Benzos for GAD - how often?
in [Anxiety]
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From: Copper on 28 Jun 2008 02:27 I was recently prescribed (30) .5mg Xanax for GAD after my anxiety levels had gone through the roof (PA's at work.) The doctor, who specializes in treating PD, recommended I only take it when things get "really bad" but no more than about once a week. This doctor isn't benzo-phobic either but I feel like since I don't have PD he doesn't appreciate where I'm coming from. I've only taken the Xanax a few times but it seems to work (maybe a higher dose to squash a true PA.) I took it before a meeting at work and I felt calm but not sedated at all instead of spending the whole 2 1/2 hours worrying about a PA. The thing is when I don't take it I feel all my typical GAD symptoms (tense, on edge, constant worry about a PA or whatever irrational fear I'm focused on that day.) So far the "magic pill in my pocket" factor hasn't alleviated the GAD and 2 1/2 years of CBT didn't either. Should I just take the xanax, or maybe a longer acting benzo, for as long as I need?
From: Philip Peters on 28 Jun 2008 08:14 Copper schreef: > I was recently prescribed (30) .5mg Xanax for GAD after my anxiety > levels had gone through the roof (PA's at work.) The doctor, who > specializes in treating PD, recommended I only take it when things get > "really bad" but no more than about once a week. This is a way of prescribing that can hardly be understood. Apparently your doctor is afraid that you will get *addicted* if you would take Xanax more often. Addicted you will not become, but you would become *dependent* when taking it at a regular daily dose. If you don't want to become dependent you could still take .5 mg of Xanax daily or less, if you wish, but *once a week* is completely arbitrary and won't help you much. This doctor isn't > benzo-phobic either I get the strong impression that he is. but I feel like since I don't have PD he doesn't > appreciate where I'm coming from. I've only taken the Xanax a few times > but it seems to work (maybe a higher dose to squash a true PA.) If you have true PA's one could wonder about your diagnosis. The DSM-IV is just a list of symptoms with a name but it's also arbitrary and without nuance. In reality anxiety disorders are often comorbid, they are not sl neatly divided as the DSM suggests. I took > it before a meeting at work and I felt calm but not sedated at all > instead of spending the whole 2 1/2 hours worrying about a PA. .....which is a hallmark of PD: the anticipatory anxiety of the next PA. The thing > is when I don't take it I feel all my typical GAD symptoms (tense, on > edge, constant worry about a PA or whatever irrational fear I'm focused > on that day.) So far the "magic pill in my pocket" factor hasn't > alleviated the GAD and 2 1/2 years of CBT didn't either. Are you sure this ws *proper* CBT? Many therapists these days say they practice CBT when in reality they don't (of course not *everyone* is helped by CBT, there is no panacea but proper CBT should at least help *somewhat*, especially when combined with medication if necessary). Should I just > take the xanax, or maybe a longer acting benzo, for as long as I need? I would stick with the Xanax because it works for you, but take the XR version which will keep you covered for either 24 or 12 hours, depending on your rate of metabolism. The dose may be raised in the bginning, it's a matter of trial and error but usually us anxiety folks stay on the same dose for years once the right dose is found (you might want to try 1.5 mg a day and go from there).You *will* become dependent on it which means your body gets used to the stuff and will have to try to afjust to it absence when you would decide to stop. This *is* associated with woithdrawal syptoms and therefore should be carried out only by way of a very slow taper (the same goes for many antidepressants, painkillers, insulin and what have you|). Ideally you would also have a script for the *IR* version you are taking now for instant relief in emergencies such as a breakthrough PA. Philip
From: Vickie on 28 Jun 2008 17:04 On Jun 27, 11:27 pm, "Copper" <cop...(a)no-where.com> wrote: > I was recently prescribed (30) .5mg Xanax for GAD after my anxiety levels > had gone through the roof (PA's at work.) The doctor, who specializes in > treating PD, recommended I only take it when things get "really bad" but no > more than about once a week. This doctor isn't benzo-phobic either but I > feel like since I don't have PD he doesn't appreciate where I'm coming from. > I've only taken the Xanax a few times but it seems to work (maybe a higher > dose to squash a true PA.) I took it before a meeting at work and I felt > calm but not sedated at all instead of spending the whole 2 1/2 hours > worrying about a PA. The thing is when I don't take it I feel all my typical > GAD symptoms (tense, on edge, constant worry about a PA or whatever > irrational fear I'm focused on that day.) So far the "magic pill in my > pocket" factor hasn't alleviated the GAD and 2 1/2 years of CBT didn't > either. Should I just take the xanax, or maybe a longer acting benzo, for as > long as I need? I have only ever taken Xanax as needed. I do have bouts of mild anxiety, in which I do some CBT, but otherwise I ride those waves out. I am not sure myself if I should take a benzo on a daily basis, because I do have frequent anxiety, but I always have just lived with it, well, with it and my SSRI. I guess that is what takes the edge off for me (most of the time). Not sure I can imagine rarely feeling any anxiety on a daily basis. You are braver than me to even think about taking a benzo regularly! Best, Vickie
From: Copper on 2 Jul 2008 22:19 > This is a way of prescribing that can hardly be understood. Apparently > your doctor is afraid that you will get *addicted* if you would take Xanax > more often. Addicted you will not become, but you would become *dependent* > when taking it at a regular daily dose. If you don't want to become > dependent you could still take .5 mg of Xanax daily or less, if you wish, > but *once a week* is completely arbitrary and won't help you much. Hello Phillip, just wanted to say I find you responses on this newsgroup to be very helpful. The doctor is actually Stuart Shipko who occasionally posts on this board. Based on his posts I would not consider him benzo-phobic. He also suggested I get regular "talk" psychtherapy which I'm not opposed to for some of my other "issues" but I'm skeptical about it's effectiveness for GAD. The thing is that since he specializes in PD, which he did not diagnose me with, I don't feel like he appreciates how much I suffer (and for how long...) > ....which is a hallmark of PD: the anticipatory anxiety of the next PA. I've had panic attacks since the age of 12 but they aren't very common, sometimes months apart, and they aren't a big source of anxiety. It's just that lately I had a couple of PA's in public/at work that were pretty traumatizing so that's what my GAD has been about. Mostly my GAD is about a whole set of irrational fears that change by the week. > Are you sure this ws *proper* CBT? Many therapists these days say they > practice CBT when in reality they don't (of course not *everyone* is > helped by CBT, there is no panacea but proper CBT should at least help > *somewhat*, especially when combined with medication if necessary). My CBT therapist actually only practices CBT and he trained under Albert Ellis. For this reason I don't know if it's worthwhile to try another CBT therapist or write it off as ineffective for me. After all, CBT isn't suppose to take 2 1/2 years to work but I kept going because I felt like I needed to do something...
