Question for those of you who take daily Benzos

[Unstrung Harp]

I've been taking benzos PRN (alprazolam or clonazepam) for over twenty years. Sometimes I take them more, sometimes less, but I've never become habituated to them, most likely because I've tried really hard not to become habituated to them because my father was addicted to valium and my grandmother died from her addiction to prescription pain killers. Consequently I've never got much past a really small dose of either drug, and I'm really sensitive to it. Right now I take .25mg of alprazolam PRN, which I might take once during the day, with generally not more than .50 that I take to get to sleep if I'm amped up. I'm considering the possibility that I've got a constant low-to-moderate level of anxiety .that I'm not even conscious is anxiety that is interfering with my work, and maybe I would benefit from taking regular alprazolam throughout the day.  I do have GAD, so that's not crazy talk, but I'm thinking that maybe I'm not even aware when anxiety is at play and should just assume it's there and treat it. But my problem is that even at small doses I get sleepy and want to nap, even after twenty years. I know some of you are on much higher doses, or take much more frequently each day  than I take a Benzo, and I wonder, does it make you sleepy and kind of dull and you fight through it, or does it just not do that for you? Should I give it a couple of months of regular dosing to get my anxiety under control, in hopes that the sleepiness will only last a few weeks?I don't feel altered on it per se, just maybe a little blunted, and I invariably want to nap, which is not conducive to getting things done. Also considering returning to clonazepam for the longer half life and taking a morning dose, but I know I will have the same problem. Am I just not being patient enough with it? Of course I will discuss this with Pdoc, but he trusts my ability to monitor myself on the benzo intake, and I think he will ultimately leave it up to me within normal range. He's almost laughed at me a few times when I've said that I was so anxious I had to take .5mg.

[dancesintherain]

Harp I can't help on the med question (I take the same tiny dose as you but daily and it hasn't ever/yet caused a sleepiness problem).  But I did want to validate the experiencing anxiety that's below what you're necessarily aware of.  I didn't realize it was going on for me until I started the xanax (though the ativan before that also helped, just to a lesser degree). 

[Iceberg]

3 hours ago, Unstrung Harp said:

I've been taking benzos PRN (alprazolam or clonazepam) for over twenty years. Sometimes I take them more, sometimes less, but I've never become habituated to them, most likely because I've tried really hard not to become habituated to them because my father was addicted to valium and my grandmother died from her addiction to prescription pain killers. Consequently I've never got much past a really small dose of either drug, and I'm really sensitive to it. Right now I take .25mg of alprazolam PRN, which I might take once during the day, with generally not more than .50 that I take to get to sleep if I'm amped up. I'm considering the possibility that I've got a constant low-to-moderate level of anxiety .that I'm not even conscious is anxiety that is interfering with my work, and maybe I would benefit from taking regular alprazolam throughout the day.  I do have GAD, so that's not crazy talk, but I'm thinking that maybe I'm not even aware when anxiety is at play and should just assume it's there and treat it. But my problem is that even at small doses I get sleepy and want to nap, even after twenty years. I know some of you are on much higher doses, or take much more frequently each day  than I take a Benzo, and I wonder, does it make you sleepy and kind of dull and you fight through it, or does it just not do that for you? Should I give it a couple of months of regular dosing to get my anxiety under control, in hopes that the sleepiness will only last a few weeks?I don't feel altered on it per se, just maybe a little blunted, and I invariably want to nap, which is not conducive to getting things done. Also considering returning to clonazepam for the longer half life and taking a morning dose, but I know I will have the same problem. Am I just not being patient enough with it? Of course I will discuss this with Pdoc, but he trusts my ability to monitor myself on the benzo intake, and I think he will ultimately leave it up to me within normal range. He's almost laughed at me a few times when I've said that I was so anxious I had to take .5mg.

If U want to stick with alprazolam- look into the XR, can be dosed once a day and u can take a bit more IR PRN if needed. I mention it cuz I found it less sedating than klonipin 

[Unstrung Harp]

1 hour ago, Iceberg said:

If U want to stick with alprazolam- look into the XR, can be dosed once a day and u can take a bit more IR PRN if needed. I mention it cuz I found it less sedating than klonipin 

Somehow I did not know xanax came in XR. Good idea. Thanks.

