Advice on benzo's for panic disorder

[Doomed2pain]

I have PTSD, adjustment disorder with anxiety and depression and panic disorder. I've used diazepam a few times for my panic and it really does help stop a full blown attack, I still feel edgy but I know for the most part it stops me from having full blown physical symptoms.

I really want to try getting back to normal and I am currently starting cbt for panic, got my second session next week (she even comes to my home as she knows how hard it is for me to go outside etc). Today was my son's first nativity and I couldn't miss it, so I asked my dr for some diazies which they have no problem with as I haven't used them since may or so and I only ever used them therapeutically. I'm just wondering how long could I use them for, as when it comes to exposure part of therapy, I am really going to need them. Could I say use them for a month, then take a break for a few weeks to see how I get on without them once the therapy is underway, and go back on if need be?

I know how easily people can become dependent so I don't want to over use them, but they are so helpful. I have never taken them for more than 2 days in a row, I take them when I really have to go somewhere. People do my shopping for me etc but there are certain things I have to do like appointments etc.

What are people's thoughts, experiences etc?

Would like as much info as possible of people's experiences when using them for panic disorder but also any anxiety disorder really.

Thankies

 

[swmo]

i also have been diagnosed with adjustment disorder with depression about 8 years ago. i was prescribed clonazepam. eventually, i was taking 2mg tid. i'm down to .5 mg bid. imo, if u never take them for more than 2 days in a row, i think you'd be ok for a month. i'm not sure, but i don't think you'd have serious wd if used as u plan. good to hear that u have a good dr that u can count on.

 

[Doomed2pain]

It took me a while to get a dr that actually cared, now I just need to find a decent pain management dr too, hopefully I will have a new one soon, just waiting for my solicitor to get it all sorted. In the mean time it's back to trial and error for my pain meds and anti depressants as we've not managed to find the right mix yet.

As for the diazepam, I've been prescribed it about 4 times this year, and it does work, now I know that if I decided to go on it long term I could without a problem and obviously taper it down when the time comes, but do I really want to go down that road? On the other hand, do I still want to be trapped in the mental state and be a prisoner in my own home like I have solidly for the past 22 months? It's a tough choice really. Did your adjustment disorder improve? Te psychiatrist I saw gave me a rather worrying prognosis, he said if the pain doesn't get managed adequately (which for now it never will be, not unless some ground breaking research is done, and said research is NOT being carried out) I will be stuck like this indefinitely at the same severity if not worsening.

Tricky tricky.

 

[charcoal]

Don't take benzos regularly for ANY length of time. They are great for a full blown, flopping around on the floor panic attack, or something very scary coming up like a dental appointment and that's it. If you feel the need to take meds for anxiety long term there are much better options that aren't benzos.

I have PTSD and have suffered from debilitating panic attacks my whole life as well as uncontrolled OCD leading to being housebound for months on end. I became a benzos addict 11 years ago because of it and nothing good came of that. In fact, it turned into a fucking disaster on top of all the psych problems. My problems are now controlled very very well with correct medication (therapy didn't work for me).

 

[Doomed2pain]

Thanks for the advice charcoal. This is why I don't want to go down the long term route, but so far none of the anti depressants I have tried have worked, on my 6th different one so far. Also giving therapy a go now to see if that makes any difference, I have my second session of cbt on Tuesday, I'm going into it with an open mind but i've noticed the ideas she's suggested so far, I do anyway. I understand that I am having an unreasonable response to ordinary situations, and I always do try and "talk" myself out of it if you will, but it never works. My physical condition doesn't help either, my sympathetic nervous system is fried so one of the things that happens is over production of adrenaline due to pain, meaning my body kicks in the fight or flight response for no damn reason, leading to, yup panic attacks over jack shit. I have anticipatory attacks too all of the time. It sucks.

What therapies did you try?

 

[charcoal]

I'm not familiar with what the various therapies consist of or what the names mean but I did the usual talking therapy for about 9 years with some other stuff thrown in (including art therapy) as we tried to find something that worked. I tended to try and 'out think" any therapeutic approach and butt heads with the procedure; whatever it was. I have zero interest in trying more therapies since meds are working so well.

