Posted by Rick on July 9, 2001, at 4:15:13
In reply to Re: One more try - Klonopin and Wellbutrin, posted by Joe Schmoe on July 8, 2001, at 19:38:55
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> > There are certainly a minority of people who fall outside the typical pattern. It's generally been felt -- even by non-benzophobic docs -- that benzos should be "used cautiously if at all" for individuals with a history of substance abuse or addiction. But some very recent studies are demonstrating that even this caution has been overstated in many cases.
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> I wonder how "substance abuse" is defined. Are we talking people who smoked pot in college, or hardcore crack users trying to quit their habit?I'm just paraphrasing what I've read, but I'm sure it's much more the latter.
> What do these people do? Just take higher and higher doses of Klonopin to try to get high?
Maybe. I know that some of my newsgroup searches on Klonopin have come up with posts in the recreational drug newsgroups. I think it's sold on the street for to be used in some kind of combo. I'm no expert here. Also, as I noted, recent studies are suggesting that past episodes of alcohol/drug addiction or heavy recreational drug use shouldn't necessarily raise a red flag for benzo-based treatments. That conclusion makes intuitive sense to me. Everyone's situation is different; these things aren't black and white.
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> > Can't you make sure you have at least a little Klonopin on you at all times, say in a little pillbox? (CVS has a great unobtrusive little round one. I taped some cotton to the bottom of the lid to keep the pills from rattling around as I walk.)
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> How similar our lives are. I have a little round gold pillbox that I pad with tissue paper so the pills don't rattle around, that I keep Xanax and Inderal in. I am always afraid of someone finding it - when sitting in deep chairs I find sometimes it slips out of my pocket (women have an advantage with purses!) and I have left it behind on chairs before. Of course when I realized it, there was a frantic search to go find it before someone else did. The big problem is not the convenience, it is trying to hide this stuff all the time. I usually keep it in my locked messy desk drawer at work now to avoid this problem. It also keeps my body heat from breaking down the medicine as it would if it was sitting in my pocket all the time. I am tempted to put it in some kind of prescription bottle, say a Claritin one or something, and just not make an effort to hide my taking it. I am tired of sneaking around. There must be a way for men without purses to work these things into their lives conveniently.Yes, this all sounds REAL familiar to me! Things constantly fall out of my pockets. But the pillbox has only fallen out a couple of times, and I've always been fortunate enough to notice it -- say when I open the car door and see it lying by the seat. I think somehow the fact that I keep it in the same pocket as my comb helps. Maybe the comb keeps it from falling out. I do know that I find myself reflexively pushing it deep into my pocket when I sit down or get up.
At least once or twice a month I forget to take the pillbox with me. That's created a little bit of worry and social anxiety on a few occasions (especially the first few times), but nothing too significant. My early-to-mid afternoon doses of Klonopin and Serzone are beneficial but seem a lot less essential than the larger doses I take first thing in the morning. In fact, I often forget to take the afternoon dose. Even with somewhat decreased benefit in a few cases, I'm stil SOOOO much better off than pre-Klonopin. Those really seem to provide the bulk of the "steady state feel".
I've sometimes dropped a pill on the floor in my office, hoping that no one walking by sees me scavenging around looking for it. While I'm still as discreet as possible (especially when I'm at the client's office, where I'll usually go into a bathroom stall to take a pill), I'm no longer as concerned about someone seeing me pop my afternoon regimen. I seem to be seeing more people, including my boss, openly downing pills from a pillbox. The Claritin bottle idea is a good one,.
I found your comment about degredation from heat interesting. I've never thought about it in terms of pocket heat, but I've had a lot of situations where I will, say, pick up a prescriotion at lunchtime and then have to decide whether I should leave it in the hot car for four hours (shaded whenever possible), or take it inside and try to keep it hidden away while also remembering to take it with me when I leave. I've done both. I've often wondered how much I should be concerned with the med breaking down in sit-in-the-car-in the hot sun situations.
> >Even if you took Klonopin regularly, missing a day probably wouldn't be too awful because of the long half-life.
