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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!
23 Responses
366811 tn?1217426272
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.

242912 tn?1402547092
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!
Avatar universal
Thank you for all your comments.  Does valium last longer than xanax?
432009 tn?1304753441
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?
242912 tn?1402547092
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.......
Avatar universal
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.  
432009 tn?1304753441
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.
Avatar universal
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.
Avatar universal
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
432009 tn?1304753441
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.
Avatar universal
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


Avatar universal
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.
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