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Author Topic: When does it become a dependency on Xanax? Paranoid Doc reducing my prescription  (Read 896 times)

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Offline Christophe

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So I've been taking about 1.5 mg of Xanax per day for a couple months now related to anxiety that started when I had a minor medical procedure.  I have this fear of things not healing and this procedure did something and took forever to fully heal and still isn't there.

I take one 1.0 mg pill in the morning because I have this morning anxiety that won't go away.  Take another half of that pill later on and I'm usually good for the most part.  I just renewed the prescription and the instructions say the bottle of 40 1.0 mg pills must last one month so he's trying to cut me down on it.  That's fine as I don't want to get addicted but this seems somewhat extreme.  I'll try and cut down but don't want to try and look into buying it online.  I'm sure that's illegal anyway and those sites are scams.

I started a half pill of Lexapro last week and had mild side effects, increased anxiety and nausea so I'm holding off on it and might give it another shot in a couple weeks.  Had another medical procedure last week and didn't want Lexapro side effects making the recovery worse. 

Any thoughts appreciated.
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I just renewed the prescription and the instructions say the bottle of 40 1.0 mg pills must last one month so he's trying to cut me down on it.  That's fine as I don't want to get addicted but this seems somewhat extreme. 

You won't become addicted, but if you've been taking 1.5mg of Xanax daily for 2 months you may have developed a physical dependence and will probably need to wean of it. This will be true of Lexapro too. Dropping the afternoon dose probably wouldn't be too difficult normally, but doing it while starting Lexapro increases the degree of difficulty. It may be better to hold off until the Xanax kicks-in, but that could take a couple of months.

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I'll try and cut down but don't want to try and look into buying it online.  I'm sure that's illegal anyway and those sites are scams.

Benzodiazepines are scheduled drugs and in some jurisdictions possession without a prescription carries similar penalties to possession of opiates, so that definitely isn't a path you want to go down.

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Any thoughts appreciated.

Benzodiazepines are no longer good primary, taken daily anti anxiety meds, not because they don't work, but because doctors are increasingly reluctant to prescribe them so getting them in the future is becoming more uncertain. Therefore the sooner you get onto a therapeutic dose of an antidepressant and off the Xanax the better. While it is likely that you could wean off the Xanax now with minimal difficulty because of the short time you've been taking it, this will become more problematic as time goes on. Switching to the long acting diazepam (Valium) and weaning off it will then be the easier option.

ATM, I think you need to discuss all this with your psychiatrist asap to formulate a plan for getting you onto an antidepressant and off the Xanax.

Ian
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NOTE: I'm not a doctor, and particularly not yours, so there may be factors I'm unaware of. Therefore all advice is of a general nature and you should consult your doctor before following any of it, especially before changing med doses.

Offline MIL_IsAHotMess

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There is a good chance you've developed a physical chemical dependency (different from addition) already. BUT you've been given different meds for the anxiety SO YOU WILL be okay without them as far as anxiety goes. Your body might fight back and you might experience some withdrawal symptoms if you cut down too fast.

The best thing is to do like "insights" suggested and start gradually tapering off. I kept a diary. And by all means, be absolutely honest with your doc about how many you take. Bring your meds into your doctor and let him see them, count them. He is your doctor and doesn't expect you to suffer needlessly through withdrawal of a chemical dependency. There are other temporary medications that help with symptoms of opioids, I don't know if they help benzo w/d but ask your doc.

If you are addicted, it's also doable, but might take more time. Lots of people kick them without benefit of another anxiety med, so you are in good shape. Be honest with the doctor no matter what the case is.
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Offline Never-Quit

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Ian, like always makes very knowledge insights and really good points. Great Post Ian! :grinning-smiley-003:

Been down this road now, with my children who are in 20's and 30's, elderly parents in their late 80's...

IMHO - from experience and dealing with doctors, you might want to talk to your doctor about the option to move you to Valium or Klonopin - since doctors less reluctant to prescribe these longer-lasting benzopines

Keep in mind most AD's and SSRI's will likely produce sexual side effects - most doctor's seem very reluctant to tell you before prescribing these medications - like Lexapro... Just something you may want to consider...

On a side note:  The doctors keep trying to reduce the dosage for mother's  Lorazepam to reduce the likelihood of Doctor's getting sued by lawyers.  There are now new reports of increasing auto accidents involving people taking benzopines which are making doctors very reluctant to prescribe these medications. 

For what's it worth - Just an opinion....I posted this earlier today:

Klonopin and Valium are two gold standards for providing "Full day shield" with a single dose, in many cases.


