Shown: posts 1 to 25 of 52. This is the beginning of the thread.
Posted by Greg on June 6, 2001, at 17:39:42
I'm thinking about asking my psych to switch me from Xanax to Klonopin at my next visit. I like the idea of a longer acting anxiety med and have been told it can be easier to quit it due to it's longer half-life. I have a couple of questions:
Can I expext the same effect from the same dose? I take .5mgs of the Xanax now, usually no more than once a day.
Can I expect some withdrawals from stopping the Xanax, or will the Klonopin keep that from happening?
Any input would be appreciated.
Tx,
Greg
Posted by PaulB on June 6, 2001, at 18:35:48
In reply to Xanax vs. Klonopin, posted by Greg on June 6, 2001, at 17:39:42
> I'm thinking about asking my psych to switch me from Xanax to Klonopin at my next visit. I like the idea of a longer acting anxiety med and have been told it can be easier to quit it due to it's longer half-life. I have a couple of questions:
>
> Can I expext the same effect from the same dose? I take .5mgs of the Xanax now, usually no more than once a day.
>
> Can I expect some withdrawals from stopping the Xanax, or will the Klonopin keep that from happening?
>
> Any input would be appreciated.
>
> Tx,
> GregTheres been a lot of information related to the type of questions your asking and its well worth scoping the previous postings-just type in xanax, klonopin and youll get loads. I have had experience with both Xanax and Klonopin.
Opinions vary as to the dosing equivalent of these two meds and there is in previous postings different peoples views.
I would think you would have the same effect from 0.5mg of Klonopin as you would Xanax. They are very similar meds but if it didnt I shouldnt think 1mg Klonopin would cause too many problems if you have tolerated Xanax well.
I certainly wouldnt think you would experience any withdrawl if you switch from Xanax to Klonopin straight away. Just think of it as switching from a short-acting xanax to a longer acting xanax with a kick. I think Klonopin is more powerful but again opinions vary.
Posted by gilbert on June 6, 2001, at 23:32:16
In reply to Re: Xanax vs. Klonopin, posted by PaulB on June 6, 2001, at 18:35:48
Just a quick thought. everyone responds two those 2 drugs differently. I have tried both and prefer the klonopin however I was forced to stay on the xanax because the klonpin made me semi impotent......really strange and not usual for the med so don't expect it for you I am a freak...I even tried it 3 times to mkae sure and each time after about a week on the med Mr happy got droopy. I think I am the only one on this board who has had this experience......also it seems that one or the other will depress you more depending on your own chemistry.....I get a fairly smooth ride out of the xanax not much rebound anxiety etc. but the klonopin is as smooth as silk no gaps with occasional jumpiness etc. You can switch right away they use klonopin to detox people off of xanax. Your doc should know the dosage and dr bob has the equiv. charts for benzos.
Gil
Posted by grapebubblegum on June 7, 2001, at 11:57:19
In reply to Re: Xanax vs. Klonopin, posted by gilbert on June 6, 2001, at 23:32:16
And just in case you didn't see it elsewhere, (not trying to nag you, my twin) consider that maybe the klonopin dose was just too high. I am getting GREAT panic attack relief on only .125 mg. 3 times per day (1/4 of a .5 mg tablet 3 times a day.) This might allow Mr. Happy to stay happy. Mrs. Happy is fine and then some; sorry if that's too much info.
And slightly off-topic, I have completely tapered off Paxil and feel fine except dammit if those brain-eyeball-freezes aren't dogging me. I mean, I'm almost afraid to look right or left because ot triggers "electric head," which happens without any apparent triggers anyway. I still don't know what it is except the explanation of a short-circuited beginning of a seizure sounds plausible but is not exactly comforting.
I'm just assuming it's harmless but annoying, and I hope it will go away soon. Just had one while typing the last sentence. I try not to dwell on it but it's an all day phenomenon and I hope it will lessen with time.
Posted by gilbert on June 7, 2001, at 13:41:36
In reply to You knew I had to jump in here, Gil , posted by grapebubblegum on June 7, 2001, at 11:57:19
HeY GBG,
I know you are very pro klonopin as am I. It worked so well for me I tried it 3 different times to make sure it wasn't all in my errr head...LOL. I even tried the reduced dose which gave me a slighter version of the problem. There is a study on the PUB MED research board where vietnam vets were given benzos for PTSD and almost on a consistent basis the vets given klonopin had erectile dysfunction. I can get the publication site for you if you need it. However diazepam and xanax and lorazapam gave no erectile difficulties to the other test groups. Now that was a male only study. My understanding was that klonopin actaully had a prosexual effect for females. With me there was no decrease in sensitivity or inabilty to orgasm just kind a like playing wiffle ball instead of hard ball.
Gil
Posted by JohnM on June 7, 2001, at 15:27:05
In reply to Xanax vs. Klonopin, posted by Greg on June 6, 2001, at 17:39:42
Klonopin is twice as potent as Xanax. 2 mg X = 1mg K. You may need to go 1mg X -- > to 1mg K at first, for the first week or so, but there won't be any dizziness, confusion or anything like that.
