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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 17 of 17. This is the beginning of the thread.
Posted by Else on June 24, 2001, at 11:27:09
I have recently gone of the Zoloft I was taking to
control my social phobia because I didn't like the
side effects. Now I take two daily doses of Rivotril
(Klonopin) 0.5mg. This barely affects my baseline anxiety
and I haven't had the nerve to test it in a stressful
social context yet. I have been told this dose is too
small. Any opinions? I have been on it for two weeks only.
Posted by judy1 on June 24, 2001, at 12:24:44
In reply to How much clonazepam is needed for SP?, posted by Else on June 24, 2001, at 11:27:09
I have panic/bipolar disorders and take 6mg of klonopin/day (2mg tid). That is considered a fairly hefty dose. I know my shrink starts his patients on .5mg tid but I'm sure every individual is diffrent. If you are not too sedated and have not noticed an anti-anxiety effect by now then you are probably taking too low a dose and should discuss it with your doc. I hope you are doing some sort of therapy in conjunction with the med. take care, judy
Posted by PaulB on June 24, 2001, at 12:28:32
In reply to How much clonazepam is needed for SP?, posted by Else on June 24, 2001, at 11:27:09
> I have recently gone of the Zoloft I was taking to
> control my social phobia because I didn't like the
> side effects. Now I take two daily doses of Rivotril
> (Klonopin) 0.5mg. This barely affects my baseline anxiety
> and I haven't had the nerve to test it in a stressful
> social context yet. I have been told this dose is too
> small. Any opinions? I have been on it for two weeks only.PaulB >
Clonazepam is my favourate benzodiazepine for anxiety because it works very well and it has a good half-life. Rather than taking it twice a day it can be an ideal benzodiazepine for 1x daily dosing. It may not build up in your system 1x daily like Valium and yet does not require the 2x daily dose of Xanax. Taken at 9.00 in the morning the effect will last till 9.00 in the evening.
Theres two good links at the dr-bob.org homepage which I am not sure you have looked at yet, one on panic disorder an done on social anxiety disorder and both cite Clonazepam as an effective treatment for both:
The treatment is initiated with 2mg/day of Clonazepam divided in two doses 1mg lunch and 1mg bed time. If the patient gets too sleepy he can stay for one week or even more with 1mg bed time only......one, two, three weeks into this schedule the patient starts to say he is a new person'
This indicates that at 2mg a day, twice what your are taking the response can take a short while but once a therapeutic amount of the drug has built up in the blood stream you may then at some point have to cut back.
This is the kind of question which Im sure your under the guidance of your physician for and if you didnt see a response at your current dose it would be his/her decision as to adjust the dosing but if you didnt continue to see a response at this dose then at least you could perhaps use this approach as a guideline, knowing that if you got too sleepy you could come off the Clonazepam for a week with no withdrawal/rebound anxiety.
Posted by Rick on June 24, 2001, at 18:41:32
In reply to How much clonazepam is needed for SP?, posted by Else on June 24, 2001, at 11:27:09
I completely agree with what Judy and Paul wrote, but with one big caution:
The Brazilian Social Phobia article in the Tips section of Psycho-Babble always gets me kind of angry, because it implies that typical doses are much higher than they normally are. Yet Dr. Bob insists on leaving this 1996 study as the sole Social Phobia link, even though is getting toasty and runs quite contrary to more stringent Klonopin studies and anecdotal reports.
Even 3 mg is considered a high dosage for most people. I did MUCH better on 1.5-2.0, and I'm not a small guy. I wonder how many people have read that misguided "3-6 mg" recommendation, took too much, and decided that Klonopin/Rivotril was ineffective or had too many side effects when in fact it could have been so beneficial at a lower doses.
Absolutely, a minority of people may require heftier doses, as is the case with Judy. And someone once suggested that perhaps generic clonazepam in Brazil is weaker than in the U.S. or Canada (for this med only, I insist on the brand). But the great majority of people should not require more than 3 mg.
Here is a Medline abstract of the definitive, placebo-controlled study on clonazepam for social phobia:
J Clin Psychopharmacol 1993 Dec;13(6):423-8
Treatment of social phobia with clonazepam and placebo.Davidson JR, Potts N, Richichi E, Krishnan R, Ford SM, Smith R, Wilson WH.
Department of Psychiatry, Duke University Medical Center, Durham, North Carolina 27710.
