Any lists of GAD specific benzos out there?

[TheSacredTree]

I recently had to switch doctors cause my old one wasn't helping and then dropped my insurance and my new one knows i work in the medical field so she is going to let me take some part in deciding the direction I want to go with some new medication changes.

Now, I've tried just about every SSRI/SNRI out there; none with good effects on me. Been on various benzos for years now and some of them have helped, others haven't. Would like to stay in the benzo class though for my generalized anxiety.

I'm wondering if anyone has or knows a list of all the benzos out there that are specified for GAD with panic attacks. She said no on any sedative types only labeled for insomnia.

I've tried Clonazepam until they added some indredients I'm allergic to (5 different brands all added it). Was the only one that's worked so far though. Valium is making me hyper and increasing my anxiety. Ativan made me suicidal. Xanax would require dosing too many times a day.

Are there any others that can be prescribed for Generalized Anxiety Disorder?

 

[truenamebrand]

It sounds like you’ve pretty much gone through the most commonly prescribed benzos. I’ve been there myself, and also suffer from GAD. I would think that, typically, clonazepam is what most doctors will use. Diazepam has some stigma that I don’t quite understand, but that’s another with a long half-life, and more suited to GAD.

Alprazolam and lorazepam both are very short-acting and geared more towards as-needed situations (as you said, too many doses required). The only other benzo doctors are known to prescribe, to my knowledge, would be temazepam. Though I believe that’s given more often than not for sleep. Personally I find temazepam much less effective than both clonazepam and diazepam.

Other than that, you and your doctor might have to get creative.

There is also phenibut, which is a GABA-b agonist. If you have some discipline phenibut can be a really good option. If you aren’t familiar, it’s unscheduled and unregulated here (assuming you’re also in the US) so you can legally purchase it online. Need any info on it just ask.

 

[TheSacredTree]

It sounds like you’ve pretty much gone through the most commonly prescribed benzos. I’ve been there myself, and also suffer from GAD. I would think that, typically, clonazepam is what most doctors will use. Diazepam has some stigma that I don’t quite understand, but that’s another with a long half-life, and more suited to GAD.

This is exactly how it was for me. Clonazepam was the first and best IMO but then the brand I liked had a few ineffective batches and the minty flavor in all the others just doesn't settle right with me. Currently on Diazepam and I suppose I can kinda see why there's a stigma but I personally am not a fan. I get the euphoria and heavy muscle relaxation from it but it just amps me up even more and raises my heart rate. I want something that makes me tired, not more awake.

Alprazolam and lorazepam both are very short-acting and geared more towards as-needed situations (as you said, too many doses required). The only other benzo doctors are known to prescribe, to my knowledge, would be temazepam. Though I believe that’s given more often than not for sleep. Personally I find temazepam much less effective than both clonazepam and diazepam.

Temazepam was actually what I specifically asked for before getting Valium but she said she doesn't like to prescribe that one for GAD, just insomnia.

Other than that, you and your doctor might have to get creative.

At this point I'm not totally sure there is any more creative to go. lol. Have tried over 30 different "add-ons" already and many different prior auths. Short of barbiturates and the odd benzos I'm curious about getting some opinions on, we've ran through just about everything on the market.

There is also phenibut, which is a GABA-b agonist. If you have some discipline phenibut can be a really good option. If you aren’t familiar, it’s unscheduled and unregulated here (assuming you’re also in the US) so you can legally purchase it online. Need any info on it just ask.

I've heard of Phenibut before but always wondered about it's safety. Have tried Kava in the past; is it better than that? And does it interfere with Gabapentin or Adderall?

 

[truenamebrand]

Phenibut, I believe, would technically fall under gabapentinoids; they’re sort of “cousin” drugs. I started gabapentin after stopping phenibut so I’ve never taken them together. I’m sure plenty of people here have.

The only effects it would have on adderall would be positive. Just like gabapentin does, it takes the edge off. It also helps with the crash, and even has a bit of syngergy.

Kava did nothing for me except make me nauseous. Phenibut is nothing like it. High doses of phenibut produce a pretty profound experience.

The issue with phenibut is all the literature is in Russian, so we don’t really know a lot about its safety profile, but it appears to be relatively safe, even in very high doses. In therapeutic doses I wouldn’t worry about it at all.