The long duration of Klonopin is nice. Try it out. You can always switch back if you want to.
Posted by Snowie on June 7, 2001, at 20:49:02
In reply to Xanax vs. Klonopin, posted by Greg on June 6, 2001, at 17:39:42
Greg,
I think everybody is different. I've tried both Xanax and Klonopin. The first time I tried Klonopin it worked almost too well, and it definitely gave my libido a boost. I went back to Xanax when I started having what I thought was depression. I had been taking 3 mg. of Xanax, and switched to 2 mg. of Klonopin, which worked fine. A few years later I decided to try Klonopin again and 2 mg. didn't do anything for me, and I had to take it just as often as I did Xanax. I also had breakthrough anxiety. I don't know if it was the generic or what, but I tried it again just recently and had a similar experience. Who would have thought Klonopin would poop out the second and third time around?
Snowie
> I'm thinking about asking my psych to switch me from Xanax to Klonopin at my next visit. I like the idea of a longer acting anxiety med and have been told it can be easier to quit it due to it's longer half-life. I have a couple of questions:
>
> Can I expext the same effect from the same dose? I take .5mgs of the Xanax now, usually no more than once a day.
>
> Can I expect some withdrawals from stopping the Xanax, or will the Klonopin keep that from happening?
>
> Any input would be appreciated.
>
> Tx,
> Greg
Posted by Daveman on June 8, 2001, at 0:18:39
In reply to Xanax vs. Klonopin, posted by Greg on June 6, 2001, at 17:39:42
Greg:
I used klonopin to taper off Xanax. It covered Xanax withdrawal symptoms and its long half life made for a smooth and relatively uneventful taper.
The one thing I noticed- and like everyone says, we all seem to react differently to these meds- is that Klonopin was, for me, quite a bit more sedating than Xanax, even at .5mg. In fact, I've kept it for p.r.n. use as a sleep aid for those nights when my bad insomnia hits. Xanax was mildly sedating, but klonopin is for me a stronger sedative (and longer lasting) even than Ambien. I've been told that tolerance eventually develops to this side effect, but I've never taken it continuously for long enough for this to happen.
Dave
Posted by grapebubblegum on June 8, 2001, at 1:02:33
In reply to Re: Xanax vs. Klonopin, posted by Daveman on June 8, 2001, at 0:18:39
Well, Gil, you know yourself best... and that was interesting that you mentioned post war vets because my recently deceased father who would have gladly joined the "Chuck E. Cheese's Frogs are us" club was a Korean war vet, and he told me he took a small dose of Klonopin only at bedtime to prevent nightmares.
Whatever med works for you. Yes, we all respond differently. I still don't know why Luvox sent me into a despondent state of blubbering tears, but I don't care; I just won't use it again. And I'm basically afraid of all SSRIs because they are near-death to my orgasmic function and life is short; I'll find something else that works if I have to.
Let us know what you and your doc come up with. Didn't you say you have an appt. soon?
I told my doc I'm on the No Paxil, just Klonopin routine and she wasn't thrilled but did approve it as a short-term (one or two months) plan. She is SO WARY of dependency and addiction. Why are doctors so prejudiced that way, even with patients who clearly don't exhibit addictive tendencies?
She mentioned that there are unresolved questions about whether benzos cause memory deficits in the long-term. I'm hoping I can use klonopin short-term only.
Cam, if you're out there, do you know about this memory loss theory? We all know benzos in high doses can cause short term amnesia... but long term? And she respectfully disagreed with your (I think it was you) idea that tolerance is developed to the motor effects but not the anxiolytic effects of klonopin; she said she has seen patients who need more and more of it over time for adequate anxiety relief and that is why the SSRI's are preferred and seen as "safer" for long-term use for panic.
Posted by Cam W. on June 8, 2001, at 9:22:03
In reply to Happen to be lurking around, Cam?, posted by grapebubblegum on June 8, 2001, at 1:02:33
Grape Gummer (GBG was too boring) - I use to think like your doctor. It is the people that keep increasing the dose that you remember. I tended to forget the bipolar patients taking one or two diazepam, oxazepam, clonazepam, or alprazolam daily for years and years (I, and many of my pdoc colleagues) find that people with bipolar disorder tend not to abuse benzodiazepines. We all do remember the ones who consistently come into the pharmacy 2 weeks early to get a month's worth of benzos, even with increases in dose. I tend to remember people who are in my face more often, than the ones who come in once a month to pick up their prescriptions, with no extra work involved (ie phone the doc to authorize early refills; the five calls from the patient in the next 2 hours to see if the doc called, although I said I would call when the doc called back; the excuses for being out early - "they fell in the sink while I was doing dishes"; "I was having a 'ginger ale' with a friend and he started fighting with me and spilled the ginger ale all over my pills"; "my friend came over and looked in my medicine cabinet, saw my Ativan and said, 'You don't need these', and crushed them under his heel"; "I left them in my pocket and washed them for the 3rd time this month". - All are true "stories").
Many times I think that there is almost a psychological thing about taking a certain number of pills a day, that equates into feeling better, with some people. This may be why some people do increase their dose. This, and the fact that the tolerance to the psychomotor effects makes it feel like the benzos are not working as well as they did.
