Benzodiazepines and Suboxone

Does buprenorphine treat depression? Is my depression from Suboxone? Will Suboxone treat bipolar? Will naltrexone or Vivitrol make me depressed?
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Jschmidt21189
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Benzodiazepines and Suboxone

Post by Jschmidt21189 » Sat Oct 20, 2018 7:08 pm

Hi. I am from the Midwest, and have been taking Suboxone 12mgs a day for a little over a year. I just wanted to see how many people are similar to me and need a benzodiazepine like Xanax Xr or Klonopin to help them function, but also take Suboxone at the same time. When I started Suboxone, my first psychiatrist who had been prescribing me Valium 10mg three times a day; decided that I could not take them both. Even if I lowered the dosage, he wouldn't do it. So naturally, I went out and found a good psychiatrist that actually understood that I was so anxious I could barely leave my house. He started me out on Klonopin at a low dose. Then as I progressed through treatment; he switched me to Xanax XR 1mg twice a day, which is still a low dose. I sometimes feel like it's too low when I have panic attacks at work or even at home around my family. I'm too scared to ask him to increase the dose though. I don't want him to take away what I already have, and every time I've asked before; he's been slightly irritated. I'm scared to switch back to Klonopin(I was up to 3mgs a day) too so I was kind of wondering if anyone had any suggestions. I know it sounds like I'm drug seeking, but I have been close to a nervous breakdown several times at work. I just feel like something is really wrong, and nobody seems to understand. My brain is just a little overactive, and the xanax is not working as well as it once did. I know it is tolerance, but what do I tell the doctor? He doesn't seem to believe me. Thank you for any replies in advance.

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Re: Benzodiazepines and Suboxone

Post by Amy-Work In Progress » Sun Oct 21, 2018 12:42 pm

The complaints you have about Xanax are exactly why Xanax, and benzodiazepines in general are not a good cure for anxiety. Let me explain...

Benzodiazepines are helpful for episodes of severe anxiety. For example, I use Xanax for panic attacks. A bottle of 30 .5mg lasts me several months. I definitely don't take it every day, because it would stop working for me like yours has stopped working for you.

What daily benzodiazepines do is not just increase your tolerance for them, which you've discovered. They actually have a rebound effect. When the xanax or valium, etc. wears off, your anxiety comes back worse than before. So you take another and then your anxiety is worse after it wears off. So you start taking two xanax, which works great at first. Then the tolerance and the rebound effect get worse, so you have to up your dose again. It becomes a vicious cycle!

Although your doctor was smart to put you on an extended release form of xanax, it's not enough to prevent tolerance and rebound anxiety. The better treatment for anxiety includes SSRIs and meditation. As a society we have gotten very impatient to fix things right now! (I was no different.) But there is value in finding out other ways to decrease anxiety, even though they take time to learn.

I hope that my post is helpful to you. It would be great if you wanted to hang around the forum and help others with questions!

Amy
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Re: Benzodiazepines and Suboxone

Post by Jschmidt21189 » Sun Oct 21, 2018 1:29 pm

I was reading your post and thinking about it(as I take my next dose). It makes complete sense. I've definitely come to a point where I kind of question why I continue to pop these little white things when they do not seem to do anything anymore. It's ironic to me that the relief I seek could probably be mine if I just held off and stopped taking them constantly. I just started to take Abilify again because I get depressed in the winter. It always took the edge off for me as well(similar to an SSRI for other people, but most likely more sedating or stimulating depending on your chemistry). I think I may start taking the Xanax on a different schedule. I'll kind of stagger my doses and give my GABA A receptors a break after the Abilify starts to take effect. I really appreciate your advice. If anyone else wants to say anything(a lot of people take benzos), please don't hesitate to let us know if you have had similar experiences. I think the cool thing is that you're not just saying to rule out the use of Xanax altogether like the media seems to be trying to do. It upsets me when I see articles titled "Xanax: America's next Drug Crisis?". Don't get me wrong, some people abuse them; but other people benefit from them.

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Re: Benzodiazepines and Suboxone

Post by Amy-Work In Progress » Sun Oct 21, 2018 3:02 pm

I'm so impressed with you for taking in my post and truly thinking about it instead of having a knee-jerk reaction!

Yes! Benzodiazepines can be very useful when used more sparingly than most people use them. I hate the fact that people are suffering increased anxiety because they don't know about the rebound effect they produce.

I have also recently come out of a profound depression that had me in its grip for two years. In my case, Wellbutrin has helped so much.

If you make any changes keep us updated on how they are affecting you. Benzodiazepines can be very tricky when you taper down from them. So go slowly when making changes. I believe that you can get to a point where the xanax is actually working for you again. I wish you the best!

Amy
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Re: Benzodiazepines and Suboxone

Post by docm2 » Mon Oct 22, 2018 11:29 am

FDA has basically said don't do it when it comes to prescribing a benzodiazepine with an opiate.
Compounding this, you won't find any treatment guidelines that advocate for regular dosing of a benzodiazepine for long term use.
https://www.advisory.com/daily-briefing ... diazepines
Many of my colleagues will not coprescribe at all. I am in the middle ground and if someone has panic then I provide a set # of doses a month. Usually less than 14. If panic is greater than that a person needs more intensive treatment with CBT, DBT or REBT; not more pills.
The days of being on an opiate (including Suboxone) and a daily dose of a benzo is rapidly coming to an end and people should prepare to be weaned off one of them. (Cut off will likely occur for many)
The reason your doctor is 'irritated' or hesitant to prescribe is because if you have an adverse event, they may as will open up their wallet to a malpractice claim. There won't be a good defense of the practice.
This is my view.
PAX

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Re: Benzodiazepines and Suboxone