Just keep in mind, it is very different than benzos. While therapeutic doses may not produce any kind of high, recreational doses actually have an anxiolytic and stimulant-like effect simultaneously. It’s not sedating like benzos, except in perhaps massive doses. It gave me lots of energy, made me talkative, motivated, while also providing anxiety relief.

Unfortunately it also took me down a really bad road since I didn’t treat it with respect. I got reckless with it and I paid the price big time. But that said, I still recommend it to people who have more discipline than I do. Used responsibly I think it can be a great option for anxiety.

 

[Trazodon't]

Have you thought about pregabalin. It acts on the same receptors as benzodiazepines and has a lot of positive feedback from people suffering from anxiety. I have never got any relief from any antidepressants but benzos do help somewhat. The only thing is I feel like they're just masking my problems so they aren't a cure they just ease the severity of my symptoms. I'm thinking of asking my doctor about pregabalin as it also helps with sleep.

 

[Nicholai]

Xanax XR? If your only gripe with alprazolam is constant redosing, it would seem that the extended release formulation would be a viable option.

 

[Keif' Richards]

Xanax XR? If your only gripe with alprazolam is constant redosing, it would seem that the extended release formulation would be a viable option.

In principle, I agree. If your only option with Alprazolam (Xanax) is truly that it doesn't last long enough, then that's no reason to exclude it. It's not extremely difficult to take a pill out and take it one extra time per day.

But... you're not going to like this at all. If I understand correctly, you are in a position where you're attempting to restart Benzodiazepine therapy and that your intent is to use the Benzodiazepines in a maintenance fashion i.e. every day, multiple times per day. If this is the case OP, I would really, really suggest that you reevaluate your situation and do some serious research regarding Benzodiazepines. All of the hype out there these days is concerning Opioid over-prescription, principally. Although in recent years, Benzodiazepine prescribing rates have also fallen, in my opinion, they have not fallen nearly enough.

There is still a prevailing attitude in the Psychiatric community that Benzodiazepines are effective when used chronically and consistently. In reality, it's common knowledge among prescribers who are actually responsible, that Benzodiazepines are meant to be used in extreme cases and only for short, predetermined periods of time. This period is not supposed to surpass 2 weeks of consistent therapy. Why? It's because Benzodiazepines typically do not retain their positive effects long-term. You could be one of the lucky ones, as medical literature does support the notion that a very minute portion of the population can use Benzodiazepines long-term with maintained efficacy and no dosage increases.

This is not "typical". It's a too common story that irresponsible prescribers put their anxious patients on Benzodiazepines, daily-monthly from the start, escalate dosage each time tolerance rears its ugly head and then, when they have turned their patients into full blown Benzodiazepine addicts, their "medical ethics" preclude them from maintaining the prescription.

We can't just prescribe these drugs to addicts, can we? That would be irresponsible!

Then, once the patient is in full-blown Benzodiazepine withdrawal and their hearing voices and having seizures, they show up at the emergency room over and over, at which point, they are labeled a drug-seeker, making it even harder for them to acquire the drugs that they need. I've counseled too many folks over PM regarding their Benzodiazepine withdrawal and although this could be seen as an extreme instance, it's really not and this has happened to countless people. Doctors are far more willing to start you on Benzodiazepines and receive rave-reviews from their patients than they are to accept the fact that they're creating addicts and deal with that problem.

Bottom line: Benzodiazepines are not meant to be used chronically. It's irresponsible prescribers who create this culture of misinformation and downplaying of the danger and negative impact on patients' quality of life. I really want you to reconsider OP. Use Benzodiazepines when you are experiencing severe anxiety and/or panic, but please don't fall into the pit of daily use. You could end up with a severe Benzodiazepine dependency and a worse anxiety than you would've ever imagined possible. This negativity is not directed at you, it's directed at these asshole doctors.

 

[TheSacredTree]

Phenibut, I believe, would technically fall under gabapentinoids; they’re sort of “cousin” drugs. I started gabapentin after stopping phenibut so I’ve never taken them together. I’m sure plenty of people here have.

The only effects it would have on adderall would be positive. Just like gabapentin does, it takes the edge off. It also helps with the crash, and even has a bit of syngergy.

Kava did nothing for me except make me nauseous. Phenibut is nothing like it. High doses of phenibut produce a pretty profound experience.