Xanax and Lorazepam have always been good - especially for Panic Attacks and server Anxiety attacks, but you need to take it several times per day for it versus just a a single dose of klonopin or valium (the two longest lasting benzos).


If you are like me, I am very paranoid about taking any medications, unless I have to, and then I will spend days researching information before I will take any medication or even health supplement...  I just want to have access to best and latest research findings myself, and not have unfounded misinformation crammed down my throat by uninformed Doctors and companies who are trying to make money from the suffering of others.

Also, new compelling current research is showing again and again - that for Anxiety and Panic Attacks - Benzodiazepines have a better profile of efficacy and less initial side effects, and safer for long time usage than the newer AD and SSRI. 

People who use these medications responsibly do not to fear dependence or so called 'addiction' - that gets thrown around by doctors and anti-medication people.   These are wonderful medications that help you tremendously.   :yes:

Even back in 1990 ...there were some reputable studies done - that have reinforced the safety of Benzodiazepines.

The report of the American Psychiatric Association's Task Force on Benzodiazepine Dependence, Toxicity and Abuse ... This document tries to dispel some popular misconceptions about benzodiazepines. ... "There is no evidence to suggest that the therapeutic use of benzodiazepines leads to abuse except in those persons who also abuse other substances." (29)

1990   Dr. Robert DuPont, a former director of the [United States] National Institute of Alcoholism and Drug Abuse, suggests, "the concept of using the lowest possible dose of a benzodiazepine for the shortest period of time is inconsistent with sound clinical practice. This concept needs to include the important qualification that our goal is to maximize the patient's ability to function well and to enjoy life. Benzodiazepines are among the safest and most effective treatments in all of medicine, including their role in the treatment of panic disorder." (29)

(29) William D. Kernodle, MD, "Panic Disorder; The Medical Point of View,"
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Offline Christophe

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Thanks all for all the great advice.

I did taper down to 1mg of Xanax yesterday and felt a little down but not overwhelming.  Problem is I'm already experiencing increased anxiety due to this latest medical procedure in my mouth which should take a couple weeks to heal but I'm already obsessing over it, feeling stings and soreness and fearing it not healing properly.  Starting up an anti-depressant right now would be tough in dealing with those side effects in addition to this.

I like the idea of switching to a longer acting drug like Valium or Klonopin but my Doctor is also paranoid about those drugs.  He thinks that if I take Xanax for too long that I'll suffer seizures when trying to get off of it.  I've heard about this but I'm sure that's rare and only for those abusing it for years.  He is my Primary Doctor and not a Psychiatrist and I've pondered seeing one but have no idea how to find a good one.  Especially in my Health insurance plan where they just send me a list of phone numbers, mostly with nobody who answers the phone on the other end.

I have been seeing a Psychologist who is a nice older man and we've been doing EMDR, EFT, and other things but I just don't think it's helping that much. 

Will try and get in and have a discussion about this soon.

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Offline Never-Quit

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Thanks all for all the great advice.

I like the idea of switching to a longer acting drug like Valium or Klonopin but my Doctor is also paranoid about those drugs.  He thinks that if I take Xanax for too long that I'll suffer seizures when trying to get off of it.  I've heard about this but I'm sure that's rare and only for those abusing it for years.  He is my Primary Doctor and not a Psychiatrist and I've pondered seeing one but have no idea how to find a good one.  Especially in my Health insurance plan where they just send me a list of phone numbers, mostly with nobody who answers the phone on the other end.

I have been seeing a Psychologist who is a nice older man and we've been doing EMDR, EFT, and other things but I just don't think it's helping that much. 

Will try and get in and have a discussion about this soon.



Good progress  :grinning-smiley-003:, I had the same argument numerous time from my general doctor - this argument will soon find itself with insufficient medical explanation since we are now seeing similar withdrawal complication from AD's/SSRI's  (especially Paxil for me),

 I remember a similar excuse from my general doctor, 15 years ago, about his concern for long term Liver damage, which historical medical data has now proven to be extremely rare. 

Point being:  We now know, that whether you are on AD/SSRI or on Benzodiazepine - you will still need to slowly taper off under a doctor's supervision.

Finding a Psychiatrist - which I know is can be very difficult - is well worth the effort!  So you can get proper Therapeutic levels of medications.

Hang in there!  Let us know how you are doing! :grinning-smiley-003:
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He thinks that if I take Xanax for too long that I'll suffer seizures when trying to get off of it.

