PRN Meds, such as benzos

Sometimes I am unsure what warrants taking an "as needed"/PRN medication.
I think at times, I fight against what I am feeling so much and skip my klonopin when in reality, I really do need it. Before I know it, it's too late, and the anxiety hits really hard. Other times, I wonder if I resorted to my klonopin too soon and think about if I could have gone without it and tried to cope better.

In other words, I am trying to find a balance when it comes to determining when I should take my klonopin, before things get worse. What are some of the "warning signs" that intuitively tell you that it is time to take your benzo? Contrary to this, what tells you that maybe you can go without it when experiencing anxiety?

I fight with myself whether to take it or not take it.

For me it's the start of an anxiety attack or panic attack. sweaty, fast heart rate, difficulty breathing. Sometimes I take one when I am going to be around a lot of people.

I’m not sure why you’d fight with yourself over your choice. Do you feel guilty if you take it? With me, if I think I may need one, I take it ( in my case it is Xanax). This works better for me as the consequences of not taking it could be negative (panic attack, extreme anxiety, etc). General disclaimer: I am not a doctor nor have I ever played one on tv.

I have ativan and klonopin. I rarely take them. I'm working on managing my anxiety without meds. I don't take them unless my anxiety starts going through the roof. Sometimes I get panic attacks when I hold off too long. I'm okay with that in my journey. Do what works for you!

I have often had the same dilemma over using Klonopin. I try to look at anxiety-provoking experiences as an opportunity to practice my coping skills. But if I use those skills first and I still feel my anxiety building, then I will take the Klonopin. I try to take the lowest dose that will help reduce the anxiety and then continue using my management strategies.

Ain’t it the truth!

I'm fighting it right now and just caved and took .25
I think for me the fear of panic kicks in and I decide to take some.
That's what it's there for right?
But I also struggle with trying to use less.

I also wonder when it's appropriate to take my Ativan. Usually it's when my anxiety is on overload and I can't calm down. I don't wanna be dependent on Ativan so I rarely take it. Plus it makes me sleepy. Sometimes I only take half.

There could be reasons why I feel that guilt, that one poster mentioned above.
I went through a time where I was dependent on them and went off on them completely. Xanax was more problematic for me than clonazepam though. I went through periods of time where I would take them around the clock all day (with Xanax), but those days are over. They were during times where my anxiety was high, but it was against my doctor's recommendations. Now, I am trying to work on coping. I do have an addictive personality.

Now, I no longer take Xanax, and I'm on clonazepam. I want to avoid getting into a pattern of dependence again, so if I can get a good handle on using them "as needed."

I have had Xanax prn for 8 years now. I am also afraid of addiction (I have a history of alcoholism, so yeah, don't want that). I take it sparingly, and my pdoc says that I should take it more (he also has a history of alcoholism and is an addiction specialist, so you would think that I would trust him).

It's hard; finding a balance between taking what is needed and not taking too much. I don't have any great answers. I take it when the agitation gets unbearable.

It's a hard place to be for sure. I'm pretty much in the same boat. My pdoc and T basically say that there's no reason I can't use my Klonopin more if I need to. But, honestly I'm most worried about being addicted to it even though there's not really been any reason for me to be worried about.

Just, not feeling anxious is amazing!

I end up taking one if I know I'm going into a situation that's going to trigger my anxiety. (Plane rides as an example). Then I kind of play it by ear for other situations.
Do I need to be able to act like an adult and not shut down?
Am I having physical symptoms (chest pain is my big one)?
Have I used non-medicinal coping strategies?
What is causing the anxiety and will it end soon?

I've taken to being more liberal with my Klonopin, but I think part of that is realizing that I am an anxious person and life is better when I'm not wound up constantly.

I have been prescribed Clonazepam "as needed" for years. Some days I really do need it, most days I don't. I usually try to analyze why I'm getting so anxious and tense and if there is anything I can do to help it. If not, then I have no qualms about taking it. That's what it's prescribed for and I'm going to take it if I need it. I've been using Clonazepam judiciously for 15 years. No dependence or anything, but if I need it then I take it. I think benzos get a bad rap, when, in fact, if not abused, they are an excellent adjunct to helping manage severe anxiety.

Iv'e been taking Xanax for years too. For me prn means .5 mg 4 times a day . I'm officially hooked and would be in the ER, most likely, if my script was gone. I have had months where I was scrambling towards the end of the month because I either had a bad month and took too many, or because I just wanted to take too many.