Clonazepam and placebo were administered in a double-blind pilot study to 75 outpatients with social phobia. The mean maximum dose of clonazepam was 2.4 mg/day at endpoint (range, 0.5 to 3 mg). Treatment was continued for up to 10 weeks. The results of an intent-to-treat analysis indicated superior effects of clonazepam on most measures. Response rates for clonazepam and placebo were 78.3 and 20.0%. Drug effects were apparent on performance and generalized social anxiety, on fear and phobic avoidance, on interpersonal sensitivity, on fears of negative evaluation, and on disability measures. Significant differences were evident by week 1, 2, or 6, depending upon the rating scale used. Clonazepam was well tolerated in general, although unsteadiness and dizziness were more severe and persistent than was the case for placebo subjects.
----
> I have recently gone of the Zoloft I was taking to
> control my social phobia because I didn't like the
> side effects. Now I take two daily doses of Rivotril
> (Klonopin) 0.5mg. This barely affects my baseline anxiety
> and I haven't had the nerve to test it in a stressful
> social context yet. I have been told this dose is too
> small. Any opinions? I have been on it for two weeks only.
Posted by Else on June 30, 2001, at 19:47:26
In reply to How much clonazepam is needed for SP?, posted by Else on June 24, 2001, at 11:27:09
Thank you all for the advice. What got me questionning my dosage was an article I read describing a study that
was done at a hospital near where I live (Montreal,Canada). The researchers obtainned excellent results with a
mean dose of 3mg but since there were only 5 participants (who were probably men as is usually the case), the
dose does seem quite hefty. However, for a while I was on Ativan 6mg daily and felt fine, that is, completely
"cured", and did not even feel drowsy (I was still somewhat insomniac, actually). I was taken off because my
(former) doctor felt uncomfortable keeping me on such a high dose. I am a 100lbs female but I think my
nervous system is that of a roadrunner. Anyhow, my doctor is not too keen on prescribing large doses of
benzos even though the Neurontin he has me on now makes me even more ataxic. I'll get this figured out in two
weeks I guess. Thank you all.
Posted by Rick on July 1, 2001, at 2:25:08
In reply to Re: How much clonazepam is needed for SP?, posted by Else on June 30, 2001, at 19:47:26
>The researchers obtainned excellent results with a mean dose of 3mg but since there were only 5 participants (who were probably men as is usually the case), the dose does seem quite hefty.
The breakthrough study I quoted on clonazepam in SP had decent female representation: about 40% of both the test and placebo groups were female. And there were a lot more than 5!
>However, for a while I was on Ativan 6mg daily and felt fine, that is, completely "cured", and did not even feel drowsy (I was still somewhat insomniac, actually). I was taken off because my
former) doctor felt uncomfortable keeping me on such a high dose. I am a 100lbs female but I think my nervous system is that of a roadrunner. Anyhow, my doctor is not too keen on prescribing large doses of benzos even though the Neurontin he has me on now makes me even more ataxic. I'll get this figured out in two weeks I guess.If the alternates don't do work as well for you as the 6 mg. Ativan, you should try to get a second and even third opinion as to whether and why it needs to be ruled out. Granted, there may be bad withdrawal (as with the "safe" AD Effexor) or even addiction in a small minority of cases with a short-acting anxiolytic like Ativan. And concomitant use of excessive alcohol or recreational drugs can cause serious problems.
But overall benzos are safe drugs. Damn safe drugs. Safer than AD's.
Best wishes, Else.
Rick
Posted by Else on July 1, 2001, at 14:40:13
In reply to Re: How much clonazepam is needed for SP? » Else, posted by Rick on July 1, 2001, at 2:25:08
> >The researchers obtainned excellent results with a mean dose of 3mg but since there were only 5 participants (who were probably men as is usually the case), the dose does seem quite hefty.
>
> The breakthrough study I quoted on clonazepam in SP had decent female representation: about 40% of both the test and placebo groups were female. And there were a lot more than 5!
>
> >However, for a while I was on Ativan 6mg daily and felt fine, that is, completely "cured", and did not even feel drowsy (I was still somewhat insomniac, actually). I was taken off because my
> former) doctor felt uncomfortable keeping me on such a high dose. I am a 100lbs female but I think my nervous system is that of a roadrunner. Anyhow, my doctor is not too keen on prescribing large doses of benzos even though the Neurontin he has me on now makes me even more ataxic. I'll get this figured out in two weeks I guess.
>
> If the alternates don't do work as well for you as the 6 mg. Ativan, you should try to get a second and even third opinion as to whether and why it needs to be ruled out. Granted, there may be bad withdrawal (as with the "safe" AD Effexor) or even addiction in a small minority of cases with a short-acting anxiolytic like Ativan. And concomitant use of excessive alcohol or recreational drugs can cause serious problems.
>
> But overall benzos are safe drugs. Damn safe drugs. Safer than AD's.
