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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 12 of 12. This is the beginning of the thread.
Posted by audrey on January 28, 2002, at 7:30:38
Hi. I know klonopin has been discussed at length on this message board, and I've been reading through some of the old posts. But I have a question whose answer I can't seem to decipher from previous comments. Do most of you who take klonopin take it alone, or in combination some other med(s)? I've been taking Buspar for a while, and although it seemed to be having a slight positive effect on my panic attacks and social anxiety at first, it doesn't seem to be having much effect anymore. I'm going to see my doctor in a couple of days, and I was thinking about requesting klonopin. Should I do away with the buspar and try it solo, or add it to the buspar, or try another combination entirely? Just wondering what other people have found effective.
Thanks,
Audrey
Posted by jimmygold70 on January 28, 2002, at 12:59:12
In reply to klonopin alone or in combination?, posted by audrey on January 28, 2002, at 7:30:38
Before you even start with Klonopin, give Paxil a trial of a couple of months. Get up to 60mg/day, stay for a while there, and see if it helps. It should help both Social Phobia and Panic Disorder. If this doesn't help or helps only partially, you can add Klonopin or Xanax.
Jimmy
Posted by audrey on January 28, 2002, at 15:13:43
In reply to Re: klonopin alone or in combination? » audrey, posted by jimmygold70 on January 28, 2002, at 12:59:12
Paxil was the first thing I tried. It was horrible! I became even more anxious (which I hadn't thought possible!) I tried it for 4 weeks, hoping the excess anxiety would pass, but finally had to give up. I was bruxing 24 hours a day (as opposed to just when I'm sleeping, which I do now), I barely slept, I cried at least a couple times a day, and I just felt afraid. Now I just feel a slighter variation on all those things, with the Buspar. I am always nervous, I wake up every morning with my heart racing, I can't concentrate, and I freak out every time I have to go out of the house. I'm just sick of this, and thought klonopin might be a good way to go since the Buspar isn't helping.
Thanks for the advice though!
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).
Posted by jimmygold70 on January 29, 2002, at 9:36:34
In reply to Re: klonopin alone or in combination?, posted by audrey on January 28, 2002, at 15:13:43
Try Serzone before you start klonopin. It should not excerabate anxiety.
Jimmy
Posted by MB on January 29, 2002, at 11:17:02
In reply to Klonopin information, posted by 3 Beer Effect on January 28, 2002, at 23:28:14
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.
I never thought Klonopin seemed like a drug I would want to abuse. If I feel really shitty, I might take an extra one because it makes me feel better, but its not like a vicodin or something where I would take it "just for fun." Anyway, if you overdo the Klonopin it just makes you tired, and that's no fun, so what's the big deal? I know, I know, I'm preaching to the choir here...
Posted by Mr. Scott on January 29, 2002, at 19:43:29
In reply to klonopin alone or in combination?, posted by audrey on January 28, 2002, at 7:30:38
Just a thought, and I certainly don't want to make an anxious person more anxious, but if you read Audrey's response to Paxil below, might not many psychiatrists see this as indicative of Bipolar Disorder? What do you think, am I off the wall here?
Scott
Paxil was the first thing I tried. It was horrible! I became even more anxious (which I hadn't thought possible!) I tried it for 4 weeks, hoping the excess anxiety would pass, but finally had to give up. I was bruxing 24 hours a day (as opposed to just when I'm sleeping, which I do now), I barely slept, I cried at least a couple times a day, and I just felt afraid. Now I just feel a slighter variation on all those things, with the Buspar. I am always nervous, I wake up every morning with my heart racing, I can't concentrate, and I freak out every time I have to go out of the house. I'm just sick of this, and thought klonopin might be a good way to go since the Buspar isn't helping.
Thanks for the advice though!
Posted by 3 Beer Effect on January 29, 2002, at 23:32:47
In reply to Re: Klonopin information, posted by MB on January 29, 2002, at 11:17:02
I haven't felt the urge to abuse my Klonopin either. It takes so long to start working, is subtle, & lasts so long that it is not a very good candidate for abuse.
I don't see why any of the benzos would be good to abuse but then you always here about people combining Xanax w/ alcohol. Look at what Jeb Bush's daughter just did- pretended to be a doctor & called in a Xanax prescription to Walgreens. If you are going to go to this risky extreme you would think that she would atleast order something more "fun" like Percodan or Diladiud (the two strongest morphine derivatives- Oxycodone & Hydromorphone), but no, she orders a benzo that can be easily bought in Mexico or even from overseas mail order.
