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Dr. Bob is Robert Hsiung, MD,
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Posted by AnneL on August 11, 2001, at 21:36:02
Feel like I am caught between a rock and a hard place.
My pdoc increased my dose of Effexor XR from 150 mg. to 225 mg. He feels I was "undertreated". (Actually I feel that the birth control pill I had taken for one cycle was the culprit in a sudden "relapse" of my depression because I felt much better after I had been off of the Pill for 3 days). But never-the-less, I followed my pdoc's suggestion and increased my dose of Effexor about 2 weeks ago. I also take Klonopin 1 mg. at bedtime which was prescribed to help counter the insomnia and panic attacks that developed when I started taking Effexor about 6 months ago. I would really like to get off of Klonopin. But I keep taking it because (1) I know I shouldn't stop cold turkey and (2) I feel psychologically dependent on it to make me sleep. I don't like the way it makes me feel as I am drifting off to sleep. It's a strange feeling of being extremely "drugged" and at the same time feeling
anxious as I literally almost "pass out". (I don't know how some people take Klonopin during the day and function!) This sensation as I drift off to sleep seems to have gotten worse since I increased my dose of Effexor and last night I woke up with an anxiety attack that lasted for about 5 minutes (an eternity!).
Last night, I started feeling paranoid that I was having "seritonin syndrome" from the increased dose, but managed to talk some sense into myself. What could be the cause of my sudden anxiety attack? Is it from the increased seritonin levels? Is it from the Klonopin? I recall having a panic attack about 4 months ago when I increased my dose from 150 mg. to 187.5 mg. that hit on day 4 of increasing the dose. I had myself convinced it was "seritonin syndrome" and was ready to head to the nearest ER. The next day I reduced my dose to 150 mg. Please tell me if this increased dose of Effexor puts me at risk for developing seritonin syndrome and what the signs and symptoms of the syndrome are. Could this just be a "ramping up" effect of increasing my dose of Effexor or can Klonopin cause anxiety? Most importantly will it go away and do you have any suggestions for coping with this anxiety if I get it again? Should I reduce the Klonopin? By the way I can't take Xanax at bedtime because I wake up 2 to 3 hours later with horrible anxiety. Thanks for sticking with this, I feel pretty scared of it happening again tonight and just want to make sure I'am not really going to "die" of some overdose of seritonin, etc. :) Anne
Posted by Janelle on August 11, 2001, at 23:03:37
In reply to Effexor ramping up effect or Klonopin side effect?, posted by AnneL on August 11, 2001, at 21:36:02
Well, I have had such trouble with EffexorXR, that my pdoc had me decrease from 150 mg to 75 mg because it was so activating and increased my already existing anxiety and agitation. I still feel lightheaded and a bit jittery at times, and will taper off it soon, but for now the doc is focusing on gradual increase in mood stablizer and doesn't want to make two changes at once or we won't know what is causing what.
I also take Klonopin 1mg at bedtime for sleep (along with Zyprexa a few hours before because for me it takes hours for it to kick in), and I have had GOOD experience with it - it relaxes me and while I seem to go from awake to kind of passed out from one minute to the next, I dream and have what feels like "normal" and restful sleep!
Also, taking the Klonpin at night seems to ward off the panic and anxiety I used to wake up with each day. That was awful - waking up with a lump in my gut, afraid to get out of bed for fear of how lousy I would feel, etc.
I agree that you should NOT go off the Klonopin cold turkey; perhaps not at all yet. The feling of being drugged yet anxious and passing out may go away in a bit more time. I just cannot imagine Klonopin causing anxiety, since it is so well known as an ANTI-anxiety med, and has helped me a lot in this respect.
Based on my lousy and anxiety-inducing experience with EffexorXR, I would think that the anxiety you are reporting is from THAT and NOT the Klonopin.
Talk it over with your pdoc, who would be best qualified to figure out what the cause of your sudden anxiety is. I can only GUESS that it could be the increased EffexorXR. I have read on here that at the low dose (like 75 mg that is all I can handle), EffexorXR works mainly on Serotonin, but at higher doses it works on that and Norepinephrine, and I think the latter is stimulating and activating.
It is indeed possible that this could just be a "ramping up" effect of increasing your dose of Effexor. Again, I've NEVER heard or read anywhere that Klonopin can cause anxiety - only the opposite - that it HELPS calm away anxiety.
The only suggestion I would have is to call your pdoc and possibly reduce the EffexorXR while keeping the Klonopin where it is (1 mg/night is not much).
Good luck, keep us posted.
-Janelle
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