From: Philip Peters on 3 Jul 2008 19:15
Copper schreef: > >> This is a way of prescribing that can hardly be understood. Apparently >> your doctor is afraid that you will get *addicted* if you would take >> Xanax >> more often. Addicted you will not become, but you would become >> *dependent* >> when taking it at a regular daily dose. If you don't want to become >> dependent you could still take .5 mg of Xanax daily or less, if you wish, >> but *once a week* is completely arbitrary and won't help you much. > > Hello Phillip, just wanted to say I find you responses on this newsgroup to > be very helpful. The doctor is actually Stuart Shipko who occasionally > posts > on this board. Based on his posts I would not consider him benzo-phobic. I know Stuart Shipko, who for a long time had an excellent website with information and a message board. He was really down there in the trenches with his grass roots movement and the Panic Disorders Institute. He is an very independent and original tinker not afraid to take controversial stances. I've seen him gradually evolve from someone who advocated the use of Xanax above all other medication (generally speaking) but over time he sort of changed his attitude towards psychotropic meds the prescription of which he feels to be too much manipulated by Big Pharma. He wrote an excellent book on Panic Disorder. His thining at this point is, I must confess, not quite clear to me, partly, I'm sure because I haven't been able to follow it since he closed the PDI and its webstie. He > also suggested I get regular "talk" psychtherapy which I'm not opposed to > for some of my other "issues" but I'm skeptical about it's effectiveness > for > GAD. It depends on what is meant by "regular" talk therapy. Psychodynamic therapy has a rather poor record regarding anxiety disorders while CBT & REBT are still the first choice therapies. The thing is that since he specializes in PD, which he did not > diagnose > me with, I don't feel like he appreciates how much I suffer (and for how > long...) I think Stuart has been around for so long and has studied anxiety disorders so profoundly and intelligently that he will actually appreciate how peole with GAD suffer (I always found him a man of a very compassionate and caring nature). > >> ....which is a hallmark of PD: the anticipatory anxiety of the next PA. > > I've had panic attacks since the age of 12 but they aren't very common, > sometimes months apart, and they aren't a big source of anxiety. OK, well, that's a good thing. It's just > that lately I had a couple of PA's in public/at work that were pretty > traumatizing so that's what my GAD has been about. Mostly my GAD is about a > whole set of irrational fears that change by the week. And did you learn to *dispute* these fears, find their triggers tc. according to Ellis' ABC etc,? It's a lot of work but it often pays off. >> Are you sure this ws *proper* CBT? Many therapists these days say they >> practice CBT when in reality they don't (of course not *everyone* is >> helped by CBT, there is no panacea but proper CBT should at least help >> *somewhat*, especially when combined with medication if necessary). > > My CBT therapist actually only practices CBT and he trained under Albert > Ellis. Sounds good to me - of course not all therapists trained by Ellis have become brilliant and also it *is* possible that CBT just doesn;t cut it for you, it's not a cure-all. For this reason I don't know if it's worthwhile to try another CBT > therapist or write it off as ineffective for me. After all, CBT isn't > suppose to take 2 1/2 years to work but I kept going because I felt like I > needed to do something... If there is no progress after 2,5 years it may be worthwhile to try something else. Did you have a good feeling about your therapist? Did you feel like you were *working together*? Of course nothing is written in stone and I do know people who have been helped greatly by psychodynamic therapy. There are also techniques like neurofeedback, acupuncture etc.etc., even weird inventions like EMDR can be helpful although no one quite knows why. All in all I feel that there is no reason not to try a highr and daily maintenance dose of Xanax XR (which covers you for 24 or 12 hours depending on your rate of metabolism), possibly augmented with Xanax IR for emergencies like breakthrough PA's. I know so many people including myself who have been helped greatly by Xanax or another benzo and yes, it's a trade-off and you will become dependent and stopping it will be difficult (although there are ways around that and I also met a significant number of people who coulkd taper off of Xanax wihout many problems). The thing is you say that it works for you and IME we anxiety sufferers very rarely have to raise our dose (after the first adjkustments in the beginning to find the right dose). To me it's simple: being dependent on Xanax beats sitting trembling in a corner of a room with my hands over my head 24/7.... of course that's every individual's own choice and responsibility. Philip |