As for the drugs you've tried, 6 antidepressants isn't very many. Try more, and you need to be trying antipsychotics and mood stabilizers too. The term "antipsychotic" is a misnomer as they are used for quite a few things so don't let it scare you off. They CAN be a nasty group of drugs but they are life changing for a lot of people too. Chances are, if drugs are going to help you (or you choose to stay on that path) you'll end up with a cocktail of drugs, 2 or more of various classes. If that works, awesome. Just don't do the stereotypical "I don't wanna be on drug long term/rest of my life" whine. If the drugs work, take em. You wouldn't stop taking allergy pills on the basis that swallowing allergy pills is a sign of weakness (or whatever people think of when taking psych drugs). It's a big pet peeve of mine in the psych world; people not willing to take drugs that work really well. I always let people know that I'm 29, swallow a minimum of 22 pills a day and wear a medical bracelet. And I feel happy for the first time in my life. :D

Anyway as you can see I'm pro medications but that's just because they work so well for me. If therapy works better for you, DOOO IIIITT!!!

 

[Doomed2pain]

I'm likely to be on medication for the rest of my life anyway so that doesn't bother me, I do just need to find the right combination. I did get really pissed earlier this year and cold turkied all of my medication, nothing was working for my pain or my mental health so I just thought fuck this I'm not taking them anymore. But I was in a really bad mental state at that point. I came round in September and accepted that I need to get some form of quality of life back so decided to get back onto meds. Like I said, we just need to find the right mixture now. And I will try the therapy, I want to give it a go, if it doesn't help, it doesn't help but at least I'll have tried every avenue I possibly can.

I'm glad you find the right mix, I can't wait until we find something that works, it causes depression in itself when I get put on new meds/doses and my problems aren't relieved somewhat. But all I can do is dust myself off and try other things. I am waiting for test results at the minute since I went on the sertraline been having problems with my blood pressure, so once I get my blood results we can work out wether it's the sertraline or another health problem causing it, but my dr won't up the dose til we get the results. If it is the sertraline I will mention the antipsychotics and mood stabilisers to her, see what she comes up with. Again, thanks for the advice, very much appreciated.

 

[charcoal]

You the perfect attitude for getting better so just keep chugging along and you WILL get better.

 

[Doomed2pain]

I hope so . Like I said, the psychiatrist that assessed me said it will be an ongoing problem in my life due to the physical condition, which sucks ass majorly, but once I'm feeling a little bit better mentally I am going to get my charity back rolling. I set it up as we have no charities for my condition in the uk, and research needs to be carried out to hopefully one day find a cure or as close to a cure as possible. But no one is funding the research, so all the money I intend to get with the charity will go towards research for a cure, and also help for sufferers that need support. I'm gutted that I had to put it on the back burner but my head went that far west that I needed to take a break and get myself fixed first, was making myself so Ill my hair fell out in places and all kinds.

 

[Roger&Me]

Don't take benzos regularly for ANY length of time. They are great for a full blown, flopping around on the floor panic attack, or something very scary coming up like a dental appointment and that's it.

Quoted for insanely large amounts of truth.

 

[Doomed2pain]

Yes I agree, this is why I only request a script when I absolutely have to. It was my son's first nativity today and there was no way in hell would I have been able to go without the diazepam I got yesterday. I also have a meeting with an occupational therapist next week too so it will come in handy for that as I am likely to freak out at them otherwise.

 

[DistyBoi]

I am waiting for test results at the minute since I went on the sertraline been having problems with my blood pressure, so once I get my blood results we can work out wether it's the sertraline or another health problem causing it

The problem with this is that people that are socially anxious will tend to be very stressed and worked up whenever they go to get their blood pressure taken (you are out of your comfort zone), so the high blood pressure may well be more to do with the setting its taken in than an actual medical issue. Get a home kit and take it by yourself a few times.

Obviously I know far less than your doctor but I doubt that for someone with major anxiety sertraline is going to do much good. For panick attack related anxiety I would highly recommend a combination of things, firstly for the physical symptoms of anxiety beta blockers like propranolol seem to help stabilize things like heart rate and fight or flight responce (also they will help lower your blood pressure). Secondly, having been put on five different anti-depressant and anti anxiety medications from GPs in the UK myself over the years, I dont think that most SSRI's or SNRI's (citalorpram, sertraline, fluoextine, venlafaxine, etc) work very well at all for this.

