Would like to Get off SSRIs

[hatgal]

Hi All - I'm new here, but have had axiety/panic issues for 11+ years. I know all of my issues are hormonally driven, but I won't bore you with that side of it.

A little history:  In the beginning, the docs put me on klonopin and it was wonderful for controlling the anxiety/panic attacks that were extremely bad. The I became pregnant and went off of it.  Fast foward to 9 months post baby and the anxiety hit again. The doc then put me on zoloft for long-term use, but still had/have the klonopin for actual attacks. Zoloft was wonderful (ask my husband!). However, after several years (my bad), I realized that zoloft was affecting my sex drive (or lack thereof very much so). I thought it was b/c of kids, etc., which it probably was, but because of the hormonal imbalance, not the actual fact of having kids.

Before kids (and the hormonal imbalances thereto) I was a very sexual person - had my husband going all the time (lol). Anyway, a few years ago I addressed the sexual issue with my doc and he prescribed wellbutrin to counteract the zoloft.  It seemed to work, but only for a while. In the meantime, had another baby a couple years ago. A few months ago I addressed the sexual issue again with my doc and he changed me from zolfot to effexor - whoah boy!!! I believe the effexor has finally put me over the edge with irritibility, disorientation, and a general insaneness (even thoughts of desperation and taking my life - not that serious, though). So a few days ago, I took my self off the effexor and resumed my zoloft.

Continued on next post..........

[hatgal]

Ok, now my question as I've been reading some archives on klonopin. Do any of you have any thoughts on stopping zoloft and just taking klonopin twice a day?  I believe this would solve my sexual isues and make me sane again. I do, however, have another issue with doing that - I take vicodin for a disc protrusion that is compressing my spinal cord (need surgery, but that's for another forum!).

Does anyone know if it would be safe to take vicodin and klonopin together? I feel this would really solve my anxiety/depression issues once and for all while allowing my old self to return, whom I have missed very much!

Sorry this is sooooo long, but I really need some help. Thank you in advance for any support you can offer.

[suzi-q]

I really don't have much info on your questions.  However, I take a medication called buspar.. It is an anti-anxiety medication that I take twice a day.  It is not the same "pow" like you get with Klonopin.  It is one of those meds that takes time to work into your system.  I find it to be very helpful with my anxiety.  However, I do also take an SSRI (Paxil) with it and I don't know how it would work alone.  I hear ya' about the sexual side effects...it's like.."I don't have a bad sex life, I have "NO" sex life!!"  LOL...just a little humor there!!!  Best to you!

[hatgal]

Hey - I have a good friend that we call suzi-q! But I knowyou're not her b/c she doesn't even own a computer or even know how to turn one on!

Anyway, I believe buspar to be like a wellbutrin and thank you for your information.  I do just want to get off the SSRIs altogether so I am seeking the advice for the klonopin.  Believe me when I tell you I'm way not too proud to be on the ssri; it's just that my hormones have gone quite haywire lately and I'd like to give the drugs a rest and see if I can get by with just the klonopin.

Thanks again, Suzi-q!  Best to you.......

[suzi-q]

Let me know how it goes!  I would like to try soon myself!!

[RCA7591]

Hatgal,

Unfortunately, sexual side effects are fairly common with the SSRI class of antidepressants. The SSRI's are best reserved for depression.

Note that BuSpar, in monotherapy, is a worthless drug (originally developed as an antipsychotic, but was a failure). It came out in the late 80's, around the same time as Prozac. For BuSpar to be effective, it must be combined with an SSRI or SNRI.

Klonopin is indicated for "panic disorder" (recurring panic attacks). Klonopin doesn't have the sexual side effects, and is very effective at preventing "panic" when taken everyday, twice daily. Klonopin is relatively free from side effects, but being in the Benzodiazepine class of drugs, one can develop a tolerance or dependency to it after a prolonged period of time. Never the less, it is one of the most effective treatments. It is the front-line treatment for panic disorder.

The average starting dose is 0.25 mg BID. After three days, the dose may be increased to the "target dose" of 0.5 mg BID.

The downside to using Klonopin is it's interaction with other CNS depressants (alcohol), narcotics, and other sedative-hypnotics. Vicodin is contraindicated with Klonopin, as it has an "additive" effect. 30% of users develop a serious tolerance to its effects (requiring more of the drug to acheive the same results), this is uncommon.

