Opinions - Prescribed too low dosage of Alprazolam (Xanax)

[dark12]

Hey all,
SWIM just got diagnosed with General Anxiety Disorder and his doctor started him on .5mg up to 3 times a day of Alprazolam. SWIM scheduled an appointment to check up on it late next week. SWIM's doctor said that he is considering giving Paxil (paroxetine) in the future on top of the Alprazolam. SWIM would like to move up to a higher dose. He was given 30 x .5mg tablets for use over 10 days. Should SWIM tell his doctor that SWIM doesn't receive full relief until he takes 1.5mg per situation? Taking 1 really doesn't help SWIM at all and 2 is cutting it close.
SWIM thinks his doctor is making sure SWIM has some pills left the next time he sees him. What should SWIM do to ramp up the Alprazolam dose and eliminate the possibility of getting an SSRI?

[staples]

Originally Posted by dark12

Should SWIM tell his doctor that SWIM doesn't receive full relief until he takes 1.5mg per situation?

Why not? I understand that to be the truth? It sounds like it helps but doesn't cover all the symptoms? To that end, does SWIY really encounter 3 situations per day that cause anxiety to the extent of warranting medication (i.e, such episodes are disabling)? I wonder how SWIY got by until being diagnosed? Be warned that taking (too much) benzos can increase one's general level of anxiety, however some people do appear to need more than 1.5mg/day...

Originally Posted by dark12

Taking 1 really doesn't help SWIM at all and 2 is cutting it close.

Perhaps another option would be to try a different benzo such as Klonnopin (Clonazepam) or Ativan (Lorazepam). Of course, if Xanax seems to be right, just weak, this might not be necessary. If it's simply not really addressing SWIY's anxiety, perhaps a non-benzo medication like Buspar (Buspirone) is the golden solution for SWIY.

Originally Posted by dark12

SWIM thinks his doctor is making sure SWIM has some pills left the next time he sees him.

What do you mean?

Originally Posted by dark12

What should SWIM do to ramp up the Alprazolam dose and eliminate the possibility of getting an SSRI?

Why "eliminate the possibility"? Might not an SSRI help? Why not try all the options to treat SWIY's anxiety? No one can force SWIY to take on SSRI, of course, but refusal to at least try it makes it sound like SWIY is more interested in getting his script for Xanax than he is for treating his alleged anxiety...

[dark12]

Originally Posted by staples

Why not? I understand that to be the truth? It sounds like it helps but doesn't cover all the symptoms? To that end, does SWIY really encounter 3 situations per day that cause anxiety to the extent of warranting medication (i.e, such episodes are disabling)? I wonder how SWIY got by until being diagnosed? Be warned that taking (too much) benzos can increase one's general level of anxiety, however some people do appear to need more than 1.5mg/day...

Perhaps another option would be to try a different benzo such as Klonnopin (Clonazepam) or Ativan (Lorazepam). Of course, if Xanax seems to be right, just weak, this might not be necessary. If it's simply not really addressing SWIY's anxiety, perhaps a non-benzo medication like Buspar (Buspirone) is the golden solution for SWIY.

What do you mean?

Why "eliminate the possibility"? Might not an SSRI help? Why not try all the options to treat SWIY's anxiety? No one can force SWIY to take on SSRI, of course, but refusal to at least try it makes it sound like SWIY is more interested in getting his script for Xanax than he is for treating his alleged anxiety...

SWIM was on an SSRI for depression about a year ago and had very negative sexual side effects. Wellbutrin XL has really turned SWIM's life around in that regard. SWIM's doctor knows that SWIM's concern is a legit one.

Anxiety has a long history in SWIM's family and up until recently SWIM just thought his personality was just uptight and shy. He has since learned that depression and anxiety often come in pairs.

SWIM would like to be able to take 1mg on a normal day and 2-2.5mg on days that include speeches, presentations, and such (At this point in college these days are frequent).

