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I am doing poorly and have a pdoc appointment coming up. Basically I've been under a lot of stress for the past month and now I'm having suicidal ideation and depressive symptoms.

My meds are in my signature. I don't want to go higher on the Prozac due to side effects (I think 80 is the recommended max anyway). Is there any way to avoid a huge med change and just tweak my current ones temporarily?

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bump abilify to 15 maybe? it's approved that high for depression adjunct, i believe.

or, if you think that the spike in depressive stuff is coming from the added stress (and i'm assuming added anxiety), maybe a better place to look would be your anxiety meds. do the ideation and depressive symptoms get better at all when you take your ativan? how often are you taking it lately?

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4 hours ago, Juniper29 said:

Is there any way to avoid a huge med change and just tweak my current ones temporarily?

I second @echolocation 's suggestion of possibly increasing Abilify to 15mg....

What is your dosage of Ativan?...If it's a small dose, maybe you could discuss with doc about increasing that a bit as well?

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59 minutes ago, CrazyRedhead said:

I second @echolocation 's suggestion of possibly increasing Abilify to 15mg....

What is your dosage of Ativan?...If it's a small dose, maybe you could discuss with doc about increasing that a bit as well?

Or take more frequently? Sorry I’m on a phone and can’t see sig so sorry if that’s a stupid suggestion 

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1 hour ago, echolocation said:

bump abilify to 15 maybe? it's approved that high for depression adjunct, i believe.

or, if you think that the spike in depressive stuff is coming from the added stress (and i'm assuming added anxiety), maybe a better place to look would be your anxiety meds. do the ideation and depressive symptoms get better at all when you take your ativan? how often are you taking it lately?

I've been taking the ativan maybe 1-2 times per week for the past few weeks. That said, I took it yesterday and again today and probably will tomorrow. It does help, I think ... after I took it last night, I felt calmer and less like I needed to put an end to my existence ASAP.

 

1 hour ago, CrazyRedhead said:

I second @echolocation 's suggestion of possibly increasing Abilify to 15mg....

What is your dosage of Ativan?...If it's a small dose, maybe you could discuss with doc about increasing that a bit as well?

I can take up to 1 mg twice a day. I don't take it very often.

26 minutes ago, Iceberg said:

Or take more frequently? Sorry I’m on a phone and can’t see sig so sorry if that’s a stupid suggestion 

Not a stupid suggestion. I have it as a PRN and don't take it often. My pdoc has actually told me not to be afraid of taking it more.

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24 minutes ago, Juniper29 said:

I've been taking the ativan maybe 1-2 times per week for the past few weeks. That said, I took it yesterday and again today and probably will tomorrow. It does help, I think ... after I took it last night, I felt calmer and less like I needed to put an end to my existence ASAP.

 

I can take up to 1 mg twice a day. I don't take it very often.

Not a stupid suggestion. I have it as a PRN and don't take it often. My pdoc has actually told me not to be afraid of taking it more.

Some pdocs will bump it to 3 or 4 times/ day in short term difficult situations, but that’s probably more for acute anxiety than the depression your feeling 

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15 hours ago, Iceberg said:

Some pdocs will bump it to 3 or 4 times/ day in short term difficult situations, but that’s probably more for acute anxiety than the depression your feeling 

Wow, I don't think I'd be able to function if I took it 3 times/day. That puts things in perspective though.

I didn't think I was feeling anxious yesterday, but my chest was hurting for a long time, which I guess is a stress/anxiety thing?

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2 hours ago, dancesintherain said:

chest hurting/tightness can definitely be an anxiety thing.

it sounds like fiddling with the ativan dosage might make sense...do you think you could take it regularly and more often if the dosage was lower?  kind of a steady state idea?

Like 0.5 twice a day?

2 hours ago, Iceberg said:

What about going to a longer acting benzo?

Maybe? I don't want it to be a long term thing, though.

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1 minute ago, Juniper29 said:

Like 0.5 twice a day?

Maybe? I don't want it to be a long term thing, though.

While many use something like klonipin daily, that didn’t always have to happen. I know some who take it PRN and others who titrate up for the hard times but then slowly taper off as things improve

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On 1/11/2020 at 7:25 PM, Juniper29 said:

Like 0.5 twice a day?

Maybe? I don't want it to be a long term thing, though.