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> I was more worried about missing a few hours than a day. If you are on an all-day assignment somewhere for example, it would be a catastrophe if your xanax ran out halfway through the day!I highly doubt that will be as much of an issue with Klonopin, especially if you do take some every morning, as I believe you said you were doing or considering. I would think that ths would keep you well above "catastrophe" level at minumum -- especially if the Wellbutrin turns out to be helpful for your SP. BTW, I assume that you've checked out your caffeine sensitivity, if you're a coffee, tea or Coke drinker. I never would have believed that largely avoiding caffeine (during the week, anyway) would make a noticeable difference in social anxiety for me, but it really does. I think cutting back on caffeine is one reason I've been able to reduce the Klonopin dosage several times.
> >Did you run out of Xanax a lot?
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> More of a case that I could really tell when a dose was wearing off. The anxiety would shoot upwards. Was it just my normal anxiety returning, or was it benzo-caused rebound anxiety? It is hard to tell, but it was a nasty effect, especially since it might take 30 or 45 minutes for the next dose to kick in. People would see you go from jumpy and nervous to dopey in the course of an hour. It must raise suspicions. And then you start taking the second dose earlier to avoid the anxious period between doses, and pretty soon you are taking more per day than you are supposed to because you don't wait the full time period between each dose...
Hope the Klonopin helps smooth that out. I bet it does.> > How distressful were the shakes? How much were you using at the time, and on what schedule?
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> I am an excellent responder to Xanax. My "mild relaxation" dose is .25 mg Xanax, and my "get ready to stand up and talk" dose is .5 mg. I have never taken more than that. .5 really knocks me out. If I take it around noon, it works for anxiety for maybe three hours, wears off, and then I start to get real tired, so by the time I get home I collapse on the couch and sleep for three hours in the evening. I am taking about occasional use mind you, not the "rebound" jumpiness that occurs with regular use. I have never taken xanax often enough to get a rebound reaction/shakes when a dose wore off, except that one month when I was tapering onto the imipramine long ago. I did not develop tolerance to Xanax in that time but I was addicted. When a dose started to wear off I was reaching for that bottle pretty quick, and when I came off it at the end of that month, for withdrawal I had overwhelming anxiety, muscle rigidity (neck would turn in little jerks, like a Parkinson's patient) and so on. That was over a decade ago and it was under bad circumstances (I had to do all this while working in a fairly stressful environment in a new job, and hide everything I was going through) so I have blotted much of this memory out. Suffice to say I have never been tempted to abuse xanax in the decade since, despite always having a bottle of it within reach. I get nervous if I take two or three Xanax doses in the same week, even though I know ratonally I would have to take it for weeks to get addicted.I know Xanax has a shorther half life than Klonopin, but I'm surprised that the effects would wear out in three hours. Or now that I think back to my own experience with Xanax, maybe I’m not *too* surprised...I know when I took as-needed Xanax (my first-ever med for Social Phobia, in tandem with Nardil), it relaxed me to some degree by making me feel a little doped-up. I didn't really like the feeling, at least not in a work setting. It was as if I was drinking but without much cognitive degredation. (Is it the same for you by any chance?..or is the pre-crash impact strictly mental?...or would you describe your acute reaction in a completely different way?)
Xanax would make me feel exhausted hours later, usually as soon as I got home. I never had any craving for more except when I couldn't sleep. That was one hell of a sleeping pill for me when I was keyed up! Oddly, it quickly seemed to become less effective even for this. Whereas one .5 mg would zap me into dreamland for awhile, I got to the point where even 1.5 mg wouldn't do it if I was really keyed up. Since starting daily Klonopin, rarely taken after 4 p.m., I have trouble getting to sleep only about one night every month or two. And even then, I nod off in not much more than 30 minutes. I still have about fifteen Xanax's left from my original, 4/99 prescription of 90 .5 mg tabs (30 times three refills), since insomnia is no longer an issue.
One more thought...I wonder if your body metabolizes Xanax quickly. If so, the same might happen for Klonopin. But it should still exert an effect lasting at least twice as long as Xanax's, probably even longer.
> > BTW, how are things going so far with the new meds? I know it may be a little early to talk about theraputic benefits, but is everything going OK side-effect-wise?
