Long term benzos!

[quale]

So I finally got a script fox Xanax from my doctor (not psychiatrist) for social anxiety. This really is a legit medical use. My excesive anxiety in some social situations (even just arranging a dental appointment) seriously fucks with my life and benzos seem to be the only way I can get relief and live life the way I want to.
My doctor however has prescribed me a very small amount (like 3 .25mgs a week). This simply isn't enough, I feel I need at LEAST one dose a day to really deal with this issue. My doctor is of the opinion (quite reasonable) that if I need more I should probably see mental health people.
I (although I did not inform my physciscian for fear he would not prescribe me) have been seeing mental health people. Psychologists are utterly unhelpfull with suggestions like try breathing deeply or similar garbage I thought up years ago. As this is a chronic issue when I do actually get refered to a psychiatrist they seem unwilling to prescribe benzos. SSRIs are utter useless crap (to me at least, and yes I have given them time to work) and I hardly have any great hope for buspar.
My first question is can I actually get a psychiatrist to prescribe me daily benzos for an indefinite period of time (i.e. not just for a month or two but until I stop needing them)? I would prefer not to lie but the fact that my anxiety has not rendered me dysfunctional (largely through extreme unpleasent effort on my part) convinces them I don't really need them. Will some psychiatrists prescribe for this or am I really going to have to lie? Secondly, do I need a recomendation from a psychologist, i.e. if I am not seeing a psychologist who recomends this sort of thing is this a deal-breaker? Thirdly, is there anyway to tell short of going to see the psychiatrist whether he is likely to prescribe anything but SSRIs/buspar?
Finally, the real drug questions of this post, is long term benzo use effective in controlling anxiety? Will I need to escalate my dose excesively to continue to get the same anxiety relieving effect or is this only an issue when they are used recreationally? Finally what about memory loss? I know that individuals taking large amounts of benzos often have serious memory problems. I know the amounts of benzos I am talking about doesn't create noticable problems when I have taken them at single instances. Will chronically taking them create more subtle memory problems...and how bad would they be?

 

[zorn]

From Gitlin, The Psychotherapists's Guide to Psychopharmacology, 2nd ed:
"By far, the benzodiazepines are the most commonly prescribed and most effective antianxiety medications currently available. As with their use in panic disorder, their advanteges in treating generalized anxiety are impressive: they are effective when taken on an as-needed basis or when taken regularly; when taken chronically, they generally do not lose their effectiveness; they have no long-term adverse effects on any organ; and, when taken in overdose by themselves, they are extremely safe.
[Patients who need intermittent (eg in social situations) would do better with a short-acting benzo like Ativan or Xanax]....
The other disadvantages of the benzodiazepines are their capacity to cause sedation and decrease cognitive capacity... Cognitive deficits are manifested primarily by a diminshed ability to learn and recall new information. These effects are probably maximal in the initial stages of treatment."
......
"The extent of the cognitive and psychomotor effects with these medications is somewhat controversial. Unquestionably, benzodiazepines can limit the ability to learn and recall new information (anterograde amnesia), especially arounf the time of peak sedation, which is typically one to two hours after ingestion.
With patients who use benzodiazepines on a long-term basis, the effect on memory is variable. Some studies have shown that patients who use low to moderate doses of benzodiazepines chronically (for many months or years) gnereally show no cognitive deficits except if tested during the one hour of peak sedation, implying that tolerance to the sedation may be linked to tolerance to cognitive side effects (Lucki and Rickels, 1986). Other evidence, however, suggests continued amnestic effects even after many years in acquiring new knowledge and in some areas of recall (Scharf, Fletcher, and Graham, 1988; Rothschild, 1992)... Most importantly, however, the amnestic effects are completely reversible, disappearing after the medication is eliminated from the brain."
So if you're only taking them during social situations, it's probably not a problem; and you won't need to keep upping your dose. Do you really need them that badly? You had anxiety just arranging a dental appointment!? Maybe it's all that weed you're smoking, man.
I'd recommend dealing with the shit and keep trying psychologists/psychiatrists until you get a good one that will script them. You'll have more control over your dose, medication, etc then, and could actually discuss related problems; and don't have to keep up the deceptive facade. I would just exaggerate the degree to which your anxiety causes problems: don't say that you socialize plenty anyways, talk about how it keeps you from meeting people, going out, etc. Make sure they think those magic words, "marked impairment in social or occupational functioning."
Incidentally, I just got a months's supply of 3mg/day lorazepam. Wanna trade?
-Zorn

 

[TrippinTreeToker]

ya man theres no way your gonna get that script. sorry buts its the damn truth.