I guess it also depends on whether one is using the drug for anxiety or whether they are using it for escape. "Escapers" tend to increase the dose. The anxiety, for them, may not be as critical as being able to "get away" for a while. I also find that those that use them for escape often use other drugs for escape, as well (eg. opiates, alcohol, pot, coke, etc.). Perhaps we should routinely do drug screens before putting people on benzos; although the praticality of this would be questioned.
As for your doc. I would be hesitant in writing benzos for patients, if I were a doc. After all, it would be my name on the prescription (and the license); and it would be me that would be called for that early refill (often by both the pharmacy and the patient). It would also be me that would be called if the person was caught selling the drug with my name on the label; and me that would be called if the person showed up in emerg, after overdosing on a drug that I gave. These are the people that I would equate with benzo use, not the 4 or 5 times more of my patients that take their benzos as directed (or less than directed) month after month, year after year.
I guess it comes down to whether one can tell if a person that one is writing that prescription for will use it for anxiety, or if that person will begin to abuse the drug. I know that I cannot tell the diffrence beforehand.
This is probably one reason why SSRIs are preferred over benzos. Also, SSRIs are safer in overdose, especially in polydrug overdoses; I believe SSRIs attack the " biochemical cause" of the anxiety more directly; and SSRI prescriptions are not monitored as closely as benzo prescriptions.
- Cam
Posted by tina on June 8, 2001, at 9:35:20
In reply to Re: Happen to be lurking around, Cam? » grapebubblegum, posted by Cam W. on June 8, 2001, at 9:22:03
You know I've taken both before and continue to take klonopin. I've been on it for ten years and haven't abused it at all.
I found the xanax worked faster but the klonopin works longer for me. The only drawback for me is that the klonopin is a bit of a depressant if taken for long periods of time. That's why my pdoc wanted to get me off it. She figures me depression stems from taking the K too long...yeah right. Anyway, like it says up there, ymmv but I don't see any diff between the two meds just that k lasts longer in your body.
love ya
T
Posted by gilbert on June 8, 2001, at 12:27:19
In reply to Re: Xanax vs Klonopin--Greg, posted by tina on June 8, 2001, at 9:35:20
It is of funny to me about the concern over benzo addiction. Of course we all know the dependecy vs addiction argument. I am very addictive. I have been to rehab three times and have been sober for 15 years now. I find that I feel way more stoned on an ssri or like I am on speed on Wellbutrin than being on xanax. The xanax just makes me feel "normal" for lack of a better word. The huge push for ssris for anxiety disorders did coincide with patents on benzos running out and new expensive drugs being pushed for panic that benzos were treating with a fair amount of success. All of the truly serious anxiety websites recommend benzo use and show it's efficacy superior to ssri treatment. I.E. Tapir, anxities.com, Dr Shipko and the Panic institute. The studies showing ssri efficacy on panic if you dig deep enough are usually sponsored by drug companies or paid for by drug companies with an interest in ssris. The ssri school of thought that benzos are addictive and your brain will shrink and memory will go is scare tactics to sell more ssris. I am not foolish enough to think that their are not those out there who abuse benzos...there are. There are people out ther abusing turpentine, there are people out there abusing ssris too. But study after study proves otherwise it is a very small minority. We are also finding out that the ssri's have dependecy problems, tolerance problems and withdrawal problems of their own. In my experience over the past 2 years of trying everthing and I mean everything the ssris have been the least cleanest drugs to get away from. The rebound depression and jones for some extra seratonin reminds me of my cocaine withdrawal and my jonesing days off the powder. I have detoxed off of vodka....cocaine....and other various substances and beilive me when I say this that coming off of antidepressants has mimicked those awful detox sysmtoms closer than any benzo withdrawal. I have come off xanax without much difficulty at all. Now I know some people have had a really hard time coming off benzos too so I don't want too sound pompous here. I just think that the stigma surrounding benzo use actually forced me to try drugs that made my condtion worse. I did not have the self esteem or fortitude to stand up for myself. My peers in AA and friends would say Gil get off xanax and try an antidepressant before the xanax leads you back to drinking.....what a joke. The closest I cam to drinking in the past 15 years was prior to getting xanax I was wound so tight I wanted to self medicate. I think my point is be carefull what is being sold to you. Very rarely do you find the right solution without doing plenty of homework on your own. Your body will tell you when it is right.
P.S. Grapebubblegum.....The doc said let's stick with what works stay on the xanax leave the rest alone see ya in 3 months so that is where I am today....Oh yeah also that vet study on klonopin and impotence I went back and looked 46 % of the klonopin users experienced impotence but the dose was like enough to knock out an elephant. I think it was from 3 to 5 grams per day. That would make everthing limp even my neck my head would be falling into my lap.
Gil
Posted by Elizabeth on June 8, 2001, at 15:37:36
In reply to Re: Happen to be lurking around, Cam? » grapebubblegum, posted by Cam W. on June 8, 2001, at 9:22:03
> I guess it comes down to whether one can tell if a person that one is writing that prescription for will use it for anxiety, or if that person will begin to abuse the drug. I know that I cannot tell the diffrence beforehand.
