Opinions - Which Benzodiazepine For Different Sorts of Anxiety?

[Orchid_Suspiria]

From a completely unproffessional point of view SWIM would have to say xanax.It seems to have a very short half life however the effects seem to come on much quicker than valium.

[DrMuffy]

Well for short anxiety attacks, a short acting one such as Xanax (alprazolam) would be good. There are also many other short-acting benzos (check benzodiazepine equivilance chart). Of course it takes a little bit to kick in so it wont calm your friend for the first part of his attack. Also, since it is short-acting, a rebound effect may happen, which would not be a good thing. Why does your friend want such a short acting one though? Because long-acting ones such as Klonopin (clonazepam) or Valium (Diazepam) can help your friend's anxiety problems all through the day due to their long half-life, so those might be a better choice for your friend.

[Psych0naut]

Originally Posted by DrMuffy

Because long-acting ones such as Klonopin (clonazepam) or Valium (Diazepam) can help your friend's anxiety problems all through the day due to their long half-life, so those might be a better choice for your friend.

SWIM thought clonazepam was pratically only prescribed as an anti-convulsant. SWIM knows a few people who had a presription for Rivotril and they all had it presribed because of their seizures.

[DrMuffy]

Originally Posted by Psych0naut

SWIM thought clonazepam was pratically only prescribed as an anti-convulsant. SWIM knows a few people who had a presription for Rivotril and they all had it presribed because of their seizures.

Well SWIdr is currently being prescribed 1mg Klonopin (Daily) for his GAD (General Anxiety Disorder). Also he has read about several others in DF who were or are being prescribed Klonopin for anxiety, so he would say it's one of the more popular prescribed benzodiazepines for anxiety.

[pankreeas]

Here's a chart with a breakdown on the 3 most popular benzo's

V = Valium (diazepam); A = Ativan (lorazepam); X = Xanax (alprazolam)

Indications (Uses):
V - anxiolytic, preoperative sedative, anticonvulsant.
A - anxiolytic, preoperative sedative.
X - anxiolytic, panic disorder.

Equivalent Doses:
V - 5mg
A - 1mg
X - 0.5mg

Approximate Half-life:
V - 100h
A - 10-20h
X - 12-15h

Onset of Action
V - < 1h
A - 1-3h
X - 1-3h

Are Metabolites Active?
V - yes
A - no
X - yes

Metabolism:
V - oxidation
A - conjugation
X - oxidation



Swim suggests trying the Ativan sub-lingual @ 1 mg before trying something like Valium. The sublingual will absorb faster which is what you want for a sudden attack... well either that or you could plug the non-sublinguals for faster onset, but that doesn't work very well in public.

[GreatWonder]

SWIG realises kick-in is going to differ for all individuals but would not have thought Xanax (Alprazolam) would take 1-3 hours, unless this is the approx time when peak concentration levels are recorded. SWIM usually starts feeling the benefits from Xanax within 20 minutes.

[kizevin]

From SWIMs personal experience Xanax does kick in faster and has a shorter duration of effect. The only benzo worth a damn to SWIM are 10mg Valiums. Those don't seem to cause quite the amnesia that Xanax and Klonopin do, at least for SWIM. SWIM can take up to 50mg of Valium and still remember what he did last night. However, catch SWIM when he's eaten a Xanax bar and forget about it, he's probably already blacked out.

[Jatelka]

Clonazepam for anxiety is a mainly US thing (as far as SWIJ can work out), she is not aware of Europe using it, except as an anti convulsant.

[Psych0naut]

Originally Posted by Jatelka

Clonazepam for anxiety is a mainly US thing (as far as SWIJ can work out), she is not aware of Europe using it, except as an anti convulsant.

That's probaply the reason then

[csharpprogrammer]

SWIY should try letting the Ativan desolve under his tounge. The onset will be quicker, and the duration should be shorter.

[Sickpup]

The FDA in the US recently approved Klonopin for GAD.The fastest acting benzo thats practical to obtain in the US,from SWIM firsthand trials.Greenstone made generic Xanax.They can hit in 20 min like a truck.Some may argue halcion,but the script wont give you enough.Tablet midazolam isnt available in the US and SWIM has to much anxiety to carry around unscripted c IV's which are a felony in most states.

