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    Bipolar and benzos
    Anon_81448 posted:
    I I was on Klonopin for 2 yrs, fairly effective. Then recently, it pooped out on me. My pdoc put me on Xanax, fast acting, I know, and it hasn't worked well at all. My question for Dr. G and the community is
    Which benzo are available to help anxiety and agitation?
    Joseph F Goldberg, MD responded:
    Dear Anon,

    Long-term use of any benzodiazepine runs the risk for tolerance and physical dependence (what you may be noticing as "pooping out"). When that happens we generally try to detox people off benzo's and use non-benzodiazepine alternatives for anxiety and agitation. Depending on an individual's unique circumstances, options for this might include atypical antipsychotics (e.g., Seroquel), gabapentin, Lyrica, Vistaril, buspirone, or possibly an SSRI.

    Dr. G.
    doxielover10 responded:
    Dear Anon,

    I am a rapid cycling bipolar 1, I am also diagnosed with PTSD. My anxiety is so bad that the minute I start to feel it, I break out in hives and sores. I have been taking 10mg of Valium 4 times a day for years. At first it was great, however, with time it stopped working. Also, I hated the idea of taking that much Valium but I hated the anxiety more.

    During one extreme anxiety spell, my Psychiatrist added Atarax
    to the Valium and it did work.
    Anneinside responded:
    I have akathisia from Abilify and was put on propranolol, a beta blocker, and was surprised to find that my anxiety was gone along with the akathisia. Propranolol's main function is for high blood pressure but also works for anxiety and akathisia. Perhaps you should consider this as it is not addictive.
    Joseph F Goldberg, MD replied to Anneinside's response:
    Dear Anneinside,

    yes, a good point...sometimes what outwardly appears to be anxiety is really not anxiety, but something else, such as akathisia (literally, an inability to sit still, or inner restlessness, caused by antipsychotic medicines (usually dose-related), for which propranolol is a time-honored remedy), or extrapyramidal side effects (such as tremor or a shuffling gait, treated with anticholnergiuc drugs) or "activation" as a side effect of some antidepressants that goes away once it is stopped, or even hypomania or psychosis can be misperceived as anxiety.

    Dr. G.
    asurvivor777 replied to Joseph F Goldberg, MD's response:
    Thank you all for the responses. I'm taking propranolol 60 mg once a day. My main concern is that I feel nervous restless possibly from the meds. I take 20 mg of Zyprexa and 200mg. The symptoms go away around 2PM. What should I tell my Dr. so I can finally get some relief? Thanks.
    asurvivor777 replied to asurvivor777's response:
    Correction: 200mg od Zoloft

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