SSRI vs Benzo for anxiety

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emmamia
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Date Joined Jan 2009
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   Posted 4/29/2010 6:23 AM (GMT -7)   
Hi

I just wanted some advice on SSRI vs Benzo for anxiety. I have had anxiety for the past 2 years, I noticed it came on after I had a fainting spell. I have been monitoring it and notice it comes on 2 weeks before my cycle begins. My doctor prescribed me clonazapam and cipralex - with the plan for me to get on cipralex and use the clonazapam until the other kicks in. I tried the cipralex one night and could not sleep and felt weird so I decided not to use it and have been using clonazapam off and on. I have researched benzos and am worried about the addicting effects etc. Since I do suffer from anxiety 2 weeks a month do you think it is better to just get on a daily drug and has anyone had success with cipralex. I obviously didn't give it a chance to work as I only took it one day!
thanks for your advice
Sarah

Howlyncat
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   Posted 4/29/2010 6:53 AM (GMT -7)   
HI
i tk this med as well as benzos for my anxiety n panic
it took some time for cipralex to kick in but it does help
as for the addicting side to benzos..stay on you rx dosage you should be fine n try the cipralex again i really think it could help
im not a zombie or hv issues from taking my benzos
they really do help to get me thru some pretty rough days....
just my opinion hope it helps a bit
lyn
..Co Moderator for Crohns...Anxiety/Panic......Alzheimers

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emmamia
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   Posted 4/29/2010 7:10 AM (GMT -7)   
thanks for your advice - do you find the cipralex makes you feel more "normal" most days and that you need the clonazapam much less or at all. I was always nervous of the cipralex because they classify it as an anti-depressant and I am not depressed.

SnowyLynne
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   Posted 4/29/2010 9:12 AM (GMT -7)   
Benzos can cause more anxiety than they are worth.
SnowyLynne


emmamia
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Date Joined Jan 2009
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   Posted 4/29/2010 9:37 AM (GMT -7)   
Thank you for you advice....I was trying to get over my anxiety naturally via naturopathic dr. with L-Theanine and accupuncture which did help a bit but not enough....I think I will start my ciprolex on saturday morning - i think the am might help me sleep a bit better at night time....the last time I did it at night and I could not sleep no matter what I did. I just want to feel balanced and normal again :)

Howlyncat
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   Posted 4/29/2010 10:49 AM (GMT -7)   
Well i agree with snowylynne on what she said i do also think if taken as directed as directed they help me

yes i am much better on the cipralex
like i said it takes time to work
give it a shot...
again jmho
..Co Moderator for Crohns...Anxiety/Panic......Alzheimers

DX..Crohns,,,A/P...Fibro...Seizures..Neuropathy...Pyoderma Gangrenosum..Deaf

I Refuse To Give Up....Others Are Worse Off Than I Am

Donate to WWW.HealingWell.com
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NEVER GIVEN UP NOR IN

Post Edited (Howlyncat) : 4/30/2010 4:31:20 PM (GMT-6)


melodee
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   Posted 4/29/2010 11:34 AM (GMT -7)   
Some say benzos are not for long term but I've been on Lorazepam for over 10 yrs and this is actually the only med that works for me. I know for some people, they can become dependant on it...but not everyone. I take it as needed.

The thing always happens that you really believe in, and the belief in a thing makes it happen.
~ Frank Lloyd Wright ~


Howlyncat
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Date Joined Jan 2005
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   Posted 4/29/2010 3:01 PM (GMT -7)   
Well not wanting to start a debate Melodee
but if you hv been taking ativan for 10 yrs n only as needed you will still hv wd if you come off
its a fact hun
i take them n diazepam hv for way over 20 plus plus yrs...
it is addictive but it can be also very helpul for a/p
and as i said you would need to be under a docs care or supervision if you were to stop cold turkey..
but hey thats just mho
lyn
..Co Moderator for Crohns...Anxiety/Panic......Alzheimers

DX..Crohns,,,A/P...Fibro...Seizures..Neuropathy...Pyoderma Gangrenosum..Deaf

I Refuse To Give Up....Others Are Worse Off Than I Am

Donate to WWW.HealingWell.com
MEDS..Lyrica..Dilatin...Pentasa...Folic acid....Ativan..,Diazapam prn..Trazadone at HS..T 4s PRN

NEVER GIVEN UP NOR IN


emmamia
Regular Member


Date Joined Jan 2009
Total Posts : 31
   Posted 4/29/2010 4:26 PM (GMT -7)   
Thank you everyone for your comments...one more thing I wanted to ask is since I really like the effect the benzo (clonazapam) does for me will I eventually get the same sense of calm off of the cipralex when it starts working. I can definitely see how benzo's could become addictive that is why I have always been very cautious with them!

thanks :)
Sarah

melodee
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Date Joined Oct 2008
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   Posted 4/29/2010 11:05 PM (GMT -7)   
Howlyncat said...
Well not wanting to start a debate Melodee
but if you hv been taking ativan for 10 yrs n only as needed you will still hv wd if you come off
its a fact hun
i take them n diazepam hv for way over 20 plus plus yrs...
it is addictive but it can be also very helpul for a/p
and as i said you would need to be under a docs care or supervision if you were to stop cold turkey..
but hey thats just mho
lyn

 
I am aware of the withdrawal symptoms. It's natural for it to happen when you taper off any type of medication. I was on a higher dosage in the midst of severe panic and anxiety. When I tapered off I did experience withdrawal symptoms. It took me a while to adjust.
 