I think Klonopin suffers from being in the same class of drugs as Xanax. The press seems to think benzos are all identical to Rohypnol & evil. The newspaper article about Jeb Bush's daughter says that Xanax is a drug "that has a heroin-like effect of slowing down the brain!!!" That is ridiculous, but for whatever reason, Xanax does seem to attract most of the abuse & bad press (even though Ativan would probably be a better choice if you just had to abuse a benzo).
Now Klonopin is set to get a bunch of bad press in the coming months because the press erroneusly reports that is it very similar to the date rape forget pill Rohypnol. It is now becoming popular because it is sold in Mexico under the name Rivotril.
3 Beers.
I never thought Klonopin seemed like a drug I would want to abuse. If I feel really shitty, I might take an extra one because it makes me feel better, but its not like a vicodin or something where I would take it "just for fun." Anyway, if you overdo the Klonopin it just makes you tired, and that's no fun, so what's the big deal? I know, I know, I'm preaching to the choir here...
Posted by MB on January 30, 2002, at 3:48:51
In reply to agree but people abuse Xanax- Jeb Bush daughter, posted by 3 Beer Effect on January 29, 2002, at 23:32:47
> I haven't felt the urge to abuse my Klonopin either. It takes so long to start working, is subtle, & lasts so long that it is not a very good candidate for abuse.
>
> I don't see why any of the benzos would be good to abuse but then you always here about people combining Xanax w/ alcohol. Look at what Jeb Bush's daughter just did- pretended to be a doctor & called in a Xanax prescription to Walgreens. If you are going to go to this risky extreme you would think that she would atleast order something more "fun" like Percodan or Diladiud (the two strongest morphine derivatives- Oxycodone & Hydromorphone), but no, she orders a benzo that can be easily bought in Mexico or even from overseas mail order.
>
> I think Klonopin suffers from being in the same class of drugs as Xanax. The press seems to think benzos are all identical to Rohypnol & evil. The newspaper article about Jeb Bush's daughter says that Xanax is a drug "that has a heroin-like effect of slowing down the brain!!!" That is ridiculous, but for whatever reason, Xanax does seem to attract most of the abuse & bad press (even though Ativan would probably be a better choice if you just had to abuse a benzo).
I fucking hate Ativan. Every time I take that crap, I dissociate. Just goes to show that all benzos are diferent and they react differently in each person. It's weird that Valium used to be the devil and now Xanax is the devil.
Posted by audrey on January 31, 2002, at 20:55:16
In reply to Bipolar type stuff?, posted by Mr. Scott on January 29, 2002, at 19:43:29
Wow, Scott! Would you mind explaining what about my response made you think of Bipolar Disorder? Just curious -- no doctor has ever mentioned bipolar disorder to me before, and I honestly don't know much about it.
Thanks,
Bobbie> Just a thought, and I certainly don't want to make an anxious person more anxious, but if you read Audrey's response to Paxil below, might not many psychiatrists see this as indicative of Bipolar Disorder? What do you think, am I off the wall here?
>
> Scott
Posted by Mr. Scott on January 31, 2002, at 23:59:46
In reply to Re: Bipolar type stuff? -- Mr. Scott, posted by audrey on January 31, 2002, at 20:55:16
> Wow, Scott! Would you mind explaining what about my response made you think of Bipolar Disorder? Just curious -- no doctor has ever mentioned bipolar disorder to me before, and I honestly don't know much about it.
>
> Thanks,
> Bobbie
>
Paxil was the first thing I tried. It was horrible! I became even more anxious (which I hadn't thought possible!) I tried it for 4 weeks, hoping the excess anxiety would pass, but finally had to give up. I was bruxing 24 hours a day (as opposed to just when I'm sleeping, which I do now), I barely slept, I cried at least a couple times a day, and I just felt afraid. Now I just feel a slighter variation on all those things, with the Buspar. I am always nervous, I wake up every morning with my heart racing, I can't concentrate, and I freak out every time I have to go out of the house. I'm just sick of this, and thought klonopin might be a good way to go since the Buspar isn't helping.Thanks for the advice though!
