Roadblock....again

[JaxRiley]

It's been ages since I posted here so not sure why I'm doing this other than to say I saw my doctor last month. Had a LONG talk about where I'm at and how I'm feeling and where do we go from here. Due to some personal issues (he didn't elaborate) he seemed more open than usual and I was totally honest with him about what and how I'm feeling.

He pretty much offered me a limited menu and asked what drug I wanted to try, saying he had no problems upping y dose of Xanax if I wanted. Well gee, thanks but that still doesn't solve the issue of it wearing off so quickly and I still cannot/will not take it with any solid regularity due to the tolerance factor.

I mentioned Valium again, he sidestepped it...again. So my options came down to Klonopin if I wanted a longer acting med...I fought him on that saying it is an anti-seizure drug with anti-panic effects-he said it's used for anxiety. He disagreed when I said it will lose effectiveness against that quickly and I have this forum to back me up on that (or at least Ryan). Oxazepam which I've had before and did nothing for me...he agreed it wasn't a good choice. or Ativan...I said I'd like to try the Ativan because it also has a muscle relaxant and maybe it'd help a bit more.He said not really-they ALL have muscle relaxants. Umm, nope...last I checked only Valium and Ativan did. Unless maybe I'm supposed to take 7 or 8 MG of Xanax at a time for that???? Am I missing something?

SO I chose Ativan (being it is a component in Valium). Did it work? Not really, I have to take 3 (1.5 MG)  (he told me 1 to 2 (.5MG pills)-that's from the tolerance from Xanax). It helps somewhat but not like I thought it may. I've blown through 60 pills in a little over  a months' time. SO am now unsure weather to call for Klonopin to shut him up and say "Look, we tried all your ways, Will you PLEASE FOR THE LOVE OF GOD let's give Valium a shot. WIth my tolerance to Xanax, it's going to take at least a month of Valium IF I was ever able to get it (highly doubt it at this point) to see if it'll work and I don't think he's willing to let me take it daily.

He did say something about he will not allow me to use benzos long term...it will be paxil if I have to do that because Paxil 'erases' where benzos only 'mask'. Pardon the hell out of me, but it seems to me of SSRI's "erase" then that's a cure fo anxiety and why isn't everyone suffering taking them to 'erase' the anxiety?

I am NOT taking SSRI's.....they are just as addictive as benzos and I am more comfortable with benzos as I know how they work with me and they don't have the mile long lists of scary side effects.

IF Valium is so bloody hard to get now,may I ask why in the hell is it still being manufactured? DO I have to have someone whack me across the back with a  baseball bat to cause a spasm to get it?

I've done my homework, I know what I"m walking into...I also know the anxiety is getting to be too much to take and the tension is just unreal.My blood pressure is now elevated as a result of the anxiety increasing.

Can someone please tell me how then hell I can get this damn med? I cannot afford a shrink...my health insurance covers psychiatry if THEY deem is necessary and only twice a month session if they deem it necessary. No shrink is going to put me on Valium and say see ya in a month-not at first anyway.

I'm unsure weather to refill the Ativan-if it doesn't work why would I refill it? But it does have the muscle relaxant but I don't want to take the Xanax.

This is MY anxiety, MY agitation, MY g@ddamned body, MY life,  MY money, MY CHOICE...no?  So in essence, I suffered before I went to a doctor but now I'm paying health insurance to get diseases. I'm paying Blue Cross for high blood pressure because of a stubborn doctor who won't try me on the original drug yet hands me the more powerful ones..../and no doubt in my mind this has more to do with no profit in Valium than anything else.

I'm scared of cardiac issues from all this stress now..I hope I can make it through roller coaster season before cardiac issues begin to arise. Maybe then he might say "Gee, maybe Valium wouldn't have been a bad choice after all."  I can tape off the Valium if and when I no longer need it...I CANNOT taper off this anxiety-this is like a cancer gnawing away at me day in and day out.

HOW IN GODS NAME DO YOU GET THIS PILL????? It's still being manufactured, I have been diagnosed with GAD...SOMEONE is getting it...HOW?????? After two + years on Xanax, I'm not even sure if Valium will work...I'd have to stay away from all of them for a month or so to clear my system.

Thanks for listening and now I'm going back to crying. Never fails-as soon as I feel good (I do have those days) and think I've finally got a grip...it comes back slamming into me "HAHA! YOU'RE NOT FREE!!!!!!" it laughs.   I am SO tired of this...so tired.

