Celexa/Xanax XR

[Littlebear51]

Hi, I have been taking Xanax .05 for years. I take a whole one at night to help me fall asleep and then take a sleeping pill. I still wake up after sleeping 5 or 6 hrs. I then take  a half xanax to help me fall back to sleep. Sometimes I take another one during the day when I am extremely stressed out. Well, anyway the dr. just put me on Celexa and Xanax XR 2MG. I get so tired during the day. I have been coming home from working and falling asleep on the couch which I never do. I still take my sleeping pill at night and it takes me awhile to fall asleep. I am only sleeping about 4 hrs and waking up. Should I take the Xanax XR in the evening? Would that help me sleep better through the night? So far I am not liking the Xanax XR.
I am feeling more relaxed but am tired all the time. Thanks, Littlebear 51

[RCA7591]

What indication was the Xanax prescribed for initially (years ago)? Insomnia?

If I understand you correctly, you took 0.75 mg of Xanax for "years", only at night. 0.5 mg initially, and then 0.25 mg when you would awake early. 0.75 mg total.

The problem with Xanax is tolerance. Over some "X" amount of time, the drug loses its efficacy (effectiveness), typically within four months. Xanax is not indicated for prolonged use, due to the high incidence of tolerance. To acheive the same desired effect, the Xanax dosage would need to be increased continually, which is counter- productive.

2 mg of Xanax-XR (extended-release) is more than double the dose you were taking at night, however, the 2 mg is dispensed slowly over a period of 24 hours. Therefore if you take the Xanax-XR in the morning, the night time dose is comparable to 0.5 mg. The pill releases 0.5 mg roughly every six hours, until the full 2 mg dose is used up. Therefore, if the drug is being used to treat insomnia (which it isn't indicated for), you are receiving the bulk of the Xanax during the day, and not at night.

Xanax and Xanax-XR are indicated only for short-term use. Prolonged use leads to rapid tolerance, particularly with the XR version. Ideally, Xanax should be used as-needed only, for the treatment of sporadic panic attacks. It is not approved to treat insomnia.

By continuing to use Xanax, you are increasing your tolerance to its effects. This will ultimately lead to rebound insomnia and severe tolerance issues in the near future. Therefore, I would speak with the doctor about replacing the Xanax with a longer acting Benzodiazepine to prevent the risk of further tolerance. I would do this as soon as possible, rather than continue to take 2 mg of Xanax-XR.

Using Xanax in combination with hypnotics (Ambien, Lunesta) further increases the risk of tolerance and rebound insomnia. None of these drugs are approved for long term use, as they ultimately lose their effectiveness.

A single, nightly dose of Klonopin, 1mg would likely eliminate the need for both Xanax-XR and the hypnotic. The Celexa may cause insomnia, as it is a mildly "stimulating" antidepressant. I would speak with the doctor about implementing 1 mg of Klonopin at night, and about eliminating the Xanax and Celexa. Tolerance to the effects of Klonopin is exceedingly rare, particularly when dosed once daily.

Ryan

[pvcqueen]

I thought xanax xr lasted about 11-12 hours.............no?  with a 90% bioavailibilty compared to the regular xanax, and a half life of around 50 hours...........?

[RCA7591]

If Alprazolam carried a 50-hour half-life, there would be no reason to manufacture an extended-release version of it.

Ryan

[pvcqueen]

xanax XR.

[pvcqueen]

12-15 hours. you are right.

[Littlebear51]

I have always had a lot of anxiety about everything. I had some bad things happen in childhood and in young adult life. I have talked to my doctor about this and even went to counseling but did not help. I have always had bouts with depression and have tried various anti-depressents which never worked. I always have trouble with sleeping because of racing thoughts. I am a bit obsessive-compulsive. I think the doctor intially prescribed the xanax for anxiety and it does help me fall asleep. The problem is I cannot stay aleep so he prescribed a sleeping pill. My doctor is always trying to get me to take anti-depressants. So, I thought I would try again. I have been only taking it for a week but got really sick yesterday. I got diarrhea and vomiting something horrible. I don't know if I just have a stomach virus or whether it is a side effect from the Celexa. I am not going to take it anymore. What is Klonipin? Will it help with my anxiety? Thanks for any help. Littlebear51

[RCA7591]

"I have talked to my doctor about this and even went to counseling but did not help. I have always had bouts with depression and have tried various anti-depressents which never worked.'

--end quote--

Not surprising that counseling  didn't help, it rarely does. It really only works if you are "suggestible", and if the counselor is able to manipulate your thought pattern. If you have a one track mind, and are not "suggestible", counseling is largely worthless, particularly when some anxiety state is involved.

The fact that you have not responsed well to antidepressants could indicate one of two things; (1) You haven't yet found the right one that may work for you, and (2) You suffer primarily from an anxiety state, with any depression occurring secondary to the anxiety.

When anxiety dominates the clinical picture, and depression is secondary, treating the dominating disorder generally treats them both.

Xanax is a short-acting Benzodiazepine, usually reserved for the short term treatment, or intermittent treatment of anxiety disorders. It is not indicated for use over the long term, as the half-life of Xanax varies from 4-6 hours (some sources claim 6-27 hours). The main problem with prolonged Xanax use is *tolerance*, which is defined as the need to increase the dosage of the drug to receive the same therapeutic effect as when you initially began to take it. Obviously, Xanax is not an attractive treatment option for a long term disorder, due to the issue of tolerance. For the long term, you would want something in which the effects would remain effective.

Klonopin, like Xanax, is a Benzodiazepine. Klonopin is long-acting, has a slow onset of action, and works on the principals of steady-state and accumulation. When dosed two or more times daily after an "X" period of time (two weeks), Klonopin reaches steady-state (an even blood plasma level). After one month of daily use, Klonopin accumulates from 1.5 to 3 times that of the steady-state level. The attainment of steady-state and accumulation does two things; (1) Reduces the risk of tolerance, and (2) Provides full 24-hour coverage for your symptoms by preventing or minimizing them before they recur. Klonopin is a long term maintanence drug, indicated for the long term management of anxiety disorders.

So the main difference between Xanax and Klonopin are their indications. The former is for intermittent use, while the latter is approved for long term use. The issue for Xanax is tolerance, which ultimately results in a partial of complete loss of efficacy over an "X" period of time (four months). Tolerance is avoided by treating a long term disorder with a long acting agent, such as Klonopin, Librium, or Valium. Klonopin is specific for "panic", and is usually the drug of choice.

Ryan

[debaser23]

Ryan said, "When anxiety dominates the clinical picture, and depression is secondary, treating the dominating disorder generally treats them both. "

I'm human proof of that.  When I first started Klonopin, I saw depression as one of the side effects and thought, "****, I guess I'll figure out a way to deal with that, too."  Instead, with one minor exception I've not experienced any periods of depression since starting Klonopin.  The exception was mild, and hey, everybody gets down sometimes.  It was nothing compared to the depression I used to have.

Good Luck,
D