The issue with phenibut is all the literature is in Russian, so we don’t really know a lot about its safety profile, but it appears to be relatively safe, even in very high doses. In therapeutic doses I wouldn’t worry about it at all.

Just keep in mind, it is very different than benzos. While therapeutic doses may not produce any kind of high, recreational doses actually have an anxiolytic and stimulant-like effect simultaneously. It’s not sedating like benzos, except in perhaps massive doses. It gave me lots of energy, made me talkative, motivated, while also providing anxiety relief.

Unfortunately it also took me down a really bad road since I didn’t treat it with respect. I got reckless with it and I paid the price big time. But that said, I still recommend it to people who have more discipline than I do. Used responsibly I think it can be a great option for anxiety.

I'll definitely have to look into that then. Thank you.

 

[TheSacredTree]

Have you thought about pregabalin. It acts on the same receptors as benzodiazepines and has a lot of positive feedback from people suffering from anxiety. I have never got any relief from any antidepressants but benzos do help somewhat. The only thing is I feel like they're just masking my problems so they aren't a cure they just ease the severity of my symptoms. I'm thinking of asking my doctor about pregabalin as it also helps with sleep.

I've definitely considered Lyrica and asked both my General and Psychiatrist about it but neither one wanted to prescribe it for me. The psychiatrist cause she said it's a bit too far out of her practice and she doesn't know much about it. And the general said no because I asked for it for my chronic back pain (which a spinal surgeon said would be permanent and is bad enough to interfere with my work at times). I'm pretty sure my primary is really just against prescribing controls though and instead put me on a ton of Gabapentin which doesn't work at all but he said it's the most he's gonna do. I'm dropping him soon though cause I don't agree with the whole letting your patients suffer to keep the license clean thing.

 

[Trazodon't]

Here in the U.K. it's quite commonly prescribed for anxiety. I can't see a problem prescribing lyrica if he's prepared to prescribe you heroic amounts of gabapentin.

 

[TheSacredTree]

Xanax XR? If your only gripe with alprazolam is constant redosing, it would seem that the extended release formulation would be a viable option.

Actually, that's a really good one I totally forgot about. Thank you.

 

[TheSacredTree]

Here in the U.K. it's quite commonly prescribed for anxiety. I can't see a problem prescribing lyrica if he's prepared to prescribe you heroic amounts of gabapentin.

And that's exactly what I said too. "Why can't we just try it and see if t works any better?"

He said he doesn't feel comfortable putting me on any more controls and doesn't think it has any benefits over Gabapentin. I don't much like the guy tbh.

 

[TheSacredTree]

In principle, I agree. If your only option with Alprazolam (Xanax) is truly that it doesn't last long enough, then that's no reason to exclude it. It's not extremely difficult to take a pill out and take it one extra time per day.

But... you're not going to like this at all. If I understand correctly, you are in a position where you're attempting to restart Benzodiazepine therapy and that your intent is to use the Benzodiazepines in a maintenance fashion i.e. every day, multiple times per day. If this is the case OP, I would really, really suggest that you reevaluate your situation and do some serious research regarding Benzodiazepines. All of the hype out there these days is concerning Opioid over-prescription, principally. Although in recent years, Benzodiazepine prescribing rates have also fallen, in my opinion, they have not fallen nearly enough.

There is still a prevailing attitude in the Psychiatric community that Benzodiazepines are effective when used chronically and consistently. In reality, it's common knowledge among prescribers who are actually responsible, that Benzodiazepines are meant to be used in extreme cases and only for short, predetermined periods of time. This period is not supposed to surpass 2 weeks of consistent therapy. Why? It's because Benzodiazepines typically do not retain their positive effects long-term. You could be one of the lucky ones, as medical literature does support the notion that a very minute portion of the population can use Benzodiazepines long-term with maintained efficacy and no dosage increases.

This is not "typical". It's a too common story that irresponsible prescribers put their anxious patients on Benzodiazepines, daily-monthly from the start, escalate dosage each time tolerance rears its ugly head and then, when they have turned their patients into full blown Benzodiazepine addicts, their "medical ethics" preclude them from maintaining the prescription.

We can't just prescribe these drugs to addicts, can we? That would be irresponsible!