[Laudaphun]

SWIM has been diagnosed with a generalized anxiety disorder and has been given anti depressants in the past, which helped somewhat but all had unpleasant side effects. SWIM has a new Dr. who is aware of his past opiate dependance and while cautious, is not totally against prescribing controlled substances. SWIM's symptoms are becoming troublesome again and he has decided that he needs to seek treatment for them again. This is a different Dr. that treated him the first time. SWIM currently has a prescription for librium that helps, however it's a little weak. SWIM wants a benzo that he can take on an as needed basis. SWIM likes the librium because he is not tempted to abuse it like some of the more powerful benzos, but it is probably a little too weak to treat his condition. SWIM doesn't want to take any medication daily, definitely no more ADs, definitely wants to steer clear of benzo dependance, and SWIM doesn't want to be impaired during his daily activities. While SWIM feels that so far librium is the best canidate to meet these criteria, he'd like something a little more effective. The Pharmacist suggested ativan. What are your suggestions?

[Lehendakari]

SWIM had good results with both alprazolam (xanax) and clonazepam (rivotril, klonopin). He takes them for social anxiety and tries to keep his tolerance low, he avoids taking it 2 consecutive days and no mor than 2 mg at once.

SWIM isn't experienced with lorazepam but it seems it is more sedating than the two above.

[ironmics]

SWIM takes lorazepam for this exact reason and has pretty good success with it. He does not find it very sedating, but everyone is different. He also cycles it with gabapentin, which also produces reasonably good effects, and it is not sedating whatsoever.

[Sickpup]

SWIM says if you can handle anxiety to a certain lvl,then if it gets too high you want to extinguish it.Xanax is the ticket,although ativan may work SWIM always aims high.Ativan is rated 1/2 as strong as xanax,and in some people even less effective.Klonopin is a long buildup always on effect,makes you zombie like after 3 months.SWIM always preferes to manage anxiety/depression with fast acting short half-life meds.Librium is an oddball thing to get out patient.It's usually only used in hospitals as a precaution vs siezures in OD patients who are on a regular unit.or detox centers also use it.I doubt that doc would write xanax.your SWIM is gonna prolly have to settle for either ativan or clonopin.mg for mg,cause he aint gonna say well ,you can have 4mg ativan or 2mg clonopin.hes gonna most likely start you on .5 klonopin bid.and max it at 1mg bid,maybe after 2years tid.anotherwords play along stay functional,look for a doc that will write,and transfere that diagnosis to that doc.Then you can get 60 bars per month.don't have to use em all,just keep a reserve.

[fizzle]

I have a script to klonopin for socical anxiety. works great. definitely wouldnt want xanax for long term anxiety relief.

[Sickpup]

Its all a matter of preferance,xanax vs klonopin debate ,is like arguing who makes a better truck ford or chevy.but as you say fizzle for long term,and i would venture to add constant.imo klonopin is long,term and constant.It's not an ideal as needed med.SWIM tried them for that and they weren't working,the next day the build up was so high SWIM was have loss of motor control in legs and could barely walk.SWIM knows if the doc aint gonna write Xanax ,settle on klonopin.Technically Klonopin is stronger and has a way higher build up in you then xanax.But the docs feel better writing it.And the new on is when someone asks the p-doc to switch to xanax,he says hes using Klonopin as a mood stablizer,which is hard to argue since it was/is originally an anti-covulsant and thats where most mood stablizers come from.

[Laudaphun]

SWIM is making a followup post now that 3 months have passed...

Anyways the Dr. gave SWIM Cymbalta for his G.A.D and a script for 30 25mg librium (no refill)... then mumbled something about trying klonopin twice daily next time if this didn't work. It was horrid... SWIM even tried to follow the Dr.s orders and give it 30 days to work and arrrrgggg.... SWIM said it was horrid. SWIM didn't take the librium while on the Cymbalta because he didn't want to think the Cymbalta was working when really it was the librium.