>I fully agree. I don't understand why everyone is so freaked out about benzos. They are some of the least toxic drugs availlable. And even if addiction was as big a problem as they make it out to be, I would rather be addicted to these innocuous drugs than miserable. I wonder what percentage of americans are addicted to coffee and couldn't get up in the morning without it?
>
> Rick
Posted by Pattisun on July 2, 2001, at 20:43:05
In reply to Re: How much clonazepam is needed for SP?, posted by Else on July 1, 2001, at 14:40:13
Okay, I've been taking generic Klonopin for 6 years now. Started out at about 3 mg/day then finally got it down to a dosage of .5 twice/day. I take it around noon, when I feel the anxiety building, and then around 2-3 in the afternoon.
I am very happy with this med and will fight like heck if anyone ever takes it away. I had to change medical providers because a new doct wrote on my file "DO NOT GIVE THIS PT KLONOPIN"--and she sent me to a psychiatrist who wrote her back and said my Klonopin/Paxil combination is a very common, sound solution for a person with panic disorder (and Graves-hyperthyroid disease).One problem I had with my panic attacks is the shallow breathing. A psychologist told me that Klonopin changes the CO2 levels in your system. So, if the attack is really bad (like I do something dumb like ride a big roller coaster)-- I can take one pill, sit still and try to deep breathe, and whalla !!!
So, try and get a higher dose from your doctor to get your anxiety under control; attend COGNITIVE therapy--it works well; then you can work on reducing your dosage.
Patti
>
I agree with your statement Rick:" > I fully agree. I don't understand why everyone is so freaked out about benzos. They are some of the least toxic drugs availlable. And even if addiction was as big a problem as they make it out to be, I would rather be addicted to these innocuous drugs than miserable. I wonder what percentage of americans are addicted to coffee and couldn't get up in the morning without it?
> > Rick"
> > I'M NOT A COFFEE HEAD, but with all the Starbucks here in San Diego, I'm sure there are lots of those addicts out there!! Patti
Posted by Rick on July 2, 2001, at 22:50:24
In reply to Re: How much clonazepam is needed for SP?, posted by Pattisun on July 2, 2001, at 20:43:05
>I agree with your statement RickIt was actually Else's observation, seconding my assertion that benzos are safe drugs overall. But
we're obviously all in agreement here.That's really something about how the new doc issued the "no more Klonopin" edict! I wonder how much time she spends at Starbuck's?
Posted by sar on July 4, 2001, at 3:06:12
In reply to Re: How much clonazepam is needed for SP? » Pattisun, posted by Rick on July 2, 2001, at 22:50:24
I'be been on .5 mg klonopin twice daily for about a week now.
it really does lessen my anxiety, but I've been pausing alot in speech and have been having trouble remembering simple words...so, in a way, this new stupidity kind of *heightens* my anxiety.
i guess i'm on clonazepam not klonopin. i'm on the generic version, is there a difference?
klonopin has helped me to like myself a bit more, but how can i do a decent job @ work or school on this stuff? is there a better alternative?
clonnazepam makes me feel like, joyfully retarded. what a trade-off.
Posted by Rick on July 4, 2001, at 5:14:07
In reply to Re: How much clonazepam is needed for SP?, posted by sar on July 4, 2001, at 3:06:12
Is clonazepam making you feel kind of tired or sedated or mildly woozy at this point (for more than short periods of time)? If so, that may be causing the problem you describe, and it will likely improve in a week or two as your body adjusts.
If, on the other hand, you can't feel the clonazepam physically but you're still having the cognitive problems, why don't you try taking less, say .75 mg. (e.g., .5 + .25). You may find this maintains all or most of the SP benefit while alleviating much of the cognitive problem. Some peoples' body chemistry is such that they can get by on as little as .5 a day.
I don't know if you've ever used an antidepressant, but people often have word-finding difficulties on those, too.
Yes, there are a lot of meds that can help with Social Phobia if you continue to have a problem with the clonazepam. They might or might not work as well for you. Sometimes a tradeoffs or trial-and-error are required. Another option is adding something to the Klonopin that can help with cognitive function, like low-dose selegiline (but NOT if you're taking an AD!!), but in my (layman's) opinion it would be premature to switch or add meds this soon, based on the response you described.