I was trying to explain that I needed the benzo to survive and that I am still on it for my anxiety and it is the only med that works for me so I continue to take it. You mentioned in your previous post that it's not for long term, but some people need to be on it their whole life and can still manage to live a normal life taking it for a long period of time. I think the majority of people on this forum are still on benzos and will continue to take it when necessary. So I was wondering why you had mentioned it should not be taken long term. If I misunderstood your post, I am sorry.
 
 


The thing always happens that you really believe in, and the belief in a thing makes it happen.
~ Frank Lloyd Wright ~


Howlyncat
Elite Member


Date Joined Jan 2005
Total Posts : 24909
   Posted 4/30/2010 2:40 AM (GMT -7)   
yes or i mis posted lol
i hv been on benzos for yrs plus n i will always be on them
i do use them to keep a/p at bay
am on ativan as well as diazepam..sorry hun for confusion
huggs
lyn
..Co Moderator for Crohns...Anxiety/Panic......Alzheimers

DX..Crohns,,,A/P...Fibro...Seizures..Neuropathy...Pyoderma Gangrenosum..Deaf

I Refuse To Give Up....Others Are Worse Off Than I Am

Donate to WWW.HealingWell.com
MEDS..Lyrica..Dilatin...Pentasa...Folic acid....Ativan..,Diazapam prn..Trazadone at HS..T 4s PRN

NEVER GIVEN UP NOR IN


debaser
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Date Joined Nov 2006
Total Posts : 1745
   Posted 4/30/2010 8:24 AM (GMT -7)   
Well, actually FDA recommends that benzos aren't used long-term for controlling anxiety disorder. But people do it anyway because that's often the only thing that works for them. I believe the concern with taking benzos long term is that they can have a negative impact on your liver. Have a thorough blood panel done with your yearly physical. The doctor will be able to notice a problem before it really begins, hopefully. This would be an even bigger concern if one has a family history of liver problems or diseases that can cause liver problems.

melodee
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Date Joined Oct 2008
Total Posts : 800
   Posted 4/30/2010 9:48 AM (GMT -7)   
Lorazepam is not metabolized through the liver. There is another benzo that doesn't effect the liver...but I don't remember the name.

The thing always happens that you really believe in, and the belief in a thing makes it happen.
~ Frank Lloyd Wright ~


stkitt
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Date Joined Apr 2007
Total Posts : 32602
   Posted 4/30/2010 10:41 AM (GMT -7)   
Good Morning Everyone,


Remember I am not a Doctor so please do discuss any concerns you have with your Doctor.



To the best of my knowledge, Lorazepam is one of the drugs classified as a benzodiazepine. These medications are completely metabolized in the liver and then conjugated to glucuronide before being excreted by the kidney. In normal individuals the duration of a benzodiazepine effect is determined by the half-life of the active compounds and the half-life of the biologically-active breakdown products produced by liver metabolism. In individuals with known liver disease, Lorazepam activity will be prolonged.

Currently, there are no benzodiazepines metabolized by kidney alone. Liver damage with benzodiazepine use is a rare occurrence. Remember, however, that liver damage in patients taking Lorazepam or Librium can produce behavioral changes.



However that being said, I do use Valium myself however at one time was on a large dose of Ativan which I weaned down using Valium weaning schedule. It took me over 1 year to wean without side effects.



I have always made sure my Dr. was supporting my decisions and yet remembering I do have patient's rights.



Take care everyone.



Kitt

Howlyncat
Elite Member


Date Joined Jan 2005
Total Posts : 24909
   Posted 4/30/2010 3:34 PM (GMT -7)   
TY Kitt for the info ..appreciated
lyn

stkitt
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Date Joined Apr 2007
Total Posts : 32602
   Posted 4/30/2010 4:08 PM (GMT -7)   
Your welcome and glad to be of any help.
 
Hugs,
Kitt

melodee
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Date Joined Oct 2008
Total Posts : 800
   Posted 5/2/2010 6:09 AM (GMT -7)   
I've been on Lorazepam for over 10 yrs and have been told many times that Lorazepam does not have much effect on the liver compared to other benzosiazepines. And you can actual read about this online on many sites. Here are some sources.  Therefore to say "These medications are completely metabolized in the liver" may cause some confusion...as benzodiazepins are metabolized differently.
 
http://psyweb.com/Drughtm/jsp/ativan.jsp
Ativan (Lorazepam) is an anti-anxiety agent (benzodiazepines,mild tranquilizer) used for the relief of anxiety, agitation and irritability, to relieve insomnia, to calm people with mania / schizophrenia and intravenously as a sedative and for nervous tension or to relieve anxiety prior to surgery. It has less of an effect on the liver than other benzodiazepines, making it better suited if you are taking birth control pills, anti-abuse drugs, propranolol, ulcer medications, or any other drug that affects the liver. Ativan (Lorazepam) may also be used to help in the prevention of severe alcohol withdraw symptoms (Delirium Tremens, or DTs), to treat amnesia, or in patients who are undergoing chemotherapy and have severe vomiting. It may be given to children to treat serial seizures by placing it under the tongue.
 
