Brief Answer:
Occasional Xanax .5 mg will not lead to development of tolerance.

Detailed Answer:
Hello XXXXXXX

Sorry you are having a stressful time. Using Xanax occasionally to sleep should not lead to tolerance. Usually we see some dependence developing when patients take Xanax in a scheduled way, particularly dosing around the clock.

If you find that you are needing to take Xanax increasingly often, you may want to consider adding an SSRI for GAD. Escitalopram (Lexapro) has one of the best side effect profiles and earliest onset of action. Since you had a paradoxical effect with Trazadone, be sure to start on a low dose such as half the starting dose. Prescribing guidelines for Lexapro are to start all adult patients on 10 mg, but I have found that when people have a history of paradoxical reactions with psych meds it is best to start very low and increase slowly. It takes longer to start getting a therapeutic effect this way, but at least the medication is tolerated.

You are probably also aware of behavioral techniques for calming the mind such as mindfulness meditation. When people are not used to doing this sort of thing, I like to suggest "4x4 breathing". It can help calm and focus you fairly rapidly and is easy to practice. You get comfortable in a chair with hands in lap. Breathe in slowly counting to 4, focusing on the breath and breathe out the same way - 4 counts focusing on breath. Do this for 4 breath cycles. Then start over. To start with, do this for 4 minutes (you can go longer but it is easy to remember 4 minutes since everything else is "4"). When your mind wanders to anxious or agitating thoughts, gently acknowledge this and return to focusing on your breath.

One other thing: Forteo does have nervousness listed as a possible side effect, but as you mention that you are having a stressful time right now, the chances are less likely that it is a side effect of this medication.

i hope this information helps. Good luck to you!

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