For GAD..xanax, klonipan, or valium better?

I've had panic attacks in the past.  Been on Xanax for over 18 years.  I've read on this forum that Klonipan is longer acting, but also, that it is more for panic attacks rather than general anxiety disorder.  Would valium be better for GAD....is it longer acting than Xanax?  After all these years the xanax isn't working as well.  been on the same dosage for over 18 years.  Don't understand why NOW it isn't working as well.  I know you can get tolerate to a dosage after months, but, I've never taken more or less than 1.5 mg a day of xanax....50 mg 3 times a day.
Thanks!

[JSGeare]

If you want a lot of different ideas and opinions, you've come to the right place. I'm not sure how any of it will help you -short of just being an interesting subject. And no one here can speak with authority on your situation. Have you thought about posing your question to a doctor -especially a psychiatrist? I am especially curious about the drop in effect of the Xanax -after all these years.

I can say that I have seen drugs which were designed for one thing used for something else. It all depends on some specific action the doctor is looking for.

Over the course of many years, other changes may also have taken effect. I urge you to get a consult soonest -and then tell us what the result was, please.

[Jade59]

Hey there!  I recently wrote down something Ryan said.  He states that Klonopin is for generalized anxiety states, whereas Valium would be for panic states.  

Hope this helps!

[sleeplesss]

Thank you for all your comments.  Does valium last longer than xanax?

[xanweaner]

That is amazing re: the differences between xanax and valium.

Why, then does valium get its bad rap? Was it because it was being prescribed by so many other specialties other than psychiatry?

[Jade59]

Hi Ryan!  Thank you for correcting me on the Klonopin/Valium issue.  I don't want to quote you incorrectly, so I appreciate that.  

Take care.......

[sleeplesss]

Thank you so much for the detailed response.  My dr. talked about switching me to Klonipan, but for GAD, sounds like valium is the better solution.  I rarely have actual panic attacks.  
Now I have to think of an approach about this with my dr. without trying to tell him how to do his job.  I like him alot, but I don't want to make him mad either.  

[xanweaner]

Ryan,

That was a great post on xanax and why valium got the bad rap. I wish I would have known that prior to starting on xanax in April 07. Fortunately, I'm weaning off and getting close to discontinuing my daily use.

Fortunately, xanax came in very handy when I needed it to stop the trembling that I had. It was fairly severe. Once I took the short-acting dose, it would stop it in about 5 minutes. However, when we started me on the long-acting, I also had to supplement with the short-acting, since the long-acting was not as effective. Obviously, my weaning off the long-acting was a bit challenging, but I did accomplish it.

After reading what many psychiatric experts write about xanax and its difficulty in withdrawal, I feel very lucky that I've gotten to this point in my weaning - but have been weaning off since Oct. 07 - 5 months....can't wait for the day when I no longer have to reach for my bottle or watch the clock to be sure that 4 hours haven't passed without my dose.

[Slappy3243]

Xanax and Xanax XR can be used long-term quite effectively as studies done in 2003 show. People will develop tolerance to its hypnotic effects but its anxiolytic effects can remain intact on a maintenance dose for years without having to increase. You are the perfect example. You used it for 18 years with great results. Another good thing about Xanax is that it does not build up in your plasma levels which lessens the chance of the drug causing depression. I have been on Xanax XR for over a year and have not required a dosage increase. While Ryan is certainly a wealth of information, people should not simply rule out Xanax XR for long-term treatment. My psychiatrist has been prescribing benzos for over 25 years and says he gets his best long-term results by treating patients with Xanax. Most doctors will also agree that withdrawal from Xanax becomes difficult at doses greater than 4 mg a day for a long period. This is not to say tha Valium may not be a better choice for people but a lot of it depends on the individual.

[Summer123]

I'm not sure how someone would go about differentiating between anxiety and depression when they coexist.  I am both anxious and depressed.  Actually, I think I'm quite depressed about my anxiety.  It is very depressing to not be able to function outside of the home without a stupid little pill.   So where I am depressed about my anxiety, I am not anxious about my depression, just anxious about everything else.  Does that mean that my primary diagnosis is the anxiety?

I have also used xanex for 20 years and only in the last 6 months did I need more xanex to function well.  This scared me and I proceeded to lower my dose down to 25% of the functional dose.   This dose guarantees me that I will be able to function well in any situation if I increase the dose back up to the 100% mark for a period of time

[xanweaner]

Again, thank you for that additional info. It is comforting for me since I take it along with an antidepressant since my depression has a strong anxiety component to it.

