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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 Caleb462 on January 7, 2003, at 0:31:25
I have serious anxiety problems, and have since a child. For the past year or so, I've been undergoing treatment for OCD and most recently, severe depression, general anxiety, self-harm, and a host of personal problems.
Anyway... I'm currently taking 150 mg Effexor XR a day... and Risperdal 0.25 mg (sometimes once a day, sometimes twice). My anxiety problems have not gotten better, in fact, they've recently been worse.
I realize the Risperdal is not a very large dose. But frankly, I'm not that keen on treating my anxiety with an anti-psychotic. I think that maybe Klonopin, Xanax, Ativan, or another benzo might be a good choice for me. But I'm horrible at bringing things like this up to my doctor, especially since he knows of my recent history of drug abuse (very mild abuse however, and in my opinion... just use, not abuse). I simply can't come up with the words.
Also... will drowsiness be a problem? If so, will it be temporary? Sedation is one side effect I can't tolerate.
Posted by viridis on January 7, 2003, at 2:31:42
In reply to Should I ask my doc to prescribe a benzo?, posted by Caleb462 on January 7, 2003, at 0:31:25
If you have a long history of anxiety, then a benzo seems like a very reasonable approach, and certainly much safer than antipsychotics (and possibly ADs). I doubt some casual drug use would be enough to prevent prescription, but it all depends on the doctor -- some will avoid benzos at all costs, whether you've ever used illegal drugs at all, while others are much more reasonable.
One thing my psychiatrist mentioned is that people who ask for Xanax are often perceived as "drug seekers". This benzo in particular has a reputation (although probably largely undeserved) for abuse liability. It also has a short half-life, which means that it generally requires fairly frequent dosing to maintain a steady antianxiety effect (and this does, at least theoretically, increase the chances of dose escalation etc.). It does work very well though.
I'm a big fan of Klonopin (clonazepam). It works very well for my anxiety, lasts a long time, has worked consistently for me at the same dose for quite a long time, and seems to be viewed as safer than most of the other benzos by many doctors. You might try an approach like "The prescriptions I've tried aren't working...I've heard that this drug called clonazepam can be very useful for anxiety, and it sounds like it could work for me". This is honest without suggesting that you're just looking for benzos in general, and by proposing one that's generally perceived as unlikely to be abused you might (if you have a sensible doctor) be able to get a prescription. If not, I'd seriously consider another doctor, ideally a psychiatrist experienced with anxiety disorders (I'm not sure what kind of doctor you're seeing, but I think that GPs are less likely than psychiatrists to prescribe benzos, especially for long-term use).
All of the benzos can cause fatigue, and Klonopin does have a reputation for inducing depression in some people. But if you're like me and the depression is mainly the result of anxiety, I doubt this will be a problem. I had some side effects (drowsiness and clumsiness, mainly) for the first week or two that I took Klonopin, but those quickly disappeared, and I don't have any side effects at all now. I'd recommend that you try it if you can.
I know how hard it can be to talk to doctors, but just remember that the main objective for you (and your doctor) should be to find the best treatment with the fewest side effects. You shouldn't be uncomfortable or embarrassed about trying to achieve this goal, and if your doctor makes you feel that way, then maybe he or she isn't the best doctor for you.
Posted by Caleb462 on January 7, 2003, at 3:14:26
In reply to Re: Should I ask my doc to prescribe a benzo?, posted by viridis on January 7, 2003, at 2:31:42
>One thing my psychiatrist mentioned is that people who ask for Xanax are often perceived as "drug seekers". This benzo in particular has a reputation (although probably largely undeserved) for abuse liability.
Actually, I think that repuation is quite deserved. Of course, this is just where I live, it may be different other places... but Xanax is a VERY popular drug. "Xanbar" and "bars" have become common drug lingo here. I've never used it, personally. I just stick to the opiods.
Anyway, thanks for the advice. Very helpful and encouraging.
Posted by viridis on January 7, 2003, at 13:43:51
In reply to Re: Should I ask my doc to prescribe a benzo?, posted by Caleb462 on January 7, 2003, at 3:14:26
Just curious -- why do they call them "bars"?
Good luck with your doctor.
Posted by Caleb462 on January 7, 2003, at 22:17:15
In reply to Re: Should I ask my doc to prescribe a benzo? » Caleb462, posted by viridis on January 7, 2003, at 13:43:51
> Just curious -- why do they call them "bars"?
>
> Good luck with your doctor."bar" refers to the 2 mg Xanax pills which are bar-shaped. And thanks.
Posted by jtc on January 8, 2003, at 9:13:13
In reply to Should I ask my doc to prescribe a benzo?, posted by Caleb462 on January 7, 2003, at 0:31:25
> I have serious anxiety problems, and have since a child. For the past year or so, I've been undergoing treatment for OCD and most recently, severe depression, general anxiety, self-harm, and a host of personal problems.
>
> Anyway... I'm currently taking 150 mg Effexor XR a day... and Risperdal 0.25 mg (sometimes once a day, sometimes twice). My anxiety problems have not gotten better, in fact, they've recently been worse.
>
> I realize the Risperdal is not a very large dose. But frankly, I'm not that keen on treating my anxiety with an anti-psychotic. I think that maybe Klonopin, Xanax, Ativan, or another benzo might be a good choice for me. But I'm horrible at bringing things like this up to my doctor, especially since he knows of my recent history of drug abuse (very mild abuse however, and in my opinion... just use, not abuse). I simply can't come up with the words.
>
> Also... will drowsiness be a problem? If so, will it be temporary? Sedation is one side effect I can't tolerate.
Hi,
I have also had anxiety and panic attacks since about 15 yrs of age. I am currently taking Klonopin .5 mg at night and have been taking it for a few years for anxiety. I am also on Effexor XR 75 mg for depression. But I think the depression is caused from the anxiety. I think the Klonopin is very good. You just have to find the right dose that works for you because higher doses can make you fatigued and drowsy. I think I will try to go off of the Effexor and just take Klonopin. The Effexor has caused weight gain for me. I have appointment with my psychiatrist on Jan. 15 and I will talk about this with him but I don't know if he will be receptive to it. I take the Effexor because I get very irritable and yell at my kids and my husband. Don't have much patience with my husband. He is not supportive at all of my anxiety and panic disorder and he thinks I should not be taking any medications. I think he is the reason that I am depressed. But until someone has experienced panic and anxiety they cannot really understand what it feels like. Anyway good luck to you with your doctor and meds. jtc
Posted by judy1 on January 9, 2003, at 12:37:23
In reply to Should I ask my doc to prescribe a benzo?, posted by Caleb462 on January 7, 2003, at 0:31:25
absolutely, benzos are the gold standard treatment for anxiety disorders. I agree with you that APs (no matter what the dose) are not appropriate in situations where psychosis is not present, the side effect profile is too great. Nobody abuses klonopin, and very few anxiety patients abuse xanax. There is a long acting form of xanax coming out that you may want to try- in the meantime if you don't have a history of drug abuse then you shouldn't be worried about developing one. best of luck- judy
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