Post by Jschmidt21189 » Mon Oct 22, 2018 3:00 pm

Yes, that is true that most doctors probably won't prescribe them at the same time(except sparingly). I've had panic disorder, for which I've received all kinds of therapy including DBT, CBT, and a dual diagnosis ongoing counseling that I'll always need, my whole life. I think that some people may have a certain set of genes(pure speculation) that seem to cause anxiety and panic, and for these people day to day life without medication(benzos for me) would not be possible. I have gone periods without benzodiazepines, and the rebound effect from me taking them for years literally made me semi-psychotic, agoraphobic, and led to more relapses than I can count. Now that I am prescribed Xanax Xr, I don't even think about using.
I agree that if you give a high dose benzodiazepine with Suboxone and the patient has a low tolerance to either drug; it could kill them(that usually happens when people inject the drugs, I believe). However, I think if someone has taken benzodiazepines the majority of their life on a near daily basis, to cut them off when they start Suboxone; wouldn't be right. Just cut the dose back. I'm happy to know that as a doctor; you're at least open to the idea of prescribing both because some of us really need these medications to function. I now have a full time job, volunteer on weekends, go to counseling, and generally try to improve my life everyday. Xanax Xr is also not the same as taking Xanax. It's a little bit lighter of a drug, and it doesn't wear off as fast. I don't know if that makes it safer, but I can tell you that my thinking is not impaired like it would be if I were taking an instant release Xanax.

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Re: Benzodiazepines and Suboxone

Post by SubstantialTarantula » Tue Oct 23, 2018 1:13 am

Jschmidt21189 wrote:Yes, that is true that most doctors probably won't prescribe them at the same time(except sparingly). I've had panic disorder, for which I've received all kinds of therapy including DBT, CBT, and a dual diagnosis ongoing counseling that I'll always need, my whole life. I think that some people may have a certain set of genes(pure speculation) that seem to cause anxiety and panic, and for these people day to day life without medication(benzos for me) would not be possible. I have gone periods without benzodiazepines, and the rebound effect from me taking them for years literally made me semi-psychotic, agoraphobic, and led to more relapses than I can count. Now that I am prescribed Xanax Xr, I don't even think about using.
I agree that if you give a high dose benzodiazepine with Suboxone and the patient has a low tolerance to either drug; it could kill them(that usually happens when people inject the drugs, I believe). However, I think if someone has taken benzodiazepines the majority of their life on a near daily basis, to cut them off when they start Suboxone; wouldn't be right. Just cut the dose back. I'm happy to know that as a doctor; you're at least open to the idea of prescribing both because some of us really need these medications to function. I now have a full time job, volunteer on weekends, go to counseling, and generally try to improve my life everyday. Xanax Xr is also not the same as taking Xanax. It's a little bit lighter of a drug, and it doesn't wear off as fast. I don't know if that makes it safer, but I can tell you that my thinking is not impaired like it would be if I were taking an instant release Xanax.
I have read that for a very small population, benzos are helpful long term. Too bad for you though, the 99% who develop worse anxiety from benzos have screwed it up for ya! By the way, do you suffer chronic pain? I am curious if adding a benzo to bupe is a godsend for arthritic type pain.
Thanks,
St. Tarantula

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Re: Benzodiazepines and Suboxone

Post by Jschmidt21189 » Thu Oct 25, 2018 3:09 pm

I do not know if adding a benzo would help with arthritic pain. I do know that they have muscle relaxant effects, Valium being one of the best in that regard. I take my benzo for extreme anxiety. You should ask your doctor. Thanks for the reply. Hope you feel better.

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Re: Benzodiazepines and Suboxone

Post by SubstantialTarantula » Thu Oct 25, 2018 10:48 pm

Jschmidt21189 wrote:I do not know if adding a benzo would help with arthritic pain. I do know that they have muscle relaxant effects, Valium being one of the best in that regard. I take my benzo for extreme anxiety. You should ask your doctor. Thanks for the reply. Hope you feel better.
Thanks J,
Yeah, I have always had such trouble with benzos that I don't even consider them anymore, not prescribed, and not RC versions. I just always would black out and decide to drink, plus compulsively redose while blacked out. Glad I finally realized it was not for me :)
Peace,
St. Tarantula

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Re: Benzodiazepines and Suboxone

Post by Jschmidt21189 » Sat Oct 27, 2018 8:43 am

Yeah, it sounds like you may be the type that should not take benzos Tarantula. I think there are a lot of people out there like you. In all honesty, I know that taking something daily is bad, however; some people do take blood pressure or cholesterol meds everyday just to stay alive. That's kind of the analogy or metaphor(I forget which one applies), that I will use for anyone out there that hasn't experienced a real panic attack. In thinking about PAX's earlier post; if I had to pick between a benzodiazepine and Suboxone, I would choose the benzodiazepine because I would suffer and possibly relapse without it. I just think people should think about what it would be like to be scared to leave your bedroom every morning and interact with other people. I am open to taking a longer acting benzodiazepine like Valium because I think Xanax is the most addictive one, but my doctor would not prescribe it. I do not understand why, but I think that Xanax Xr works okay and after hearing from all of you; I am grateful that my doctor prescribes it at all. Seriously. Thank you all for your replies.

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Re: Benzodiazepines and Suboxone

Post by SubstantialTarantula » Sat Oct 27, 2018 7:35 pm

Jschmidt21189 wrote:Tarantula.
Let me go out of my way to discourage readers from trying Phenibut in their search for an anxiety med. I tried it and found that it jacks your heart rate up for like 24 hours plus! Wtf!? Maybe there is a dose that is safe but I stopped trying after a couple times taking an eighth of a teaspoon.
St. Tarantula

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