By longer acting, they don't mean how long you'll actually be taking a drug; they mean a benzodiazapene with a longer half-life or duration. If you switched to something like clonazepam, which has a longer half-life than lorazepam, you could conceivably take it twice a day but have it provide longer coverage and help to manage anxiety. 

 

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On 1/11/2020 at 9:39 AM, Juniper29 said:

I didn't think I was feeling anxious yesterday, but my chest was hurting for a long time, which I guess is a stress/anxiety thing?

Beta-blockers like propranolol can help with these types of anxietysymptoms quite well. Some people can use a beta-blocker alone for anxiety, but I still need a benzo for the "general" anxiety symptoms since propranolol only helps the somatic symptoms like jitteriness, chest pain, and rapid heart rate.

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10 hours ago, psychwardjesus said:

By longer acting, they don't mean how long you'll actually be taking a drug; they mean a benzodiazapene with a longer half-life or duration. If you switched to something like clonazepam, which has a longer half-life than lorazepam, you could conceivably take it twice a day but have it provide longer coverage and help to manage anxiety. 

 

I understand that. I just know that a lot of people who take clonazepam take it long term as opposed to PRN.

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1 hour ago, Juniper29 said:

I understand that. I just know that a lot of people who take clonazepam take it long term as opposed to PRN.

Although, long acting benzos taken PRN are often considered to be at lower risk for dependance than short acting ones like Xanax 

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33 minutes ago, Iceberg said:

Although, long acting benzos taken PRN are often considered to be at lower risk for dependance than short acting ones like Xanax 

I just don't get why Xanax has such a bad reputation. Same as Dexedrine. Somehow Ativan is safer than Xanax just as Adderall is safer than Dexedrine?

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Xanax was wonderful for me, but I was worried about it being such a quick fix.  I found myself frequently checking the clock for my dosage time.  I wasn’t comfortable with that, so I’ve switched to XanaxXR and it’s been a gem.  I do think there’s less or a risk because I can mostly take it in the morning and then not think about it but feel the effects.

i wasn’t addicted to regular Xanax, but I didn’t like the feeling of wanting a quick fix.

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Back when my pdoc trusted me with benzos, I used to have multiple benzos on my prescription, different ones for different types of anxiety, and I got 90 of each one. I used to get 90 Xanax per month, 90 Serax per month, and at one point I think I had 90 Valium per month on top of those two. She didn't mind me having multiple benzos, and rather large quantities of them, for use as I wished in my hands. Eventually when I started self-harming by taking lots of benzos at once, she backed me down to 30 a month of one benzo. She only just recently started trusting me with benzos again, and I pulled the stunt I did with the Xanax this past weekend, and when I was on the phone with her telling her what I did, she said "maybe you don't need benzos for a while." Great... 😩😑 Don't know what I'll do for anxiety now.

I forget why I said all this...

13 minutes ago, dancesintherain said:

i wasn’t addicted to regular Xanax, but I didn’t like the feeling of wanting a quick fix.

I think it was this that I was going to tag something onto. I think I was saying what I said about having multiple benzos because I used to have Xanax + Serax for a long time a while back. Serax is actually probably the slowest benzo to act, but is also very short in its duration of action. Subjectively, it's probably the smoothest benzo. I usually don't notice it has worked until after it has done what I needed it to. I like it for non-emergency anxiety—like background anxiety that isn't distressing me much, whereas Xanax I like for emergencies of panic and anxiety attacks that are debilitating me at that moment.

At one point I was on a rather low dose of Xanax XR + infrequent Xanax IR doses for breakthrough anxiety. I think it was 1 mg of Xanax XR (she wouldn't budge any higher), and Xanax IR 1 mg once a day as needed (so I had 30 per month). It worked kinda, but Xanax XR just isn't potent at all for me, and I even had an authorized generic version of it, meaning it was equivalent to brand-name.

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I think part of the issue is that it really obvious when it kicks in and reallyyyy obvious when it wears off (unlike something like klonipin which may be more gradual) and that creates the feeling of really needing that next dose, making it have a higher abuse potential. Just  my theory 

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1 hour ago, Iceberg said:

I think part of the issue is that it really obvious when it kicks in and reallyyyy obvious when it wears off (unlike something like klonipin which may be more gradual) and that creates the feeling of really needing that next dose, making it have a higher abuse potential. Just  my theory 

Ativan is somewhere between Xanax and klonopin in that respect, right?

I took it 1-2 times daily for a week and then stopped a couple days ago. I don't seem to be having any issues with stopping, fortunately.

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