30 days later...
SWIM is back at the Dr. office for his follow up. A newly hired young, and actually quite attractive Dr. was there as opposed to the one SWIM had seen last time. SWIM said exactly what he said in his post above in regards to his scripts from the previous visit. She gave SWIM Paxil... SWIM did not request a benzo script, therefore did not get one, but he still had a bottle of librium at home so no biggie. SWIM took the Paxil for 3 days and side effects were just the same as the Cymbalta, zoloft, lexapro, effexor, and every other anti-depressant some Dr. had tried before to treat his G.A.D. When SWIM side effects being the same, he meant in general... of course a few are a little worse than others, some like Cymbalta caused nauseau which SWIM had not noted with other ADs... 3 days of Paxil and SWIM threw it in the garbage and started taking his librium, which might work, but his supply was too limited for him to take enough.

30 days later....
Before SWIM saw the Dr. while talking to the nurse(an ex-Ativan addict) he mentioned that 2 visits ago klonopin had been mentioned... She scoffed and said that the Dr. didn't make note of anything like that on the charts. A different Dr. yet is in the office and SWIM told her just what he said in the previous paragraph, so she concluded that my seretonin/norepinephrine receptors apparently weren't what needed tweaking. She gave SWIM buspar, which made SWIM happy, because he'd come to loath(substitute stronger word here with same meaning if you can think of one) anti-depressants. She asked SWIM how many libriums he had left, SWIM replied, "not many" thinking she was gonna give him more ... Now this is the only funny part of SWIMs story, instead of writing him a script for more she just replied, "alright, its ok if you take them with the buspar." SWIM immediately asked if he could have more and she eyeballed him... and told him she'd give him only 10 more of them, while she wrote it SWIM continued to talk instead of the dead silence thing while she wrote out the script that he had to ask for. She ended up writing it for 15. SWIM thanked her over and over for sending him home with a script for something that was NOT an anti-depressant. As we walked out the door, she told SWIM ...and if you find you still need something for inbetween, next time we can give you some klonopin. That statement doesn't make sense to SWIM, "in between"? Does she mean if SWIM needs something in between his 15mg buspar x3 daily? Or maybe she meant "on top of" the buspar. Another thing that SWIM is confused as hell about is that she was really hesitant about giving SWIM anymore librium (which is weak as hell and SWIM doesn't see much abuse potential in it), however less than 2 minutes later she was talking about putting him on klonopin. Perhaps SWIM is missing something here. This Dr. is conservative, but not one of those Dr. who will give you ibuprofen if you go in and ask for something for pain(unless of course she thought that you were lying).

SWIM is about 2 weeks from his followup. SWIM is able to tolerate the buspar unlike the antidespressants, however he's not sure if it is a placebo effect or not but it seems as if I feel a little better(just a little better mood)... however it has helped little with my anxiety so far.

[Sickpup]

Busbar sucks,all the docs know that.They usually give it to patients who are dumb enough to say they drink or get high.Klonopin is best 24/7,Xanax as needed.

[roserjoe]

SWIM has a moderate case of social anxiety, and has recently acquired 10mg of diazepam and 10mg of diazepam. In the past he has used alcohol and codeine at parties to ease the anxiety and make him more chatty. Well he is planning on asking this girl out who he has liked for a while, and as you may know this can be very nerve-racking especially which someone with social anxiety. He has talked to her a few times in the past and enjoyed every conversation immensely. So he was thinking of taking some of the benzo's he has, to make him a bit more chatty and ease the anxiety etc. when he asks her out/goes out with her. He really likes this girl and would like to just be himself without anxiety holding him back. So SWIM wonders what sort of dose he should take to gain these effects. He was even considering mixing in 200mg of codeine or something. Any suggestions? Or should he just brink it without the drugs and hope he can overcome the anxiety. Are there any benzo potentiators apart from codeine/alcohol? because he doesn't have very many benzo's.

[piddleton]

Diazapam - although I like to consider myself something of an expert on drugs, professionally speaking, of course, I'm not convinced that I know enough about the effects of diazapam on the nervous system.