Then, once the patient is in full-blown Benzodiazepine withdrawal and their hearing voices and having seizures, they show up at the emergency room over and over, at which point, they are labeled a drug-seeker, making it even harder for them to acquire the drugs that they need. I've counseled too many folks over PM regarding their Benzodiazepine withdrawal and although this could be seen as an extreme instance, it's really not and this has happened to countless people. Doctors are far more willing to start you on Benzodiazepines and receive rave-reviews from their patients than they are to accept the fact that they're creating addicts and deal with that problem.

Bottom line: Benzodiazepines are not meant to be used chronically. It's irresponsible prescribers who create this culture of misinformation and downplaying of the danger and negative impact on patients' quality of life. I really want you to reconsider OP. Use Benzodiazepines when you are experiencing severe anxiety and/or panic, but please don't fall into the pit of daily use. You could end up with a severe Benzodiazepine dependency and a worse anxiety than you would've ever imagined possible. This negativity is not directed at you, it's directed at these asshole doctors.

Oh trust me, I totally agree with you on all of that. I'm actually in the process of deciding on a college to go for Psychopharmacology at the moment so the intricacies and side effects of all these medications are one of my favorite things to spend my time researching.

Unfortunately though I've been prescribed different benzos for over 5 years now after having tried all other options and so far nothing but Clonazepam has worked for me.

I have always tried to minimize the amount I take though and only use it when I really need to or am in a more stressful situation than normal.

I did see what those withdrawals are like though when I was prescribed Ativan and had to discontinue it cold turkey after becoming suicidal partly due to the pills and partly because of difficult times. Was not fun to say the least.

 

[Trazodon't]

I'm not a fan of antidepressants and react badly to them all except mirtazipine. It seems like me you are running out of options but mirtazipine has been ok for me at a low dose just for sleep

 

[TheSacredTree]

I'm not a fan of antidepressants and react badly to them all except mirtazipine. It seems like me you are running out of options but mirtazipine has been ok for me at a low dose just for sleep

Funny you mention Mirtazapine as that's actually the only one I was ever able to tolerate as well. But after taking it for too long it eventually got to the point where I'd have withdrawals to the Mirtazapine before I could even take my next dose in the night. I'd take it at midnight and by 4 or 5 pm the next day I'd be in agony until I took it again.

 

[Keif' Richards]

I get what you're saying Sacred, about being well-read on the subject, but what we're discussing would probably not be considered an "intricacy" of Benzodiazepine biochemistry, it's more like one of the defining characteristics of the group. Believe it or not, this actually speaks volumes. I'm not trying to get down on you at all, but there is a near-literal paradox concerning the prescription of Benzodiazepines, in that, the more training someone has received, the less likely they are to view Benzodiazepine dependence as a likelihood, as opposed to a possibility.

I've had numerous Psychiatrists, including a Psychiatrist who specializes in addiction medicine, runs the largest public Psychiatry clinic in Vermont and overseas at least 5 other PsyD's and PA's, Practicioners etc. and he told me with a straight face that Benzodiazepines do not present problems for those who do not abuse them. It requires a conscious decision to turn to the dark side to have Benzodiazepines bite you in the ass. This isn't a microcosm of the Psychiatric community.

I totally get that nothing else has worked for you... yet. I've been involved with Psychiatry for 20 years to your 5 and I'm still perfecting things. It's no reason to throw in the towel and settle into a lifetime of Benzodiazepine use. You are well aware of how these things "sometimes" end up considering your knowledge of pharmacology. Honestly, Pharmacists seem to be the only ones in this world with a shred of common sense when it comes to prescription guidelines.

I'm not arguing the point because I want to prove you wrong. I really don't want you to have to deal with this stuff.

 

[squirrel_girl]

have u tried hydroxyzine? didn't work for me unfortunately but a friend w severe GAD is able to use it as a daily and then use benzos only for panic attacks. it's weirdly an antihistamine (like extreme benadryl). idk if it's what ur looking for but maybe an alternative to look into.
i hope u find something that works (( anxiety is so awful
(also, idk if this is an option but have u talked 2 ur insurance about covering a clonazepam that ur not allergic to if there is one out there? clonazepam like u said is the only thing that's worked for me so far)

 

[TheSacredTree]

I get what you're saying Sacred, about being well-read on the subject, but what we're discussing would probably not be considered an "intricacy" of Benzodiazepine biochemistry, it's more like one of the defining characteristics of the group. Believe it or not, this actually speaks volumes. I'm not trying to get down on you at all, but there is a near-literal paradox concerning the prescription of Benzodiazepines, in that, the more training someone has received, the less likely they are to view Benzodiazepine dependence as a likelihood, as opposed to a possibility.

