Posted by Alan on December 28, 2002, at 13:33:34
In reply to Re: Why is Klonopin? - many uses long half life » chad_3, posted by bluedog on December 24, 2002, at 19:26:31
> > My opinion is that:
> > 1) Long half life unlike xanax and ativan
> > 2) Less sedating than most benzodiazepines
> > 3) Long shot best benzo for Social Phobia
> > 4) Good for panic at low dose
> >
> > 5) Good for many "antipsychotic wounded" people - the best common drug for most tardive movement disorders... Many here use it as a/p substitute once their aquired brain lesions from the a/p.
> >
> > 6) Combines well with the serotonergics which dominate the patented drugs right now - provided the sertonin add-in does not cause too much sedations and sexual side effects.
> >
> > Chad
> > http://www.socialfear.com/
> >
> >
> > > Does anybody know why almost everyone on this board who takes a benzo takes Klonopin? It definitely *is* the benzo du Jour. Once in a while I see Xanax mentioned on this board, but Valium, Ativan, Librium are almost unmentioned. Anyway, maybe they are mentioned, and I just don't see it. However, I've got to say that it seems 90% of all benzo posts are about Klonopin. Why is it the popular one?
> > >
> > > MB
>
>
> Hi Chad, I have a question for you.
>
> I am a long term social anxiety sufferer. I live in Australia and for whatever reasons (the reasons are always medico-political) there are many more legal restrictions on doctors prescribing Klonopin rather than Valium and the doctors actually prefer to prescribe Diazepam over Klonopin in Australia which appers to be the exact opposite of the situation in the USA.
>
> So I guess you could say the in Australia (at least the State in which I live) Diazepam is actually the Benzo "Du Jour" with Temazepam probably sitting on an equal footing with Diazepam though Temazepam is more often used for insomnia problems. For these reasons my PDoc preferred to put me on Valium rather than Klonopin for my social anxiety.
>
> It just so happens that Clonazepam has been the drug that has been the most heavily researched in relation to social anxiety. However have you seen the following 2001 study? I have higlighted with capitals the part of this abstract that caught my attention!!!
> ==================================================================================================
>
> http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11206035&dopt=Abstract
>
> 1: J Clin Psychiatry 2001;62 Suppl 1:50-3 Related Articles, Links
>
> Benzodiazepines and anticonvulsants for social phobia (social anxiety disorder).
>
> Jefferson JW.
>
> Madison Institute of Medicine, Inc., and the University of Wisconsin Medical School, USA. JeffJ@healthtechsys.com
>
> Both benzodiazepines and conventional anticonvulsants have been evaluated as treatments for social phobia (social anxiety disorder). Among the benzodiazepines, clonazepam is the best studied, ALTHOUGH THERE IS REASON TO EXPECT THAT ALL BENZODIAZEPINE ANXIOLYTICS WOULD BE EFFECTIVE FOR THIS CONDITION. Among the anticonvulsants, gabapentin and pregabalin, an analogue of gamma-aminobutyric acid (GABA), have been shown to be more effective than placebo in double-blind studies. Other than a small negative open study of valproic acid for social phobia, there is a paucity of information on whether other anticonvulsants might be useful for this condition.
>
> PMID: 11206035 [PubMed - indexed for MEDLINE]
> ==================================================================================================
>
> Chad my question for you is as follows:-
>
> With Diazepam also being a long acting benzo can you see any reason why the reasons you state in your post about Klonopin would not also apply to Valium?
>
> Thankyou and regards
> bluedog
============================================From my POV, this thread makes a lot of great points...the research, the politics of medicine,etc.
My own view is that there is no inherent superiority amongst bzds FOR ANY GIVEN INDIVIDUAL when it comes down to the treatment of anxiety.
That's why it's important to be able to try, as an individual, all of the bzds as necessary.
Anxiety disorders share with them common symptoms but originate from individual cases/causes that no one yet knows what necessarily differentiates the specific origins of symptoms amongst individuals. How much is genetic, mow much is behaivioral for instance is just one of the questions. Is there an underlying physiological problem yet undiscovered - one that falls through the cracks of the standard panel of tests normally given to rule out physiological causes (celiac disease for instance)?
That's why up to a certain point, the plethora of research and evidence while informative doesn't apply to individual cases. Individuals are not statistics as is obvious.
It is relatively easy to, with the help of an enlightened physician that knows this class of meds well, perform their own clinical trial in order to see what works best for them. It's relatively easy to switch out the different bzds if done with guidance since one gets an almost immediate effect in order to evaluate (as opposed to AD's, anti-convulsants, anti-psychotics, etc).
The problem is finding a physician that is up on their stuff and will, with all of the politically, morally, and commercially driven benzophobia, listen to their *individual* patient as to what they are telling them.
If xanax or ativan works markedly better than klon or valium, then the patient needs instruction and support about keeping up with their dosages so there is a steady state achieved with the relatively shorter half-life versions. It is the pragmatic approach as I see it (and have experienced it myself).
If klonopin works better than valium for any given individual, what in the end is the difference what the bzd of the day is?
In my opinion we as individual patients deserve no less expertise, understanding and compassion that originates from the attitude and outlook of our physicians.
Alan
poster:Alan
thread:132156
URL: http://www.dr-bob.org/babble/20021223/msgs/133516.html