Anxiety Community

Slappy, when you started off Lexapro...did you start a low dose, and how long did it take for it to stop your anxiety?I tried it once, and when i took 5 mg i nearly threw up..In addition did the lexapro work well enough to lessen your need for xanax?

by david85, Mar 12, 2008 07:44PM

by heartfluttersflyawayplz, Mar 12, 2008 09:10PM

xanax is not a long term med and your body will want more and more of it , klonopin is a good choice and is long term. i know been there .ask your dr about a long term med like klonopin or valuim they are both good meds for anxiety. i to can feel my heart beat , and its not a good feeling but if i let it pass it goes away. try and think or do something elsa. like when lieing in bed just pray it always helps me , to pray for my family i feel better knowing am praying for there safty. God Bless you .

by Slappy3243, Mar 12, 2008 09:26PM

To: heartfluttersflyawayplz

Xanax can be used long-term without any tolerance just like any of the other benzos. There have been studies done showing no dosage increase after about 3 years of continuous use. If you do decide to take xanax long-term, I would suggest that you take Xanax XR. It avoids the ups and down of regular Xanax. I have been on it daily for well over a year WITHOUT the need to increase my dose. There was another thread made recently in which the thread starter has been using Xanax daily for 18 years without the need to increase dose. The only real downside to Xanax is that since it does not stay in your body for that long, the withdrawals will be worse when you do want to come off. Klonopin made me depressed when I took it before Xanax and my doctor says that happens to many of his patients. That is another thing to consider as well.

Here is a brief summary of the results of the studies on long-term Xanax use:

"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]"

Xanax has gotten a bad reputation since when it is abused and used recreationally, tolerance does occur. Xanax is also fairly easy to obtain so it is popular among teenagers that get drugs off of the black market.

-Adam

by Slappy3243, Mar 12, 2008 09:35PM

To: david85

I started my dose of Lexapro at 10 mg. It was a direct transition from Paxil which is why I did not start at 5 mg. I eventually got up to 20 mg of Lexapro but it was too much. It made me feel really dead in the head and just out of it. I went back down to 10 mg for a while and I do feel that it helped somewhat with the anxiety/depression but I still just felt really blunted so I decided with my doctor to come off of it which I am in the process of doing now. Since I switched directly from Paxil, I am not totally sure how long it takes for Lexapro to take effect. But if it is like the other SSRIs I have tried, I would give it a few weeks before you should expect any results. Honestly, I am not sure if it lessened my need for the Xanax XR. That is the problem with taking two drugs at the same time. That is why I am coming off of the Lexapro as well; to see if the Xanax XR can handle my issues or if I do need an SSRI to complement the Xanax. I will see after my SSRI withdrawals are done withing the next two weeks.

-Adam

by RCA7591, Mar 13, 2008 12:31AM

To: Adam

"Xanax can be used long-term without any tolerance just like any of the other benzos."

^quote

If Xanax (in any preparation) is used over the long-term, it will lose its efficacy. There is one exception to this rule - the elderly. An elderly person's general metabolism is more inclined to be supressed when compared to that of a younger or mid-aged individual. In this case, the long-acting Benzodiazepines such as Clonazepam and Diazepam accumulate excessively in the plasma, as the P-450 metabolic (hepatic) pathway is supressed. Thus, the elimination half-life of the longer-acting agents is prolonged, and this poses the risk of excessive somnolence, ataxia, falls, and other such hazards. In the case of elderly persons, the shorter-acting agents are more desirable, Lorazepam being the top choice.

In the normal person, with a normal hepatic metabolism and normal renal function, the half-life elimination of Alprazolam is roughly six hours. The duration of the clinical benefit of Alprazolam is four hours in its standard preparation. Xanax is very short-acting, and as such, the drug peaks and troughs rapidly in the plasma. The drug specifically targets the major CNS inhibitory neurotransmitter GABA(a). Alprazolam agonizes (ie: adds to, increases the availability of) GABA(a1, a2 ,a3). Since the drug peaks and troughs rapidly in the plasma, the alpha subunits of GABA are agonized and then antagnoized. It is this chronic peak and trough, and agonizing and antagonizing that leads to tolerance. Alprazolam binds very tightly to the GABA synapse, and once the plasma level in no longer sufficient to maintain binding, rebound results. With prolonged use, withdrawal symptoms manifest - even if the drug is consumed.