Hi Cam. I like your post, very thoughtful (as always) even though I don't agree 100%.
You never know for sure, but there are clues. Doctors tend to want to err on the side of caution. Personally I think that the risk that a patient will abuse the meds is outweighed by the risk that the patient will get inadequate treatment.
> This is probably one reason why SSRIs are preferred over benzos. Also, SSRIs are safer in overdose, especially in polydrug overdoses; I believe SSRIs attack the "biochemical cause" of the anxiety more directly; and SSRI prescriptions are not monitored as closely as benzo prescriptions.
This is a good point. Benzos are pretty safe in overdose by themselves, but when you add alcohol or other CNS depressants to the picture, all bets are off. (On the other hand, polydrug overdoses involving SSRIs can induce the serotonin syndrome, which is very hard to treat.)
I don't agree with the "biological cause" hypothesis (especially since there are so many varieties of anxiety), but many doctors do and that is one reason that they can be stingy about benzos.
-elizabeth
Posted by Elizabeth on June 8, 2001, at 15:47:38
In reply to Xanax vs. Klonopin, posted by Greg on June 6, 2001, at 17:39:42
> Can I expext the same effect from the same dose? I take .5mgs of the Xanax now, usually no more than once a day.
I would say that Klonopin is slightly less potent than Xanax -- i.e., a slightly higher dose may be required. I would expect your total daily effective dose (ED) of Klonopin to be somewhere between the ED of Xanax and twice the ED of Xanax. So for example, if you take 0.5 mg of Xanax four times a day (total 2 mg/day) then you would probably need somewhere between 2 and 4 mg of Klonopin daily -- maybe 1 or 1.5 mg twice a day, maybe 1 mg three times a day, etc.
Remember that the dose is divided up differently: Klonopin is typically taken at most three times daily, whereas most people who take Xanax need to take it at *least* three times a day. A consequence is that Klonopin is less likely to cause a "roller coaster" of anxiety/not-anxiety, but rather, smooth, normal-feeling relief.
Klonopin is certainly not *more* potent than Xanax. Also, YMMV -- you're not guaranteed to get the same effects from both drugs. In particular, some people report depression as a side effect of Klonopin, whereas that is very rare with Xanax. This is especially important if you have anxiety and depression.
Some people find Klonopin more sedating than Xanax at effective doses.
I find that 1 mg of Klonopin in the morning, 1 in the afternoon, and 2 at bedtime is about right for me. I've never used Xanax on an around-the-clock basis, but when I need it (this is usually for psychomotor agitation or panic attacks, and I've also used it for antidepressant withdrawal symptoms), it's usually in the 1.5-2 mg range, with 2 mg being more appropriate for panic attacks. If I were taking it around the clock I would expect to be taking about 4 mg/day (1 mg four times a day), but I would want to be able to take an extra 1 mg for breakthrough anxiety if needed.
I've thought about trying to use Xanax as an antidepressant; the dose requirement here is much higher, though -- probably at least 2 mg four times a day.
> Can I expect some withdrawals from stopping the Xanax, or will the Klonopin keep that from happening?
Klonopin -- provided you're taking a dose that is equivalent for you -- should block the benzodiazepine withdrawal syndrome that you would ordinarily get from discontinuing Xanax.
-elizabeth
Posted by gilbert on June 8, 2001, at 16:22:59
In reply to Re: Xanax vs. Klonopin, posted by Elizabeth on June 8, 2001, at 15:47:38
It is so weird I can take xanax once a day and not have rebound maybe I am a slow metabolizer. I also recall reading somewhere that people short on gaba have less side effects from withdrawal periods. The worst sensation I have ever even gotten from forgetting to take the xanax is a kind of low blood sugar feeling but nothing that makes me run for a needle and a spoon like you read about. I also think Elizabeth makes some very valid points. I have stayed on the same maintenace dose of xanax for the last year it still gives me the panic coverage I need. I have friends and family mebers on effective doses for over 10 years. The chances someone could get that long and stable of a result from the same ssri without increasing the dose or augmenting with a second drug or poop out is slim. The talk about how ssri's get to the root of panic disorder while benzos only medicate the symptoms is hogwash. Any drug I have taken with seratonin effects screws me up worse than prior to meds. Any drug with noraephrinine effects gives me tachycardia....Take a short term ssri and see what kind of roller coaster ride you get. I was on paxil and luvox talk about up and down. The benzos have been around along time. The studies on abuse even show people with panic and anxiety even ex addicts like myself don't abuse the meds. The abuse that comes from ER rooms and walk in clinics is different in that patients melt down the pills and shoot them either with heroin or cocaine. These are not people looking for a solution to panic disorder, these are people trying to slow their hearts down and still be able to shoot coke, or something to even out their heroin with. Very few street addicts would be happy with the results they get from swallowing the pills. They have to be torched and mainlined to get that instantaneous blast most addicts look for. Doctors and emergency room workers who have benzo beggars show up should look first for needle marks or crack smokers they ain't there just for the pills.....sometimes they will use the pills to get them from one fix to the next but it sure ain't for anxiety disorder. I have been around and worked with addicts for the better part of 20 years and no one I know was holding up a pharmacy for xanax or klonopin......It was not their drug of choice for abuse...it wasn't even in the top 10.....now demerol or morphine that's a different story.