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> Very well. The first few days on the Wellbutrin I felt very upbeat (probably a little mania, I got this when starting Serzone as well) and high/euphoric (I assume this is the dopamine effects of Wellbutrin kicking in). I felt like I had taken a happiness pill. I mean it felt great. Since upping the dose to 300 mg I feel more normal. I went sparingly on the Klonopin at first but now I am taking it several times a day to get used to it. It is very subtle, doesn't make me continuously yawn like the xanax would.Sounds like an auspicious start.
I forgot about the yawning! I was afraid people would think they were boring me. Celexa also had that effect on me big-time, as did some of the other meds I tried, to a lesser degree. I still get into that mode about once every week or two.
> The chemistry is complicated here. I am not sure if .5 mg per dose will be enough Klonopin; and if it isn't, I am not sure if that is because of the Wellbutrin; and if it is because of the Wellbutrin, I am not sure if that is because I have to get used to the Wellbutrin, or whether the Wellbutrin will always be activating and require more Klonopin even after the initial three weeks. In time I will get it sorted out. I suspect I may have to take more Klonopin for the first few weeks till the Wellbutrin settles down, and then cut back on the Klonopin. But that is assuming the Wellbutrin will settle down. It has not really made me anxious yet, except for occasional tightness in the chest which the Klonopin seems to relieve, but the effect of the Wellbutrin could well be simply negating some of the benefits of the Klonopin. I wonder if Wellbutrin becomes less activating after two or three weeks? I am definitely enjoying the reduced appetite (I am somewhat overweight) - wonder how long that will last!
Yeah, it's hard sorting these things out when you have to start both meds at once (even though that's what most pdocs want you to do, since they typically view the benzo as a temporary augmentation or adjustment aid to the AD). All of the possible scenarios you presented are plausible, and it sounds like you’ve already got some good “contingencies” in mind. There are a lot of current and past Wellbutrin users on this board, likely including some with both Social Phobia and some shade of depression. Would be interesting to see what they have to say about adjustment to Wellbutrin activation.
> Thanks for all the information. The data on Konopin sounds very positive. My question is this: what is your dosing regimen? Do you take it three times a day? It sounds like that would be, say, 7 AM, 3 PM, 11 PM. But what is the point of taking a social anxiety drug at 11 PM at night? Is it to avoid a withdrawal reaction, or is there some therapeutic benefit to maintaining steady-state of this stuff?
Frankly I don't think there *is* much benefit to taking it at bedtime, and I don't. I initially avoided bedtime dosing because I had sleep apnea (since gone away since I shed quite a few pounds), which can be exacerbated by benzos. So I inadvertently learned that I didn’t need a bedtime dose. (The logic of an 11 p.m. dose seemed strange to me, too.) The aforementioned fact that Klonopin helps me sleep, even though I often take my final dose as early as 1 p.m., should be testament that -- at least for me -- 3-time dosing is unnecessary to maintain consistent benefit.
I find it *very* important to make the first dose the biggest one - 2/3 to 3/4 of the daily total. I usually take the rest of the daily amount 5-7 hours later. If there's a difficult challenge coming up (e.g. a big presentation) I might change the timing a little so that I get some an hour ahead of the event. Once in awhile I'll take an extra .25 (or even .5), especially if I'm facing a whole day of social. business-social and/or performance situations, say at an out-of-town convention. But I find the "extras" less and less necessary as time goes on. I do have two rules that I've learned I need to follow consistently: 1) Never take more than 1.0 mg at a time, and 2) Don’t take doses of any size less than 4, preferably 5, hours apart. If I violate either of these the result can be sedation/dopey feeling and some loss of effectiveness.
But, again, the worst that happens with some variation in the routine is a temporary, modest degradation in effectiveness, not an “Oh, shit, I’m f**d” situation. I obviously can’t guarantee the same will apply for you, but I’d be surprised if you don’t see significant movement in that direction vs. your experience with as-needed Xanax...especially after the gradual experimenation and fine-tuning.
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> Thanks again. So far I have been taking Klonopin once a day (first several days) and then twice a day (the last several days). Have not taken one late at night yet.I'd suggest you don't. The few times I gave that a try, I just woke up groggy.
poster:Rick
thread:68599
URL: http://www.dr-bob.org/babble/20010708/msgs/69449.html