Rick
Posted by sar on July 4, 2001, at 5:59:43
In reply to Re: How much clonazepam is needed for SP? » sar, posted by Rick on July 4, 2001, at 5:14:07
Rick,
thanks for your informative response.
my diagnoses (all up in the air, i'm young & have been seeing psychs for a few years) are numerous but unconfirmed. The order in which I received them: social phobia, depression, dysthymia, GAD, and these next 2 are *really new and up in the air*--borderline/bipolar.
i'm a cocktail unto myself, eh?
i'm going to ride out the klonopin a bit longer based on your positive remarks about it. i feel so much more affectinate and relaxed, i just wish i could carry on a damn conversation without forgetting complex words like "and" and "the." i'm also on 40 mg prozac, have been for a few months, but did not experience the word-finiding difficulty 'til i started taking klonopin.
i have one more question. i feel bad asking it. i drink everyday. i drink like a fish, actually. i know know know know that this is very wrong and bad, but will it reduce klonopin's effectiveness? do you know? just wondering.
ahhhhh in forty years i'll be in a muu-muu slurping down valiums and mai tais. kriste. i hope not.
i think my depression and social phobia largely go hand-in-hand. the old "which cmae first, the chicken or the egg?" question. i don't know.
all i know is that sp bothers the hell out of me and i want to feel COMFORTABLE, as comfy as i can...you think klonopin is the best? not Neurontin?
thanks,
sar
Posted by Else on July 4, 2001, at 11:48:02
In reply to Re: How much clonazepam is needed for SP?, posted by sar on July 4, 2001, at 5:59:43
I find this so strange. My level of tolerance is such that even if I take 2mg in the middle of the day I don't even feel sedated and I have not been taking these for long. I used to take Ativan but that was a year ago. On 0.5mg I feel nothing special. I need at least 1mg to tackle my anxiety and I would probably need 3mg to use it as a hypnotic. Neurontin makes me dumb and ataxic as well but it's not as bad as it was at the beginning. Right now I feel just fine and I can work and write and do whatever. Perhaps it's just a natural tolerance or maybe it's because I'm a regular drinker (I have about a beer a day, usually less on average, say 4-5 a week). Anyway, I guess that's the reason why doctors prescribe such *small* doses to me. They aren't so small to other people.
Posted by Rick on July 6, 2001, at 2:15:18
In reply to Re: How much clonazepam is needed for SP?, posted by sar on July 4, 2001, at 5:59:43
> Rick,
>
> thanks for your informative response.
>
> my diagnoses (all up in the air, i'm young & have been seeing psychs for a few years) are numerous but unconfirmed. The order in which I received them: social phobia, depression, dysthymia, GAD, and these next 2 are *really new and up in the air*--borderline/bipolar.
>
> i'm a cocktail unto myself, eh?Not so sure about that, but I got a kick out of the way you expressed it. Very poetic. I am sorry to hear that you're dealing with so much, but it's good you're addressing these things early. It's highly unlikely that all of the above describe you; different pdocs and therapists come up with different diagnoses for the same person. In terms of meds, though, a lot of the same drugs are used to treat the various disorders you mentioned.
> i'm going to ride out the klonopin a bit longer based on your positive remarks about it. i feel so much more affectinate and relaxed, i just wish i could carry on a damn conversation without forgetting complex words like "and" and "the." i'm also on 40 mg prozac, have been for a few months, but did not experience the word-finiding difficulty 'til i started taking klonopin.
Sorry to be so blunt, but if you drink heavily you shouldn't be taking Klonopin at all. Most importantly, mixing benzos with too much alcohol really can present a health risk, potentially even lethal. One or two drinks might be OK, but beyond that your're taking big risks. Alcohol also tends to worsen depression. And it's a health risk in a lot of other ways, too. Again, I'm talking about *heavy drinking*, not mild or moderate. (Although I was warned by several social phobics who used Klonopin before I did not to drink *at all* when using K.) Really, for your own well-being you should make an all-out effort to cut the boozing down to a reasonable level. If you just can't, you should probably stay away from benzos completely.
Besides the risks, alcohol does lessen Klonopin's effectiveness. For me, it lessens it significantly. That's why I avoid having more than, say, one beer in a social setting. (Even with that litle booze I know I'm going to lose part of the Klonopin benefit. But I'm very booze-sensitive.) With people I'm really comfortable with, I might have two beers, or a hard drink.Finally, alcohol definitely increases any Klonopin side effects. So if it has a mild "dumb-down" effect for you taken with Prozac, that effect could be greatly magnified when you add booze into the mix. If you can, try not drinking for a few days and see if you experience less cognitive decline form Klonopin than before.
Is the Prozac helping with your depression? If so, didn't it help any with your social phobia, too? Neurontin doesn't help with SP in as many cases as Klonopin, but given your drinking habits maybe you should give Neurontin a try instead for safety reasons. A lot of people do respond to Neurontin. Cognitve problems can occur with Neurontin for some people, and again alcohol would probably magnify that effect. (But at least this combo wouldn't be as risky to your health.)