 

[PhreeX]

I assume you're a young person - late teens perhaps? You'e getting Xanax - albeit a low dose, but thats more then most young adults... as Zorn said, do you REALLY need it that bad? If so, then you need to find a long-term solution, which will include other drugs ... most psychitrists don't want to start you on benzos at a young age, because dependance (not addiction) is a major factor.. he gave you 3 a week - I would think this should suffice...
Is long term benzo use effective? Yeah, of course, you have anxiety, you pop some pills and the problem is solved.... however, and I say this again, dependance can become an issue - zorn gave a good answer, it's true, long-term users can function fine under the influance of the drugs - HOWEVER - it becomes a tool of escape, and your bodies natural coping (sp?) mechanisims will break down... you get to the point where the littlest thing goes wrong and you gotta pop another Xanax... factor in tollerance, and it gets scary ..
BUT, and lets get hypothetical here... say you want to secure something a little more long-term, a little more steady.... you need to take the Wellbutrin route... "but PhreeX, Welbutrin isn't worth it's weight in sand?" you say .... well, Wellbutrin is great for depression, however, it causes a lot of anxiety and nervousness - so you feel great but you have this anxiety... it's WELL DOCUMENTED that a long-acting benzo is a suggested companion if anxiety persists... so, you go in and take your Wellbutrin script (you can just ask for it by name - say a friend is on it and it has helped him) ... a few weeks later call and say you have never felt better in your life, say shit like "it's as thought someone opened the blinds and let the sunlight into my life" ... BUT, there is that pesky anxiety and nervousness you get, say it will set in about an hour after you take your Wellbutrin, and lasts for a good number of hours - tell your doctor that "Wellbutrin has given my a positive outlook on life, but with this anxiety it causes I dont think its worth it" .. in MOST cases you will be started on a small dose of a long action benzo - ie .5mg Klonopin ... overtime you can up this (I mean, like many months, not your next visit) .. of course some doctors will try to lessen the dose of Wellbutrin, to wich you can say it's not longer having the same positive effect ...
This method will also work with SSRI's, but it seems that Wellbutrin works best as the anxiety is SO common .. I currently take 1mg Klonopin, 3 times a day ...
Now working from Klonopin to a short acting benzos is a totally differn't story... first get on something then I will further explain...
But honestly, your doc isn't going to give you major amount of Xanax alone, you will need to get on an SSRI or Wellbutrin so the anxiety is justified-without a doubt!

Originally posted by TrippinTreeToker:
ya man theres no way your gonna get that script. sorry buts its the damn truth.
Can't you post anything usefull? Don't just say "sorry, you're fucked"... give a reason!

 

[quale]

Thanks for the long answer. I am in my early 20's so maybe the docs will be more likely to prescribe.
As for the question of do I really need it. I find myself avoiding things like ordering pizza because I might not know what I am doing correctly. I have trouble purchasing a CD at the store convinced that whoever is ringing me up is judging my purchase. While I can and do make myself do these things I don't think the level of constant worry about my social status is normal.
In many areas though i function fine...but in and of itself this is a significant negative in my life...and my personality is so differnt and so much less enjoyable in these certain sorts of situans I therefore have further hegative consequences.
Moreover, anxiety problems run in my family and the need for psychiatric drugs is dependent not only on the severity of your problem but also the situation you are in. Nearly EVERYONE has too much anxiety in many social situations...but based on their circumstances this may or may not need to be treated. Just like someone dispossed to unhappiness who is leading a great life may not need anti-depressants.
Of course people will respond that what I probably need is a higher dose of self confidence...or at least self confidence in these situations. Yes of course, and stimulants are far far better at addressing these issues...in fact experience suggests that codeine is far better as well. Codeine of course I will not get prescribed and stimulants are in fact too addictive. Of course their is always the risk of dependence etc... however I don't really like the effect of benzos that much. Moreover, as I want it to treat a thousand little things a day I would prefer a long acting benzo taken at a regular daily dose thus reducing the risk of popping a pill in response to a problem (therefore why three a week is not enough). I also think this risk is a minor harm compared to say going to a rave once a month and rolling as I imagine many others in similar situations do.
On the face of it this seems a textbook case for prescribing SSRIs. Unfortunatly 9 weeks of prozac showed no signs of helping. I understand effects should start to show after 8 weeks. Unfortunatly paxil and celexa rendered me essentially non-functional (needing to sleep 18 hours per day). If some nice doc wanted to prescribe me a psychostim (or even that new shit which obliterates the need for sleep) I would give it a try but a solution which doesn't let me function is no solution at all.
If people have suggestions (and not work at it/psychotherapy I have essentially exhausted these) I am perfectly willing to hear them. Sure buspar seems appropriate but everything I hear seems to suggest it is utter crap, i.e., doesn't really work...but I will ask on another thread about it.
Yes I am soliciting the advice of strangers on the internet for this issue...but my experience is that psychiatrists don't know crap.
[ 07 January 2002: Message edited by: quale ]