The first time I ran out of Xanax, I was starting to get withdrawal symptoms. My Pdoc asked me why I took more than prescribed, and I told him "because they were nice". He was genuinely shocked by my answer. He told me he was expecting the same slew of excuses that most of his patients gave him in similar circumstances.

Moderation is key.

I have a bottle of 25mg of Quetiapine that was prescribed near 2 years ago to take as needed. You are right... where is that line between taking it and not needing to do so? I can't find it. I will ask myself, "Is it time? Is it time?" and haven't a clue. I've had some pretty rough goes with anxiety in hindsight but have most times told myself, "Nah, take it when it gets even worse"

This is interesting though because I can count on one hand I think the times I have lost all hope and taken a PRN. But two of those times have occurred in the last week and I doubled the dose each time.

I've taken Ativan before the only thing is I could barely keep my eyes open when I took it so I didn't like taking it unless I felt a huge need to. It made me superr drowsy and I believe it was only .5 mg

If quetiapine helps your anxiety at such a low dose I don't think you really need to worry so much about it. As far as addiction goes it's pretty innocuous. I take it at 50mg every night for sleep. I worry a whole lot more about when to take the Xanax.

Wonderfalls, it's not necessarily about addiction. It's about losing coping skills. If every time your anxiety level hits a certain level, you take your PRN, you'll never learn to manage that level. Of course, if the level is truly unmanagable, it's necessary. But if you also take it when the level is nearly unmanagable, and you do that too often, in the end you'll lose the ability to manage that level and that will also become unmanagable. Your threshhold will lower.

When I was first prescribed PRN benzodiazepines, my pdoc warned me about this. I suggested I write down every time I used it and the reason (basically: day, time, dose, reason (only a few words, maybe 4 or 5 if the reason was particulary complex) and sometimes the location (school, ward, home..), then share it during the appointments. He liked that idea and I did for a long time; almost immediately I also wrote down when I didn't use the PRN even though it might have been warranted, and used/tried to use coping skills alone.
I don't write it down like that anymore, although he does generally ask in session if I've used any that week and how many. I don't always remember exactly, but enough to give an indication.

I use the PRN mostly for these reasons: symptoms are interfering with attending classes at school (or interfering with work); flashbacks (a lot of things count as flashback, but I mean when I actually feel I'm in that situation again. If I don't 'handle' that I'll THINK I'm in that situation again, and I'll be screaming and thrashing about on the ground for about 2 hours. Maybe 90 minutes if I'm lucky. So I take a PRN to help prevent it from getting to that point, also because once I'm in the flashback, I'm not aware enough to take my medication even if someone were to put it to my mouth. I call the first - feeling I'm Back There - an incomplete flashback, and the second - knowing I'm Back There, and behaving as though I am - a complete one); severe anxiety that lasts longer than an hour or two; to settle down to sleep if I'm too agitated and sometimes anxious (unless I'm too afraid to be partially knocked out, then I won't take it). I also often take half a dose before tests; not for the performance anxiety (although it does help with that a little), but to take a tiny bit of the edge of so that if things go wrong, they'll go wrong more slowly and I'll be able to take a full dose before I'm too incapacitated. It depends, if I've had a good few days or week or month trigger/trauma/anxiety-wise, I'll probably not take it.
And sometimes for severe SI urges. I don't usually take them for SUI urges, either I'll 'defeat' the urges by internal motivation or I give in. Well, I might take the PRN if I have the unstoppable urge to use a method I know won't work.
Also for a while I used the sleeping PRN as a knock-out drug: if I was feeling particulary awful and it was 19.00 or after, I'd use the pill and go to sleep. It helped me a lot to be able to escape like that. (My rule for PRN sleeping meds (my pdoc has sometimes changed my PRN to a regular med for a few days or week or even a few weeks, but then I don't count them as PRN even though it's the same drug in the same dose from the same bottle) is that I never take them three nights in a row. (I came up with that 'rule', pdoc thinks it's sort of funny I think) Because I'm ****-retentive like that, that means I never take them two nights in a row: that would mean I wouldn't be able to take them the third night, and what if that third night would be the most awful night ever? (Pdoc thinks that's hilarious. 'You don't want to take it three nights in a row, so you don't take it two nights in a row.')
And I use them if a panic attack is likely and would also be extremely unhelpful. Such as before doctor's visits that I expect (or know) to include an uncomfortable physical observation, or if I'm rather anxious/agitated and have to go to PT or chiropractor (which causes me a lot of anxiety anyway, and I can't get treated if I'm having a panic attack).