You should ask for your opitions with atypical antidepressants. The main one that doctors in the UK seem to be ok prescribing for patients that dont respond to the first or second line treatment is Mirtazapine. It will be slightly sedative for the first few days of using, but this will wear off within a week, and you should be left with only the positive effects. No withdrawals or addiction with this drug either, which is a bonus. As a last resort you can ask for your opitions on an MAOI based antidepressant/anxiolytic, they do come with a higher risk of harmful diet and drug combination complications, but are still considered very effective in their mental effects.

In terms of your benzo use I would never start using benzos more than 1 time a week, and only in extreme situations. All to easy to have one in your pocket ready for an emergency and instead end up working yourself up about an event and taking it when you dont really need it. You will get addicted and find life a lot harder when you can not use them in future if you start relying on them. A few other drugs that may have similar effects without such bad withdrawal and addiction issues you can ask your doctor about might be Baclofen, Pregabalin and Gabapentin. GPs may not have heard about them at first, as they are not commonly prescibed in the UK, but they should be able to find information about them if you ask.

 

[Missykins]

Sorry, OP, maybe it's buried in here somewhere, but what does your solicitor have to do with any of this?

 

[swmo]

my adjustment disorder is basically gone. it wasn't meds that made it go away, either.

 

[Cyc]

The problem with this is that people that are socially anxious will tend to be very stressed and worked up whenever they go to get their blood pressure taken (you are out of your comfort zone), so the high blood pressure may well be more to do with the setting its taken in than an actual medical issue. Get a home kit and take it by yourself a few times.

Yep, I believe it's called, "White Coat Syndrome"

 

[Mariposa]

OP, I too have panic disorder. As much as I would like to not take benzos (Valium every other day, Xanax for acute reactions), my doctor and I agree that I would be an absolute wreck without the minimal amount I take.

I know others will disagree with me on this, but here goes.

In a person with no history of benzodiazepine abuse who has not developed a tolerance (most people do - I know of only one person who has not besides myself, hopefully they'll chime in) they are relatively safe. We tried propanolol/Inderal, and I do have my script on hand for a "flop on the floor" reaction... but my blood pressure is already on the low end of normal! I'll split one 10 mg tablet in half and still notice a significant drop to the point I cannot drive or even raise from a seated position abruptly. The last time I took it was when I had a panic attack in my sleep. I knocked my head into the door really hard getting up to use the toilet (directly across a short hallway) in the middle of the night. Heaven forbid I had tried to shower or something like that.

To propanolol's credit, it is not addictive. I couldn't imagine anyone abusing it. Cognitive-behavioral therapy with a competent therapist will teach you to recognize your triggers and hopefully provide you with insight into your condition. Likely the best thing I learned from it was a simple technique called "thought-stopping" that you can do yourself. If you have a negative or anxious thought enter your mind, visualize a bright red stop sign, take a deep breath to re-oxygenate your body, hold and gently release. I use this often in anxiety-provoking situations. It's something I was originally taught in an acting class in college, but was reaffirmed when I entered therapy. I lack stage fright or fear of public speaking so I adapted the technique to my anxiety.

I also find that keeping a private journal where I write out my thoughts without fear of judgment or reprisal helps me.

One thing I did figure out (mostly) on my own was that my panic reactions can be adaptive. You NEED that fight-or-flight response sometimes. Our ancestors as humans became humans had to run from predators - we still do. Can't do that without your natural adrenaline.

I wish you the best with each of your conditions. It DOES get better with insight and proper treatment - which may or may not include benzos.

 

[Doomed2pain]

I have been suffering from low blood pressure, not high. And it only started after I went on sertraline so we are trying to rule out any under lying conditions. I fainted the other week which is why the tests have started. I have tried mirtazipine it sent me insane. I have been on both gabapentin and pregabalin for my crps, but couldn't tolerate either even though I gave gabapentin a long time, was on it for months, got up to 3200mg a day, but the side effects were too bad. I only got to 150mg of lyric and had to stop as it was even worse than gabapentin.