Well...take it with a grain of salt if there is a more obvious and simplistic explanation (like maybe you just can't tolerate SSRI's), but for you to become worse on an SSRI when trying to treat anxiety or depression is in stark contrast to all the clinical studies that suggest just the opposite should happen. It is however pretty common I think for a bipolar (and this has become a rather inclusive category recently) to have a depression become more agitated and to even intensify because activation is added to depression rather than having the depression relieved. Bipolar II also frequently has comorbid anxiety disorders attached to it. So really I think I was looking at your nonresponse or worsening of symptoms as potential red flags for bipolar disorder.
Again I am just theorizing... Most people think of bipolar disorder as having well defined periods of becoming totally high eventually leading to psychosis and deep melancholy depressions. However more and more attention is being given to milder or more mixed syndromes that might respond to similar treatments which include Lithium and a host of mood stabilizer anticonvulsants or in some cases newer atypical antipsychotics. Seems that some thought leaders are saying a mild hypo or mini mania may be missed in some depressives and give rise to Antidepressant failure or short lived success with them, and perhaps worsening of the illness entirely.
It is also possible that you just have a bad anxiety disorder and Klonopin is the way to go although I think you mentioned you were depressed as well.
Scott
Posted by Elizabeth on February 2, 2002, at 11:09:15
In reply to Re: agree but people abuse Xanax- Jeb Bush daughter » 3 Beer Effect, posted by MB on January 30, 2002, at 3:48:51
I agree that the idea of abusing Klonopin is just plain weird. Different people have different responses to drugs, but my experience (from talking to lots of people who've taken Klonopin, that is) has been that most people really don't get a kick out of Klonopin. There are some people who seem to like Xanax, although personally I don't find it any different than Klonopin in that respect.
I think it's pretty sad when people go to extreme measures like faking scripts (a pretty serious offense, BTW) just to get benzos (even people who are the president's niece and probably will not get in any real trouble -- no names :) ).
> If you are going to go to this risky extreme you would think that she would atleast order something more "fun" like Percodan or Diladiud (the two strongest morphine derivatives- Oxycodone & Hydromorphone),
You forgot oxymorphone (NuMorphan) -- seldom prescribed, but I've heard it described (by someone who would know) as being the best of all the opioids, "better than heroin" (some say the same of Dilaudid, of course, but most of those probably haven't tried NuMorphan since it's not used much). But these are much more closely monitored because they're Schedule II. A script for Dilaudid or NuMorphan would pretty much instantly provoke most pharmacists to call the doctor. Trying to fake a script is stupid, but trying to fake a Xanax script isn't nearly as stupid as trying to fake a Dilaudid script. (Percocet is more commonly prescribed to outpatients and probably wouldn't earn the double take from the pharmacist.)
BTW, a lot of people (the majority, I think) don't like opioids -- their reaction is either indifferent or dysphoric. Probably among these are some who enjoy Xanax (recreationally, that is). If one of these was going to fake a script, I'd expect it to be for Xanax rather than for Percocet.
> > The press seems to think benzos are all identical to Rohypnol & evil.
Oh jeez. Flunitrazepam is Just Another Benzo. It's not exceptionally dangerous or anything. As the stories involving Klonopin have shown, any benzo can knock out a person who's not tolerant, particularly when mixed with alcohol. (Keep an eye on your drinks, people!)
> > The newspaper article about Jeb Bush's daughter says that Xanax is a drug "that has a heroin-like effect of slowing down the brain!!!"
That's funny, because I've taken morphine and it feels mildly "speedy" to me (although not as speedy as buprenorphine), whereas benzos are strictly calming/sedating. Anyway, their effect is certainly not "heroin-like," by any standard -- except the standard of an ignorant person.
> I fucking hate Ativan. Every time I take that crap, I dissociate. Just goes to show that all benzos are diferent and they react differently in each person. It's weird that Valium used to be the devil and now Xanax is the devil.
Valium was prescribed on a massive scale in its time, and it got a very bad rep since some people did abuse it. The drug companies claimed that benzos would not be "addictive" like their predecessors, the barbiturates. Similarly, Xanax was initially touted as being a "non-addictive" benzo, and when it was heavily prescribed in the early '80s there was a big backlash when it turned out that some people were abusing it.
-elizabeth
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