I thank God my pdoc allows me the opppportunity for a normal life with the use of xanax.
Gil
Posted by Elizabeth on June 8, 2001, at 16:24:15
In reply to Re: Xanax use, posted by gilbert on June 8, 2001, at 12:27:19
> I find that I feel way more stoned on an ssri or like I am on speed on Wellbutrin than being on xanax.
I sympathise. I feel much more like myself on opioids than I do on typical ADs. Definitely not "stoned."
> The huge push for ssris for anxiety disorders did coincide with patents on benzos running out and new expensive drugs being pushed for panic that benzos were treating with a fair amount of success.
Antidepressants also tend to have more side effects, especially for people with panic disorder, than benzos do.
> All of the truly serious anxiety websites recommend benzo use and show it's efficacy superior to ssri treatment. I.E. Tapir, anxities.com, Dr Shipko and the Panic institute. The studies showing ssri efficacy on panic if you dig deep enough are usually sponsored by drug companies or paid for by drug companies with an interest in ssris.
I think this is plausible, but could you point me to some research showing benzos to be superior? They definitely work faster and without the initial period of increased anxiety; I'm thinking more of the long term (after the AD has had a chance to work). I have panic disorder and my experience has been that ADs work fine; when I was on them (I'm in the process of a switch right now) I never needed to resort to using my "emergency Xanax" for panic.
> The ssri school of thought that benzos are addictive and your brain will shrink and memory will go is scare tactics to sell more ssris.
I agree, although it is true that chronic benzo use (not necessarily abuse) causes long-lasting brain changes. It's *not* known whether these changes constitute "brain damage" or have any bad effects, though.
> I am not foolish enough to think that their are not those out there who abuse benzos...there are. There are people out ther abusing turpentine, there are people out there abusing ssris too.
Those are almost silly examples. But for kicks, try searching Medline for tranylcypromine and (abuse or addiction or dependence). Tranylcypromine *would* be a controlled substance under the Analogues Act if it hadn't already been in use when the Act was passed.
> But study after study proves otherwise it is a very small minority.
Yes. And furthermore, the very small minority consists almost exclusively of people who are abusing other drugs also.
Cam makes a good point that if you get into trouble with benzos, the doctor who prescribed them can get into trouble too. But you're right, doctors are overly benzophobic as a result.
> In my experience over the past 2 years of trying everthing and I mean everything the ssris have been the least cleanest drugs to get away from. The rebound depression and jones for some extra seratonin reminds me of my cocaine withdrawal and my jonesing days off the powder.
MAOI withdrawal is worse, but AD withdrawal is not generally associated with cravings. It's a pharmacological abstinence syndrome, not an addiction.
> I have detoxed off of vodka....cocaine....and other various substances and beilive me when I say this that coming off of antidepressants has mimicked those awful detox sysmtoms closer than any benzo withdrawal.
You're in the minority there, although this might have been because doctors didn't recognise AD withdrawal phenomena until relatively recently (so they just had their patients stop the SSRIs cold turkey). People who have experience with both often say that benzo withdrawal is worse than heroin withdrawal.
In most cases, there are ways to make drug discontinuation relatively painless. You can switch to a milder and longer acting drug (e.g., buprenorphine to get off of heroin, or Klonopin or Tranxene to get off of Xanax), for example. You can also try to treat the withdrawal symptoms with drugs like anticonvulsants (for benzos), or clonidine, propranolol, etc. (for opioids). This can work with AD withdrawal syndromes as well: switching from Effexor or Paxil to Prozac; using benzos, Benadryl or hydroxyzine, etc. to alleviate the withdrawal symptoms.
> I just think that the stigma surrounding benzo use actually forced me to try drugs that made my condtion worse.
That has happened to a lot of people: you're definitely not alone.
> I did not have the self esteem or fortitude to stand up for myself.
It's *hard* to stand up to doctors, AA members, friends, relatives, etc. when they're all pushing you to do something that you don't feel is right for you. Don't get down on yourself over it. There was a time when I was younger and feeling *very* demoralised I had a tough time standing up to doctors and psychologists, and it ended up making things worse for me too.
> My peers in AA and friends would say Gil get off xanax and try an antidepressant before the xanax leads you back to drinking.....what a joke.
What a joke indeed! Alcohol is a lame and toxic substitute for benzos -- if you have adequate doses of benzos, you don't *need* to drink. The idea that a history of alcoholism is cause to avoid benzos is just wrong -- morally as well as factually.
> Your body will tell you when it is right.
Amen.
> The doc said let's stick with what works stay on the xanax leave the rest alone see ya in 3 months so that is where I am today....
Stick with what works. Nice. I'm glad you've got a doc who understands that.
Oh yeah also that vet study on klonopin and impotence I went back and looked 46 % of the klonopin users experienced impotence but the dose was like enough to knock out an elephant. I think it was from 3 to 5 grams per day.
