Topic: anxiety

Question: How can I talk to my psychologist about upping my dose of Xanax?
I’ve been on 0.5 mg of Xanax twice a day for the past month. It hasn't been helping me at all, but when I take 1 mg during a big anxiety attack, it calms me down. I was wondering how I can ask my psychologist to up the dose to 1 mg twice a day without her thinking I'm abusing them. I just have very big anxiety attacks. Should I stay on the 0.5mg and deal with the attacks or should I ask to up the dose? I'm afraid she will take me off them and put me on something else.

Answer (from Kaileen McMickle, MS, LPCLicensed Professional Counselor):
It seems like what you are looking for is a way to advocate for yourself and that's so important in mental health! You know best what is working for you and what isn't, so you are the best person to speak out for yourself to the people that can help you. I have extensive training in substance abuse and medications used in therapy, and I work with many people that take Xanax.  Counselors may not prescribe, but with the right training we can educate and help you move through the complexities of medication usage when paired with therapy. There's definitely some debate about using medication in the counseling world, but many people are prescribed Xanax to cope with big emotional responses.  We don't know much about your situation here--if you are in counseling, what types of other coping skills you've tried to use, etc., so it'd be hard to suggest not taking anything for your symptoms.  You are obviously struggling and sometimes stabilization is the best you can do.  And the fact that you are considering dealing with the attacks as an option is a sign you are willing to negotiate your dosage and maybe even the intense fear you are experiencing.  That's seriously so courageous.A little bit about Xanax--Xanax is a drug in the Benzodiazepine family and is fast-acting.  That means it does only help short-term, but your body also builds a tolerance to it pretty quickly (just as people build tolerance to alcohol).  That could be why they aren't as effective for you at the dosage you are taking, especially if you are prescribed to take them twice a day.  It's really important that you discuss the symptoms you are still having with your prescribing provider, as well as when you are taking the medications so they understand the details of your situation and can determine if or how to modify your dosage.  These providers know a lot about the medication process and the more info they have, the better they can meet your needs.  They are ultimately the ones that will work with you to decide whether or not Xanax is the best for you and your situation.I definitely understand your concern that your provider may basically take away how you cope with panic attacks.  That's a scary thought!  Prescribing providers are typically trained in detecting medication abuse, and it is very common for people with anxiety issues to request higher dosages.  I have had plenty of clients ask for increased dosage.  Not only can this get you the assistance you need at the time you need it, but give you a voice in your treatment.  You may end up using that same voice for request to lower your dosage in the future.I do feel an ethical duty to let you know about some of the dangers of Xanax.  Benzodiazepines are depressants and work on the central nervous system (CNS) to do things like slow down your heart rate, breathing, etc. (as you can feel when they do work).  They should never be taken with any other depressants, such as alcohol, barbiturates, and other medications in the Benzo family.  Combinations like these could be fatal.Another danger is that there's a common pattern of relapse after discontinuing Xanax.  This means that symptoms tend to come back stronger than they were before taking the drug.  The reason for this is because when you are taking Xanax, your brain tries to intensify your fear reaction to override the drug.  So when you discontinue it, your fear reactions are still at those heightened levels.  Your prescribing provider can talk to you more about that and/or the process of tapering off the medication to make that less likely when that time comes for you.If you are in counseling and doing exposure activities, (being exposed to things you fear and sitting through the anxiety response) Xanax does interfere with this process.  The brain can't learn a different response if you feel calm.  This is something your counselor (if you have one) can discuss with you as well.The last thing I'd like to say is that there could be some value to practicing other ways to manage your anxiety if you want to make more long-term changes.  That decision is completely yours!  If/when you feel ready to do that, a counselor can help you learn how to move through anxiety without being as reliant on Xanax.  I hope this is helpful and you find what you need!

Answer (from Sherry Katz, LCSWCouples and Family Therapist, LCSW):
Do you think you're abusing xanax?It is a highly addictive drug so maybe one reason you feel compelled to take more is bc you already are addicted.Drugs don't do anything helpful in solving life's problems.   Once the effect wears off, the stressful situation is once again waiting for you to address it.Think over your reason for not directly asking your psychologist about upping your dose.Also, do you ever talk about your life problems with this psychologist or only your need for drugs?    The more gradual path to a better life is to not need drugs in the first place. This consists of your willingness to face the matters that are creating such terrible feelings inside you.

Answer (from Catherine Misita):
Staying on the lower dose may give you more room to learn strategies for coping with your anxiety.  Medications are so helpful, and needed at times, but it's also important to have a variety of tools you use to manage your responses to stress.  If you are not already seeing a therapist, consider finding one who can help you learn some effective strategies, like replacing self-defeating thoughts with ones that work better for you, or mindfulness, relaxation, or other tools to keep your anxiety in the manageable range!

Answer (from Lauren Ostrowski, MA, LPC, NCC, BC-TMH, CCTP, CCHI tailor my therapeutic approach to each client's strengths and goals):
In general, Xanax is very short-acting. You mentioned that you are afraid that your medical provider will take you off of the Xanax and put you on something else. If the Xanax is not working well for you, I wonder if something else may work better. What is your reasoning there? Also, sometimes there are medications that you can take in addition to Xanax.In addition to talking with your medical provider about changing the medication, try to track your levels of anxiety on a scale of 1 to 10 throughout the day so you can get a pattern of what is happening. Also consider writing down what is happening before you have anxiety attacks. This may help your medical provider know what medication may be helpful to you or what changes could be made.As far as how to discuss this with your medical provider, I would suggest mentioning the symptom changes you are having (anxiety attacks that are not helped with 0.5mg of Xanax) and ask what they would suggest that might help. If your medical provider suggests taking you off of the Xanax, I would recommend talking about the reasons why you would prefer to stay on the Xanax and what your concerns are about coming off of it. You could also ask whether anything could be combined with Xanax.There are also many other anxiety medications. I have seen lots of people that take more than one medication to lessen anxiety that they are having.I would also consider talking with a therapist (unless the person who is prescribing a medication is also doing therapy with you). Getting more information about your anxiety and how it is affecting you may be greatly helpful to you.