Sort of funny is that I've been doing extremely badly these last 5 weeks or so, and if anything, my benzo use only decreased slightly. Mostly because - to paraphrase an email I sent to my pdoc - I use the benzo's to get back into balance, and I'm so far removed from balance it isn't even funny. They don't help enough and I have no idea when to actually use them because I'm totally not OK, never OK at any moment, and can't really define how notOK I am at any given moment.

Funny construction in my country is a PRN Bed-contract. It means you have a 'contract' allowing you to call the crisis ward 24/7 to talk to a nurse, then if that it isn't enough come by and physically have a chat with a nurse, then if that isn't enough stay the night (most are for 24 hours, as is mine, but I also know of 48 or 72-hours. Of course, you can always stay shorter). There are basically two constructions - one is that you can come as often as you want in a set period of time (usually 2 or 3 months, but they can be extended every time. I've had mine for just short of 4 years), the other is that you can come a certain amount of times in as much time as you want (e.g. 3 or 5 or 10 times). Or a combination - x times in 1 month. The 24-hour admission is done by the nurses - the on-call pdoc can be consulted, but that's only if necessary. (Some people have other rules, such as not being allowed to make use of the contract for 24 hours after self injury, drinking, ... because the contract is intended to be used to prevent crisis. Mine doesn't.)
I've called a handful of times, I think two or three times to talk to a nurse and a few more times because I needed something from a pdoc. My mother has also called a few times (e.g. when I was in my one and only manic moment (can't be really called an episode given that it lasted for less than half a day)). And I spent the night once.
(I usually talk to helplines if I want to talk to someone, because I feel at ease calling those just to chat, which I don't feel when calling the ward. I call the ward when I have a clear question or a problem that can be solved; I call a helpline for support. (I once walked away from home to commit suicide, failed, called the ward asking how to get back home. Not sure if I was really not sure how to get back, or if I was asking for help (hey, I did just try to kill myself, just wanted to tell you) and wasn't sure how to phrase it otherwise. Anyway, they had me call my parents or ask permission for them to call them I think? and they picked me up. By the way, a few hours later my own pdoc called me - he was the on-call pdoc that weekend and had heard about my nightly escapade)

For me, I was prescribed Ativan a few years ago. Only 10 pills. I have used I think 5 in total. I’ve been told that they are probably expired, so I may asked my pdoc to prescribe new ones.

But for me, I take them when I know that a certain event is triggering (ie presentations). I have taken them also when my suicidal thoughts were bad, or when I’m was having a random panic attack. I have taken it one time because my thoughts were racing so bad from anxiety that I couldn’t sleep... I think it depends. I also took it when I had really bad chest pain from anxiety too. I think it just depends on the person and what you believe isn’t manageable at the time.

It's great Breadfish that you have a system that works for you. It sounds like your condition requires a lot of support from different sources and that you're getting it. It would drive me crazy, though, to have such rigid rules and I'm afraid that my former or my current psychiatrist would be (indulgently maybe) annoyed if I always relayed to them a detailed list of when I did or did not use the drugs they've prescribed. It doesn't seem like anyone on this thread anyway just pops pills without trying to cope first.

The funny thing is that the list was actually my idea. Pdoc explained about using meds when you would still be able to cope, means you won't be able to cope at that level anymore at some point. I suggested I write down my use so he could keep an eye on it.
Nowadays he usually just ask whether I've taken any, but that is mostly to get additional information on how I am doing. If I've had a lot of PRN for agitation, it's another indication of my agitation.
Also adding to the list about when I didn't use the PRN was mostly for my own sake and insight, not for his. I just wrote it in the same notebook.

I️ take Ativan and I️ try to only take I️t when really necessary. I️ accidentally took 3 in one day. And I️ freaked out and didn’t take any for a week.

I️ can usually wait it out.

I used to have so very few of my Xanax that I never took them on time. I needed them so bad so I tried to save the few I was allowed to, so it became the opposite situation. It made my panic attacks come much more often because I saved the pills. And it is much harder to stop than prevent an attack. Meaning I needed more pills compared to prevented it. I got really frustrated with that situation.

Somewhere along the lines I was allowed daily usage. It is actually oddly connected to me having so few at first, it made me more worried because I couldn't have more panic attacks than the pills allowed me to. If I had been allowed a little more and a little more lax to use them, but still not enough to take daily, I don't think I would've been so high anxiety that I needed them more often.

It's dang complicated.

Lately, I am noticing that my PRN benzos are not working as well, because my AP has been lowered. Since my AP isn't doing enough to control my anxiety and agitation, I think if it's increased, I won't feel like I need to use klonopin as often. I only started having to use klonopin more often recently, and I noticed it became that way when my Seroquel was lowered....so it's definitely time to increase the Seroquel.