As far as general anxiety goes SWIM has panic attacks on extremely mundane everyday problems. An example may include having a nervous breakdown is SWIM's girlfriend doesn't answer her phone late at night because the only thing he can think of is the possibility that she is in serious danger.

dark12 added 9 Minutes and 12 Seconds later...

Grrr I hate not having an edit button.

What SWIM meant about his doctor wanting to see how many pills he had left in 10 days is that maybe his doctor wants to make sure SWIM isn't popping them too often.

[staples]

Originally Posted by dark12

SWIM was on an SSRI for depression about a year ago and had very negative sexual side effects. Wellbutrin XL has really turned SWIM's life around in that regard. SWIM's doctor knows that SWIM's concern is a legit one.

I'm not sure what you mean by "turned SWIM's life around," but Welbutrin is not an SSRI. If you mean an SSRI had awful side effects and then SWIY got Welbutrin, well: that doesn't necessarily mean other SSRIs will have the same side effects, in fact that's pretty normal. Also Welbutrin may cause anxiety, whereas SSNRIs aim to help anxiety with the noradranergic action.

Originally Posted by dark12

As far as general anxiety goes SWIM has panic attacks on extremely mundane everyday problems. An example may include having a nervous breakdown is SWIM's girlfriend doesn't answer her phone late at night because the only thing he can think of is the possibility that she is in serious danger.

Then it sounds like panic disorder, not general anxiety disorder... SWIY should look into techniques to reduce anxiety such as controlled breathing, tensing then relaxing certain muscles, and so on. I've also been diagnosed with panic disorder and I've found that music in particular helps a lot, particularly some with binaural beats. If SWIY would like, I can find more information and post it here.

Originally Posted by dark12

Grrr I hate not having an edit button.

What SWIM meant about his doctor wanting to see how many pills he had left in 10 days is that maybe his doctor wants to make sure SWIM isn't popping them too often.

I'd be very surprised if a doctor expected the patient to produce the prescription bottle... It's not as if the patient needs to go to that specific doctor; this is about SWIY, not SWIY's doctor, and I would suggest going to a different one if the current one isn't treating SWIY appropriately and professionally.

Edit: had a few more thoughts when re-reading this.

[dark12]

Originally Posted by staples

I'm not sure what you mean by "turned SWIM's life around," but Welbutrin is not an SSRI. If you mean an SSRI had awful side effects and then SWIY got Welbutrin, well: that doesn't necessarily mean other SSRIs will have the same side effects, in fact that's pretty normal. Also Welbutrin may cause anxiety, whereas SSNRIs aim to help anxiety with the noradranergic action.

Then it sounds like panic disorder, not general anxiety disorder... SWIY should look into techniques to reduce anxiety such as controlled breathing, tensing then relaxing certain muscles, and so on. I've also been diagnosed with panic disorder and I've found that music in particular helps a lot, particularly some with binaural beats. If SWIY would like, I can find more information and post it here.

I'd be very surprised if a doctor expected the patient to produce the prescription bottle... It's not as if the patient needs to go to that specific doctor; this is about SWIY, not SWIY's doctor, and I would suggest going to a different one if the current one isn't treating SWIY appropriately and professionally.

Edit: had a few more thoughts when re-reading this.

Thanks for the response.
SWIM meant that Wellbutrin really helped his problems while causing very few side effects.

We'll see how today goes.

[staples]

Originally Posted by dark12

Thanks for the response.
SWIM meant that Wellbutrin really helped his problems while causing very few side effects.

We'll see how today goes.

Ah, well lucky for SWIY, I liked Welbutrin but it made it impossible to pick up a glass of water without using both hands (very shaky). It really can worsen anxiety though. Of course I'm not in a position to say if that's SWIY's case or not but I submit it as a consideration.

Indeed SSRIs are known for being somewhat overhyped and having potentially terrible side effects (serotonin syndrome...) but that's not a reason to not at least try different ones so that they can be ruled out if they don't work. And who knows, perhaps one will work very well for SWIY, wouldn't it be worth it to find out?

