Posted by Rick on September 11, 2000, at 2:35:30
In reply to Re: Squirrely? Donna Lynn, posted by annie8 on September 10, 2000, at 13:53:16
Donna -
Everyone reacts differently to different meds. But in placebo-controlled, double-blind studies, NO med has ever shown a greater Social Phobia response rate (near 80%) than the benzo Klonopin.
And that response comes FAST -- for me it was virtually immediate, and never let up. (Let me know if you'd like to see the actual study from Duke University.)Initially, my pdoc tried several different AD's and even a few other benzos for my severe but non-depressive Social Phobia. But almost as soon as I started Klonopin, I got my life back. 70% of my people-fear disappeared, and the remaining 30% became less acute (although I hardly became a "party animal"). Klonopin is a godsend for me.
The fear of scrutiny just dissolved away to normal, non-phobic levels.If you need QUICK (let alone the most effective) relief, try it! A psychiatrist will be much more likely to let you take it long-term than a general practitioner would.
After some week-one sedation, I have had no *negative* side effects from Klonopin, EXCEPT when doses were taken too close together (for me that's less than four hours apart), or when I took too much in one day. While optimal dosage varies widely by person, I think you would want to take 2mg/day MAX (in two or three doses), especially if you're also taking an AD. Indeed, I learned early on that Klonopin actually worked *better* for me when I *reduced* the daily dosage from 2.5-3.0 mg/day to 1.5-2.0 mg/day. Now, after a year, I take 1.25 mg/day (maybe up to 1.75 on days with extra-challenging events like big presentations or social events filled entirely with strangers). My pdoc (practicing 22 years) says that few people are prone to future withdrawal symptoms as long as they consistently stayed under 3.0 mg/day.
BUT...if you have abused drugs or if you drink more than a moderate (preferably low-to-none) amount of alcohol, let your doctor know this and be extra-careful not to take too much. (I've never taken the generic - clonazepam - but some people have suggested it's not quite as potent as the brand and may require a somewhat higher dosage).
As for sleep, you likely won't need sleep aids anymore, especially if you take some Klonopin at bedtime. The downsides to bedtime dosing are that you may become dependent on it for sleep; and that it's better to have peak blood levels of Klonopin when social challenges are apt to arise, rather than while you're sleeping. I have always taken most in the morning -- and none after 2 or 3 p.m. -- yet it instantly eliminated 95% of my insomnia (partly because it also reduces general anxiety). If you have sleep apnea or resiratory problems, try to take your last dose on the early side, since Klonopin can aggravate respiratory disorders.
You and I actually have some interesting parallels med-wise. After six months of Klonopin, with 70% relief of my Social Phobia symptoms day-to-day, I decided to see if I could "go for the gold" and close in on 100%. (BTW, if I gave you the FULL history, this post would become even lengthier.) But the first AD I tried adding (not counting a few PRE-Klonopin AD trials) was Celexa. This seemed to help a bit after eight weeks at 20 mg, but the extra relief wasn't worth the frequent fatigue, mental slowness, and moderate sexual dysfunction I was experiencing at this lowish dose.So I replaced the Celexa with -- you guessed it -- Serzone. There have been some small-scale studies suggesting Serzone's effectiveness in Social Phobia. Serzone seems to be a real wildcard in general, with some people experiencing major side effects/lack of efficacy in depression or anxiety...while it's been a no-side-effect but potent-relief med for others.
When I started Serzone (continuing the Klonopin, of course!), I started sensing some added benefits ater a few weeks. But (to a lesser degree than the Celexa) it sometimes made me feel a little lethargic and unmotivated. I convinced my pdoc to let me add the fairly new (to the U.S.) medication Provigil, whose only "official" designation is for narcolepsy. It is unrelated to potentially addicting and side-effect-prone traditional stimulants like Ritalin and aphetamines. While others on this board have had some problems with Provigil (sometimes related to concurrent or recent use of other stimulants, in my opinion), it has been a wonderful addition to my Social Phobia "cocktail". I have had no significant side effcts, and it started working on day one. Provigil eliminated the frequent lethargy (but had NO effect on my ability to sleep when I WANT to), and made me feel more alert, sharp, and -- here's the best part -- a lot more sociable. While Klonopin and Serzone removed the people-FEAR, concurrent Provigil made me gravitate TOWARDS people, made me more enthusiastic, proactive, assertive, and talkative. (Still no "party animal" by any stretch!)
Once again, it's essential to work towards the individulaized optimal dosage -- not too low, and not too high. (For me, "not too high" applies especially to the Provigil. Taking too much can cause a tinge of nervousness on a stressful day.) Right now, I've stabilized at 450mg/day Serzone, 100mg Provigil (occasionally 200), and of course 1.25 mg Klonopin (occasionally a little higher).
It's hard to say how much of that "go for the gold" benefit comes from the Serzone and how much comes from the Provigil. AD's often take a long time to begin working for Social Phobia (when they work at all). Indeed, the latter of the two Serzone Social Phobia studies showed the biggest leap in efficacy coming between weeks eight and twelve! Based on some recent studies (including some I cited in a new-topic post submitted here a few hours ago), I think the Provigil and Serzone are working synergistically. But I'm confident that at this point the Serzone would be helping even without the Provigil -- certainly a lot more than the Celexa did.
But, bottom line is still: If you need quick and effective relief, Klonopin is by far your best bet. And, whatever you do, don't let a doctor try to prescribe it on an "as-needed" basis! Regular use provides much better relief and eliminates sedation as your body gets used to the med. Also, no other benzos (e.g., Xanax, which I tried) compare to Klonopin for Social Phobia. (One placebo-controlled study showed some benefit from Ativan and/or Xanax, but with far less consistent relief than seen in the Klonopin study.)Good luck to you, Donna. You'll get through this!
Sorry for rambling a bit...
RickP.S. It is has been suggested that Serzone *may* increase the amount of Klonopin in the blood by delaying its metabolism. But this is only a hypothesis, based on Serzone's demonstrated doubling of Xanax concentrtions, as well as Serzone's MAJOR increase in Halcion levels (contra-indicated). But the official Serzone monograph has no warning to avoid concurrent Klonopin use. I know that I've experienced no problems. My decrease to 1.25 mg of Klonopin came back when I tried Celexa, not the Serzone.
P.S. #2 If anyone writes back about the dangers of sustained benzo use, I will not respond because we've been through this tiresome debate too many times. Sure, there are some people have difficulties due to a variety of factors, but I've seen fewer people complaining of low-dose benzo withdrawal than of Paxil or Effexor withdrawal. Used responsibly, benzos are very safe. Most (not "all") studies from respected researchers debunk the benzo myths...which even many pdocs cling to, unfortunately.
poster:Rick
thread:44488
URL: http://www.dr-bob.org/babble/20000905/msgs/44600.html