I've had numerous Psychiatrists, including a Psychiatrist who specializes in addiction medicine, runs the largest public Psychiatry clinic in Vermont and overseas at least 5 other PsyD's and PA's, Practicioners etc. and he told me with a straight face that Benzodiazepines do not present problems for those who do not abuse them. It requires a conscious decision to turn to the dark side to have Benzodiazepines bite you in the ass. This isn't a microcosm of the Psychiatric community.

I totally get that nothing else has worked for you... yet. I've been involved with Psychiatry for 20 years to your 5 and I'm still perfecting things. It's no reason to throw in the towel and settle into a lifetime of Benzodiazepine use. You are well aware of how these things "sometimes" end up considering your knowledge of pharmacology. Honestly, Pharmacists seem to be the only ones in this world with a shred of common sense when it comes to prescription guidelines.

I'm not arguing the point because I want to prove you wrong. I really don't want you to have to deal with this stuff.

And I once again agree on all of that. I've had psychiatrists prescribe me miscellaneous different benzodiazepines before saying "now remember, these are just a band-aid; not to be taken forever" but their definition of band-aid being rip it off and replace with a different benzo.

And also, pharmacists do seem to have much more common sense in protecting us patients but I also work in a pharmacy and can tell you first-hand that we're endlessly getting more laws which the government thinks will help protect the people but realistically just does the exact opposite. For example, nowadays the pharmacist has to do a "consultation" every time a patient gets a "new" prescription called in. Well guess what, almost every control requires a "new" prescription to be called in each time (in my state at least). Can we realistically check which ones are truly new and which ones aren't every time someone comes in to get a control, absolutely not; unless the people in line want to wait an hour whenever they come in. Basically they'll just put out their fingerprint and walk away now. So even in the pharmacy people aren't going to be getting much info unless they ask nowadays. It's sad really.

But there is one thing I'm still slightly confused about in your comments; are you saying you're totally against the use of benzodiazepines for generalized anxiety disorder? Or saying they should prescribe them but give more information and warning when they do?

 

[TheSacredTree]

have u tried hydroxyzine? didn't work for me unfortunately but a friend w severe GAD is able to use it as a daily and then use benzos only for panic attacks. it's weirdly an antihistamine (like extreme benadryl). idk if it's what ur looking for but maybe an alternative to look into.
i hope u find something that works (( anxiety is so awful
(also, idk if this is an option but have u talked 2 ur insurance about covering a clonazepam that ur not allergic to if there is one out there? clonazepam like u said is the only thing that's worked for me so far)

Unfortunately I have tried Hydroxyzine as well and it didn't work at all for me. And we just tried last month working on a prior authorization for brand name Clonazepam but the insurance wasn't going for it.

Thank you though, anxiety really is the worst.

 

[emperorowl]

Just wanted to chime in about the gapapentin- I was prescribed that for my GAD and although it does work, it can be really finicky. Some people need super high doses (as in grams!) to get any effect and tolerance builds FAST. You can't take it every day even at the prescribed dosage because after 3 days tolerance is already through the roof. It DOES act kinda similarly to a benzo in that it affects GABA receptors indirectly, but it is actually more similar to GHB + alcohol, it will ease your anxiety and make you a bit intoxicated (and that's just at my prescribed dose of 200mg 3x a day) and it's also a bit stimulating and sedating at the same time oddly enough. I can only take it for a few days and then have to take a day or two off to reset tolerance. It also takes FOREVER to kick in- something like 4 hours, a bit less with food. I have panic attacks on top of my GAD so it's definitely not something I can take on the spot and get relief, I have to let it build up all day first. The WD's from it are also pretty horrible, like phenibut. Lyrica is just gabapentin's big brother btw, it's stronger so you can take a smaller dose but the tolerance issues still remain. Just wanted to let you know in case you look into it, def research it first because it's a bit weird of a drug.
EDIT: OH forgot to add, I feel you on the klonopin, that is my supreme benzo of choice and it works sooooo well for GAD and panic attacks, I would cry if I became allergic to it!!