1 hour ago, dancesintherain said:

Harp I can't help on the med question (I take the same tiny dose as you but daily and it hasn't ever/yet caused a sleepiness problem).  But I did want to validate the experiencing anxiety that's below what you're necessarily aware of.  I didn't realize it was going on for me until I started the xanax (though the ativan before that also helped, just to a lesser degree). 

Thanks, dances. I’m glad I’m not the only one with stealth anxiety. 

[Bueler]

Hi Unstrung,

I can speak as someone who has used daily benzos in high doses long-term.

The simplistic answer is you're on a low dose, you probably would benefit from taking it more often (might not), but it's a really effective medicine.

Having said that, what you give up is having a powerful medicine.  In other words, because of tolerance and using benzos for sleep and during the day, if I have an unusually anxious period, I could take 1-2mg Xanax and not get relief.

So I'm only warning you that, if you can get away with how much you're using now, don't go down the slippery slope I went down.  You're using it really responsibly right now, and you should keep doing that.  If you take it more frequently in higher doses, it will end up feeling the same as now, except you'll need bottles of the stuff to feel that way or just to feel baseline.

Please be careful and consider this your nuclear option, not your first option.  If you need the nuclear option, it is a strong class of drugs...

[Unstrung Harp]

6 minutes ago, Bueler said:

Hi Unstrung,

I can speak as someone who has used daily benzos in high doses long-term.

The simplistic answer is you're on a low dose, you probably would benefit from taking it more often (might not), but it's a really effective medicine.

Having said that, what you give up is having a powerful medicine.  In other words, because of tolerance and using benzos for sleep and during the day, if I have an unusually anxious period, I could take 1-2mg Xanax and not get relief.

So I'm only warning you that, if you can get away with how much you're using now, don't go down the slippery slope I went down.  You're using it really responsibly right now, and you should keep doing that.  If you take it more frequently in higher doses, it will end up feeling the same as now, except you'll need bottles of the stuff to feel that way or just to feel baseline.

Please be careful and consider this your nuclear option, not your first option.  If you need the nuclear option, it is a strong class of drugs...

Thanks for your response, Bueler. As I said, I've been really careful with it over the years and conscious of not wanting to become dependent. I still don't want to become dependent, but I'm feeling kind of desperate that my current portfolio of meds is not doing what I need it to do for me to feel functional. I know that I have been undermedicating my anxiety rather than overmedicating it. I used to take buspirone, which presumably worked on the anxiety to the extent that buspirone works, but now the Xanax is all I have going to specifically address the anxiety. Will proceed with caution.

[HydroCat]

I take .25mg Clonazepam as part of my daily cocktail for OCD related anxiety.

It made me sleepy when I was not taking it daily, now it just keeps my anxiety levels low (and constant).

Alprazolam is short acting so it is considered better as PRN.

Clonazepam is the longest acting so it is theoretically better for constant anxiety levels.

[Wonderful.Cheese]

@Unstrung Harp

I take 1 mg of klonopin , three times a day currently. I have taken 1 - 3 mg of klonopin daily in divided doses, depending on how bad my GAD is doing at the time.  Pdoc and I adjust it down or up depending on how bad the anxiety has been lately.

Right now we have settled on a higher dose but honestly I am non functional without a benzo. I have not tried any other with the exception of Ativan briefly. I prefer klonopin because it lasts longer than other ones and it works for me personally. I can’t even leave the house not to mention drive to known places or talk to people or do anything without klonopin. I get so paranoid and anxious. The worry over everything is endless. I can’t take SSRI’s for anxiety because I am so prone to mania. So those are out. 

I understand the horrible GAD monster. I hate the incredibly disabling anxiety so much. I’m sorry you are going through this too. It might be worth looking into a longer acting benzo like Xanax XR (as was mentioned) or even klonopin if you discuss this with your pdoc. I do not get tired from klonopin personally. I don’t know if klonopin is better for this or if my anxiety is so high that the klonopin just sort of brings me down to normal speed or if I have gotten used to the sedation piece and still benefit from the anti-anxiety piece? Hard to know. 

I hope you find relief soon. 

