Alprazolam/Xanax for nighttime anxiety?

[Librella]

I am currently taking nortriptyline 25mg for ibs and migraines. It does nothing for anxiety at that dose, so my doctor also prescribed alprazolam for acute anxiety/panic. Lately I’ve been having a lot of anxiety at night, I have nightmares and wake up feeling panicked, or wake up too early and my mind starts racing. However I don’t feel anxious when I’m first going to bed. Would taking alprazolam before bed as a preventative for the midnight panic work? I know it’s not something to take every day so I’ll probably have to figure something else out long term. I have non pharmaceutical coping mechanisms too but I’m getting sick of having to deep breathe myself back to sleep a few times a night.

[panic_down_under]

I am currently taking nortriptyline 25mg for ibs and migraines. It does nothing for anxiety at that dose, so my doctor also prescribed alprazolam for acute anxiety/panic. Lately I’ve been having a lot of anxiety at night, I have nightmares and wake up feeling panicked, or wake up too early and my mind starts racing. However I don’t feel anxious when I’m first going to bed. Would taking alprazolam before bed as a preventative for the midnight panic work? I know it’s not something to take every day

Probably, but benzodiazepines should only be taken in the short-term because they actually worsen the underlying brain issue that manifests as anxiety and/or depression. The prescription antihistamine *hydroxyzine might be a better bet, either alone, or alternating with alprazolam. It is moderately sedating and is a fairly potent anxiolytic, not quite as potent as alprazolam, but often potent enough.



*Hydroxyzine comes in two forms, hydroxyzine pamoate (Vistaril) and hydroxyzine hydrochloride (Atarax). Anecdotally, the pamoate form is claimed to be the more effective anxiolytic, but just how true this is remains a matter of debate in forums.


I’ll probably have to figure something else out long term.

As you're already taking it why not increase the nortriptyline dose into the therapeutic 75-150mg dose range. It is as likely to work as any other AD.

[Librella]

Thanks for the info.


As you're already taking it why not increase the nortriptyline dose into the therapeutic 75-150mg dose range. It is as likely to work as any other AD.

I have thought about this. My GI prescribed the nortriptyline, and my GP doesn’t seem to know much about it. They wanted to use lexapro instead but I said no to that for now. Thinking I might have to get a psychiatrist for this medication stuff. I’ll ask about the hydroxyzine too.

[panic_down_under]

My GI prescribed the nortriptyline, and my GP doesn’t seem to know much about it.

TCAs have a number of advantages and are arguably more effective than SSRIs and SNRIs, although as with everything AD related, YMMV. Unfortunately, doctors who qualified after the late 1980s often have little experience of them, or the even older MAOI class ADs, wrongly believing SSRIs and SNRIs are superior ADs when their only real advantage is being safer in overdose and even this isn't true for all of them.