>
> i have one more question. i feel bad asking it. i drink everyday. i drink like a fish, actually. i know know know know that this is very wrong and bad, but will it reduce klonopin's effectiveness? do you know? just wondering.
>
> ahhhhh in forty years i'll be in a muu-muu slurping down valiums and mai tais. kriste. i hope not.
>
> i think my depression and social phobia largely go hand-in-hand. the old "which cmae first, the chicken or the egg?" question. i don't know.
>
When someone has a chronic anxiety disorder, it's usually the unrelenting anxiety that leads to depression.
Posted by sar on July 6, 2001, at 13:11:07
In reply to Re: How much clonazepam is needed for SP?, posted by Rick on July 6, 2001, at 2:15:18
Rick,
Thanks again. i'm writing this drowsily because i woke up early to go with a friend to an AA meeting at 7 this morning.
right, i agree with you on the subjectivity of all those diagnoses! too much doc-hopping; plus everyone's dynamic, everyone changes, and all this dx'ing began 5 yrs ago (i feel like a diferent person now.)
be blunt! thank you for your bluntness! i knew i was being stoopid drinking on klonopin--oh Rick, one of the first days I was on it I drank port wine--knocked me out in no time.
i'd rather give up drinking than give up klonopin.
will try once again.
thanks again,
sar
Posted by Rick on July 6, 2001, at 15:23:58
In reply to Re: How much clonazepam is needed for SP?, posted by sar on July 6, 2001, at 13:11:07
> Rick,
>
> Thanks again. i'm writing this drowsily because i woke up early to go with a friend to an AA meeting at 7 this morning.
>
> right, i agree with you on the subjectivity of all those diagnoses! too much doc-hopping; plus everyone's dynamic, everyone changes, and all this dx'ing began 5 yrs ago (i feel like a diferent person now.)
>
> be blunt! thank you for your bluntness! i knew i was being stoopid drinking on klonopin--oh Rick, one of the first days I was on it I drank port wine--knocked me out in no time.
>
> i'd rather give up drinking than give up klonopin.
>
> will try once again.
>
> thanks again,
> sarsar, I like that determined sound in your last post! It's inspiring to me. Do whatever you can to keep it up, since determination to do what's best for yourself is half the battle. Of course I'm sure you know that this positive attitude needs a dash of realism so that you don't start giving up should you get hit with some unexpected and troubling curveballs, or should you have to retrench and try new treatments. I already said this in an earlier post, but I'll say it again (because I'm frankly kinda jealous!): It is SO advantageous to your long-term health and quality of life to be able to identify and address chronic problems early instead of many years later.
Best to you,
RickP.S. Reading about your plethora of docs and diagnoses, I kept visualizing a spinning "Price Is Right" type wheel, but with doctors' faces and diagnoses on it instead of cash amounts. (Not that pdocs are averse to cash, by any means.) Kind of like, the "Diagnosis Is Right", with your host Dr. Bob shouting, "come on down" but disqualifying contestants who aren't civil. ("You're still invited to watch the show, but you can't play.") Of course, instead of CBS, the show would appear on PBS - The PsychoBabbleService.
Please forgive me. You can see that one thing I personally have to overcome is a compulsion to make pathetically lame attempts at humor, especially of the punning variety. But that spinning diagnosis wheel image just set me off. BTW, if you're fairly new to this board, you won't even "get" all of the lame "jokes".
Posted by sar on July 7, 2001, at 0:59:06
In reply to Re: How much clonazepam is needed for SP? » sar, posted by Rick on July 6, 2001, at 15:23:58
>
> P.S. Reading about your plethora of docs and diagnoses, I kept visualizing a spinning "Price Is Right" type wheel, but with doctors' faces and diagnoses on it instead of cash amounts. (Not that pdocs are averse to cash, by any means.) Kind of like, the "Diagnosis Is Right", with your host Dr. Bob shouting, "come on down" but disqualifying contestants who aren't civil. ("You're still invited to watch the show, but you can't play.") Of course, instead of CBS, the show would appear on PBS - The PsychoBabbleService.
>
> Please forgive me. You can see that one thing I personally have to overcome is a compulsion to make pathetically lame attempts at humor, especially of the punning variety. But that spinning diagnosis wheel image just set me off. BTW, if you're fairly new to this board, you won't even "get" all of the lame "jokes".Rick--I'm still laughing, what a nut I must look like shakily trying to type while giggling so hard. that was no lame joke, my friend, that was one of the funniest posts I've read on this board. I hope the Doctor gets a kick out of it, too.
thanks for your kind words and help.
sar
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