[Guest]

After several strange attacks involving severe chest pain dizziness high and irregular heartbeat, (at the hospital my heart rate was 265 bpm) i was diagnosed with panic disorder. after several months of trial and error on different meds, my doctor of several years, prescribed troprol xl (blood pressure has been high ever since that day at the hospital, but it's under control now. also 100mg zoloft a day. things got better but the attacks still came usually while driving on long trips or in crowded malls or stores. so i began to avoid these places. but the attacks would still come out of nowhere. as a last resort, he prescribed xanax. i have a naturally high tolerance to drugs and after six years, i take 6 to 10 mg of xanax with the zoloft and toprol.... now as tolerance has developed, the attacks are returning although not usually as severe. my problem is the xanax has begun to quit working. i have an appointment with my doctor on thursday and what alternatives do i have? would valium be a viable alternative? if so what is the criteria for swithing? how much valium is equivilent to 1mg of xanax? in your opinion are the benzo's safe for long term use, or should i began a controlled termination of them all together?
thanx
dbh

[Guest]

Your case is too compicated for me to offer any but the broadest advice. For example, a heart rate of 265 seems either innacurate or not really compatible with a diagnosis of panic disorder. 10 mg of Xanax is a very high dose. It will be difficult to switch. Indeed, attention and worry over severe withdrawal is warranted. While Benzos are typically safe and effective over the long haul, the large dose you are taking is problematic. I do not want to appear alarmist. I have had one or two patients who have required the sort of intervention you are getting. I have switched them to longer acting agents such as Klonopin. I don't know if you will find an effective control of symptoms without using a benzo. In sum, these questions are more for your doctor as a more thorough knowlege of previous history and current functioning is in order.
[quote] After several strange attacks involving severe chest pain, dizziness, high and irregular heartbeat, (at the hospital my heart rate was 265 bpm) i was diagnosed with panic disorder. after several months of trial and error on different meds, my doctor of several years, prescribed troprol xl (blood pressure has been high ever since that day at the hospital, but it's under control now... [/quote]

[Guest]

the 265 bpm is documented by the hospital and my chart. from what i've been told and read, i have 80% of the simptoms and high, irregular heart beat is one of them, also sweating, shaking, being detached (like an out of body experience, looking down on me and the ppl around as if i'm watching it from outside myself. confusing from irregular heartbeat and lack of blood and or oxygen to brain. isolating for fear of another attack. avoiding large crowds. i am a very out going ppl person. i take the high dose of xanax, but you would never know i've taken anything. i mean i don't get a buzz or slurred speach. it just helps with the anxiety. but i'm concerned.... if it stops working, i'm subject to 2-3 attacks a week. and also, SSRI's are great except for one major problem. they relieve me of my sex drive totally and when i do have sex it takes 45 minutes to reach orgasm and the orgasm is dulled from what it normally would be without the zoloft. in other words i hardly feel it. this is becoming unexceptable. i've actually considered just quitting all of it cold turkey, but
probably not a good idea. i can stop taking xanax for 3 days with little discomfort, mostly just insomnia with minor irratibility. i have read some ppl can take 1 mg xanax for three months and have terrible withdrawal, while others can take high doses for years with relatively minor withdrawal.
a friend of mine who was abusing the drug several years ago, taking 10 mg daily for 1 year decided to cold turkey and threw his away. within 12 hours he started becoming extremly ill, within 36 hours, he was seeing pink, green and blue flouresent bunny rabbits in his front yard. i'm happy to say he is in a twelve step program with several years clean today. but i've never experienced anything like that even after 72 hours. i was also told by a doctor, if you quit them for 2-4 weeks your tolerance will go down and you can go back to a low dose, but how do you survive the attacks during this time. also when i quit taking them for a few days, my bp goes up as high as 165/126. soon as i get back on the xanax, i drops to normal 120/80.
thanx for your input.
[quote] Your case is too compicated for me to offer any but the broadest advice. For example, a heart rate of 265 seems either innacurate or not really compatible with a diagnosis of panic disorder... [/quote]