-Ryan

[DragonTU84]

Now, I know this is a little off-topic, but my doctor recently prescribed me with Lorazepam 0.5 mg for my panic attacks. However, since he didn't believe I had the full-blown Panic Disorder, he felt that would be a suitable benzo. for my Panic Attacks. However, today I popped my first pill for the day around noon. About an hour afterward, approximately around 1:05 p.m., I had a FULL BLOWN ATTACK of the head wackiness (as I call it) where it feels like my brain is going haywire, dizziness/lightheadedness, vertigo, increased heartbeat, clamminess and sweatiness, hot flashes, etc.!!

I am just wondering if I am on the RIGHT Benzo. for my attacks, or if you think something like Klonnopin is better suited for my attacks?? My psych upped me to 1 MG, but I am wondering if switching to another benzo. would benefit me in the long run?? What do you think RCA, as you seem to have good knowledge on Panic Attacks and Disorder and the proper meds. for it.

I cannot take any SSRI's, FYI. I get a weird neurological/physiological reaction that causes electrical sensations/vibrations and a ten-fold pins-and-needles feeling to surge through my head, as well as increased Panic Attacks and mood swings (occasionally).

Yet what Benzo. do you think a person like me (that obviously can't take SSRI's) could take? Do you think the Lorazepam 1 MG will be sufficient enough, or is there another one my psych. should prescribe for me?

[imcrazy2]

You need to be VERY careful switching suddenly from effexor to zoloft--effexor has a very short half-life and zoloft has a longer half-life, so you could have MAJOR side effects froom the switch.....e-mail me for more info....***@****

[RCA7591]

Dragon,

How was the Lorazepam prescribed (once or twice daily)?

There have been rare reports of Ativan (Lorazepam) causing "extra pyramidal" side effects (those opposite to what the drug is intended to treat). Perhaps this is the case. Personally, I wouldn't even take it again, as the same thing is likely to recur.

Ativan is not the best Benzodiazepine for panic disorder. Ativan in general is not a very useful drug for panic. It is helpful for GAD on a PRN basis. Klonopin (Clonazepam) is twice as strong as Ativan, and has a much longer half-life. I would recommend Klonopin 0.5 mg BID (every 12 hours). Klonopin targets panic specifically.

Definitely let your doctor know about the extra pyramidal side effects you experienced. Ask for Klonopin.

-Ryan

[hatgal]

Ok, I already take Zoloft, as you all know and klonopin for anxiety instances.

However, I have an opportunity that I really, really really want to do - go visit my best friend in NC next weekend - yes, FLYING!

Does anyone have any thoughts on what else I could take in addition to or besides klonopin  in order to fly. I am absolutely petrified to fly and I would be going alone.  Haven't flown in about 11 years!

Thanks for any suggestions.

[hatgal]

I'll also open a new thread with this topic.  Thanks.

[396SS]

I hate flying too.  I take, for example, my valium like 3 hrs or so prior to flying.  Then, 1/2 prior to boarding - I just take dramamine.  I'm then pretty much careless.  Honestly, I can't sleep much, b/c the dramamine gives me a restless leg type feeling, but it is minimal compared to the anxiety of flying.  Hope this helps.  Take care and go on your trip:)

[DragonTU84]

"Dragon,

How was the Lorazepam prescribed (once or twice daily)?

There have been rare reports of Ativan (Lorazepam) causing "extra pyramidal" side effects (those opposite to what the drug is intended to treat). Perhaps this is the case. Personally, I wouldn't even take it again, as the same thing is likely to recur.

Ativan is not the best Benzodiazepine for panic disorder. Ativan in general is not a very useful drug for panic. It is helpful for GAD on a PRN basis. Klonopin (Clonazepam) is twice as strong as Ativan, and has a much longer half-life. I would recommend Klonopin 0.5 mg BID (every 12 hours). Klonopin targets panic specifically.

Definitely let your doctor know about the extra pyramidal side effects you experienced. Ask for Klonopin.

-Ryan"

I am told to take the Lorazepam 2-3 times a day up until bedtime. Before I was taking 0.5 MG twice daily, now I am taking 1 MG since the doctor thinks my reactions was due to it just not being strong enough.

I was fine for over a week on it. Just yesterday's attack made me wonder if I was on the right Benzo. My Psych. highly recommends it, and uses it for his treatment of Panic Attacks and Disorders. He said it is also the least likely to cause side effects, and knowing how sensitive my autonomic nervous system is (especially towards SSRIs), he thought Lorazepam would be the best.

He thinks I have more GAD with Panic Attacks, so he thought Lorazepam would suffice. However I cannot deal with getting attacks like the one I had to endure. Yet I will ask him the next time I see him about Klonopin and its benefits vs. Lorazepam, and also inform him that you told me about the pyramidal effect of Lorazepam/Ativan for Panic Attacks.