***GRAMS***????
I think this is the abstract of the study you mean:
Anxiety 1994-95;1(5):233-6
Clonazepam-related sexual dysfunction in male veterans with PTSD.
Fossey MD, Hamner MB.
Ralph H. Johnson Veterans Administration Medical Center, Charleston, SC 29401, USA.Medication-induced sexual dysfunction can significantly interfere with patients' quality of life and lead to poor compliance. This retrospective study examined the records of 100 male veterans with post-traumatic stress disorder (PTSD) selected in alphabetical order from an active treatment file of 230 patients. Forty-two patients had received clonazepam (mean maximum dose: 3.4 +/- 1.6 mg/day) at some point during their treatment. Of these, 18 (42.9%) complained of significant sexual dysfunction (primarily erectile dysfunction). Eighty-four patients received diazepam (mean maximum dose: 52.1 +/- 29.7 mg/day), nine received alprazolam (mean maximum dose: 5.2 +/- 2.8 mg/day) and eight received lorazepam (mean maximum dose: 3.8 +/- 2.4 mg/day). None of these patients complained of sexual dysfunction during treatment with these three other benzodiazepines. Our findings suggest that benzodiazepines, particularly clonazepam in the current study, can be a cause of sexual dysfunction in many male patients. Prospective studies comparing the overall clinical utility of various benzodiazepines are indicated in this and other clinic populations.
Some of those doses are high-end, but not outrageous. Klonopin 1.8-5.0 mg/day isn't at all unreasonable. 50 mg of Valium and 5 mg of Xanax are a bit high, but not too bad. Like I said (different post, same thread), the dose range of Xanax for depression is around 8-12 mg/day.
-elizabeth
Posted by gilbert on June 8, 2001, at 16:36:25
In reply to Re: Xanax use » gilbert, posted by Elizabeth on June 8, 2001, at 16:24:15
Thanks Elizabeth it is the study I read and I keep screwing up that grams thing on my post and scaring the hell out of people. Have you ever read any of the interviews of Stuart Shipko....or gone to his website. He has quoted some long term studies there. I will find the other web site studies and give it to you but I know Dr Shipko has some of that data. I have searched extensively on this topic to try and rid myself of the guilt of benzo use and I have not marked down all of the reasearch URL's But I will track a couple for you and get them to you.
Thanks,
Gil
Posted by lisa99 on June 8, 2001, at 21:24:22
In reply to You knew I had to jump in here, Gil , posted by grapebubblegum on June 7, 2001, at 11:57:19
feel fine except dammit if those brain-eyeball-freezes aren't dogging me. I mean, I'm almost afraid to look right or left because ot triggers "electric head," which happens without any apparent triggers anyway. I still don't know what it is except the explanation of a short-circuited beginning of a seizure sounds plausible but is not exactly comforting. > > > > > >
I've seen a zillion different names for the kind of funky symptoms all the various meds posted on this site produce, and brain eyeball freeze and electric head are pretty on target. Is there any research that puts these phenomena which we all seem to be suffering into "scientific" terminology which everyone understands and knows what is really going on?????
Posted by gilbert on June 8, 2001, at 22:19:32
In reply to Re: You knew I had to jump in here, Gil » grapebubblegum, posted by lisa99 on June 8, 2001, at 21:24:22
Elizabeth,
You said you were in the middle of a med switch if I am not prying too much what and why. I would love to have had a ssri work for me much more socially acceptable...almost hip to be on prozac now. People just love too know your balancing out your chemical problems. I just can't seem to get a dose that doesn't kill my sex life. My latest trial was 5 mg per day and still anorgasmia......did you also have to dose way down on an ssri. The only thing I didn't try was like 2.5 per day or 5 mg every other day and would ya think these doses would even be effective at blocking panic.....that's if they still didn't take away my sex life. My wife and I are very much in love she is 41 and hitting her prime...we enjoy each other very much I just am not willing to handicap or diminish those wonderfull moments of intimacy. Please don't any body follow up with how great it is just to cuddle and smile on the ssri while sex takes a back seat I have had ample time to cuddle whilst on my ssri's and while augmenting them with the so called cures..
Gil
Gil
Posted by Elizabeth on June 8, 2001, at 23:29:44
In reply to Re: Xanax Rollercoaster effect, posted by gilbert on June 8, 2001, at 16:22:59
> It is so weird I can take xanax once a day and not have rebound maybe I am a slow metabolizer.
Maybe. Its metabolism is mediated primarily by the cytochrome enzyme p450 3a6. How much do you take? I know some people who take the full daily dose in the AM and don't have need for more.
> The worst sensation I have ever even gotten from forgetting to take the xanax is a kind of low blood sugar feeling but nothing that makes me run for a needle and a spoon like you read about.
< giggle > Not with Xanax! (Some people really get fixated on the ritual of shooting up, to the point where if they don't have anything, injecting *water*
> I also think Elizabeth makes some very valid points. I have stayed on the same maintenace dose of xanax for the last year it still gives me the panic coverage I need. I have friends and family mebers on effective doses for over 10 years.
This is typical. Some people do develop tolerance, but that is rare.
