Is this unethical?

[nuttynutskin]

She wants to put me on primiodone and propranolol. Does anyone have any experience with either of those?

 

[aihfl]

Propranolol will alleviate anxiety; esp physical symptoms like shaking etc. Don't know about the other drug.

 

[nuttynutskin]

Thanks for the info. You've been on it I take? If so what was your dose?

 

[Jabberwocky]

Propranolol will alleviate anxiety; esp physical symptoms like shaking etc. Don't know about the other drug.

It’s only really indicated for performance anxiety. It will probably be helpful in controlling nutty’s blood pressure and whatnot, and possibly have some effect on anxiety, but it isn’t going to be very significant in all likelihood. I am not suggesting it isn’t worth trying, just that it is of limited anxiolytic potential.

Thanks for the info. You've been on it I take? If so what was your dose?

Usually it is prescribed at 10-20mg for anxiety.

I don’t have any experience with primidone, but it seems like it has quite a number of indications, from psychiatric use to controlling epilepsy. It is probably worth trying. I mean, at this point what do you have to lose? Anything that might help more than harm when it comes to staying off the booze and dealing with benzo withdrawal is I think worth experimenting with.

 

[cj]

I don't understand her overall plan really. Are you trying to completely quit benzos or just reduce your dose? Either way a taper with a long acting benzo makes more sense then these band aid drugs. I would dump the physician

 

[nuttynutskin]

I WANTED to stay at 2mgs but my new doctor cut me back. She's definitely not going to prescribe more benzos and even said that eventually she'd like to see me off the xanax. I would possibly try to find a new doctor, but I got welfare insurance which makes it hard, and if I dump this doctor I won't have a xanax script at all. I feel kind of fucked over by the whole system. It was my old doctor from the same practice that got me addicted in the first place. I never knew about the withdrawal or anything like that when I first started taking it, and he never told me. One time when I was signing a medication contract one of the nurses told me that you don't typically withdrawal from this type of medication. At that time I knew a little bit about benzo withdrawal just from reading and was thinking BULLSHIT! I think doctors and nurses need to have a better understanding of benzos. They owe it to their patients. It's just as much malpractice to keep someone on benzos for 7 years as to cut their dose in half IMO.

 

[cj]

I WANTED to stay at 2mgs but my new doctor cut me back. She's definitely not going to prescribe more benzos and even said that eventually she'd like to see me off the xanax. I would possibly try to find a new doctor, but I got welfare insurance which makes it hard, and if I dump this doctor I won't have a xanax script at all. I feel kind of fucked over by the whole system. It was my old doctor from the same practice that got me addicted in the first place. I never knew about the withdrawal or anything like that when I first started taking it, and he never told me. One time when I was signing a medication contract one of the nurses told me that you don't typically withdrawal from this type of medication. At that time I knew a little bit about benzo withdrawal just from reading and was thinking BULLSHIT! I think doctors and nurses need to have a better understanding of benzos. They owe it to their patients. It's just as much malpractice to keep someone on benzos for 7 years as to cut their dose in half IMO.

I agree with you man you are getting fucked. I don't know the specifics of your insurance and I realize jumping docs is a risk but honestly she is doing you harm. I would seek a second opinion but obviously I'm not you. After 7 years you need a long slow taper off if your not going to experience crippling problems. I mean we are talking serious problems. Her actions so far shows a disregard for your well being and that's no doc I would want to have.

 

[Jabberwocky]

That is really good advice

 

[aihfl]

It’s only really indicated for performance anxiety. It will probably be helpful in controlling nutty’s blood pressure and whatnot, and possibly have some effect on anxiety, but it isn’t going to be very significant in all likelihood. I am not suggesting it isn’t worth trying, just that it is of limited anxiolytic

TPD, have you ever been on propranolol? Because I have and I can assure you it has value in alleviating physical withdrawal symptoms in particular. I am prescribed the 20mg dose.

 

[Jabberwocky]

Yup, for years for this purpose. I’m not saying it doesn’t do anything for anxiety, but as you mentioned it’s more the physical symptoms, and the effects are rather subtle subjectively speaking. It can be a very useful drug, but it will be of limited use in dealing with serious social phobia or panic disorders.

Another thing to keep in mind with this medication is rebound hypertension. My doctor initially forgot to mention that. It is really the reason I don’t use it very often anymore, because after using it very regularly for about a year I started to need to take it to help manage BP and whatnot. That isn’t the end of the world, but it is really not cool either.

The risk/reward ration for this stuff is rather low (meaning more potential reward than risk), but it’s of limited efficacy when it comes to much about anxiety disorders, and doesn’t come without its own risks. Please don’t misunderstand, I’m not saying it won’t be helpful - just that it is of limited helpfulness.

 

[simco]

OP, this may be obvious...but you can always look for a new doc while continuing to work with this one, only making the switch once you've got proper care lined up. That doesn't solve the problem of limited options. But limited options are better than no options.

 

[aihfl]

But limited options are better than no options.

TPD, that is my point with the propranolol. Yes it's not the ideal drug for this situation, but it will help and some help is better than no help. The OP has made it clear that detox and/or rehab in his area is not an option and the difficulties posed by finding another physician.

 

[Jabberwocky]

Indeed, it is better than nothing. That is just an unfortunate place to be.