If you were silly enough to quit cold-turkey from a highish dose and had a susceptibility to seizure then it is possible, but it is very rare when benzodiazepines (BZDs) are weaned off. Anyway, weaning off the short acting BZDs like Xanax isn't the best way of doing it as at the low doses near the end of the taper their short half-lives can trigger a yoyo effect as the med enters and drops out of the system which can be unpleasant. Far better to switch to diazepam (Valium) and wean of it. Together with its active metabolites, it has a half-life of up to 200 hours so is essentially self-tapering. Because it comes in physically large low dose tablets it is also much easier to taper off in small steps.

Ian
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NOTE: I'm not a doctor, and particularly not yours, so there may be factors I'm unaware of. Therefore all advice is of a general nature and you should consult your doctor before following any of it, especially before changing med doses.

Offline Christophe

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Hopefully I'll be able to get a prescription for Valium and do as you suggested.

It's at the point now where a 1 mg tablet of Xanax is only lasting a couple of hours before I start feeling anxious again and the only option is to start taking more or switch and get off of it and onto something else.  I'm starting to notice some withdrawal symptoms by going from 1.5 to 1.0 mg per day.  Not bad but it's there.  Just want this nightmare to end.
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It's at the point now where a 1 mg tablet of Xanax is only lasting a couple of hours before I start feeling anxious again

It takes Xanax 1-2 hours to hit peak plasma levels which is when it is at maximum effectiveness so I suspect this is more a psychological response than a chemical one.

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and the only option is to start taking more or switch and get off of it and onto something else.

You could try supplementing it with hydroxyzine (Vistaril, Atarax), a prescription antihistamine with anti anxiety properties. It is not as potent as the benzodiazepines, but is longer acting than Xanax and there are no dependency issues.

Ian
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NOTE: I'm not a doctor, and particularly not yours, so there may be factors I'm unaware of. Therefore all advice is of a general nature and you should consult your doctor before following any of it, especially before changing med doses.

Offline Never-Quit

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Ian, Great Post  :grinning-smiley-003:- Tapering off Xanax - "Far better to switch to diazepam (Valium) and wean of it. Together with its active metabolites, it has a half-life of up to 200 hours so is essentially self-tapering. Because it comes in physically large low dose tablets it is also much easier to taper off in small steps.

Ian"  :yes:

I agree, I had some family members that were getting off Xanax and Lorazepam  (these family members were not too responsible in using these meds)... - their doctor had put them on Valium, and then wean them off Valium.  Which at the time was very interesting.  I believed I read something in regards to "Ashton Method" at the time,  which is now a standard protocol used in tapering off Benzodiazepines.

So, I would think there would be a distinct advantage in using a longer lasting benzo, like Diazepam (valium) to start with, instead of shorter acting one, when someone wants to get off of them.

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I believed I read something in regards to "Ashton Method" at the time

To give Heather Ashton credit, she has done much to push the concept and undoubtedly made life easier for many by doing so, though I'm not sure it was her idea. I seem to recall reading about the diazepam switch long before I heard of Ashton. Unfortunately, she has also contributed much to the vilification of BZDs, and more recently antidepressants, particularly the SSRIs.

Quote
So, I would think there would be a distinct advantage in using a longer lasting benzo, like Diazepam (valium) to start with, instead of shorter acting one, when someone wants to get off of them.

I depends on how they are used. If BZDs are only needed occasionally for breakthrough anxiety, etc, the short acting ones, Ativan (lorazepam), Xanax (alprazolam), etc, are probably the better option as they kick-in a little faster and there is less risk of developing dependence if they are needed 2-3 times a week. For 24/7 protection (which I don't advise) then the longer acting BZDs would be better.

Ian
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NOTE: I'm not a doctor, and particularly not yours, so there may be factors I'm unaware of. Therefore all advice is of a general nature and you should consult your doctor before following any of it, especially before changing med doses.

Offline Christophe

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So after seeing the Dr yesterday, we are going to supplement Buspar with the Xanax.  He wants me to taper off the Xanax slowly then gradually increase the Buspar to three tablets a day.  He says Buspar is more sedating and should be taken before going to sleep.  Will give it a try as the reviews for Buspar are mixed.  If it doesn't work I could call and try and get Valium.  Would rather try that than going on Lexapro.
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Offline Never-Quit

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So after seeing the Dr yesterday, we are going to supplement Buspar with the Xanax.  He wants me to taper off the Xanax slowly then gradually increase the Buspar to three tablets a day.  He says Buspar is more sedating and should be taken before going to sleep.  Will give it a try as the reviews for Buspar are mixed.  If it doesn't work I could call and try and get Valium.  Would rather try that than going on Lexapro.