> The chances someone could get that long and stable of a result from the same ssri without increasing the dose or augmenting with a second drug or poop out is slim.
Now, that, I don't know about. It seems to me that SSRIs do poop out, but it's not clear how frequent that is. Also, if there is a tolerance phenomenon, it is much slower than benzo tolerance can be for those who do develop tolerance to benzos.
> The talk about how ssri's get to the root of panic disorder while benzos only medicate the symptoms is hogwash.
Yeah. People try to make the same claim about opioids and depression. There's no evidence to support it.
> Any drug I have taken with seratonin effects screws me up worse than prior to meds.
Now, that may be an immediate effect related to the panic disorder. Study after study has shown serotonin sensitivity in people with PD. The chronic use of SSRIs decreases this sensitivity, I would bet.
> Any drug with noraephrinine effects gives me tachycardia....
How bad? (Like, how many beats/minute?) I regret giving up on desipramine because of this relatively minor and treatable side effect.
> Take a short term ssri and see what kind of roller coaster ride you get. I was on paxil and luvox talk about up and down.
Short-acting, you mean? I never took Luvox, but I got agitated/hypomanic on Paxil.
> The benzos have been around along time. The studies on abuse even show people with panic and anxiety even ex addicts like myself don't abuse the meds.
Yeah. The information hasn't had a chance to trickle down to the average community pdoc yet, though.
> The abuse that comes from ER rooms and walk in clinics is different in that patients melt down the pills and shoot them either with heroin or cocaine.
Yes: it's the people who are abusing other drugs who look for benzos in order to abuse them. Heroin addicts seem to have a general preference for sedative-anxiolytic drugs; cocaine users sometimes like the combination (like a milder speedball?).
> Very few street addicts would be happy with the results they get from swallowing the pills.
Here's something that gets me: making benzos, opiates, stimulants etc. hard to get by prescription doesn't affect junkies a bit because the black market is completely unregulated. It just makes life harder for people with pain or anxiety or ADD or depression.
> They have to be torched and mainlined to get that instantaneous blast most addicts look for.
That's true. I don't think most people realise that. I sometimes hear that someone gets a fantastic high from oral opiates; I never fail to be surprised. They're nice, no question, but it's not a rush. I don't even have a basis for comparison, but I don't get high from oral drugs -- nothing that I'd identify as a high, and nothing that anyone observing me would identify as a high, either.
> Doctors and emergency room workers who have benzo beggars show up should look first for needle marks or crack smokers they ain't there just for the pills.....sometimes they will use the pills to get them from one fix to the next but it sure ain't for anxiety disorder.
Hmm. Arguably, addiction often arises as a result of self-medication of anxiety or mood disorders.
> I have been around and worked with addicts for the better part of 20 years and no one I know was holding up a pharmacy for xanax or klonopin......
Holding up pharmacies. Jeez. Ever see _Drugstore Cowboy_? (Note that Bobby throws away a bottle of 10 mg Valiums; when you have a bottle of something ending in "-morphone" in your hand, Valium doesn't seem like much!)
> It was not their drug of choice for abuse...it wasn't even in the top 10.....now demerol or morphine that's a different story.
Morphine has poor bioavailability when taken orally. And Demerol is just weird, although I gather that IV Demerol is an experience like no other.
> I thank God my pdoc allows me the opppportunity for a normal life with the use of xanax.
And I'm glad for you. A normal life is what we all strive for.
-elizabeth
Posted by Elizabeth on June 8, 2001, at 23:36:59
In reply to Re: Question for Elizabeth, posted by gilbert on June 8, 2001, at 22:19:32
> You said you were in the middle of a med switch if I am not prying too much what and why.
I stopped taking Parnate because I didn't think it was doing me much good. I'm doing an experiment with Ultram at the moment, but otherwise I'm just taking buprenorphine and occasional benzos.
> I would love to have had a ssri work for me much more socially acceptable...almost hip to be on prozac now.
Forget socially acceptable; it's just *easier*. Prozac (up to 60 mg) and Zoloft (up to 200) were totally free of any side effects for me. Unfortunately they were also free of any other effects as well.
The only thing I didn't try was like 2.5 per day or 5 mg every other day and would ya think these doses would even be effective at blocking panic.....that's if they still didn't take away my sex life.
They might be effective. The way to treat PD with ADs is to start at a low dose -- like 10 mg of imipramine, 5 or even 2.5 of Prozac, 25 of Zoloft, 37.5 of Effexor, etc. -- and increase it very slowly. And hope you have Xanax handy while you're waiting.
Sexual dysfunction is a side effect that many pdocs don't take seriously enough (weight gain is another). The problem, I think, is that they can't put themselves in our place. Like, how would they feel if they put on 50 lbs, or couldn't have an orgasm anymore?