 

[T. Calderone]

I WANTED to stay at 2mgs but my new doctor cut me back. She's definitely not going to prescribe more benzos and even said that eventually she'd like to see me off the xanax. I would possibly try to find a new doctor, but I got welfare insurance which makes it hard, and if I dump this doctor I won't have a xanax script at all. I feel kind of fucked over by the whole system. It was my old doctor from the same practice that got me addicted in the first place. I never knew about the withdrawal or anything like that when I first started taking it, and he never told me. One time when I was signing a medication contract one of the nurses told me that you don't typically withdrawal from this type of medication. At that time I knew a little bit about benzo withdrawal just from reading and was thinking BULLSHIT! I think doctors and nurses need to have a better understanding of benzos. They owe it to their patients. It's just as much malpractice to keep someone on benzos for 7 years as to cut their dose in half IMO.

Wow. There are so many doctors out there who don't like to prescribe benzos yet remain clueless as to their withdrawals. Are you feeling any better today? If you're still sick, make an appointment to go back. What you can do is look up the Ashton method of tapering and show this to her.

I'm not sure how the Medicaid system works in your state but in the county where I live, there are only two psych groups that accept it. Both of them require patients to see a therapist in conjunction with psychiatrist. Personally, I would be afraid to try a new doctor because they might not give you Xanax at all.

I'm glad you were able to stop drinking. That in itself is huge!

 

[nuttynutskin]

Wow. There are so many doctors out there who don't like to prescribe benzos yet remain clueless as to their withdrawals. Are you feeling any better today? If you're still sick, make an appointment to go back. What you can do is look up the Ashton method of tapering and show this to her.

I'm definitely doing better than I was but still having symptoms. I have an appointment to go back Friday. I doubt showing her any tapering methods is going to change her mind tho because I talked about going back to 1.5mgs and she wasn't having it.

I'm not sure how the Medicaid system works in your state but in the county where I live, there are only two psych groups that accept it. Both of them require patients to see a therapist in conjunction with psychiatrist. Personally, I would be afraid to try a new doctor because they might not give you Xanax at all.

Yeah, that's what I'm afraid of. I guess I could call around and see what's out there, but I have no idea how you would find out if a doctor is ok with a slow assisted benzo taper over the phone.

I'm glad you were able to stop drinking. That in itself is huge!

Well it wasn't entirely by choice since my parents took control of my SSI. I suppose I can't blame them since I was drinking myself to death, but it's putting a bit of a strain on the relationship. Now I have to get permission to spend my own money if I want to buy something which kind of sucks.

 

[Reanimator13]

Been on xanax on and off for a lot of years... That said 2mg is really not that much. Anytime I have quit you get a kick back. Anxiety goes way up. Lasts a few days and starts to level.The big problem is after the xanax you still have to deal with the anxiety that you were being treated for. Most of the drugs have nasty side effects I could not tolerate. What worked for me was good old fashioned exercise and meditation. I still get a bottle of 30 .5mg every 6 months if I ask. Its nice to be able to take a mini vacation on those really shitty days.

Best of luck
R13

 

[cj]

Generally phychiatrists are more open to prescribing benzos. You can also see one without dumping your general practitioner so it's not terribly risky either if they decline to help

 

[chompy]

Been on xanax on and off for a lot of years... That said 2mg is really not that much. Anytime I have quit you get a kick back. Anxiety goes way up. Lasts a few days and starts to level.The big problem is after the xanax you still have to deal with the anxiety that you were being treated for. Most of the drugs have nasty side effects I could not tolerate. What worked for me was good old fashioned exercise and meditation. I still get a bottle of 30 .5mg every 6 months if I ask. Its nice to be able to take a mini vacation on those really shitty days.

Best of luck
R13

This. And find a new doctor/psychiatrist that is knowledgeable about the proper way to taper a person off of short acting benzos using diazepam or clonazepam as a substitute. Gabapentin will help in the short run. I've been on benzo's for years and it makes me feel like a drug addict.

 

[nuttynutskin]

Not to be rude, but this is definitely going to take more than a few days to recover from. 7 years on xanax and 5-6 years of heavy drinking and my nerves are shot. I couldn't even get out of bed the first day or two that I quit drinking and was already decreased in my xanax. The decrease didn't affect me at first because I just started drinking heavy again, but after my money and alcohol all ran out, HOLY SHIT. I won't go into all the gory details but I basically had to learn to walk again because my equilibrium was so fucked up. It wasn't until about a week that I was slowly making some improvements. But on a positive note I started taking the propranolol and primidone and I gotta say they definitely have helped my intention tremors. I think alcohol helps with them more, but my liver is too messed up and I guess I'd rather not die of cirrhosis. Besides that I have no control over my finances anyways.

 

[cj]

Not to be rude, but this is definitely going to take more than a few days to recover from. 7 years on xanax and 5-6 years of heavy drinking and my nerves are shot. I couldn't even get out of bed the first day or two that I quit drinking and was already decreased in my xanax. The decrease didn't affect me at first because I just started drinking heavy again, but after my money and alcohol all ran out, HOLY SHIT. I won't go into all the gory details but I basically had to learn to walk again because my equilibrium was so fucked up. It wasn't until about a week that I was slowly making some improvements. But on a positive note I started taking the propranolol and primidone and I gotta say they definitely have helped my intention tremors. I think alcohol helps with them more, but my liver is too messed up and I guess I'd rather not die of cirrhosis. Besides that I have no control over my finances anyways.

No doubt it's going to take some time but I wouldn't be overly pessimistic on the timeline. I'm glad the meds are having a positive effect. Your going to work through this buddy