Posted by 3 Beer Effect on January 28, 2002, at 23:28:14
In reply to Re: klonopin alone or in combination?, posted by audrey on January 28, 2002, at 15:13:43
Buspar has been proven to NOT be effective for social phobia/anxiety. I have been posting on this board for quite a while, & have never met anyone that has found Buspar effective for anything. Doctors like Buspar because it, unlike the benzodiazepines, is not prone to abuse, but from research I have read, it doesn't seem to be a very effective drug.
Since you had too much anxiety & insomnia with Paxil, you probably won't fare well on any of the other SSRIs. Paxil is the most sedating of the SSRIs so if it gave you insomnia/anxiety then all of the others will too, probably worse.
As far as Klonopin goes, less than 1 mg/day is usually ineffective (according to a Harvard Medical School Study). Most people on this board seem to be on several different medications either to cancel out side effects from other medications or because they have a 'heavy' diagnosis such as Bipolar disorder etc. that warrants multiple medications.
Klonopin will work very well by itself & can be used with Buspar but that is not a very popular combination, probably because most people who start benzodiazepines never go back to taking Buspar probably because it seems much less effective.
The usual starting doses of Klonopin are either 1 or 1.5 mg/day & it is "increased in increments of 0.125 to 0.25 mg bid every 3 days until panic disorder is controlled or until side effects (somnolence, drowsiness) make further increases undesired. It is possible that some individual patients may benefit from doses of up to a maximum dose of 4 mg/day." "Daily doses between 1 & 2 mg offered the best balance of therapeutic benefit & tolerability" (for panic disorder)- Roche Laboratories.Most studies I have read about the effectiveness of Klonopin for social phobia used much higher doses than the 1 to 2 mg Roche recommends for panic disorder. The dosage for social phobia is generally 2-4 mg/day depending on how much is tolerated before the patient becomes excessively somnolent or drowsy. This higher dosage probably works better for social phobia because Klonopin has serotogenic properties (but without the side effects & insomnia of SSRIs) & is a social disinhibitor at high doses.
The half life of Klonopin is usually 30-40 hours but its duration of action is about 12 hours, & so if you suffer from insomnia it might be better to divide it into 2 daily doses 12 hours apart, one in the morning & one an hour before bedtime. I think most people, because of the long half life just take Klonopin in the morning- if you are most concerned about daytime anxiety (e.g. social phobia) this might work better.Some tolerance with Klonopin occurs but that takes awhile (about 2-3 months). Tolerance & depedence to Klonopin have been greatly exaggerated & confused with other, more addictive "immediate gratification" benzodiapines such as Xanax or Ativan. A slow taper when discontinuing Klonopin prevents any problems with dependence/withdrawl. Withdrawl from Klonopin is nowhere near as bad as SSRI withdrawl, & though some rebound anxiety occurs the patients anxiety level is usually LESS than when they started benzo therapy.
I would personally use only name brand Klonopin, especially if you have medical insurance, since some material I have read suggests that generic versions of benzodiazepines are often inferior (Roche laboratories invented Valium & Klonopin).
poster:3 Beer Effect
thread:91852
URL: http://www.dr-bob.org/babble/20020124/msgs/91971.html