[Slappy3243]

Ryan,

I am a bit confused in regards to your post. Since Pfizer did not do a study in regards to the long-term efficacy of Xanax, that means it cannot work long-term? To me, it sounds like they themselves did not do a long-term study just like pretty much all of the other Benzo manufacturers. Could you point me to a study that shows the long acting benzos like Valium keep their anxiolytic where Xanax doesn't in the long-term? I would like to learn as much as I can.

Here is a quick summary of the 2003 study: "However, in 1992 Romach and colleagues reported that dose escalation was not a characteristic of long-term alprazolam users, and the majority of patients indicated that alprazolam continued to be effective.[13] A 2003 study did not support the hypothesis that long-term use of benzodiazepines frequently results in notable dose escalation.[14]In a 1-year follow-up study of patients with panic disorder continuing treatment with clonazepam, 90% maintained a positive response without developing significant tolerance. In a 2.5-year follow-up study of alprazolam therapy, little evidence of tolerance emerged.[15]"

Link to one of the studies http://www.ncbi.nlm.nih.gov/pubmed/1970813

Quoted from that link is this: "In a 2.5-year follow-up study of alprazolam therapy, little evidence of tolerance emerged and initial therapeutic gains were maintained, even among patients who decreased or discontinued medication. As with antidepressants, many patients remain on high-potency benzodiazepine medication after short-term treatment; the choice of maintenance agent should reflect side effects of treatment as well as the ease of discontinuation. The high-potency benzodiazepines are a reasonable alternative to antidepressants, which involve problems of morbidity, noncompliance, and risk for overdose. Discontinuation may be less difficult with the longer-acting high-potency benzodiazepines, which thus may be advantageous for long-term treatment. It is necessary to determine the contributions of all aspects of treatment, both behavioral and pharmacologic, to the longitudinal course of patients with panic disorders."

So as far as withdrawals go, a longer acting benzo may be better but Xanax is still a very viable alternative.

-Adam

[Slappy3243]

Also, the fact that the thread starter has been on the same dose of Xanax for 18 years without having any issues is also evidence that Xanax can be useful in the long-term treatment of anxiety.

[david85]

Clinical aspects of chronic use of alprazolam and lorazepam.

Romach M, Busto U, Somer G, Kaplan HL, Sellers E

Clinical Research and Treatment Institute, Addiction Research
Foundation, Toronto, Ont., Canada.

OBJECTIVE: The authors' goal was to determine the clinical
characteristics of persistent users of
alprazolam or lorazepam who wished to discontinue their medication.
METHOD: Long-term users
(daily use for more than 3 months) of alprazolam (N = 34) or lorazepam
(N = 97) who entered an
outpatient treatment program for discontinuation of benzodiazepines were
carefully assessed.
Detailed histories of benzodiazepine use were obtained; a structured
interview was used to make
psychiatric diagnoses based on DSM-III-R criteria. RESULTS: The majority
of patients were using
low therapeutic doses of medication (lorazepam: mean = 2.7 mg/day;
alprazolam: mean = 1.2
mg/day) and had either maintained their initial daily dose over time or
decreased it. Individuals
tended to shift their use of medication from an as-prescribed to an
as-needed pattern. Forty-seven
percent of the patients were diagnosed with at least one current anxiety
disorder, most commonly
generalized anxiety. At least one diagnosable personality disorder was
found in 45% of the patients,
most commonly obsessive-compulsive personality disorder. Patterns of
benzodiazepine use were
influenced by age, gender, and past history of alcohol dependence.
CONCLUSIONS: Long-term
users of alprazolam/lorazepam seeking treatment for discontinuation had
clinically important past and
current psychiatric histories. They used a constant or decreasing dose
of medication and made
attempts to stop their use. Persistent use of alprazolam/lorazepam for
therapeutic purposes did not
represent abuse or addiction as the terms are usually understood. A
substantial proportion of these
patients may be receiving appropriate maintenance therapy for a chronic
psychiatric condition.

[treefarmer1]

Hi Sleepless,I see you are having problems with anxiety,and panic attacks,I tried all the meds your are taking.Cymbalta also.I am taking the herb Bacopin right now.I found out I have HepatitisC 2 years ago.I really do not want to damage my liver anymore with script meds.Check ouy www.protazen.com I am thinking about trying this product,This might help you out.Good luck Treefarmer1  

[david85]

Xanax is actually the #1 choice for Panic disorder.