I'm just trying to play devil's advocate because it seems like SWIY is certain of what treatment he needs, while that is his doctor's job to determine. Other than that, though, it does sound like SWIY may need a little more xanax than originally prescribed. However, just as well, I'm not really in a position to make such a judgment.

Good luck and let us know how things go.

[WashHeights187]

Originally Posted by staples

Why not? I understand that to be the truth? It sounds like it helps but doesn't cover all the symptoms? To that end, does SWIY really encounter 3 situations per day that cause anxiety to the extent of warranting medication (i.e, such episodes are disabling)? I wonder how SWIY got by until being diagnosed? Be warned that taking (too much) benzos can increase one's general level of anxiety, however some people do appear to need more than 1.5mg/day...

Perhaps another option would be to try a different benzo such as Klonnopin (Clonazepam) or Ativan (Lorazepam). Of course, if Xanax seems to be right, just weak, this might not be necessary. If it's simply not really addressing SWIY's anxiety, perhaps a non-benzo medication like Buspar (Buspirone) is the golden solution for SWIY.

What do you mean?

Why "eliminate the possibility"? Might not an SSRI help? Why not try all the options to treat SWIY's anxiety? No one can force SWIY to take on SSRI, of course, but refusal to at least try it makes it sound like SWIY is more interested in getting his script for Xanax than he is for treating his alleged anxiety...

SWIM is in the same boat and has chosen NOT to "eliminate the possibility." SWIM tried with his doctor to get a switch from klonopin to xanax, as SWIM generally enjoys sticks more...but SWIM's doctor is also a drug therapist in addition to being a shrink...and also knows SWIM's history with opiates as SWIM's dochas been prescribing suboxone for 3 plus years. SWIM was actually surprised to receive a 1mg 30 pills/month scrip...first starting at .25 and getting an increase. SWIM readily admits using them for pleasure as SWIm wants nothing to do with benzo addiction, which ntaking them every day would most surely result in no?

WashHeights187 added 40 Minutes and 21 Seconds later...

Originally Posted by dark12

As far as using opiates for depression I agree that they should not be used. A year ago when SWIM's depression was peaking SWIM am sure he would have just used the opiates way overboard to numb real life.

If SWIM were prescribed an opiate for anxiety SWIM thinks it would be much more effective than the Alprazolam he is taking now. When SWIM uses Alprazolam it seems to make him sleepy and lose concern with anxiety instead of helping him open up. At sub-recreational doses of hydrocodone, SWIM found that his social inhibitions were much lower and he was much more confident in his future and present. SWIM knows that these feelings are obvious precursors to psychological addiction unfortunately.

SWIM has a check-up with his doctor on Friday and would absolutely love to be able to suggest a small dosage of hydrocodone for his anxiety, but he knows he would probably never be taken seriously again and be labeled a druggie. So SWIM will probably just accept another scrip for Alprazolam and maybe combine it with caffeine or something to negate the sedation.

SWIM just wishes there was an anti-anxiety drug that focused on reducing inhibitions.

SWIM agrees, swim has a klonazapam scrip but gets very sleepy. More than that, SWIM will sleep like a rock the night swim ingests them. Truth is, SWIM uses them recreationally rather than "as prescribed." Good combination recommended by swim, hot coffee in the winter or hot mate, in the spring an summer iced coffee and even better and healthier, iced mate with lemon. It has less caffeine than coffee but is both healthier and easier on the palate. Swim has problems with diahhrea so mate is better for swim. A doctor would almost never, at least in the U.S. prescribe opiates for anxiety/depression. and unless swiy gets teeth pulled every month, hydrocodone wont be prescribed.

WashHeights187 added 10 Minutes and 49 Seconds later...