[DonnieB1984]

You're Dr. is basically the same as most. He is watching his *** but also he is correct about the benzo vs. meds like paxil or my personally used lexapro. I've been on Xanax for 1 year and have tried Klonipin and Valium. Valium I got off of quickly bc of the same reason I don't take tamazapam (sp?) any more. It does in fact work well in taking away the anxiety but it makes the user VERY tired. Plus the tolerance goes up twice as fast as Xanax. The reason your doc wants to put you on a long term non benzo is because they actually repair the problem, not just stop it. See, your brain is "leaking" chemicals like a dam with a leak in it. The benzos just add to the amount of chemicals your brain has, The meds like lexapro, paxil, zoloft, etc actually work to "repair the hole". Therefore in time you will be able to totally get off of the meds (hopefully) and function normally. If you were to continue the benzos all that would happen is you would continue to accumulate a dependency and never actually "get better". Plus high levels of benzo consumption have been known to cause many other problem in the chemistry of your brain. I know you your pain, I am in the same boat. The lex I cant actually feel work but the Xanax I can. I just have faith after all of my reading (a LOT) in my Dr.s opinion and the drug facts themselves that in time taking the meds that will help totally correct the problem actually will. As far as obtaining the drugs you think that you need that your current Dr. refuses to prescribe, well that is just a matter of switching Dr.s until you find one who is just willing to try whatever their patient thinks he or she actually needs. I wouldn't count on it though, because I have been through four or five before I even found one who gave a **** about my disorder whatsoever. Best of luck to you.

[Paxiled]

A lot of misinformation here.  There is no evidence -- repeat, none -- that anyone with a mental disorder has any less or more serotonin that anyone else.  That was made up by pharmaceutical companies.  What is true is that ssris and snris and all the rest allow the body to use neurotransmitters longer by blocking the body's normal breakdown of them.  Problem is, the body then shuts down serotonin receptors because it doesn't need them anymore, and when you go off them these receptors wake up again causing many of the problems of withdrawal.  So there's no free lunch.  By the way, klonopin doesn't stop working over time, and no benzo is better than another, it's just which one works for you.  Valium is short acting, makes you tired, and then you're anxious again.  For me, ssris and trycyclics worked better, but trycyclics stopped working and stopping Paxil gave me a horrendous set of problems.  Again, there's no free lunch.  On the other hand, valium is no more dangerous than any other benzo, and if that's what you want, find another psychiatrist who will work with you.  This one won't, shed him or her.  And just because Ryan says it doesn't make it true, it just makes it Ryan's opinion based on the PDR and pharmaceutical company sponsored studies and such, not on knowledge.  There is no knowledge about the brain yet, just information.

[Ryan7591]

"A lot of misinformation here."

^quote

There certainly is (in the post you referenced above).

I agree with you on the 5-HT. No, there isn't one shread of evidence to support that some are "deficient" or "depleted" of 5-HT, Norepinephrine or any other neurotransmitter for the matter, or that any of these neurotransmitters are "unbalanced" in folks afflicted by anxiety or depression. There is evidence of excessive glutamate activity in the schizophrenic brain, but that is beyond the scope of this forum's subject material.

What there IS a clinical (and objective) evidence of, is a lifting of depression by inhibiting the reuptake of 5-HT, Norepinephrine, or both. However, by the same token, there is also evidence that inhibiting the reuptake of these various neurotransmitters may induce paradoxical reactions, new psychiatric or neuropsychiatric conditions that were not present prior to drug initiation, suicidal impulses, obsessive impulses and an entire slew of other adverse effects. But just because depression is lifted (in some) by altering a set of neurotransmitters doesn't mean that they are imbalanced. I personally do not believe in chemical imbalances as they relate to the brain, with the exception of organic brain disease such as schizophrenia. I believe that anxiety and depression are maladaptive responses to certain life circumstances and experiences. I believe that some are more predisposed than others to developing such responses. I also believe that if the maladaptive response is overcome, homeostasis will be reestablished, leading to amelioration of the symptoms. Easier said than done....

