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Dr. Bob is Robert Hsiung, MD,
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Posted by Billski99 on October 26, 2003, at 16:56:39
During my first meeting with my new shrink last week, he outright prescribed Provigil, Lexapro, and Wellbutrin, but then offered me a choice between 10 mg diazepam 3x-day and an unspecified dose of Xanax.
Years ago I abused Xanax terribly, stopped abruptly, and experienced a full-blown psychosis for five days which made any of my many acid trips child's play by comparison.The diazepam is making me groggy but not alleviating my panic attacks. I read that there is a new time-release form of Xanax - has anybody here used it yet? And I don't know anything about Klonopin, although I've heard good things about it from other anxious/panicky folk.
Will anyone please venture recommending one of these benzos over another, and hopefully explain why? I'm not after a buzz, but I am after a subjectively distinct impact (as opposed to "I think I might possibly feel somewhat less nervous" - which is all I got from the daily 3,600 mg of Neurontin I've been taking!)
My new shrink *seems* pretty open to reasonable suggestions, so I don't think that'll be a problem. Frankly, I'm curious about Klonopin, but what's a perceptibly effective dose? (I notice they now range from .125 mg to 2 mg - that's quite a span, no?) If he's willing to write for 10 mg of Valium, what dose of Klonopin could I reasonably suggest?
Sorry I've blathered so long. Any and all help, advice, suggestions, and/or warnings will be much appreciated. Thanks.
Bill
Posted by Ame Sans Vie on October 28, 2003, at 7:27:56
In reply to Klonopin vs Valium vs Xanax?, posted by Billski99 on October 26, 2003, at 16:56:39
Okay, Bill, here's the skinny. :-)
First of all, equivalent single doses of the three benzodiazepines in question are largely held to be as follows:
10mg Valium = 1mg Xanax = 0.5mg Klonopin
This would make Klonopin among the strongest of all available benzodiazepines, along with Halcion and Rohypnol which are equipotent (but Rohypnol is illegal in the U.S. and Halcion is used for sleep).
I too used to VERY heavily abuse Xanax -- think 60mg/day for months. Almost all bought off the street at $30/day. People ask me often how I was able to function at all at that dose, but I've always had a naturally high tolerance to these drugs, as is demonstrated by my current daily dosage of 12mg Klonopin (equivalent to 240mg Valium!). I never experienced a psychosis withdrawing from Xanax, but it was most certainly the most hellish two or three days in my life -- numbness and tingling all over, foggy head, suicidal ideation, incoordination, tremors, extreme weakness...
Now I've obviously learned to control my use of benzos and they've been a lifesaver. The choice between Valium, Xanax, Klonopin, or other benzos is a very individual one, though. For many, Xanax has a more antidepressant effect, possibly due to it's release of serotonin in the brain -- but then I'm sure I don't need to tell you about Xanax. ;-) Klonopin may also have this serotonergic effect. Valium apparently does not, but has some properties of its own (most notably, profound muscle relaxation).
Many find that Valium, taken long-term, causes a horrible depression. But many others find the same true with Klonopin. Few find that to be the case with Xanax.
How long does a single dose of Valium last for you? The usual duration is three or four hours, slightly shorter than Xanax (immediate-release version). There is an extended-release form of Valium available, called ValRelease, if you decide to stick with Valium and are bothered by the constant dosing.
You definitely don't have to be a rocket scientist to notice that so many of us on this board prefer Klonopin. :-) Its side effects are extremely benign, it usually doesn't cause depression, and it can be taken two or three times a day for full 24-hour coverage (some lucky dogs can get away with once daily dosing). I use the relatively new Klonopin Wafers myself, which are just a form of the drug that dissolves in the mouth and takes effect more quickly.
Xanax, Xanax, Xanax... wonderful drug. I still take it occasionally at a dose of 4mg as-needed, but I rarely need it more than twice a week. I have tried Xanax XR, which you mentioned, and it is wonderful -- full 24-hour coverage in a single dose. However, Medicaid won't pay for it and I couldn't afford the cost each month so I'm "settling" for Klonopin. :-)
As far as what doses would be reasonable to ask for from your pdoc, 1mg three to four times daily would be a good bet for Xanax (3-4mg once daily with Xanax XR), and 1mg twice daily should work great for Klonopin (though this is 0.5mg higher than its equivalent dose to Valium). Doctors often like to stear clear of Xanax, or prescribe very tiny doses (e.g. 0.25mg) which are likely to be of little help at all. Klonopin is viewed by most doctors as less abuseable though, and so it is much more frequently prescribed than either Xanax or Valium, and at higher doses. How else would I be getting the equivalent of 240mg/day of Valium if doctors were afraid to prescribe it? lol It isn't just my current doctor who's liberal with the dosage either -- all my past doctors have been willing to prescribe high dosages (the maximum daily dose recommended by the FDA is 20mg, though doses this high are generally reserved for seizure treatment -- nonetheless, this helps doctors to view it as a safer medication to prescribe in high doses).
I hope this helps -- anything I've left out, ask away!
Michael
Posted by Viridis on October 29, 2003, at 3:36:28
In reply to Klonopin vs Valium vs Xanax?, posted by Billski99 on October 26, 2003, at 16:56:39
I don't like Valium -- it makes me feel sleepy and drunk (only the unpleasant aspects). Xanax is great, but tolerance can develop rapidly, and a lot of doctors are afraid of it -- it can be risky even to ask for it. I use it occasionally, probably the best approach if you're going to take it. Klonopin is very effective for anxiety, with minimal side effects or tolerance issues for most people. It's also much easier to get prescribed, so seems the obvious choice for a first benzo. Typical doses are 1-2 mg/day, and it may take a couple of weeks to get used to it. It really does work well, and I have zero side effects (after a brief adjustment period), nor have I had to increase the dose after 2 1/2 years.
Posted by Ame Sans Vie on October 29, 2003, at 6:09:00
In reply to Re: Klonopin vs Valium vs Xanax? » Billski99, posted by Viridis on October 29, 2003, at 3:36:28
I concur with everything Viridis said, including having taken Klonopin for 2.5 years now as well without tolerance, lol. Funny. However, I only *wish* I could take 1 or 2mg and feel fine, lol!
Michael
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