Originally Posted by truth

SWIM has been wondering this too. SWIM has been on xanax and only really just falls asleep. SWIM never feels really that good or warm. Always just really tired. SWIM is trying to switch to Klonopin. SWIM feels exactly what SWIY is saying. Xanax does not help with SWIMS panic disorder just makes SWIM sleepy all day. SWIM is also looking for a benzo with the same effect as that. SWIM is in the same boat

SWIM has a scrip for klonopin, what is swiy's dose of xanax? SWIM started using xanax recreationally, but swim was buying it off the street. Luckily, SWIM's doctor gave swim a scrip for klonopin, first the lowest dose which was .25 i believe, then swim managed to procure a 1mg, the middle dose. SWIM enjoys klonopin better, but hasn't sworn off sticks, even though swim must purchase them for 5 dollars a pop. Does swiy find klonopin "better" for swiy's anxiety disorder? Swim finds they BOTH have the same, or very similar effects, the only real difference being xanax is much shorter acting, therefore hasd more of a "kick" I guess you would say. At present, SWIM uses his scrip for both, anxiety and recreation, but more for recreation as swim gets only 30 1 mg a month and takes between 5-10 ata time. Unwise? Perhaps...SWIm is an addict

[dark12]

Originally Posted by WashHeights187

SWIM is in the same boat and has chosen NOT to "eliminate the possibility." SWIM tried with his doctor to get a switch from klonopin to xanax, as SWIM generally enjoys sticks more...but SWIM's doctor is also a drug therapist in addition to being a shrink...and also knows SWIM's history with opiates as SWIM's dochas been prescribing suboxone for 3 plus years. SWIM was actually surprised to receive a 1mg 30 pills/month scrip...first starting at .25 and getting an increase. SWIM readily admits using them for pleasure as SWIm wants nothing to do with benzo addiction, which ntaking them every day would most surely result in no?

WashHeights187 added 40 Minutes and 21 Seconds later...

SWIM agrees, swim has a klonazapam scrip but gets very sleepy. More than that, SWIM will sleep like a rock the night swim ingests them. Truth is, SWIM uses them recreationally rather than "as prescribed." Good combination recommended by swim, hot coffee in the winter or hot mate, in the spring an summer iced coffee and even better and healthier, iced mate with lemon. It has less caffeine than coffee but is both healthier and easier on the palate. Swim has problems with diahhrea so mate is better for swim. A doctor would almost never, at least in the U.S. prescribe opiates for anxiety/depression. and unless swiy gets teeth pulled every month, hydrocodone wont be prescribed.

Yea SWIM wasn't expecting much.
SWIM has been combining his Alprazolam with caffeine and it seems to help a bit. As far as treating anxiety, SWIM prefers Kratom much more.

[WashHeights187]

Originally Posted by dark12

Yea SWIM wasn't expecting much.
SWIM has been combining his Alprazolam with caffeine and it seems to help a bit. As far as treating anxiety, SWIM prefers Kratom much more.

kratom as in the herb/plant? taken by swiy as tea? Swim has heard good things about kratom, but swim has never personally used it to treat anxiety.
Where is swiy located, in Uk or US, elsewhere? What about xanax then slamming a red bull or two? swim has tried that but dislikes the crash of energy drinks...much more noticeable than caffeine crashing.

[dark12]

Originally Posted by WashHeights187

kratom as in the herb/plant? taken by swiy as tea? Swim has heard good things about kratom, but swim has never personally used it to treat anxiety.
Where is swiy located, in Uk or US, elsewhere? What about xanax then slamming a red bull or two? swim has tried that but dislikes the crash of energy drinks...much more noticeable than caffeine crashing.

SWIM is located in the US and buys Kratom from an online vendor. One can buy Kratom as crushed leaf or the extract. The crushed leaf is much harder to get down, but SWIM finds the effects to be much more satisfying. SWIM just eats the Kratom whether its dried leaf or extract.
SWIM will probably start chugging energy drinks with his xanax. SWIM just doesn't even know if it's really helping or if the placebo effect is overpowering.