SWIM bought diazapam from an online pharmacy, a business that has its origins in Egypt.

He recently took 15mg of tablets, the effects were immediate: dizziness, drowsiness; clumsy, always bumping into things; a blinding headache. But after feeling very strange, drunklike, the symptons started to clear and the transformation was apparent, to anybody that knows him, the confidence suddenly set in and he became more social, virtually free from those normal but very dehabilitating inhibitions that hinder conversations with another human being.

So maybe the diazapam was good after all, just the initial side effects were something of a surprise to the two of us.

Now can somebody tell me a little more about how often and how many diazapam tablets you should take a day, and for how long because I'm all too aware of the addictive properties of such a powerful drug and I wouldn't for him to take too much.

Now I know that some of you are from America and your situation probably is a little different - in the UK the culture among medical professionals is still a little backwards in terms of adminstering pyschotropic drugs for treating common disorders and most of the time the burden usually falls upon a psychiatrist rather than a general practioner to make that decision and this could take months and months of being on a waiting list and there is no quarantee that seeing a pyschiatrist will even lead to treatment. Many patients are turned away.

Personally I believe this to be a complete waste of time and would rather consult a GP over such a minor and easily solved issue; leave the complex mental health problems to the pyschiatrists. We have so few working in the NHS and the waiting list is much too long, it can take up to several months to be seen by a physiatrist and even then very few consultations end with just the one session, there is usually a few follow up appointments, which could add another month or two to the process. I know that we should grateful for our free healthcare sytem and for the most part I am but if only things would speed up a little, it is our health we are talking about and every day that zaps by is another 24 hours lost from our lives when we could be doing something worthwhile and meaningful and not hindered by social anxiety or problems of a similar kind.

Mankind is naturally imprisoned by fear - when we talk about freedom we mean at a superficial level only; absolute freedom is an illusion because it is fear that prevents him from following his impulses, from living the life he so desires hungers afer but people with social anxiety or some other type, whether it is generalised anxiety or performance relaxed, are in a considerably worse position than the average person; prisoners of their own insecurities, men and women who cannot relate to each other because they fear taking the next step and open themselves up to rejection, reproach and whatever else that assaults their minds; because they surrounded themselves with an impenetrable suit of armour, that is designed to do one thing only, protect their feelings from being hurt and thus ultimately protecting their opinon of themselves because it is that which we endeavour to maintain in the highest possible regard.

[fnord]

15mg is a lot!try 2mgs 3 times a day and you wont have those side effects you spoke off,starting out at 15mg would easily cause teh problems you spoke of.


Antianxiety

• PO (Adults ): 2-10 mg 2-4 times daily • IM, IV (Adults ): 2-10 mg, may repeat in 3-4 hrs as needed • PO (Children >1 mo): 0.12-0.8 mg/kg/day 3-4 times daily • IM, IV (Children > 1 mo): 0.04-0.3 mg/kg/dose q 2-4 hr to a maximum of 0.6 mg/kg within an 8 hr period if necessary

[piddleton]

I hadn't realised - his tablets are something like 5mg each. So in theory could probably go up to 10mg each, 2 to 4 times a day.

He is about to go through an exam, a painful practical exam akin to putting your balls in a grinder and slowly turning the handle. Even a sado would wince at the thought of that.

SWIM is a little concerned that if his anxiety attacks return during the resit he will fail again and end up on his bottom, with no career and a $60,000 university loan to pay back. It makes no difference that SWIM's academic grades were very good, this practical exam counts for everything.

Under the circumstances SWIM has very good reason to be anxious. And therefore he will probably need to be very careful when choosing the appropiate dosage - too low and he might panic again, too high and he might not able to gather his thoughts together.

[bloot]

Yes, in theory one could use 10mg two to four times.. but this is not a dose to start out on.

[fnord]

try 2.5mgs(or probably less!) 3 times a day and see how it works out for you before you start taking super high doses. most people i know aren't on more then 6mgs total for the day.remember that benzos interfere with memory so you don't want to go to high or all your studying will be in vain.