Missy kins, I was in an accident which is what caused all of these problems, and the nhs pain management dr was shit so my solicitor is finding me private drs including a clinical psychologist to provide me with emdr, the nhs doesn't offer it. I'm seeing a cbt therapist from the nhs to tide me over til I start seeing the private on. The psychiatrist said he wants me to receive intensive treatment for the next 3 years.

As for the benzo's they do work, and as I'm going to be medicated for life, I don't think throwing another drug with high dependence rate into my meds regime makes much difference. I've been on opiate therapy for over 2 years so I know my body is dependent on them, I had to go through fentanyl withdrawal when he chemist didn't order my patches so suffered a full weekend withdrawing from 75mcg ph. Boy did that not help my pain, I had a few tramadol left over from when I used to take them (I gave away 300 50mg tabs to my friend, but found 10 that had fallen down the back of a drawer. Needless to say, it didn't do shit, even combined with cocodamol, suppose it did help a little but not much.

I do try and stop my negative thoughts when they appear but it often doesn't work. And I've been writing a journal for over 2 years, documenting my pain and sometimes just ranting when my head is bad, I document all my attacks, my depression etc. It's easier for me to take that to my drs appointments then we can throughly see how my meds are working

Thanks for all the replies

 

[pammy]

I to suffer pretty bad at times with my nervers so i go to see my doctor who would normally prescribe with 10mg of diazipam for around 2 weeks it does the job for me normally anyway good luck x

I have been suffering from low blood pressure, not high. And it only started after I went on sertraline so we are trying to rule out any under lying conditions. I fainted the other week which is why the tests have started. I have tried mirtazipine it sent me insane. I have been on both gabapentin and pregabalin for my crps, but couldn't tolerate either even though I gave gabapentin a long time, was on it for months, got up to 3200mg a day, but the side effects were too bad. I only got to 150mg of lyric and had to stop as it was even worse than gabapentin.

Missy kins, I was in an accident which is what caused all of these problems, and the nhs pain management dr was shit so my solicitor is finding me private drs including a clinical psychologist to provide me with emdr, the nhs doesn't offer it. I'm seeing a cbt therapist from the nhs to tide me over til I start seeing the private on. The psychiatrist said he wants me to receive intensive treatment for the next 3 years.

As for the benzo's they do work, and as I'm going to be medicated for life, I don't think throwing another drug with high dependence rate into my meds regime makes much difference. I've been on opiate therapy for over 2 years so I know my body is dependent on them, I had to go through fentanyl withdrawal when he chemist didn't order my patches so suffered a full weekend withdrawing from 75mcg ph. Boy did that not help my pain, I had a few tramadol left over from when I used to take them (I gave away 300 50mg tabs to my friend, but found 10 that had fallen down the back of a drawer. Needless to say, it didn't do shit, even combined with cocodamol, suppose it did help a little but not much.

I do try and stop my negative thoughts when they appear but it often doesn't work. And I've been writing a journal for over 2 years, documenting my pain and sometimes just ranting when my head is bad, I document all my attacks, my depression etc. It's easier for me to take that to my drs appointments then we can throughly see how my meds are working

Thanks for all the replies

 

[xburtonchic]

Benzos are tricky indeed. They work differently for different people. I too have PTSD, and generalized anxiety disorder, and without my benzos, I would be an absolute mess. I want to add a different perspective on the whole benzo debate.

Like I said, it's different for everyone. It depends on the individual. But I can say for sure that not everyone becomes dependent on them with long-term use. I don't know why this is - maybe it's a mental thing, who knows. I'll use my own experience as an example, because sometimes it's just a matter of finding the right benzo that works for you. When I was 16, I had horrible anxiety to the point where I couldn't even eat, and was prescribed Xanax long-term. I was on it for 6 months, and when I came off, the anxiety had gone away completely... I didn't have withdrawals or anything. I was just myself again. I believe a large part of this is because I didn't KNOW back then that quitting Xanax cold turkey could cause horrible withdrawals, and so I never psyched myself out about it... and it therefore didn't happen. That's why I have my whole "withdrawals are mostly a mental thing" theory.