[truth]

SWIM has been wondering this too. SWIM has been on xanax and only really just falls asleep. SWIM never feels really that good or warm. Always just really tired. SWIM is trying to switch to Klonopin. SWIM feels exactly what SWIY is saying. Xanax does not help with SWIMS panic disorder just makes SWIM sleepy all day. SWIM is also looking for a benzo with the same effect as that. SWIM is in the same boat

[dark12]

Originally Posted by truth

SWIM has been wondering this too. SWIM has been on xanax and only really just falls asleep. SWIM never feels really that good or warm. Always just really tired. SWIM is trying to switch to Klonopin. SWIM feels exactly what SWIY is saying. Xanax does not help with SWIMS panic disorder just makes SWIM sleepy all day. SWIM is also looking for a benzo with the same effect as that. SWIM is in the same boat

Interesting. I haven't quite had a chance to read about Klonopin. Ill do some research here in a sec. Its unfortunate opiates get such a bad rap because of all the over-abusers.

To the previous poster, I have been doing exercises to try to help with the anxiety, but we are in a drug forum so clearly this is the hopeful solution I am down to.

[staples]

Originally Posted by dark12

Interesting. I haven't quite had a chance to read about Klonopin. Ill do some research here in a sec. Its unfortunate opiates get such a bad rap because of all the over-abusers.

Also, neither general anxiety disorder nor panic disorder appear to be indications for opiates... Many people like Klonnopin, I'm not sure how quickly it kicks in and how long it lasts in relation to xanax, but I believe it's generally one of the quicker, shorter-lasting benzos. I personally didn't have any luck with it even when the dose was tripled, but I think I'm the oddball in this case -- most people find it effective.

Originally Posted by dark12

To the previous poster, I have been doing exercises to try to help with the anxiety, but we are in a drug forum so clearly this is the hopeful solution I am down to.

It's very easy to do some of these exercises incorrectly and many people become frustrated when they do not work, have you consulted with a therapist on this? or is it based on personal research?

Biological forms of therapy, especially in the case of treating anxiety, are normally combined with psychological therapy, and studies show that each form of therapy is about equally effective separately, but combined they are even more effective, so I think it is quite relevant to the discussion.

For what it's worth, after being on Ativan daily for a couple years, I've never felt better than when I dramatically decreased my dose.

[dark12]

I see where you are coming from with the exercises thing.

As far as opiates go, SWIM is not expecting to get any for his issue. SWIM is simply saying that while SWIM used hydrocodone it gave him the exact relief he was looking for. SWIM would take 15mg on a normal day and he would feel very social and open to others. When SWIM was alone the euphoria helped him remain calm and collected even if SWIM would normally be panicking or stressing. On the weekends instead of smoking a bowl SWIM might just raise his hydrocodone up 25-30mg and enjoy some company.

I am sure after reading the end you think SWIM is just some kid looking to score some meds to have fun. That is not the case, SWIM would just like to explain the exact kind of drug he is looking for. SWIM knows this is a pipedream, but he is open for suggestions from those who know where he is coming from.

[truth]

Originally Posted by dark12

I see where you are coming from with the exercises thing.

As far as opiates go, SWIM is not expecting to get any for his issue. SWIM is simply saying that while SWIM used hydrocodone it gave him the exact relief he was looking for. SWIM would take 15mg on a normal day and he would feel very social and open to others. When SWIM was alone the euphoria helped him remain calm and collected even if SWIM would normally be panicking or stressing. On the weekends instead of smoking a bowl SWIM might just raise his hydrocodone up 25-30mg and enjoy some company.

I am sure after reading the end you think SWIM is just some kid looking to score some meds to have fun. That is not the case, SWIM would just like to explain the exact kind of drug he is looking for. SWIM knows this is a pipedream, but he is open for suggestions from those who know where he is coming from.

