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Thread: Xanax to other supposedly anti-anxiety drugs

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    Xanax to other supposedly anti-anxiety drugs 
    #1
    Had a nine-night stay in the hospital earlier this month after developing suicidal ideation 4-5 days after starting Effexor. I was also on 50mg. of Pamelor and 30 mg. of Remeron. I think the plan with my outpatient psychiatrist was to eventually eliminate the Pamelor, increase the Remeron, and go up on the Effexor. When I ended up in the hospital, I was pretty set on having ECT; I had it before 5 1/2 years ago, and it was a true miracle. But we live in another state now, 2000 miles away from our previous home, and this was a new hospital for me. It is a large teaching facility and their psych ward is considered one of the best in the country. I was only there nine nights because our insurance would not authorize any more time there, despite appeals by the psychiatrist on my end (they would not authorize inpatient ECT, either). Then I got a rude awakening when I found out this facility would not offer ECT if you are taking any anti-seizure medication. As long as I was on Xanax (I was taking regularly scheduled .5mg. ER Xanax in the AM and PM, with .25mg PRN; some days I just took the scheduled, and some days I had to take an additional .25mg-.75mg.), and Pamelor, they could not do ECT. I wasn't willing at this time to go off Xanax (we are in the middle of a major relocation and I'm also experiencing PTSD from other events over the last 18 months), so they recommended I give gabapentin a try to use instead of Xanax. In the hospital they switched me from Xanax to gabapentin in one day. I had a rough first week, but they also added 2.5mg Zyprexa (with plans to increase it to 5mg, which we eventually did) and 25mg.Trazadone at night to sleep (one time I took another 25mg. three hours later and my BP dropped to 83/52, so no more 50mg of Trazadone for me). We started the gabapentin at 200mg. three times a day, and I worked up to 300mg. four times a day. They also upped my Remeron to 45mg. In the hospital I was allowed .25mg. Xanax PRN, but only after I'd take a gabapentin as the first line, so the .25mg. was maybe once every day or two. I think they felt if I wasn't going to do ECT immediately, it was OK to take a.25 mg. of Xanax a day if I needed it.

    It wasn't a fun time - my anxiety was still relatively high, and I probably won't know what caused the new physical anxiety (shaking, cognitive dysfunction - slurred some of my words, repeated words twice, fogginess, slow cognition... couldn't get some words from my brain to my mouth), but the suicidal ideation did slightly improve. Now I am under the care of my new psychiatrist (that I like a lot), and he and my therapist believe it's best if I sort of continue what I'm doing because I have so many things coming up in the next month - we have to go back to our home in our previous location, meet the movers, and have all of our stuff moved to where we are, as we will be closing on a new house this Tuesday. There's some cosmetic work we want to have done, which is stressful, and then there's the holidays (which will be minimal for us this year).

    Since getting home, I have three times gone 48 hours without any Xanax. But when I hit that 48 hour mark (as I did this morning), the shaking starts again (for instance, typing on the laptop is sort of challenging due to my hands shaking), the anxiety really ramps up, despite taking my 300mg. gapapentin this morning. I'm pretty sure if I took .25mg. of Xanax at this point, the shaking and anxiety would go away, and it would keep me mostly anxiety-free the rest of the day and evening. I wouldn't feel a need for it, for another 48 hours. From my understanding, Xanax is a short-acting drug, so I guess my question is, why is it taking 48 hours for me to feel effects of not having any? The doctor told me I would have to go at least 72 hours without it, before the acute side effects would start to abate. So really, if I can go 48 hours, I'd really only have a bad 24 hours of feeling like this before it would peak, if I'm understanding it right. I guess the experiment I'm trying is, what is it going to be like to get off this so ECT can become an option if other medications don't work for anxiety and depression (ECT also did help with my anxiety, as well as depression). And yes, I'd have to get off the gabapentin, too, to do ECT. The p-doc at the hospital said to prepare people for ECT, they will often use Zyprexa and Trazadone (low dose during the day) to help with the anxiety while people are doing ECT and can't take any anti-seizure medication. So basically I would walk around like a zombie, knocked out on those meds to get me through the ECT. Now, she said you have to not have taken any Xanax for 24 hours prior to an ECT treatment. Since they do them, pretty much M, W, Fri., I could take one the afternoon after ECT, and be OK until the next treatment, if I'm taking one now about every 48 hours. The other option is, there are probably ECT centers in our large metropolitan area that will do ECT while you're on Xanax. How it was explained to me was, if you're on any anti-seizure medications, they will have to use a higher voltage to induce the seizure. And when you use higher voltages, you increase side effects. When I did ECT 5 1/2 years ago, they did allow me to be on Xanax, but I did have some short-term memory loss (most of it came back in the months following treatment), cognitive slowing, and am wondering if I did ECT without being on Xanax, would my memory loss and slow cognition be less. So that's why I'm really hoping to eliminate the Xanax eventually.

    Any thoughts on my plan here?
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    #2
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    My guess is it takes 48 hours to completely eliminate the Xanax from your system. The symptoms your having are classic benzo withdrawal type things. But honestly your doctor is way more educated on the subject then anyone here. I will say .25 is a really low Xanax dose so I don't think your in danger of a siezure if you just tried pushing through the symptoms. But discuss with your doctor before you do anything he hasn't advised
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    #3
    Not really worried about seizures because I'm on gabapentin and Pamelor (who knew it had anti-seizure possibilities?). It's just so hard to determine whether what I'm experiencing is acute withdrawal from Xanax, or side effects of the new meds. Yes, I'm hoping after the first of the year, when things settle down, I can try to jump from it, so I'm going to try to minimize my use between now and then. Thanks!
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    #4
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    My hopes are blighted, my heart is broken, my life a burden, everything around me is sad and mournful; earth has become distasteful to me, and human voices distract me. It is mercy to let me die, for if I live I shall lose my reason and become mad.
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    If you're having suicidal thoughts and the SSRI's aren't helping I would stop taking them, but it sounds like you haven't given them "enough time" to work.

    Please be careful. What do your therapist/docs think is best?

    Starting 1 psych med at a time is wisest; throwing a bunch on at once can be problematic.

    Take time and be careful
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    #5
    The suicidal thoughts have abated. The staff at the hospital were very clear... if they come back, I can go back to the psych ward; there's no shame in it. Now I'm just incredibly frustrated. The side effects (whether they're from benzo detox or new meds) have left me fearful of driving a car, so I don't. I either have someone else drive (like my husband or daughter) or I take Uber. And yes, pharmakokinetics are real (my husband is a scientist and worked at a big pharmaceutical for 29 years, so he is a great resource for some of this). I don't like starting more than one thing at a time. But we gave the gabapentin a few days in my system before they added the Zyprexa, then increased the Zyprexa. Most of the problematic symptoms I had in the hospital have also abated. For now, I'm just dealing with the symptoms I get when I'm approaching 48 hours without any Xanax. I see it as a positive that I've eliminated two extended-release Xanax a day, to one .25mg. every other day. My therapist is supportive of what the psychiatrist is doing and he wants to see me every week for now to monitor my mood. My therapist (who collaborates with other professionals at a major teaching hospital) actually was a physician's assistant years ago in her first career before going back to school to get her Ph.D. She sees a lot of patients in a clinic who have chronic pain issues, and has referrals for physicians who use CBD oils and/or ketamine as alternatives when depression becomes treatment-resistant. Not ready to try those yet, but they are options, and when she shared that with me (and had solid referrals), it is the first hope I'd had in a while.
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    #6
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    I'm glad your getting really good treatment. That's something to be thankful for
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