 

[Effigy]

I've never had any problems getting a psychiatrist to perscribe me bemzos for long term care. Currently I am seeing two and getting a monthly script from both.
Here's what you should do, imo: Go see a psychiatrist. Explain to him/her how bad your problem actually is. You sound pretty convincing in waht you wrote in this thread. I would say you are a candidate for benzos if anyone ever was. List the meds you have already tried that ended up being no help at all. It's good that you already failed with a bunch of meds. It's now time to move on to something else. Next explain how your doctor put you on xanax and tell'em it worked. You finally got your life back and shit. You are seeig the psychiatrist cause your doctor feels more comfortable having you in someone in mental health care if benzos are the route you're gonna take.
I wouldnt say that .25mg helped you out much. Say 0.5mg a couple times per day seems to work great. after a few of months at this dosage you can start saying that it's not as effective as it was and the psychiatrait will start increasing your dose. Dont get too greedy with this though cause they might start to have concerns anbout addiction. I usually quit asking for an increase when I get up to 1mg 3 times per day.
And dont hide the fact that you are seeing a psychologist. That makes you seem all the more convincing. It shows you have a real problem that you are really trying to find an answer to. Alos that's just one more form of treatment that failed you.
[ 07 January 2002: Message edited by: Effigy ]

 

[PhreeX]

Originally posted by Effigy:
I wouldnt say that .25mg helped you out much. Say 0.5mg a couple times per day seems to work great. after a few of months at this dosage you can start saying that it's not as effective as it was and the psychiatrait will start increasing your dose. Dont get too greedy with this though cause they might start to have concerns anbout addiction. I usually quit asking for an increase when I get up to 1mg 3 times per day.
Yeah, that works in theory but for most of the population you're shit outta luck! If you say "I'm poping .5mg three times a day" then 95% of medical professionals are going to try to get you off the med before addiction becomes a problem, or they will figure you're already addicited ... sorry man, you have the system working against you - but you also have a legit need, so, play their game and take whatever they give you, but always come back saying that none of it works like the Xanax .. good luck, but 1mg tid is asking a lot...
Be sure to tell your doc the stories about ordering pizza and that type stuff, it really makes a difference.. then again, if you're buying rap/jungle the people at the music store ARE judging you! You're a bad, bad person!

 

[Effigy]

No, no. I said .5mg twice a day. I dont see anything wrong with that. Xanax is short acting so you are gonna have to dose at least twice a day. .5mg isnt a very high dose.
And yeah 1mg tid is asking alot. Definately dont ask for it anytime soon. It should take you no less than a year to build up to that.
[ 08 January 2002: Message edited by: Effigy ]

 

[quale]

Of course they are judging you. I worked as a clerk at one point...you don't have much else to do except form opinions about the people who come in to buy things. We are judged a hundred times a day on all sorts of small issues, some good some bad. The trick is not thinking/worrying/caring about it.
Anyway thanks for all the advice ppl (jesus these thanks things make me fell like a dirty raver)

 

[eacoasticas]

A Completely diffrent method of gaining self-confidence.
The key is not to lower your level of conciousness but to learn how to gain control over it. Get that ego-boost when you need it the most but remember to keep it in check or you'll probably be an awful person.
Get Tribulus Terrestis Complex w/ Yohimbine, take 3 times / daily.
Get Ginseng (preferably Koregin brand), take 2 times / day.
Get DHEA 50 or 100mg's, take 2 times / day.
Get Pregnenolone 30mg's, take 2 times / day.
Get 5-HTP 100mg's, take 100mg's morning and 300mg's before bedtime.
Get PREDATOR brand St. Johns Wort extract, take 3 times / day.
Get DLPA 100mg's (DL-Phenylalanine), take 500mg's 3 hours after 5-HTP in morning and 200mg's 3 hours before 5-HTP at night.
Get SAM-E 300mg's (double strength), take 2 times daily.
In Case of SEVERE anxiety (hardcore trembling, shaking, sweating) take propanolol, dose as needed.
You'll be fixed in less then a month. It's up to you now. Take my word for it.