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I have panic/anxiety disorder. After many years on Xanax Xr

I have panic/anxiety disorder....
I have panic/anxiety disorder. After many years on Xanax Xr (1 mg. twice daily) my new psychiatrist convinced me to taper completely off the xanax xr, using klonopin 3 times daily (.5 .5. 1mg) while tapering down. After almost 2 months of trying, I had to give up, so he told me I had to find another psych doc. Another words, he fired me!! I did find another doctor and he put me on Ativan 2mg. daily, (.5, .5, 1mg). After 2 weeks of ativan not working, he wanted me to try xanax again. I thought he meant XR which I did use from meds I had left over. He meant regular xanax. Anyway, the XR made me feel terrible. Ater 2 weeks of this, I asked him to please give me something else. He put me back on Ativan, same dose as before. I gave it 3 weeks and it didn't work any better than the first time I tried it. So three days ago when I saw him he put me on Klonopin (.5 a.m. .5 at 2 p.m. 1mg. at bedtime). Because Klonopin is much stronger I thought I would feel less anxious and sleep better the first night. To my surprise, it didn't happen. Here I am in day 2 of taking Klonopin full time daily. My questions are, what is going on and how long does will it take for my body (brain) to adjust to the stopping of Ativan and the starting of taking Klonopin? How long will it take for Klonopin to stabalize?
Sorry so long a question....
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Answered in 2 hours by:
5/27/2017
Dr. David
Dr. David, Doctor (MD)
Category: Mental Health
Satisfied Customers: 47,527
Experience: Experienced and Compassionate Physician Trained in NYC Ready to Help.
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I am sorry you have these symptoms

you need additional medications along with benzos to help decrease your anxiety symptoms.

have you tried sertraline, paroxetine, fluoxetine to help decrease your anxiety symptoms? these medications when used with ativan or klonopin or xanax can help decrease your anxiety further.

klonopin is not a stronger medication, it is a longer acting benzo

you should talk to your doctor about hydroxyzine and buspar as well which can help

and you should also take propranolol which can help decrease racing heart symptoms and help decrease anxiety symptoms.

it sounds like you will continue to have anxiety symptoms if you just take a benzo and that is it.

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Customer reply replied 6 months ago
Hi doctor....sorry, but your reply didn't answer my question. I am already taking 150mg Effexor XR. The Xanax XR worked well for me until I allowed a new pdoc who I didn't know was benzophobic talk me into tapering off the Xanax.
Customer reply replied 6 months ago
Thank you but I would prefer talking to a mental health professional.

that is good you are on effexor.

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Dr. Kaushik
Dr. Kaushik, Psychiatrist
Category: Mental Health
Satisfied Customers: 4,696
Experience: MD Psychiatry
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Greetings​.
Welcome to the site.
I am a Psychiatrist and I believe that I can help you with your query.
Well since you have been taking benzodiazepine medications since quite a while therefore your body has started to develop tolerance or resistance against their effects and this explains why Ativan and earlier xanax stopped working for your anxiety after only few days if use. While klonopin is a potent anxiolytic agent against anxiety but still it belongs to the same category of Benzodiazepine as the previously used xanax and ativan , so while it may start its action in alleviating anxiety in the next few days ( roughly 5-7 days ) but it also stands at a risk of becoming ineffective after a while thereby warranting increment in its dose.
So my humble opinion is that while you wait for Klonopin to swing into action against anxiety , you also ask your doctor to up the dose of effexor xr to 225 mg which is the optimal dose of effexor meaning that it can provide maximum benefits at this dose. The 225 mg dose of effexor shall be taken in 2 divided doses of 150 mg in the morning and 75 mg in the evening ( 4-5 pm).
Also adding a natural supplement like L- methylfolate at dose of 7.5-15 mg / day, your anxiety can become effectively controlled.
So I suggest you to increase the dose of effexor xr to 225 mg in 2 divided doses , introduce l-methylfolate at 7.5 mg dose and wait for next 5-7 days for Klonopin to swing into action.
I hope this helps.
Wish you all the best.
Please kindly leave a POSITIVE RATING if you are satisfied with the answer.
Regards
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Customer reply replied 6 months ago
Thank you, ***** ***** your reply. I agree with your opinion that I need to add something more to the Effexor dose I am currently taking. I will talk to my doctor tomorrow and I believe he will also agree. When I saw him last week he informed me that he had to stop practicing by the end of July. I knew he had Parkinson's disease for the past several years but it was under control. He had assured me and his staff that he would be able to practice into the foreseeable future. Suddenly that all changed the day before my appointment. I said all that to say that at my appointment he thought I needed to add something else to my effexor but was hesitant to do so since he wouldn't be around to oversee the results. He felt I should wait until I see a new Psychiatrist. I agreed with him. However, upping the effexor seems to be a very good idea since I'm already on the med and wouldn't be introducing an entirely new med. I'm a little hesitant about the supplement L-methylfolate only because I don't seem to have good results with supplements. I'm very sensitive to all types of "meds". I'll await your thinking about this. Another thing, I'm not too keen on starting two meds (even a supplement) at the same time. If I were to have a reaction I wouldn't know which one was the culprit.
Do not​ worry about the supplement , it is basically a modified version of folate ( B 9 ) vitamin, so expect no side effects. SWell, you see I have personal clinical experience in my own patients about usage of l methyl folate as a supplement given in both Depression and anxiety and it is what is quite effectively used as an adjuvant agent alongside main treatment. You see l methyl folate is nothing but a slightly modified version of folate that is vitamin b 9, so you may expect no side effects whatsoever with its usage. In addition to this, since you have already been tolerating effexor xr at a fairly moderate to high dose of 150 mg , so using 225 mg in two divided doses should not pose any threat. The concomitant use of both of these will only bring in positive results but still it you are overly concerned then you may introduce l methyl folate after 1 week of raising the dose of effexor xr to 225 mg.
I hope this helps.
Wish you all the best.
May I please request you to kindly leave a POSITIVE RATING if you are satisfied with the answer.
Regards
Dr. Kaushik
Dr. Kaushik, Psychiatrist
Category: Mental Health
Satisfied Customers: 4,696
Experience: MD Psychiatry
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Customer reply replied 6 months ago
Thanks again, Doctor. One final question...do you have a certain brand name for L methyl folate that you can recommend? I'm always leery of just picking one off the shelf without knowing anything about it. I'm sure you know what I mean.You have been extremely helpful. I really appreciate your commonsense replies.Warmly,
Rita
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Dr. Kaushik
Dr. Kaushik
Dr. Kaushik, Psychiatrist
Category: Mental Health
Satisfied Customers: 4,696
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Experience: MD Psychiatry

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