Edited June 7, 2019 by Wonderful.Cheese

[l'appel du vide]

I think switching to Klonopin would help you so much. I wouldn't want to be on Xanax daily with that short of a half-life, it's kinda scary to me. I purposely try to take medications that have long, long half-lives. I'm prescribed Klonopin 0.5mg twice a day, but I usually only take 0.25mg twice a day. I feel fine on it, not sleepy at all. My anxiety and panic attacks (not sure if you get those) have been 100% controlled for 6 years, the whole time I've been on Klonopin daily. My daily Klonopin dosage has ranged from 0.5mg-3mg a day throughout the years, but it has never lost its efficacy. I really don't think you will have an issue with addiction, and it sounds like you could really use the anxiety relief. I'm an addict and I even use my Klonopin responsibly, I don't really think benzos are that abusable. They don't do anything for me. Most people I know that abuse benzos do it to enhance other drugs or to come off drugs, and you have neither of those problems. I think you should try Klonopin 0.5mg twice a day, and then eventually when your anxiety improves you can try Klonopin 0.25mg twice a day.

I wish you the best of luck, and I know you will get through this. You deserve relief, so do it for you.

[CrazyRedhead]

Personally, for me, I would be non-functional without a benzo.

I've been taking daily Klonopin for 6 years....I take 1mg in morning, and 2mg at bedtime......I realize this is a moderately high dose, but you probably would not need that much...............When I first started taking it, it was somewhat sedating, but that side effect wore off after awhile.

I have tried Ativan, but prefer Klonopin because it's longer-lasting.......I have never tried Xanax, though.

[random_name]

.

Edited October 19, 2019 by Lapis.Lazuli

[Unstrung Harp]

@Wonderful.Cheese @l'appel du vide @HydroCat @CrazyRedhead @Lapis.Lazuli sounds like Klonopin is the way to go. I take Klonopin sometimes, and sometimes have prescriptions for both. I get Xanax for when I fly because I need it to take effect quickly, so I had that and kind of got out of the habit of Klonopin. I feel weird when I have prescriptions for both of them to take to the pharmacist, because I also take Adderall, and I feel like the pharmacist, who is my neighbor, must be tsk tsk tsking me. But I'll talk to my Pdoc about taking Klonopin regularly, and hope that the sedation subsides. Sometimes we've had the strategy of my taking Klonopin at night with the idea that there would be some carry over into the day without the sedation.

[HydroCat]

On 6/9/2019 at 5:17 PM, Unstrung Harp said:

@Wonderful.Cheese @l'appel du vide @HydroCat @CrazyRedhead @Lapis.Lazuli sounds like Klonopin is the way to go. I take Klonopin sometimes, and sometimes have prescriptions for both. I get Xanax for when I fly because I need it to take effect quickly, so I had that and kind of got out of the habit of Klonopin. I feel weird when I have prescriptions for both of them to take to the pharmacist, because I also take Adderall, and I feel like the pharmacist, who is my neighbor, must be tsk tsk tsking me. But I'll talk to my Pdoc about taking Klonopin regularly, and hope that the sedation subsides. Sometimes we've had the strategy of my taking Klonopin at night with the idea that there would be some carry over into the day without the sedation.

I take Klonopin at night because of the potential sedation.

I thought that it was making me sleepy during the day but looking back it more likely was the Mirtazapine (which is a strong antihistamine and super-sedating by itself) I was on at the time.

Anyway, either the sedation effect wears out with time or it wasn't there to begin with.

That being said, I am only on 0.25mg.

Good luck!

[looking for answers]

On 6/6/2019 at 8:19 PM, Iceberg said:

If U want to stick with alprazolam- look into the XR, can be dosed once a day and u can take a bit more IR PRN if needed. I mention it cuz I found it less sedating than klonipin 

not to play contrarian but xanax was more sedating for me that klonopin. Both the IR and XR

[Unstrung Harp]

On 6/13/2019 at 10:05 AM, looking for answers said:

not to play contrarian but xanax was more sedating for me that klonopin. Both the IR and XR

In my recollection the Klonopin and xanax sedation are similar for me. I asked Pdoc about Xanax XR and he said he doesn’t really tend to prescribe it and doesn’t seem interested in starting now, so that point is pretty much moot.

On 6/13/2019 at 7:25 AM, HydroCat said:

I take Klonopin at night because of the potential sedation.

I thought that it was making me sleepy during the day but looking back it more likely was the Mirtazapine (which is a strong antihistamine and super-sedating by itself) I was on at the time.

Anyway, either the sedation effect wears out with time or it wasn't there to begin with.

That being said, I am only on 0.25mg.

Good luck!

I’ve decided after discussing with Pdoc to stick with Xanax right now, have been taking .5 at once consistently all week and today it seemed to make me less sedated than it had been, so I’m hoping that’s a trend.