My own experience, having taken all these medications,  is that Buspar is not even in the same league as Xanax or Valium - Buspar is not a controlled substance which is why many doctors love to prescribe this medication.  But, you might have success, since meds will respond to differently to each person's body - :winking0008:

Keep us informed on your progress, and if you begin to suffer higher anxiety, I would not hesitate to call my doctor back and get the Valium  :yes:

 :sign0111:  keep us informed of your progress!!
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Will give it a try as the reviews for Buspar are mixed.

Buspar is a med which seems to work extremely well for a few, but is less effective than M&Ms for most, so keep your fingers crossed that you're one of the few.

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Would rather try that than going on Lexapro.

IMHO, antidepressants are better than benzodiazepines as primary anxiety meds.

Ian
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NOTE: I'm not a doctor, and particularly not yours, so there may be factors I'm unaware of. Therefore all advice is of a general nature and you should consult your doctor before following any of it, especially before changing med doses.

Offline NeverAgain2

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Ian, like always makes very knowledge insights and really good points. Great Post Ian! :grinning-smiley-003:

Been down this road now, with my children who are in 20's and 30's, elderly parents in their late 80's...

IMHO - from experience and dealing with doctors, you might want to talk to your doctor about the option to move you to Valium or Klonopin - since doctors less reluctant to prescribe these longer-lasting benzopines

Keep in mind most AD's and SSRI's will likely produce sexual side effects - most doctor's seem very reluctant to tell you before prescribing these medications - like Lexapro... Just something you may want to consider...

On a side note:  The doctors keep trying to reduce the dosage for mother's  Lorazepam to reduce the likelihood of Doctor's getting sued by lawyers.  There are now new reports of increasing auto accidents involving people taking benzopines which are making doctors very reluctant to prescribe these medications. 

For what's it worth - Just an opinion....I posted this earlier today:

Klonopin and Valium are two gold standards for providing "Full day shield" with a single dose, in many cases.


Xanax and Lorazepam have always been good - especially for Panic Attacks and server Anxiety attacks, but you need to take it several times per day for it versus just a a single dose of klonopin or valium (the two longest lasting benzos).


If you are like me, I am very paranoid about taking any medications, unless I have to, and then I will spend days researching information before I will take any medication or even health supplement...  I just want to have access to best and latest research findings myself, and not have unfounded misinformation crammed down my throat by uninformed Doctors and companies who are trying to make money from the suffering of others.

Also, new compelling current research is showing again and again - that for Anxiety and Panic Attacks - Benzodiazepines have a better profile of efficacy and less initial side effects, and safer for long time usage than the newer AD and SSRI. 

People who use these medications responsibly do not to fear dependence or so called 'addiction' - that gets thrown around by doctors and anti-medication people.   These are wonderful medications that help you tremendously.   :yes:

Even back in 1990 ...there were some reputable studies done - that have reinforced the safety of Benzodiazepines.

The report of the American Psychiatric Association's Task Force on Benzodiazepine Dependence, Toxicity and Abuse ... This document tries to dispel some popular misconceptions about benzodiazepines. ... "There is no evidence to suggest that the therapeutic use of benzodiazepines leads to abuse except in those persons who also abuse other substances." (29)

1990   Dr. Robert DuPont, a former director of the [United States] National Institute of Alcoholism and Drug Abuse, suggests, "the concept of using the lowest possible dose of a benzodiazepine for the shortest period of time is inconsistent with sound clinical practice. This concept needs to include the important qualification that our goal is to maximize the patient's ability to function well and to enjoy life. Benzodiazepines are among the safest and most effective treatments in all of medicine, including their role in the treatment of panic disorder." (29)

(29) William D. Kernodle, MD, "Panic Disorder; The Medical Point of View,"


I agree with you. 

In fact, recent studies have shown that for many people SSRI's and SNRI's are not much more effective than a placebo.  A placebo is fine, if it works, but for so many, like a sugar pill, they do not work, whereas bensos have been proven to have a quick (and for many) lasting effect on their anxiety, until  they can understand anxiety through Cognitive Restructuring or they make the life change they have to or they simply calm down.

Benzo hysteria started in the UK, has spread to the US, and shows no sign of abating.  In fact, this anti-medication hysteria is also spreading to anti-depressants, which, as I mentioned, do help some people, whether or not we know why.

Good post.
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