[sleeplesss]

Thank you for all your comments.  I really think that part of the reason my xanax wasn't working after 18 years is the fact that I was on vicodin for 6 months for a back problem.  I tapered off the vicodin, and the anxiety increased.  I can't help but think that this was not a coincidence.  Any thoughts on my theory?  In fact, now that I've been off the vicodin for weeks now, the anxiety seems to be better.  It was mostly bad during the time I was tapering.

[Slappy3243]

I totally feel that tapering off a drug like Vicodin can give you anxiety. It is a powerful narcotic that has withdrawal effects like any other drug in its class which includes anxiety. These are just some of the withdrawal effects of the drug:

The symptoms of Vicodin withdrawal include but are not limited to:

restlessness

muscle pain

bone pain

insomnia

diarrhea

vomiting

cold flashes

goose bumps

involuntary leg movements

watery eyes

runny nose

loss of appetite

irritability

panic

nausea

chills

sweating


Hope that helps you.

[level]

I was on klonopin for 8 years and was able to taper down slowly from 1.5mg a day to 0 but anxiety came back full force about a year later and had to get back on a benzo. Went with valium and have been on that for 7 years now.

If I don't take valium the withdrawals start kicking in real real bad about the 3rd day. I have tried to switch over to ativan, serax, and xanax and just dump the valium all together to give the other ones a go but I can't do it because the valium withdrawals start kicking in.

The only drug I have been able to completely switch back over is klonopin where I did a valium taper and added klonopin over a period of a few weeks and I didn't notice any withdrawals from valium doing that. However, I just hated how I felt on the klonopin-out of it, little depressed, drugged up, and it didn't seem to help my GAD either.

So now, I supplement a xanax or a serax or an ativan every now and then because the valium just doesn't really seem to be doing that great for my GAD anymore. I really wanted to just get off it and just try xanax by itself to really evaluate it but again I haven't been able to successfully do that because I get valium withdrawals each time. I guess I would have to do a complete valium taper then pick up one of the shorter acting ones but the valium withdrawals are not pleasant at all and you do feel them-it just takes a day or two longer. I am interested in just going on the xanax even though it might not be the right decision but again I just haven't been able to just dump the valium and do a straight crossover to it without the withdrawals from valium.

[Coolbucket]

I have just read your posts and am confused about your authority. I noticed you didn't have "Dr" in front of your name. Your advice is dangerous and confusing. First, according to Dr Ashton," a Benzo is a Benzo". Xanax just has a shorter half life than Valium. 1mg of Xanax = 10mg Valium. They both affect the same transmitters at equal dosage. I know you're trying to help but I believe you are scraring people. Here's the deal folks, see a quilified Doctor who knows about Benzo withdrawal. Remember one thing, you made the decision to take this garbage ( as I have) and now we all have to pay the piper. It won't be easy..period. If you listen to everybody in these "Benzo rooms" you wouldn't have a clue as to how to aproach your detox needs. Notice, non of these people (including me)
are Doctors. Contact your local Detox clinic and make an appointment to get some advice on your needs. You are addicted as I am. You CAN do this but do it right. Ryan has some good advice but it's not the ONLY way to detox.
God bless you and you CAN get off these Devils!

[bpchrisb]

Honestly, over the years, I have been on most of the benzos and I will say that I prefer Klonopin or Xanax XR over the rest.

Klonopin- longer acting, smooths everything out nicely and you develop less of a tolerance to it. Causes some depression for me though.

Xanax XR- hits quick and stays in your system for awhile; nice 12 hour long half life. Best PRN medication for me; calms me down immediately and I don't get the rebound anxiety the normal Xanax causes.

I do like Valium because it's doesn't snow me the way the other benzos do; it just chills me out.

I don't like Ativan; it's wayy too potent for me. I don't take it anymore; I used to take 1mg of it every month or so and found that when it got out of my system, I had some serious rebound anxiety from it.

[Teedie04]

Are klinopin and Xanax both benzo's?

[lynn57]

Klonopin and Xanax are indeed both benzos.  I take Klonopin and am now on a much lower dose than I was two years ago.  When I quit taking the Klonopin it was a long taper because I didn't want the normal discomfort.  A year later I started at the lower dose.  Klonopin is effective for my panic attacks and my GAD.  I have taken it alone and now with Celexa.  My doctor prefers it over all other benzos for long term use.  That's one doctors opinion but I agree with her.

[anacortes]

Did you have any problem swhen you started the Celexa.  I was given 10mg yesterday and took only half of it last night. I have had a terrible headahce all day long and feel tired and seem to have high blood pressure. Did you experisnce any of this with teht celerxa