Alprazolam never reaches steady-state in a normal subject, as its elimination half-life prevents its accumulation. This includes the XR version. Without accumulation to prevent the chronic peak and trough in the plasma level, and without accumulation to prevent the antagonizing of the GABA(a) synapse, tolerance is the end result. Think of it as recharging a battery. Eventually, the battery will no longer hold a sufficient charge after "X" amount of charges. If the battery were eliminated and replaced with a constant voltage source, the issue would be resolved entirely.

Thus, those Benzodiazepines that are long-acting (Chlordiazepoxide, Clorazepate, Clonazepam, and Diazepam) accumulate in the plasma. Accumulation assures the retainment of a steady-state plamsa level, plus some additional headroom (1.5 - 10 times that of steady-state depending on the agent in question). The GABA(a) synapses are always agonized, and as such, the development of tolerance is not an issue over the long-term. There is no interdose, rebound, or loss of efficacy over the long-term. The sole reason why is because the plasma level remains steady. There is no peak and trough in the plasma level, and there is no *change*.

You mention depression, and Benzodiazepines in general have no useful indication in the treatment of depressive states - they worsen depressive states. Likewise, antidepressants have no useful indication in the treatment of pure anxiety states - they worsen anxiety states. Your favorable outcome with Lexapro suggests that depression dominates the clinical picture. The fact that Klonopin precipitated depression also suggests this. Xanax generally will not worsen mild depressive states due to its Triazolo structure, and Xanax may be masking an underlying depressive state in your case.

If you had a favorable result with Xanax, logic suggests that you would respond extremely well to a Tricyclic antidepressant, such as Elavil, Pamelor, or Sinequan. The Triazolo (three-ring) structure that is attached to Alprazolam is very similar to that of a Tricyclic antidepressant.

As for the random, ****-on clnical trials you've found online pertaining to Alprazolam, they can be very misleading. The one you quoted was a Canadian study for example. Canada has a single-payer healthcare system, and as a result, the doctor-to-patient relationship is often compromised in such a setting. Thus, it would be far easier to prescribe a drug such as Xanax and mask a patient's complaints, rather than for the doctor to actually address the problem using more time-consuming approaches. There is generally some incentive for these random trials, and here the incentive is to attempt to falsely justify the long-term use of Alprazolam due to time constraints. The Internet is the last place to be searching for concrete evidence.

So, short of some unusual circumstance, Xanax is NOT indicated for long-term use. Reverting back to the original prescribing information from 1981, Xanax was developed for intermittent, infrequent use in anticipatory and panic states.

Ryan

by RCA7591, Mar 13, 2008 01:37AM

very mild cocaine use has left me with an awareness of my heartbeat in my abdomen that is causing me anxiety. I JUST want to be able to lay down and not feel my heartbeat in my abdomen. I can feel it beating without touching it. I can take my pulse simply by laying down and feeling it beat. Cardiologist did an echocardiogram and it was normal.

I have obviously quit recreational cocaine use.

A GP put me on lexapro but I have yet to start taking it...for fear it will just make me worse. I just want to be CALM and COOL...cant I be prescribed something for that?

^quote

Your experience is not atypical. Cocaine is an analeptic (stimulant). You got a taste of autonomic activity that was initially induced by the coke, and have developed a sensitivity to it. In short, your nervous system has lost its homeostasis (balance), and you are a state of over-awareness with a primary focus on your heart.

The Echocardiogram excluded a cardiac etiology for your symptoms, so what you are experiening is psychosomatic in origin.

Lexapro and other antidepressants stimulate the CNS, some directly and others indirectly. This is not the effect that you are looking for, and if you take the Lexapro, your sensations will be amplified x10. The issue is autonomic hyperactivity, not depression. Thus, Lexapro is a bad choice in my opinion.

I would suggest that you consult with a Psychiatrist, describing the sequence of events that have led to the fixation in regards to your cardiac function. You are in the early phase, and the cycle can be easily broken. I would recommend Librium, 5 mg, t.i.d. Librium is a very mild Benzodiazepine. This drug blunts autonomic hyperactivity by mildly depressing the central nervous system. Maximum efficacy is seen in one month, however, the benefits will be immediate. The effects are subtle, and should provide just enough relief to reassure you that everything is going to be OK.

