It’s nice when things go smoothly, isn’t it . . . Now, personally, I can’t remember a time when things DID go smoothly. It always seems that something is cropping up and disturbing the day. Stress from home. Stress from work. The kids. Traffic. And then . . . once again, you are in panic mode and you have to get yourself back to baseline before being able to take on even the mundane tasks of life. . . and I don’t have a panic disorder!!! For those of you who DO suffer with ongoing anxiety symptoms and intrusive panic attacks, even mild increases in stress (or sometimes no stress at all) can bring about dramatic and crippling anxiety symptoms.
My hope when I treat anxiety is to take the anxiety away. I’m not aiming for numb and sedated. Just not overwhelmed with anxiety. Klonopin, as many of you know, is one common tool used to address this and, when it works well, is great. It can prevent the onset of anxiety and keep you moving along in your day getting done what needs to get done. As the old saying goes, “an ounce of prevention is worth a pound of cure”. But those of you who struggle with anxiety know that breakthrough anxiety is just all too common. So, what is the best way to address it?
Of course, the best, when possible, is to use one of the antidepressants that work on anxiety. These tend to be effective, are non-addictive and have fewer sedating side effects. They are not without their problems, however. I have covered that sufficiently in other blarticles so I won’t cover that here. I will suppose that either the antidepressants don’t work well enough or you don’t tolerate them. The use of Klonopin in these cases can be very helpful. When breakthrough anxiety occurs, there are several different approaches. Whenever possible, I use higher doses of Klonopin. Again, this goes back to the “ounce of prevention” statement made above. But there are limits here. Sometimes, you go up on the Klonopin and all you get is tired and fuzzy. Sometimes, even going up does not seem to capture the breakthrough. In these cases, use of a rescue medicine can be very, very, VERY helpful. In years past, I tried to avoid the use of Xanax for breakthrough anxiety because of it’s higher abuse potential. My patients have found Ativan (another short acting benzo) not as helpful, however, leading me back to using Xanax. It has a very quick onset of action, so relief comes quickly. It tends to provide relief without making you overly sedated. It is short acting so that the side effects that do occur do not hang around for a long time.
There are no studies showing that use of different agents in this benzodiazepine class can be used together safely. They have been widely used in combination for many years without evidence of difficulty, so it has become a standard of practice. It is important to be cautious about the potential for sedation. Xanax will be more sedating when used in combination with Klonopin compared with use of Xanax alone. Caution should be exercised, especially when you are tired or when you are first using the combination together.
As always, you should not take more Xanax or Klonopin than you are prescribed. You should never combine them with alcohol, and you should contact your doctor if you continue to have breakthrough anxiety.
–Dan Hartman, MD
What would be very helpful here is what sort of Xanax dosage and schedule you usually employ for anxiety breakthrough. I know it is a an individual thing, but some rough guidelines would really be helpful-for example, I take 2.25 mg/day Xanax for my current extended manic disorder, but there are times, as you wrote that anxiety nonetheless becomes overwhelming. I tend to just suffer rather than increase the dosage, since I’m concerned about taking more Xanax on a regular basis. My physician is not concerned about me increasing my dosage (I have had five, multi-years-long periods of severe PD during my life), but I am concerned-so I end up at most increasing the dosage 0.25 mg for at most two days…which is somewhat helpful (actually, I’ve found 0.25 mg more helpful than 0.5 mg in such situations, in terms of decreasing anxiety-but then, I’ve only tried an additional 0.5 mg twice, ever-and felt badly about doing it. I guess the question is, “how long can the average person increase their Xanax dosage without becoming dependent on the new, higher dosage?”
Thank you!
1. On comment (1) above, it should read,”… I take 2.25 mg/day Xanax for my current extended PANIC disorder”. Big difference.:>}