Now, flash forward to two years ago, when my opiate addiction caused my anxiety to come back. I had been anxiety-free for about 6 or 7 years and thought I was home free, so you can imagine my annoyance at having to deal with this debilitating condition again. Once again, I was prescribed Xanax for long-term use. By then, I had learned to start doing my research before taking things, so I knew Xanax could cause withdrawal if you quit cold-turkey. Guess what happened when I would go a few days without it? Yep - withdrawal. Because I knew it was something that could possibly happen. It was minimal - just twitching and extreme paranoia when I would smoke weed - but it was still there. So I continued taking them everyday and along the way, I just decided to not let them have power over me anymore. That I was in control, not Xanax. This went on for a year until the Xanax stopped working and I was at the max dosage allowed, so I took myself off of them. I had already decided a while back that I wasn't afraid of this drug anymore, that it didn't have power over me, and that I didn't need it to avoid withdrawal, but simply to manage my anxiety. Guess what happened when I got off this time? Nothing. No withdrawals, and that was after an entire year of daily use.

HOWEVER... and this is where things turn around... my anxiety came back worse than before due to some unfortunate traumatic events. I told my doctor that I didn't want Xanax, I wanted a different benzo. He prescribed me Librium. Didn't work for my anxiety. I tried it out for a month, but it wasn't helping, so I asked him to put me on Valium instead. And let me tell you - Valium has been my life saver. Not only is the half-life longer, and therefore my anxiety is managed almost all day - and sometimes even into the day after, but it's also much milder than Xanax and less sedating. I have been on 10mg daily for three months now without any problems or any need to increase the dosage. As a matter of fact, some days I don't even take it at all. I just forget. I don't wake up in the morning and my first thought isn't "I need to take a Valium" the way I am with my Suboxone or the way I was with Xanax. I'm not addicted to it by any means. Am I dependent on it? Yes, but not in the way you would think. I depend on it to manage my anxiety. If it weren't for my anxiety, I know I would be able to flush all the pills down the toilet and never look back without any problems. I know, because I've experimented a few times with not taking them for a few days. The only thing that happened was that my anxiety came back.

I'm not advocating long-term benzo use. I'm fully aware that a lot of people do become dependent on it. I'm just adding a different perspective, that benzos aren't the devil's advocate. I suppose they deserve their reputation, because problems do arise more often than not. I'm one of the exceptions to the rule, and I know that. But long-term benzo use CAN be effective with the right mindset and the right benzo. Just like I didn't react well to Xanax the second time I went on it, I'm reacting just fine to the Valium. It's the same way that some people react badly to certain anti-depressants and others don't. Most people have great experiences with Lexapro and Celexa for example, but I don't react well to it. Reactions to any type of addictive drug is completely dependent on the individual, their mindset, their specific issues, and the drug itself. It's not a black and white type of thing.

As much of an advocate I am of Valium, I will say one thing: I don't advise benzos as a permanent solution. They simply mask your anxiety, not the problem that's causing it. Any medication that's designed for any type of mental disorder is only effective if you are proactive in identifying the cause and then fixing it. Valium is okay for me personally for long term use, but it is not a permanent solution. I won't get off of them until I am confident that I can manage my anxiety on my own. Same story with the Lexapro - as much as I hate it, I won't get off of that either until my PTSD has been more or less eradicated through therapy... or is at the very least manageable. I would suggest the same thing to anyone taking benzos. Whether you choose to see a therapist or use alternative remedies, I feel it's imperative to do this to accompany whatever drug you're taking. Like I said, it's effective - but it's not a permanent solution.

 

[S.M.F.G]

Cant say much more than whats been said..... TREAD CAREFULLY!!

I thought i had it under control @ .5mg its 2 years on and i need 6mg a day and they starting to not cut it as they used to. Tollerence is a bitch i can fight it for so long but i end up havin to have those pills now. Maybe for short term A couple of weeks, In my case ive exausted all the anti depressantss and antipsycs they fuck with me so bad... all im takin ragularly is the benzo atm and it helps, but on another aspect of things it doesnt help. But id be fucked without em. Thats what doc is sayin and he was a grad with honours and the best reputation there is in town. same with my therapist. I cant condone The use even though theyve saved my ass its come @ the cost of dependancy