Ryan

by Slappy3243, Mar 13, 2008 01:53PM

To: RCA7591

Ryan,

Do you have any links to studies that back up what you are saying? I am only asking because I at least provided some factual information based off of studies pertaining to taking Xanax in the long-term. If you are are correct, why have I been on the same dose for well over a year without increasing my dosage? What about the person who posted that has been on it for 18 years without increasing dosages? What about my psychiatrist who prescribes it long-term and doesn't need to increase the dose in over 90% of his patients? My doctor certainly disagrees with you. I mean, sure you seem to have done a lot of research but I would like to see some studies posted that show that Xanax cannot be used long-term without building tolerance. All of the doctors I have spoken with do not share your opinion. Of course I have much more faith in my doctors than a guy on a forum (no offense to you, you are trying to help) but many people are desperate and may feel that what you are saying is completely correct. I am just wondering if you can back it up.

Also, you mention that Pfizer does not mention Xanax for long-term use. Can you show me a benzo manufacturer that does recommend their drug for long-term use?

-Adam

, Mar 13, 2008 06:26PM

I am going to hide under my bed for this one!

by Jade59, Mar 13, 2008 06:34PM

Oh Slappy, with all due respect, I don't think you know who you're dealing with here.

Good luck!

, Mar 13, 2008 06:38PM

To: FMXSMKR

Hey g/f........there's room for two under my bed. Shall we watch the fireworks from there?
Poor, poor Slappy

by Jade59, Mar 13, 2008 06:42PM

OMG, you make me laugh OUT LOUD!! Yes, lets watch!

, Mar 13, 2008 06:53PM

To: FMXSMKR

We better stop or JSGeare will send us to the principle!

(I'll bring the popcorn!)

by Jade59, Mar 13, 2008 06:56PM

Oh alright, if we must.........still laughing though.

OK, I'm done.

by Slappy3243, Mar 13, 2008 07:02PM

LOL guys. I am not challenging him to a duel or anything. I am just living proof that Xanax can be used long-term term without increasing the dose. There are also other members here who have used Xanax for a quite a bit longer than me without increasing the dose.

Sorry, but I disagree with him and I am not scared to show my opinion since all he brings to the table is his opinion as well. I even posted links to studies by doctors showing that it can be used long-term. He then states that it can't be used long-term because of this and that but he isn't a doctor nor has he ever provided a link to a study that specifically shows that Xanax cannot be used long-term. It seems like he is merely making inferences based on the information he has gathered from the drug. I can sit on google all day if I want and get all the information he gets about the drug as well. I think I asked some valid questions that he should hopefully be able to answer. If he can provide me with valid studies that prove I am wrong, then so be it, I will be wrong, it doesn't bother me. But after speaking with several doctors on the matter, they disagree with him as well in regards to using Xanax long-term.

It seems like you guys are either scared of him or think what he says his 100% correct all of the time and what he says applies to everybody. I thought we are all here to help each other? I am certainly not here to fight with anybody.

-Adam

, Mar 13, 2008 07:06PM

To: FMXSMKR

................girls just wanna have fun.............

OK. I'm done, too.
But Slappy will be "well done!"

OMG, someone stop me!

by Jade59, Mar 13, 2008 07:11PM

To: Slappy

No, we don't want to fight either and I'm sorry to laugh, honest.

Ryan is studying to be a psychiatrist and knows tons about pharmacology, but he really doesn't need me to stick up for him. He does a good job for himself.

Friends?

by Slappy3243, Mar 13, 2008 07:15PM

I actually hopes he can post the information I asked for and actually prove that Xanax cannot be used long-term. This way, I won't be misinformed and I can tell me doctors that they are wrong. ;)

Also, I am not scared of getting "owned" on a message board. I am just trying to help. I just don't want people to rule out Xanax for long-term treatment when it could really help them. It has helped me for sure. It has helped another poster for over 18 years.

He seems like a very knowledgeable guy and I respect that. However, I personally respect the conclusions of random studies and opinions of doctors in regards to health issues. I will never tell somebody they NEED to take Xanax XR for the long-term. I just want them to know that it is an option and I among others and living proof.