SWIM could not of said this better. Exactly how swim feel. opiates take away all fear and make everything feel so comfortable. SWIM loves this feeling and will forever. Thats what needs to be anti depressants. Opiates

[dark12]

Would it be absolutely ridiculous of SWIM to suggest that his doctor prescribe an opiate for his anxiety since Alprazolam just makes him sleepy?

SWIM imagines posing this question then seeing his doctor look at him like a heroin addict. Are there accounts of opiates being prescribed for anxiety?

[JJx23]

Well this is for dark12. First off, if you are starting on Xanax (Alprazolam), it will take a little while before the sleepiness goes away. This is a known cause with Xanax (Alprazolam), simply because it does treat insomnia, but once it is in your bloodstream for a few days to a week, it won't make you as tired during the day. Now everyone is different, but this could definitely be the case for you. You should either talk to your doctor about this, perhaps he could try this? Just a tip. =)

Hope this helps,

Regards.

[dark12]

UPDATE:
SWIM has been out of Alprazolam for a while since he has been so busy with finals week and is sick of having to beg his doctor for 30 pill increments. SWIM is back home now and went to his family doctor. After a 20 second conversation about girls he was given a scrip for 180 .5mg alprazolams. P
SWIM's not sure what to do with these.

[blackdb1]

Swim was put on .25mgs of alprazolam one week ago. The Dr. said take 3 times a day as needed, but the nurse told swim if he could save them 'til night as to be able to take a higher dose. Swim found that .5 is required for significantly lessening his anxiety, while 1mg is the lowest effective dose for a panic attack. Swim was diagnosed with panic disorder and acute anxiety. Swim actually got the script from an E.R. doc, the psyciatrist who evaluated swim gave him a copy of his evaluation incase he needed to get some meds before June 6th.

Anyways swim is hoping to get dosage increased to .5 mgs 3 times a day. This way he can use 1mg for anxiety and .5mg for sleep as swim has horrible insomnia and benzos and opiates are all that can get him a TRULY good nights rest!


Do you swimmers believe that swim will have a problem getting his dosage increased to .5 or 1mg 3 times daily? This is truly not for recreational puposes!!! Swim has functioned as if he was a 'normal person' this past week. haha

That's incredible that swiy got 180 xanax a month!!! Swim could stretch that out over 2 or 3 months!!! If docs prescribe amounts like that hopefully swim can get a decent increase in his script!

[staples]

Originally Posted by blackdb1

Anyways swim is hoping to get dosage increased to .5 mgs 3 times a day. This way he can use 1mg for anxiety and .5mg for sleep as swim has horrible insomnia and benzos and opiates are all that can get him a TRULY good nights rest!

SWIY wants to use a higher dose for anxiety than for sleep?

[blackdb1]

Yes actually swim does. He can use 1mg for a panic attack or .5 twice daily as anxiety management. Swim has always had trouble with sleep because of his mind racing. Swim can get his mind calmed down with .25 and get to sleep, but in the midst of a panic attack would need .5-1mg...

Swim doesn't understand why this is hard for swiy to believe??? Swim also has seroquel and flexiril for sleep. along with valerian root and melatonin. This is why swim uses a lower dose of benzos or even opiates for that matter to get to sleep.

blackdb1 added 16 Minutes and 5 Seconds later...

Swim re-read swiys question and thinks he understands swiys question the way it was intended to be.


If swim was about to go to bed and was having bad anxiety or a panic attack it would take at least 2mgs to induce sleep. However swim always takes 3mgs melatonin and pops a movie in to calm down. Swim only has BAD anxiety during the day while doing regular tasks, usually he's fine at night just watching a movie. If not he usually can smoke a bowl of ghanja and get his mind to slow down enough to relax and prepare for bed. Swim had to go along time before getting any sedatives so he learned sleep hygiene and taught himself to wind down at night at LEAST 3 hours before sleep!!!

So do swiyou guys think swim'll encounter problems trying to get a small increase in dosage or what? By the way not trying to thread jack just saw that a thread he was gonna create already existed so tried here first.

Thanks for any help guys swim will really appreciate it!!!!