Lorazepam and oxazepam undergo only hepatic glucuronidation. Benzodiazepine oxidation is decreased in persons with liver disease and the elderly. Accumulation with resultant excessive sedation and respiratory depression may be significant when administering chlordiazepoxide or diazepam to patients with impaired oxidative metabolism. Lorazepam and oxazepam metabolism is minimally affected by age and liver disease. Chlordiazepoxide and diazepam are erratically absorbed by the intramuscular route. Lorazepam is predictably absorbed by the intramuscular route. Oxazepam is not available in parenteral form. Lorazepam appears to be the safest empiric choice among the various benzodiazepines for treating AWS in the elderly and in patients with liver disease, or those who require therapy by the intramuscular route.
 
 
There are two phases of liver metabolism.
Phase 1 occurs in smooth endoplasmic reticulum: reduction, oxidation, and hydrolysis.  All the cytochrome P450 happens in Phase 1.
Phase 2 occurs in periportal region of portal triad:  glucoronidation, acetylation, sulfation.
The trick of this is to understand that liver damage (cirrhosis, etc) affects Phase 1, not Phase 2.
This is why Ativan (lorazepam), Serax (oxazepam) and Restoril (temazepam)-- all metabolized primarily by Phase 2-- are favored in drinkers or cirrhotics.  Also, renally metabolized or cleared drugs will not be as much affected (for example, Neurontin.)
Luckily, lorazepam does not require oxidation (hepatic, the liver) to metabolize, so this makes it useful for alcoholics.

The thing always happens that you really believe in, and the belief in a thing makes it happen.
~ Frank Lloyd Wright ~


stkitt
Forum Moderator


Date Joined Apr 2007
Total Posts : 32602
   Posted 5/2/2010 6:29 AM (GMT -7)   
Melodee,


Good Morning ! My info re the metabolizing of Ativan was strictly FYI only and I did qualify that by saying "I am not a Doctor" In know way was I trying to turn this into a debate.



As with many sites on the internet you can always find two view points which makes it confusing.



Another source I just read states Ativan :"Metabolism and Excretion: Highly metabolized by the liver".



In the long run it is best for all members to check with their physician's if they have any concerns.



Thank you for the links.



Kindly,



Kitt

debaser
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Date Joined Nov 2006
Total Posts : 1745
   Posted 5/2/2010 6:31 AM (GMT -7)   
To get back to the original conversation which was about Klonopin, the reason I brought up the liver thing I suppose is because I'm very lucky to be one of these people who's at risk for liver disease. My brother died of cirrhosis caused by A1AD, and I carry the dominant gene for that, too. Klonopin is metabolized by the liver and so I have to be monitored. My doctor said it's unlikely to ever cause a problem, but it's better to be safe than sorry. Anyway, a lot of people are adopted or whatever and don't know their family history so it certainly can't hurt to be tested. It's just a simple blood panel.

But I didn't want to cause alarm or start a debate. It's just something some people should ask their doctors about, and beyond that I wouldn't worry about it.

Post Edited (debaser) : 5/2/2010 7:34:11 AM (GMT-6)


melodee
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Date Joined Oct 2008
Total Posts : 800
   Posted 5/2/2010 6:48 AM (GMT -7)   
I did not think this was turning into a debate Kitt and Debaser! LOL :))) I should have included the emoticons! smilewinkgrin
 
I just wanted to point out (like I mentioned in my previous post) that Lorazepam is the only benzodiazepin that has worked for me the past 10+ years and there is no way I can switch meds at this point...(I've switched meds like 5 times and none of them worked.. ) and I was never told about Lorazepam causing negative effects on my liver. So after this liver thing was brought up, I looked it up again.  I am a bit worried now. I think I will make an appointment and have everything checked. I have had some blood work done in the past two years...but I guess it's best to have it checked anyway.

cool smilewinkgrin cool smilewinkgrin   cool   smilewinkgrin More emoticons. LOL

 


The thing always happens that you really believe in, and the belief in a thing makes it happen.
~ Frank Lloyd Wright ~


stkitt
Forum Moderator


Date Joined Apr 2007
Total Posts : 32602
   Posted 5/2/2010 8:14 AM (GMT -7)   
Hey Melodee,
 
It is always good to have info and input from everyone.  I am with you on the medication,  I need the Valium so I use it as it does help me.  I think if the Ativan works for you then you should use it too.  Talking with your Doctor is good to just reassure your mind.  :)
 
More emoticons  smhair turn shocked tongue yeah smurf smilewinkgrin scool smhair smhair smhair
 
Gentle Hugs,
 
Kitt
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