Ryan, I am certainly not trying to call you out so please don't take it that way. I do respect you and all of the information that you bring to the board. I just happen to disagree with you on one issue. Sorry.

-Adam

by Slappy3243, Mar 13, 2008 07:19PM

To: FMXSMKR

Ryan certainly seems to know a lot about pharmacology. My google comment was just a joke by the way. It was just meant to show he a lot of information, but so far, no long-term studies to back it up with. I admire him for training to be a psychiatrist, but as of right now, he isn't one, so I tend to listen to my doctors and other doctors whom I have contacted in regards to the issue.

On a side note, I find it funny that SSRIs are meant to be used long-term, but there are really no long-term studies to show their efficacy past a few months or so.

Oh and yes, we are still friends. :)

-Adam

by Jade59, Mar 13, 2008 07:30PM

To: Slappy

I am one of those people who has taken a short term benzo since 1980!! First Ativan, now Xanax since 1995. I just take it at night for sleep and maybe a little bit for something like a dental appt. I thought it had stopped working, but last July, I stopped smoking cigs and weed and once the withdrawals were all over, which took me about 2 solid months, the Xanax seemed to work okay for me. I must say, however, I do start to feel a little shaky by nightfall and I attribute this to the Xanax. I am going to post to Ryan at some point to find out how to transfer to Valium safely now that I've weaned myself down from 2mgs at night to 1mg. We'll see.

Btw.....I do know that Ryan gets his info from the Merck Manual and Merck Index so I feel pretty good about his advice.

I hope he responds to you too, I am curious to see what he says

Take care hun.....

by Slappy3243, Mar 13, 2008 07:43PM

To: FMXSMKR

Quick question for you. Have you tried the Xanax XR by any chance? It avoids the ups an downs of regular Xanax. While it is advertised to last 24 hours, it doesn't for me. I take it once every 12 hours and I avoid the ups and down of regular Xanax. Just something you may want to consider. It is available in generic form as well so you don't have to pay the the enormous price as you would if you got it straight from Pfizer. Just a suggestion that you may want to look at before you switch over to Valium. :)

-Adam

by Slappy3243, Mar 13, 2008 07:50PM

The Merck Manual is only $65. I should buy it. I am looking at it right now. It actually states that anxiety disorders can be a direct result of a physical disorder such as an irregular heartbeat which is what triggered my downward spiral when I was 17. Ever since I had my arrhythmia, I have never been the same. It was like a switch went off in my head and I started to suffer from severe anxiety, depersonalization, and self-monitoring. Even though my heart is fine and I was told by about 100 cardiologists that I have nothing to worry about, my mind still takes over. I am truly amazed at what the brain is capable of. Well, at least I am now certain was initially caused my anxiety (well 98% certain).

-Adam

by Jade59, Mar 13, 2008 07:54PM

To: Slappy

I haven't considered that. Thanks for the info. I don't really need anything throughout the day, just at night. I have generalized anxiety and, at my age, have learned to live with it during the day. And, now that I don't smoke, I feel SO MUCH BETTER. Sleep better too. Plus, I really hate how the Xanax makes me feel and I'm happy it's worn off by morning.

I'm so glad it works for you though!!

, Mar 13, 2008 08:10PM

To: Slappy

I, too, shall jump on the bandwagon of apologies. Sometimes we get a bit carried away with silliness and I really hope that we didn't hurt your feelings.
Ryan has gained ENORMOUS respect on this forum, which is his due for all the help he has given to so many, so selflessly, for so long considering the goal he has set for himself. None of us has ever felt the need for him to "qualify" his responses and it's not becuase we are afraid of him or being "owned" as you said. (which I fear I don't understand) I am not going to get into the Xanax debate except to say that what I have learned from Ryan, (even tho he may not, as yet, OWN that sheepskin) has motivated me to once again get off Xanax. There are, no doubt, exceptions to every med out there. Just as there are exceptions to every rule. And if we look hard and long enough, we will always be able to find someone who agrees with us. The choice is ours. I chose to believe Ryan.
Please, again accept my apologies for having some fun at your expense. Your opinions are as valuable as anyones. I'm glad you've found us and hope you stay with us.
Peace
Greenlydia

by Slappy3243, Mar 13, 2008 08:44PM