to me. I was given 10mg Valium nightly to withdraw from 1.5mg Xanax of about 10years use (much of that decade at lower Xanax levels). I tried to follow her three week taper on just this
Valium. It was a terrible struggle. I tried to tell the gp and my pdoc that I underdosed and going too fast. This was percieved as drug seeking. I stopped the Emsam, too, because neither one would support my sleep during the Emsam trial. My pdoc 'let' me do this. Then came very bad
therapy of the you need to look at your sh*t kind (I do have PTSD and they knew that.). Any request of even an AD even
amitiptlyne became a sign of my pathology. This was so
nightmarish. I was taken to a dual diagnosis recovery house
were they said I didn't belong because I wasn't an addict. They said I was withdrawing.Both these doctors are gone now. My husband fired them,
because when I had tried a few times to fire my pdoc/therapist that he would say that was pathological. It
wasn't until he became incoherent and yelling at my husband that my husband got the full extent of the situation. This same pdoc refused (!) to refer me to another pdoc. Yes. I know this sounds crazy. PTSD symptoms became
prominent in a new way. This might be TMI, but for a person with social phobia and PTSD, I just hid in my house twitching and stuttering. I wouldn't stutter with my child. Just normal with him. Thank goodness. What I now recognize as acute withdrawal was terrible. I was screaming at times and writhing. When my husband called the AA gp, she more or
less said, see, I told you she had dependency issuses. Take her to the ER.Well, my husband who knows me and finally did his crash course in pharmacology is on board now, went to the new shrink, and supported restarting everything for me.
I am improving. I usually wake up at 4:00 and today slept until 7:30. Had sleep paralysis last night at 11:00pm, panicked, wanted to dump the Xanax, but my husband talked me down. Guess it's still possible to panic on xanax. I am just following this new doctor's advice to the letter right now. He wants me stable. If I decide to withdraw or reduce, he demonstrated that he knows how to do this without provoking massive withdrawal. He isn't afraid of medication like my last few doctors and interprets my struggles not as drug seeking
behavior but as a patient trying to deal with her symptoms.I don't know what to say. He was a quick study, had my very
professionally lucid Stanford assessment, and pegged me as someone how struggles with the idea of being on medication and who continually under doses and minimizes my psychiatric medicine use. Hence the instructions to take Xanax xr whether I thought necessary or not. Otherwise, there is not stability.This actually iis a long answer :-/ but a few asked why I was tapering. It wasn't my idea, but I thought why not, until it became clear it was against every wise thing I knew about tapers. I mean, who wants to be on meds?-- that is, until they are actually taken away. Believe me, if someone is labelled an addict and dependent, forget about having any voice in anything. People just stop listening. I temporarily lost my rights as a human being. If this is what happens to
the 10% of the population who may be truly struggling with addiction (as in craving a substance) I know why they might evade treatment. Chances are they are treated without compassion and have their rights taken away. God bless them. Sincerely, I will never look at life the same way again. I would never treat people like how I came to be treated for a while. It shoots any compliance they desire and any chance
to become healther and to heal.
I am feeling a little dopey this morning, but physically less startled. So far, just tiny moments of stuttering. HP, thanks., And Jedi, too. I thought stuttering and other symptoms might indicate irrevisible brain damage :-/> I'm pretty sure the stuttering is the Xanax withdrawal. Years ago when I ran out of Ativan for a few days, I developed this spasm on the right side of my mouth. My speech was uncontrollably slurred, all I could do was lay down, and I'll never forget my aunt looking at me like I was a crack addict.
>
> The truth is no matter how you do it, withdrawing from benzos is hard-going. It's a full-time thing: you shouldn't be withdrawing from another drug at the same time. It took me several months to withdraw completely from an average dose of Klonopin I was on for a few years. Three weeks is way WAY too fast for 2mg of Xanax.
>
> My strategy is stay on the same agent but just reduce by the absolutely smallest increment. Take a .25mg and cut it into halves. So you'd be decreasing in .125mg increments - starting from 2mg would be 1.875mg, 1.75mg, and so on. Then you have to figure out how much time your body needs to adjust to the lower dose. If after a week you're ok, go to to the next increment. At this rate it will take you a month to go from 2mg to 1.5mg. To me this is like the absolute fastest you can taper - your body will probably need more time. The slower you go the better your chances of minimizing rebound anxiety and having to restart the taper, which is what you have to do now.
>
> I think it's a good idea to restart the EMSAM - I feel like if you responded to the EMSAM you should try to find an agent that combats the insomnia. But one thing at a time. Is there any particular reason you have to come off the Xanax now?
>
> Hang in there fb, you're not alone in this. I and pretty much everybody here has walked the same path you're walking - and we survived. You will too. Never doubt human resiliency.
Posted by jedi on July 20, 2011, at 12:54:56
In reply to Why I came off Xanax :-/ » hyperfocus, posted by floatingbridge on July 20, 2011, at 10:58:57
FB,
Sounds like your new PDOC is a winner. That can sure make all the difference. And having your husband on board to support you through this has to be a huge relief. When we are in such pain that the smallest decision is monumental, help from others can make all the difference. I'm so sorry you went through this with your previous doctors. It seems like a common theme in this field of work. I had a PDOC that treated me for 9 months once. I went to him seeking an alternative to Nardil, because of the side effects. After many, many unsuccessful med trials; he absolutely refused to put me back on Nardil. It was the only medication that had worked out of 45+ trials. He would have let me die before restarting Nardil. I finally had to use my one month emergency stash and get stable enough to find a MD to prescribe the MAOI. I don't think I would be here today, if I hadn't taken that action. I found the MD who would prescribe Nardil for me, and have been pretty much stable on it for eight years. I live with some side effects, but I live!Good luck to you FB, you are on the right path. A lot of people care.
Jedi
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