Which is why there is dope, an easy way out ... or at least initially. Every psychotropic agent loses it's efficacy, in part or in full. It may or may not be an appreciable loss of efficacy, but there is some loss after "X" amount of time. There are a plethora of factors involved, such as the system that metabolizes the drug, the half-life of the drug, the specific neurotransmitter system that the drug targets, time, the individual, the individual's state of health, and so forth. There is no possible way to forecast how long "brand Z" will maintain it's efficacy short of actually trying it. And even if there is no appreciable loss of efficacy, the drug is likely to be discontinued at some point, at least on a trial basis. When it is, whatever neurotransmitter system that it targeted will be compromised, leading to some degree of "discontinuation syndrome" until homeostasis is restored. Of course, the same could be said for cardiovascular agents such as alpha and beta blockers, corticosteroids such as Prednisone, and plenty of others. If any bodily system is compensated for via a synthetic drug, the removal of that drug, regardless of the rate of discontinuation, will carry some consequence. Homeostasis is not instantaneously restored in the case of any of these drugs.

You wrote that Klonopin does not stop working over time. For panic, it usually does not (appreciably), but it would ultimately depend on the person. Klonopin caused me harm. For generalized anxiety, it typically does. Then again, it's not indicated for GAD. For petit-mal seizures, it loses it's efficacy in 30% of cases as reported by Roche. In my opinion, the figure is 100%. Over the long-term, Klonopin induces negative behavioral changes in 25% of uses on a dosage of 1.5 milligrams daily. Klonopin is chlorniated Nitrazepam. Chlorinated compunds are poison. Klonopin is metabolized by the CYP3A4 enzyme of the P-450 pathway (by the liver). When reduced to its active and inactive metabolites (Acetylclonazepam and Hydroxyacetylclonazepam), it is oxidized into free radicals. There are two trains of thought on free radicals....(1) They extend life, and (2) They shorten life. No one knows what the correct answer is. My guess is #2, given the long-term side effects of Klonopin (cognitive issues, possible liver dysfunction and thrombocytopenia, general deterioration, joint issues, muscle weakness, blah).

Valium...can be very useful. It isn't chlorinated, it isn't as potent as Klonopin, it doesn't bind to central gabaergic receptors and it carries less of a risk over the long-term for the majority. It is a fairly unique drug with a biphasic half-life and several active metabolites. The estimated half-life for Diazepam is extended by one hour past the age of 20 years.  20 hours for Diazepam, and 36-200 hours for Desmethyldiazepam. The former is an anxiolytic, the latter is a skeletal muscle relaxant. Looking at those two figures alone, it would appear that Valium is long-acting. It is, and it isn't. Depends on how it is dosed.

_______________________________________________________________

[Ryan7591]

continued...exceeded limit:

The initial distribution phase for Valium is two hours, with a half-life of one hour. That's how long Valium stays in your head. The main problem with Valium, other than it's potency, is high protein binding. It is 98% bound to plasma proteins, and rapidly absorbed. It is just as rapidly redistributed to adipose (fat) tissue, where it is stored for a very long time. A single dose of Valium exerts an effect ranging from 4-8 hours. Age and liver function are the two variables that determine the duration of action. On average, it is 6 hours for a single oral dose. However, if taken three-to-four times daily, it accumulates significantly over a span of one month. Once it does, it is no longer a short-acting agent. Any interdose issues that were related to it typically vanish as a result of this accumulation to steady-state. In addition to accumulating to steady-state, it accumulates between 5-7 times that of steady-state over a period of two months - more in the elderly. This can be good or bad, depending on age. In a younger person, it provides 24/7 coverage against GAD symptoms, so long as the dose is in the 15-40 mg range, and divided into three or four doses. In the elderly, the risk of injuries from falls and liver damage is increased significantly.

You mention Tricyclics. I love this class of antidepressants. They are good for many things...anxiety, depression, insomnia, neuropathic pain and migraines. I have all of those problems, and take 75 mg of Sinequan daily. It works very well for me, and is underrated as an anxiolytic in my opinion. In low doses (less than 10 mg), it almost always works for insomnia. 1, 3, and 5 mg tablets are currently being reviewed for approval for insomnia. Imagine that over Ambien, which is nothing more than a modified benzo. These drugs are slowly making a comeback. If Tofrnail stopped working for you, there are many others that you could try. Anafranil is one of them. Vivactil is another. There are dozens more.

In addition to those is a new MAOI patch, Selegiline, sold under the name Emsam. The 6 mg patch carries no dietary restrictions. The point I'm trying to get across is there are many things you've not tried. I know you've had several bad experiences, but relief is out there if you want it. You don't have to live in misery, not in this day and age.