-elizabeth
Posted by gilbert on June 8, 2001, at 23:57:14
In reply to Re: Xanax » gilbert, posted by Elizabeth on June 8, 2001, at 23:29:44
Elizabeth,
What works for you. It seems we have similar paths like Grapebubblegum too. Here is my list of tried and failed meds...buspar, serzone, remeron, prozac, celexa, paxil, luvox, deseryl, pamelor, zoloft, elavil, klonopin,......and I know I am forgetting a couple. Now over the past 2 years I have given most ot these the good ole college try. Are you saying that if staying on ssri's long enough the side effects become less. My experience is otherwise. I was on only 5 mg prozac per day each time I tried it which was 3 times. The sexual side effects got worse and worse. I was on serzone and remeron not only did I get anorgasmia on both but I felt like a total zombie worse after each dose. Do you have any insight you could share with me. The xanax works best but it is not without it's drawbacks as well.......apathy etc....What's a neurotic middle aged male to do.....LOL
Gil
Posted by SalArmy4me on June 9, 2001, at 2:00:41
In reply to Re: Elizabeth what works for you, posted by gilbert on June 8, 2001, at 23:57:14
I was thinking of desipramine or an MAOI/RIMA for you. MAOI's are some of the most effective and potent antidepressants still on the market.
> Elizabeth,
>
> What works for you. It seems we have similar paths like Grapebubblegum too. Here is my list of tried and failed meds...buspar, serzone, remeron, prozac, celexa, paxil, luvox, deseryl, pamelor, zoloft, elavil, klonopin,......and I know I am forgetting a couple. Now over the past 2 years I have given most ot these the good ole college try. Are you saying that if staying on ssri's long enough the side effects become less. My experience is otherwise. I was on only 5 mg prozac per day each time I tried it which was 3 times. The sexual side effects got worse and worse. I was on serzone and remeron not only did I get anorgasmia on both but I felt like a total zombie worse after each dose. Do you have any insight you could share with me. The xanax works best but it is not without it's drawbacks as well.......apathy etc....What's a neurotic middle aged male to do.....LOL
>
> Gil
Posted by gheld on June 9, 2001, at 9:39:26
In reply to Re: Happen to be lurking around, Cam? » grapebubblegum, posted by Cam W. on June 8, 2001, at 9:22:03
> This is probably one reason why SSRIs are preferred over benzos. Also, SSRIs are safer in overdose, especially in polydrug overdoses; I believe SSRIs attack the " biochemical cause" of the anxiety more directly; and SSRI prescriptions are not monitored as closely as benzo prescriptions.You must mean that SSRI's are preferred by physicians who don't or won't spend the time necessary to accurately diagnose their patients as having anxiety or panic and not depression. Considering the side effect profiles I'd think a benzo would be preferable to an SSRI every time if it would work. I have never heard of a person dying or suffering any irreversible damage from an OD of benzo's. Have you?
Gordon
Posted by Cam W. on June 9, 2001, at 10:33:50
In reply to Re: Happen to be lurking around, Cam?, posted by gheld on June 9, 2001, at 9:39:26
Gordon - Yes, I have heard of several suicide deaths from from overdoses of benzodiazepines mixed with alcohol, resulting in respiratory depression. Also, more people have died from taking taking overdoses of benzodiazepines alone (granted, it is rare), while people who have taken massive overdoses of SSRIs alone have recovered without any problems. There have only been a few deaths reported in which someone has died from ingesting overdoses of SSRIs alone, but less than 10 worldwide (I believe).
As to considering the side effects profiles, the top ten side effects listed for any SSRI usually describe the start of side effets of these drugs, and disappear within 2 weeks in a vast majority of people.
The body has adjusted to a lack of serotonin by altering the mix of the other neurotransmitters. With an increase in serotonin, as a result of taking an SSRI, one must expect that the body would have to readjust the mix of other neurotransmitters, hence, the start up side effects.
If the depression/anxiety did not result in a decrease of serotonin and you add an SSRI, then, yeas, you are going to get side effects associated with excess serotonin. These side effects are similar to the start-up side effects and really, the only way to tell the difference is (sometimes) the intensity of the side effect and if the side effect does wane over 2 to 3 weeks.
Let's compare side effets profiles (in no particular order):
Rivotril™ (clonazepam - Klonopin™ -U.S.)
Most Common - CNS depression in approx, 50% of people, respiratory depression, aggressiveness, argumentative behavior, hyperactivity, agitation, depression, euphoria, irritability, forgetfulness, confusion, nystagmus, unsteady gait, slurred speech, dysarthria, vertigo, palpitations, gynecomastia, hallucinations, muscle weakness, low back pain, increased appetite, nocturia, hypersecretion in upper respiratory tract, urinary retention, enuresis....Prozac™ (fluoxetine)
Start-up side effects - headache, nervousness insomnia, anxiety, emotional lability, nausea, tremor, dizziness, diarrhea/constipation, myalgia, flu-like sympoms, anorexia.....Long-term side effects - decreased libido, anorgasmia, increased appetite, excessive sweating, fatigue, twitching, change in accomodation, acne, back pain, joint pain, dry skin, urinary tract infection, painful menstruation....
Choose your poison. (ref. Compendium of Pharmaceuticals and Specialties, 2000).
BTW - If your doc does not spend time with you, find one that does; one that you can trust and trusts you. My pdoc and I work closely together to monitor my progress. He is only a phone call away, day or night.
- Cam
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