Posted by Rick on November 12, 2001, at 2:11:31
In reply to Re: klonopin......Thrud, posted by PaulB on November 11, 2001, at 3:02:57
Interesting perspective.
In the U.S. Klonopin/clonazepam's two formal indications are epilepsy (certain types) and panic disorder. Even though it was introduced as an anti-epileptic here years before the PD indication was added, I'd wager that PD and many off-label uses account for the lion's share of Klonopin scripts. This is because it's such a versatile and effective med, and also because there are so many new anti-convulsants which may hold some advantages in that arena.
As you may know, some of the many uses of Klonopin include several forms of anxiety (besides PD, it's especially effective for social anxiety, as I can personally attest), a sweeping variety of movement disorders, as an adjunctive med in unipolar and especially bipolar depression, as an adjunctive med for OCD (I have my doubts about efficacy there), and for pain management.
I was personally introduced to Klonopin's versatility in a quite unexpected way. Shortly before I started taking Klonopin for social anxiety in summer 1999, I had been planning to finally see a TMJ speciaist about the frequent facial and jaw pain that I had been suffering through for about ten years. (Over-the-counter pain medications had provided me zero benefit. My sister was treated for bruxism-induced TMJ with a bedtime splint, and my boss was treated for TMJ with three surgeries.) As time passed I realized that the unsually long facial-pain-free period that started about the time I began taking Klonopin for social anxiety seemed to have become permanent. Later I did a Medline search on TMJ and clonazepam, and sure enough there was a study that discussed how Klonopin effectively treated TMJ pain. Now that was certainly a very pleasant and unexpected "side effect"! I still have virtually no problem with facial pain, even though I'm only taking 1 mg/day of Klonopin.
BTW, apparently many benzos are used as anticonvulsants, but none of the other meds in this class seem to be as effective as Klonopin.
Rick
> The themes written about in the posts on depression and Klonopin are issues that I have looked into in the past. I thought they were interesting to read and would add that Klonopin, I think, is different from Ativan, and other typical benzodiazepines with pro-GABA effects only because it is also an anticonvulsant, with marked sodium cannel blocking properties. This for a start can help to alleviate or worsen depression. In fact in the UK, Clonazepam is marketed almost exclusively as an anticonvulsant under the trade name Rivotril. Klonopin's seroternergic properies stem from its metabolite mCPP which is an agonist at the 5-HT2c receptors. This metabolite is metabolised by the CYP2D6 isoenzyme so Im sure it doesnt take long for the liver to metabolise it too quickly to have any effect. The only other reason I can think that Klonopin is likely to cause or worsen depression, more so than the other benzodiazepines is because of its high-potency. It very tightly binds to the bz receptors to exert its anti-anxiety action. This may cause a more severe dampening of the monoamines in the brain.
> PaulB
poster:Rick
thread:83124
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