Thanks for all of your help!

~Crystal~

[RCA7591]

Crystal,

Here are some key notes I dug out of the PDR on Ativan:

"The effectiveness of Ativan (Lorazepam) in long-term use, that is, more than 4 months, has not been assessed by systematic clinical studies. The physician should periodically reassess the usefulness of the drug for the individual patient"

"Rare Reactions: Disorientation, depression, nausea, change in appetite, headache, sleep disturbance, agitation, dermatological symptoms, eye function disturbance, together with various gastrointestinal  symptoms and autonomic manifestations."

"Common Reactions: In a sample of 3500 anxious patients, the most frequent adverse effects were sedation (15.9%), followed by dizziness (6.9%), weakness (4.2%), and unsteadiness (3.4%)."

"Physical and Psychological Dependence: Withdrawal symptoms similar to those of barbiturates and alcohol have been reported following abrupt discontinuation of Benzodiazepine drugs. These symptoms include convulsions, tremor, abdominal and muscle cramps, vomiting, and sweating. Withdrawal symptoms have been reported following abrupt discontinuation of Benzodiazepines taken continuously at therapeutic levels for several months."

"Peak plasma level is obtained after 2 hours following administration of Ativan. The mean half-life for unconjugated Lorazepam is 12 hours."


I don't agree with the 12 hour half-life, as it is highly variable depending on metabolism. It is more like 6-8 hours, making interdose anxiety common with Lorazepam. That is why it is typically prescribed TID, rather than BID. In fact, the PDR lists the "typical dose" as 2 to 3 mg given TID, in divided doses. In other words, 1 mg taken three times daily is common.

Ativan (Lorazepam) is a general anti-anxiety drug, and does not target "panic" specifically. The plasma level will also "peak and trough" between doses, as it is rapidly eliminated. This causes breakthrough anxiety and withdrawal phenomenon. For this reason, it is better suited for occassional use (PRN, as needed).

On the other hand, Klonopin (Clonazepam), has a 50 hour half-life. The onset of action is long (45 minutes to 2 hours), peak plasma level is reached after 2 hours, and the drug is very slowly eliminated due to the long half-life. In other words, it remains in your blood much longer than Lorazepam. A steady-state (maintenance) plasma level is obtained when dosed BID (twice daily), typicallly at 1/2 mg doses. Klonopin primarily targets panic.

1/2 mg BID of Klonopin will directly replace your 1 mg BID of Ativan. Klonopin is "very smooth", so if you have a sensitivity to SSRI's and other drugs, Klonopin would be a good choice. Librium is the 2nd best choice, but must be doses QID (four times daily).

I disagree with your shrink that Ativan has the best side effect profile, as it's short half-life effects plasma levels (and therefore, the frequency of your symptoms). It has a "rollercoaster effect", and is no better than Xanax in this regard.

-Ryan

[DragonTU84]

Ryan,

First of all, I thank you for all of your prompt responses.

Now, regarding the Lorazepam vs. Klonopin debate.

I won't see my Psych until another 3 weeks, so do you think it would be alright if I just stuck with the Lorazepam until I am able to see him and try and get onto the Klonopin?? I really don't want to just STOP the med., because I think on no med. I am just back to square one and getting attacks every few days. At least now it is only once a week tops...

Also, for now the Lorazepam doesn't seem to do much for me. It does not have that "calming effect" that benzo's are supposed to cause. For me, I just feel like my normal, every-day old self, even taking 1 MG of the Lorazepam daily. It does however overall make me a little more tired during the day, up until the medicine starts to wear off after its peak 4-6 hours later.

But my problem isn't entirely Anxiety to begin with. I do have anxiety, I will admit that, but it seems to have stemmed from when I first started getting Panic Attacks. The Panic Attacks just raised my anxiety levels which is now causing me some mild increased anxiety during the day. I think once my psychiatrist gets to the root of the panic attacks, then the anxiety will also diminish, and my main anxiety is the FEAR of getting MORE and WORSE panic attacks, typical of Panic Disorder.

Otherwise, I am able to go about the day calm and carefree, as long as I am not worrying about getting another attack or another attack doesn't spring up and interrupt my day!!

However, since I am otherwise pretty functional, he did not want to diagnose me with the full disorder (Panic Disorder) and instead just give me a med. to target anxiety specifically. Yet the worst thing for me right now IS the panic attacks. If I didn't have the PA, then I think 90% of my apprehension, fears and overall anxiety would diminish.

I will certainly address the issue with him, but like I said, it won't be another 2-3 weeks until I see him. Do you think I can suffice on just the Lorazepam in the meantime?? What do you recommend??

