Posted by S.D. on October 23, 2000, at 21:19:59
In reply to Re: AndrewB, S.D., and JohnL, posted by Billb on October 16, 2000, at 20:10:54
>However, I have tried 2 mg. of clonazepam daily
> and feel such a positive step change I am
> reluctant to further experiment. I am told
> that clonazepam is addictive and is therefore
> non-desirable, however, it is such an effective
> social anxiety med. My doc. is reluctant to go
> with the clono because it is potentially
> addictive. Wow, life has gotton good since
> clono, what should I be watching out for?If you got your clono some way without your doc,
watch out for running out! I wouldn't expect
major Withdrawal effects after only a couple
weeks, but still...
Regarding withdrawal effects, search medline
( http://www.ncbi.nlm.nih.gov/PubMed/ ) for
studies of this. My impression of my recollection
from when I studied this is that severe and
longlasting effects are rare, and significantly
biased towards people who used it for, say, 2+
years or used unusually large amounts, or both.
I don't have access now to the relevant article
titles, but it's best and easy enough to search
for yourself. I do recall finding
one or more studies showing a constant moderate dose
for at least a few months working well and not
causing any significant withdrawal problem.
These article abstracts may ease your mind. And
if you don't want to change doctors, maybe showing
these to him/her will be persuasive.
(I've had difficulty acting assertively
like that with doctors, but I bet on clono
we both could do it!)But if your doc really isn't gonna go for it, dump
him/her! I'll bet any psychdoc and even primary-
care doc would be happy to give you all the Paxil
you wanted, but only *some* psychdocs will be cool
with clonazepam. So find one that will prescribe it
and haul ass!! I'd bet such docs are on average
the better ones anyway, meaning that I think bias
against it is more likely to be due to lack of
knowledge than willingness to prescribe it is.
Maybe you can call around to find out who will
prescribe it, or maybe they all want their $$
for "initial evaluation" session before they'll
talk to you.
If you do have to "go in blind", here's possibly
a way to increase the chance of getting one that
prescribes it when appropriate:
I've been to three private-practice pdocs; the
last two were listed in the 1996 or 1997
edition of the book "The Best Doctors in America",
which noted 'psychopharmacology' was one of their
subspecialties. I don't know any better way to
get this subspecialty (indicated by the doc
him/herself) information.
Neither of these psychiatrists volunteered clon.
as a '1st line' choice for social anxiety but were
comfortable with it when asked.
This book is no longer published. The method
was to poll doctors as to who, in their own
specialty, they would send their dear sick mother
to. I don't know if these are really the best
doctors; anyhow, check your local library.Since even most withdrawal problems are handled
by tapering off as slowly as needed, something I'm
personally more concerned about is cognitive impairment.
That is, as with other benzos, studies have measured
negative effects on memory and 'mental sharpness'
in some way, persisting long after discontinuaiton
in some cases. Ironically, while many docs are
too afraid of 'addiction potential', my experience is
that none have volunteered info on this cognitive
effect, or considered it important when asked about it.
A person is unlikely to notice his own
impairment, and I'm not saying it is severe. But
since I depend on my brains more than my charm and
good looks, my plan was to quit within 9 months or so,
having in the meantime had enough exposure therapy
to make the changes stick. I'm heartened that I've
had good results with a low 1.25mg/day Klonopin, but
still I gotta quit sometime.The last thing I want to suggest you watch out for
is Brand-name Klonopin vs. a generic clonazepam.
1) some who've had both say Klonopin is better, or
stronger for the same dose
2) Klonopin is more expensive (likely even if
you have insurance) but not bad.
I think my copay was $55 for 100mg.
Cheap at 10 times the price,
for a chance at having a real life.
3) Pharmacy probably will fill with generic unless
you specifically state Klonopin every time
you refill it.
4) I read this tip somewhere, maybe here:
There are multiple makers of generic clon.
so your pharmacy might switch makers on you
and of course won't think to tell you.
The gist of what I remember reading is that
the potency of two makers' generic could
differ from each other enough to knock some
people for a major loop.>Should I try the 60 mg. of Paxil and see what it
> does before I demand clono?
As I recall, 40mg paxil was doing it for you for
depression, but not SAD. Maybe there is a study
out (good ol' pubmed) that compares dose to response
for SAD. If not, maybe let your current side effects
guide you since I presume 60mg will be worse than 40.
> Is clono a long
> term solution?From the studies on withdrawal and cognitive problems
that I mentioned above, being rare but probably increas-
ingly likely with long (years) term use, I think even
most doctors who use it would say no, not like with
many antidepressants for which the conventional wisdom
seems to have moved alot toward accepting multiyear use.
Moreover, published studies tend to show that patients
who were treated only with clonazepam relapsed sooner
(although I wonder if these people remained isolated
after discontinuing the med., because if the clon.
allows you to engage in more social situations, isn't
that in fact 'in vivo exposure therapy'? Or is there
a specific way you have to do the exposure for it to
be 'therapeutic'?)
Take the clon & get some behavioral/exposure-type therapy
(by 'self-help' book if you prefer or circumstances dictate:http://www.amazon.com/exec/obidos/ASIN/0967126509/drbobsvirte00-20
http://www.amazon.com/exec/obidos/ASIN/1879237237/drbobsvirte00-20
http://www.amazon.com/exec/obidos/ASIN/0380783991/drbobsvirte00-20)
The former should make you more able to do latter,
as you have already discovered.
"Cognitive Behavioral Group Therapy" (CBGT) is a phrase
you will see perhaps more than any other, regarding
psychotherapy treatments for SAD. I didn't
think I could face a group situation like that before
Klonopin (and once dropped out of a therapy group that
wasn't even for SAD treatment) but I bet I could now
(too bad very few exist specifically for SAD) and
judging by your comments I'll bet you could too, or
maybe you don't need it and the self-help will be enough.
If you've read this far, thanks, and I hope some of it helps.One request for Billb:
From your comments, clon. must have been as good or better
for you even that it is for me (and it's darn good for me -
right now, you'd have to pry it out of my cold, dead hands
to take it from me.)
Can you tell us about one or two positive experiences
you've had since it kicked in? I think many people would
get a boost from reading something like that.> SAD in SC
SAD in SD
poster:S.D.
thread:42531
URL: http://www.dr-bob.org/babble/20001022/msgs/47209.html