You say I give my opinion. In this post, I largely did, but for the most part what I write is based on fact, and my facts extend well beyond any PDR. If it's not a widely accepted fact, I'll state so. Frankly, you have made more accusations than anyone. Case in point from above "Valium makes you tired". Valium never made me tired, but it could certainly have that effect. On a panic disorder patient, it typically causes a paradoxical effect of stimulation and increased panic. Paxil gave you problems. I also took Paxil, and I didn't have any problems stopping it. I know a dozen others who also stopped taking it without problems. I don't have a personal vendetta against you, I'm not on a power trip, I have no vested interest in the big pharma companies, and I'm no longer a med student. My only interest in these drugs is as a sufferer of anxiety, along with physical illness. I value what you contribute to this forum, and I enjoy engaging in a rational conversation with you. The only thing I don't like is when opinions are misrepresented as facts, or when strong opinions pertaining to unique outcomes can potentially and negatively influence the minds of others on this forum. Anxiety folks in general are very suggestible, and I always try to keep that in mind. Like you, I often fall short of that goal by disclosing too much. There is a lot that I would like to disclose, but refrain from doing so for various reasons.

Best regards,

Ryan

[Ryan7591]

JaxRiley,

If you have developed any significant tolerance to Xanax, Valium is highly unlikely to be of any benefit to you, with the exception of higher dosages (30-40 milligrams daily). Getting on the Valium (a one month process), may prove very difficult. Ativan is effective, but keep in mind that it is 1/2 the strength of Xanax, and has very little anti-panic properties. In addition, Ativan is short-acting, just as Xanax is. Tolerance is a major problem with long-term use. Rebound between doses is another major issue.

Aside from Klonopin, there are no other Benzodiazepines that will be as effective for you as the Xanax once was. The remainder of the long-acting benzos (Librium, Tranxene and Valium) are very weak relative to Ativan and Xanax. High dose Valium would likely be effective, but you may have a problem obtaining the dosage you need...upwards of 40 milligrams daily. Valium is very effective, but not when you've developed tolerance to high potency, short-acting benzos. There''s just not a lot of "muscle" behind a milligram of Valium. You'd need many milligrams, more than most GP's would prescribe. If you really want the Valium, you'd need to see a psychiatrist. Even there, there is no guarantee that you'll  receive it. The majorirty will push Ativan and Klonopin, primarily because Valium is very weak. Neurology, oddly, has taken the lead of prescribing Valium for muscle disorders.

-Ryan

[Paxiled]

All points well taken.  My only problem with your posts, and I appreciate every one of them, perhaps I didn't make that clear, is you tend to generalize information, whereas I try to emphasize the individual nature of how people respond.  I'm not trying to get into a contest with you, I just worry that people take what you say as universally true, which it isn't.  Sometimes you say so, and sometimes you don't.  You have a following here, which puts a responsibility on you which you undoubtedly never asked for.  I did get offended the first time I ever posted on here when you doubted my experience, and when you doubt the experience of others.  But please, keep posting, and I'll keep replying not to counter what you say, just to let people know that though what you say does apply to most, it doesn't necessarily apply to any one individual.  by the way, never knew you were a medical student -- you know way too much about how drugs work for me to think you were a medical student!

As to klonopin, very interesting post.  I didn't know that about the chlorine.  I've been on it for more years than I can remember, and I'm frankly afraid to go off it, and all the psychiatrists I've seen are afraid to take me off it.  I don't believe it's given me any of the ill effects you've mentioned, but I can't it's helped a whole lot either.  I find it a short term help, just like any other benzo.  Tricyclics had pretty bad side effects for me, and then stopped working.  Paxil had its side effects, too, but it worked better than anything else I've taken; unfortunately, the side effects got worse over time and interfered when I decided to return to full time writing, and I've also said the main problem was a quack of a psychiatrist who never told me about withdrawal even while I was in it.  By the time I found the courage to find out it was too late to follow the recommended protocols.  I thought it would just stop, but it never did, now I'm on 30mg of Lexapro hoping, but not getting much.  My problem was mainly anxiety attacks, now I have constant intense anxiety and morbid depression, neither of which I ever had until I discontinued Paxil.  Obviously, that makes me pretty pissed off.

Valium worked for me about a half hour, then just left me tired.  Like I say, all of these are very individual.  

[Paxiled]

One other thing.  Free radicals both increase and decrease life.  It depends on which ones you're talking about, and whether the body has the appropriate amount of antioxidants to keep it functioning properly.  Oxidation is just one of the many ways the body has to rid itself of what it doesn't need anymore, so it's a necessary process, but if the body lacks the proper balance of antioxidants free radicals cause all kinds of havoc.