Q: Xanax & Nighttime Dose?
I've been on Prozac for years as I was diagnosed with
major depression however in the last year I've been diagnosed bipolar2.
Strong family history of manic depression. Prozac seems to be the only antidepression that
lifts my depression. I've tried mood stabilizers and they seem to bring me down
too much so I take benzodiazepines. First I took Ativan and then my doctor
wanted me to try Clonazepam as it stays in system longer so not as many ups and
downs however that also seems to bring me down causing more depression. He has
now prescribed Xanax. My question is even though I have anxiety I don't have
trouble sleeping (sometimes too much), so is it necessary to take the Xanax or
any benzo at nightime as well as during the day?
Dear Ms. B' --
In my view the first step here is to make sure that the "anxiety" is not some
form of bipolar-like symptom that could be being made worse by the
antidepressant (sounds like you're still on the Prozac, right?). If that was so,
in my experience it would be hard to ever make that go away as long as the
antidepressant was still around; or if you could, you'd have to pile on quite a
bit of benzodiazepine (Xanax, Ativan, Clonazepam) and it would seem to "stop
working". That loss of response could be the development of tolerance to the
benzodiazepine, or it could be the continued evolution of unquieted bipolar
mixed state that was being pushed along by the antidepressant. Note, "could
be", not "is". These interpretation has to be considered because it
leads to a very different approach; but this interpretation is not necessarily
correct. There are two research groups (led by J. Amsterdam and G. Parker) who
believe that some versions of bipolar II can be managed on with an
antidepressant alone as the "mood stabilizer".
As you can imagine, if my concern was correct, then
you'd have to look for some alternative to the Prozac to address the depression.
Fortunately there are mood stabilizers that have antidepressant effects (here is
my list of 9 "antidepressants
that aren't antidepressants", some of which are also "mood stabilizers" of a
sort. Again, not that I'm recommending a wholesale switch in approach; just an
additional option to think about.
Now, as for your question: sounds like you could
discuss with your doctor (perhaps already have, by this time?) a trial of using
some of the total daily dose at night; versus using it all during the day
instead (perhaps spread out through the day, as Xanax doesn't last a whole day
for many people, as you probably have discovered). You see, that was the simple
answer to your question. I hope that turns out to be all you need; but in case
you need more than that, I hope that the first couple of paragraphs might be of
use as well.
Published October, 2006