I thank you for all of your help Ryan, and for the person who started this topic, I apologize for interrupting it to ask this question. It's just that I saw that Ryan had mentioned Klonopin, which is what my GP had wanted me to start on, yet I never took it since I wanted to see a Psychiatrist who I thought would be better knowledgeable on my health and situation to prescribe the proper med. I know that she (my GP) thought highly of Klonopin, and didn't even want to THINK of Ativan/Lorazepam or Xanax as an option. Yet my Psychiatrist just thinks SO highly of Lorazepam...so I just didn't know what to do or believe.

Thanks again for all of your help Ryan!! And I hope to hear from you soon!!

~Crystal

[DragonTU84]

Ryan,

First of all, I thank you for all of your prompt responses.

Now, regarding the Lorazepam vs. Klonopin debate.

I won't see my Psych until another 3 weeks, so do you think it would be alright if I just stuck with the Lorazepam until I am able to see him and try and get onto the Klonopin?? I really don't want to just STOP the med., because I think on no med. I am just back to square one and getting attacks every few days. At least now it is only once a week tops...

Also, for now the Lorazepam doesn't seem to do much for me. It does not have that "calming effect" that benzo's are supposed to cause. For me, I just feel like my normal, every-day old self, even taking 1 MG of the Lorazepam daily. It does however overall make me a little more tired during the day, up until the medicine starts to wear off after its peak 4-6 hours later.

But my problem isn't entirely Anxiety to begin with. I do have anxiety, I will admit that, but it seems to have stemmed from when I first started getting Panic Attacks. The Panic Attacks just raised my anxiety levels which is now causing me some mild increased anxiety during the day. I think once my psychiatrist gets to the root of the panic attacks, then the anxiety will also diminish, and my main anxiety is the FEAR of getting MORE and WORSE panic attacks, typical of Panic Disorder.

Otherwise, I am able to go about the day calm and carefree, as long as I am not worrying about getting another attack or another attack doesn't spring up and interrupt my day!!

However, since I am otherwise pretty functional, he did not want to diagnose me with the full disorder (Panic Disorder) and instead just give me a med. to target anxiety specifically. Yet the worst thing for me right now IS the panic attacks. If I didn't have the PA, then I think 90% of my apprehension, fears and overall anxiety would diminish.

I will certainly address the issue with him, but like I said, it won't be another 2-3 weeks until I see him. Do you think I can suffice on just the Lorazepam in the meantime?? What do you recommend??

I thank you for all of your help Ryan, and for the person who started this topic, I apologize for interrupting it to ask this question. It's just that I saw that Ryan had mentioned Klonopin, which is what my GP had wanted me to start on, yet I never took it since I wanted to see a Psychiatrist who I thought would be better knowledgeable on my health and situation to prescribe the proper med. I know that she (my GP) thought highly of Klonopin, and didn't even want to THINK of Ativan/Lorazepam or Xanax as an option. Yet my Psychiatrist just thinks SO highly of Lorazepam...so I just didn't know what to do or believe.

Thanks again for all of your help Ryan!! And I hope to hear from you soon!!

~Crystal

[RCA7591]

Hi Crystal,

I would continue to use the Lorazepam at the prescribed dose for the next three weeks, until you can speak with the Psychiatrist. Any reduction in your dose at this point will intensify your symptoms.

From your description, it sounds to me as though you are indeed suffering from "panic disorder", which is a true DSM diagnosis. There wasn't a problem with trying Lorazepam, but it clearly isn't having enough of an impact on your symptoms. "Fear of future panic attacks" is a major criteria for panic disorder.

The Psychiatrist's job is to improve your "quality of life" by minimizing your symptoms are much as practical. No single drug can fully "null" your symptoms, but there are better alternatives to Lorazepam. Klonopin is the obvious choice, and is indicated for the long-term maintenance of panic disorder.

When you do get an opportunity to speak with the Psychiatrist, be sure to mention the "fear of future attacks". I would also mention Klonopin.

The "calming effect" is merely sedation, a quality of all Benzodiazepines. When used at therapeutic doses, over an extended period, this side effect tends to abate rapidly. One should not "feel" a Benzodiazepine, per se (particularly Klonopin). Most people on maintenance therapy would simply feel "normal", with a large reduction in their symptoms.

-Ryan

[tarwolve]

does anyone take zoloft and lexapro together? I am on 50 mg zoloft but raising it increases my anxiety, so doc has added 5 mg lexapro. I'm still nervous skittish and depressed. it's been 3 weeks. I have been on the zoloft alone for 1 year but it has lost it's punch.Any thoughts?