Xanax treatment OK for long term, should I ask my psychiatrist?

[Spartacus007]

From the age of 16 I have been taking Valium. After my mother died I experienced what my GP described as multiple episodes of post traumatic stress disorder.

When I went onto the Xanax I felt invincible. It was a real knockout. I started taking it every day. I had no friends, no hope for the future, no job prospects, my quality of life was zero and well, I had nothing. I lost a lot of weight. I went onto the Xanax after my mother died. She died nearly a year ago and I still have difficulty coping.

Then because I took too much Xanax (anything up to 10mg to 14mg per day) my doctor took me off them and stabilised me on Valium. That was fine, but I was not given a tapered withdrawal and went down to 10mg Valium/day. I couldn't cope and the nurse at the intake centre would tell me to go to the hospital to pick up more tablets. Now I feel the need to take 30mg Valium/day.

I have just started an alternative: Ativan 2.5mg tabs. They don't seem to have any effect. I took three tabs at once and it didn't make a dent (or not that I noticed).

My disorder is severe anxiety and panic disorder and now I am wondering what to do. My prognosis from the last visit with the psychiatrist was "very bleak."

I don't have easy access to a psychiatrist where I live in country Australia. It can take months.

I have read that it is safe to use Xanax long term (this was described as 4 years) so long as there is no continuing to increase the dose and you take it as prescribed. Should I call the intake centre and ask to speak to the psychiatrist about putting me back on Xanax? The other alternative is Valium, but 10mg tablets are not available in Australia and Valium repeat prescriptions are also not available in Australia. I would find either effective, although I prefer the Xanax because interestingly enough I can function quite well on it (I can read, study, do things like that) which is possible with Valium but only after a few hours of taking it.

Thank you for your time and advice.

[RCA7591]

10-14 mg of Xanax daily is "excessive". The problem with using such a large dose is *tolerance* (which would develop rapidly, likely over a period of a few months), and render the drug ineffective. It would also increase your tolerance to other Benzodiazepines, making them "less than optimal" for control of your symptoms. For this reason, Benzodiazepines must be used carefully, in reasonable doses.

Ideally, Xanax should be reserved for PRN (as needed) use only. Optimally, Xanax should only be used to "stop" a panic attack, and not for the *maintanence* of anxiety disorders.

Each Benzodiazepine class of drug exhibits similar effects on the brain and CNS, producing various degrees of dose related
anticonvulsant-sedative-anxiolytic properties. The difference between the various classes is the *half-life*. Benzodiazepines  with shorter half-lives are best suited for PRN use, while those with longer half-lives (greater than 12 hours), are better suited for *maintanence* of anxiety disorders.

Xanax falls under the category of the short half-life class of Benzodiazepines. If taken daily, it must be used TID or QID (three to four times daily), generaly every 4-6 hours to prevent "interdose anxiety". The problem with this approach is increased tolerance and dependency. The shorter acting drugs are more difficult to withdrawal from, as they have an immediate onset of action, and a short half-life. They "wear off" too quickly to be used as maintanence therapy.

A better choice for the maintanence of anxiety is a potent Benzodiazepine with a long half-life. Klonopin (Clonazepam), is the best drug in this class, and serves this purpose well. When dosed BID (twice daily), a steady-state blood level is established, which blocks or minimizes the effects of "panic".
Ideally, Klonopin should be taken every day, twice a day, with the doses spaced 12 hours apart.

For milder cases, Librium and Valium are good choices, but they must be dosed TID or QID, as each has two half-lives, the first of which is very short (much like Xanax). In the case of Valium, the first metabolite (Oxazepam) is rapidly removed, while the second metabolite (Nordiazepam) has a longer half-life approaching 200 hours.

Perhaps the best option for you at this point is to first stabilize on Valium, and then make the transistion to Klonopin (Clonazepam). Since you were previously taking such large doses of Xanax, you may need to start on 2 mg of Klonopin daily (1 mg every 12 hours). If this in not sufficient, the dose may be increased to a *maximum* of 4 mg daily (2 mg BID, every 12 hours). Klonopin is twice as strong as Xanax, and twenty times stronger than Valium. Once stabilized on Klonopin 2 mg, you should give the drug a week or two to reach a "steady-state" level. If optimal results are not obtained, the dose may be increased to the maximum of 4 mg daily.

For maintanence, Klonopin is the best Benzodiazepine, and retains it efficacy in 70% of individuals without the need to increase the dose. Avoid shorter acting drugs such as Xanax, Ativan, Serax, and Tranxene, unless they are to be used PRN only.

PRN Drugs:

Ativan (Lorazepam)
Serax (Oxazepam)
Tranxene (Clorazepate, regular)
Xanax (Alprazolam)
Niravam (Alprazolam rapid release)

Maintanence Drugs:

Klonopin-Rivotril (Clonazepam)
Librium (Chlordiazepoxide Hydrochloride)
Valium (Diazepam)






-Ryan

[Spartacus007]

Thank you Ryan, I had absolutely no idea whatsoever about these medications and which ones were best for what. I was told nothing. First I was on Valium, then panic attacks and trauma started in earnest after I only had just normal anxiety since I was 5 years old (psychiatrist prescribed Xanax) and he didn't explain anything to me. I was under the impression I could take Xanax for anxiety and panic attack, and obviously I quickly got to excessive usage. That's obviously why my GP took me off Xanax immediately (this was about 3 months ago) and stablized me on Valium.

But now the Valium is becoming ineffective and is barely making a dent, even when I take 40mg. I also didn't know about the PRN and various other technical things and the difference between panic attack usage and maintenance of anxiety.

I will print this off for my doctor tomorrow and show her. She's very good and in the surgery if the isn't sure of something she makes a call to someone at the hospital who does.

Thank you very much for your time, and preventing me from "demanding" Xanax again! (Which could have resulted in disaster yet again...)

James

[Spartacus007]

Ryan,

You are obviously extremely knowledgeable and I thank you for taking the time to respond to my question. I think you know more about these things than my GP and psychiatrist put together. (I get a new shrink every three months however, and a different diagnosis every time!)

If you have time may I correspond with you by email briefly? I noticed on the forum someone else has.

My email address is: ***@****

Thanks again Ryan. You've been a great help and have significantly relieved the worry I have felt this evening.

[RCA7591]

James,

I sent you an e-mail message. Feel free to ask any questions.

-Ryan

[leeia]

Hello, I am a mother of 3 & my first husband commited suicide over 5 yrs ago. Due to panic attacks & anxiety I was put on xanax & stayed on them for over 2 yrs. I since remarried & stopped taking the meds for over 2 yrs. Over the past year or more my very mature & very emotional 13 yr old daughter has had bad episodes of anxiety, ie, crying, hyperventilating, insomnia etc. She has been diagnosed with depression,add and anxiety disorder. For a period of time she had started cutting her wrists (to ease "mental & emotional pain") she says. After having to deal with her issues I began having panic attacks again and was put back on xanax. We have no health insurance and cannot afford to take my daughter to a psychiatrist, altough she has been seeing a counselor for several months. She has stopped cutting (thank God) but occasionally has episodes of manic crying, panic attacks & insomnia. Is it wrong for me to give her a half mg (0.5) of xanax at times like these? She is a healthy girl, weighing about 130 and is 5'3". Do you have any suggestions for any homeopathic remedies as well?