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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 9 of 9. This is the beginning of the thread.
Posted by Julia on October 21, 2002, at 8:02:40
I've rec3ntly posted twice-going through major agitated depression and benzo withdrawal(don't tell me to stay on benzos,they depress me terribly, at least diazepam and lorazepam both have, and lorazepam gave me myoclonus as do some a/ds.Bizarre but apparently documented.I am now down to 6 mg diazepam,cutting 1 mg per fortnight.I think i will leave offf the SAM-e in case it is exacerbating things-but the 100mg of trimipramine helpsme sleep but is not touching the depression.I can't stand much more, I have bad ME and have to rest a lot which allows me much too much time to ruminate.But I am semmi-suicidal at present.Could this be withdrawal depression-in which case will it respond to antidepressants or do I have to wait until I'm offf the diaam.Life is just trying to exist through each day,but no morer, and i am losing hope.Pleas offer hope/encouragement/ideas,i'm getting desparate.I do have a very supportive doctor, and am at least listened to Thanks
Posted by hiba on October 21, 2002, at 11:43:55
In reply to HELP please DESPAIR dreadful,benzo withdrawal??, posted by Julia on October 21, 2002, at 8:02:40
Dear Julia,
Your letter is obviously written in an overanxious bout. Don't worry, it is pretty normal. Valium(diazepam) is notorious for aggravating pre-existing depression and first of all what you will have to do is to get it off completely. Your physician can help, The safe method is the same one that you follow now, but adding klonopin and stopping valium abruptly is another option. An equivalent klonopin dose may be 1 mg at night. Klonopin doesn't usually aggravate depression, but there is evidence for its mood stabilizing properties.
Trimipramine is a highly sedating antidepressant and its sedative effect is usually apparent after a single dose. As a rule antidepressant effect will follow after a couple of weeks. But if you are so weired, and need an instant change very badly, only benzos (other than valium and librium ) can help. Xanax and klonopin can bring instant relief in most patients and talk about this option to your physician. Xanax in fairly high doses can have a dramatic antidepressant effect. It is proven. Don't give up, all those horrible symptoms you experience now is only of a transient nature. It is only a matter of time.
HIBA
Posted by jyl on October 21, 2002, at 12:51:41
In reply to HELP please DESPAIR dreadful,benzo withdrawal??, posted by Julia on October 21, 2002, at 8:02:40
my dear sweet julia,
take deep breath....
i find when i am "on the wall"if i write everything down that is on my mind-sentence structure and spelling dont count-i usually cant relax a bit(enough that i can have a good cry)
i feel better afterwards.
its worth a try hun.
goodluck
jyl
Posted by Julia on October 21, 2002, at 13:38:32
In reply to Re: HELP please DESPAIR dreadful,benzo withdrawal??, posted by hiba on October 21, 2002, at 11:43:55
> Dear Julia,
>
> Your letter is obviously written in an overanxious bout. Don't worry, it is pretty normal. Valium(diazepam) is notorious for aggravating pre-existing depression and first of all what you will have to do is to get it off completely. Your physician can help, The safe method is the same one that you follow now, but adding klonopin and stopping valium abruptly is another option. An equivalent klonopin dose may be 1 mg at night. Klonopin doesn't usually aggravate depression, but there is evidence for its mood stabilizing properties.
> Trimipramine is a highly sedating antidepressant and its sedative effect is usually apparent after a single dose. As a rule antidepressant effect will follow after a couple of weeks. But if you are so weired, and need an instant change very badly, only benzos (other than valium and librium ) can help. Xanax and klonopin can bring instant relief in most patients and talk about this option to your physician. Xanax in fairly high doses can have a dramatic antidepressant effect. It is proven. Don't give up, all those horrible symptoms you experience now is only of a transient nature. It is only a matter of time.
> HIBADear Hiba, thanks for your encouragement.The one thing I am sure of is that I want to get off any benzo.I've been on the trimipramine 5 weeks now with no antidepressant effect,although it helps the agitation a bit.I've tried adding SAM-e 400mg for a couple of weeks but can't even decide if it makes me better or more anxious:I don't want anything to aggravate the agitation, but even trying to make the decision about whether to take it or stop it or try a higher dose for a bitlonger fills me with ridiculous anxiety.I've read that obsessive ruminations can be a feature of benzo withdrawal. My doc has suggested adding in nortriptyline to boost the a/d effect of trimipramine.I just can't wait to get through withdawal and out the other side, and hang onto the fact that it must then get better-I know i get a lot of rebound anxiety at present.Thanks Julia
Posted by hiba on October 22, 2002, at 1:23:23
In reply to Re: HELP please DESPAIR dreadful,benzo withdrawal?? » hiba, posted by Julia on October 21, 2002, at 13:38:32
Dear Julia,
In A state of anxiety, you will not be able to take a correct decision because anxiety can have a devastating effect on our concentrating abilities. So what you will have to do now is to overcome the anxiety which is dominating all of your thoughts. It is not easy without the help of a medication at this time. Something has to be done to calm your agitated nerves and only an effective benzo can do it. Don't think that you are going back to benzos again. It is only a matter of time. Once your mental state is stabilized, you can chose the best antidepressant to treat your depression as well as obsessive worries and taper the benzo slowly. The reason trimipramine doesn't work well for you is, you have dominating obsessive worries and trimipramine is not a proven anti-obsessive antidepressant. The only tricyclic having anti-obsessive property is ANAFRANIL (Clomipramine). And it is the best. The newer antidepressants like fluoxetine, fluvoxamine and sertraline have unique anti-obsessive properties, but they are more activating than Clomipramine. Clomipramine has excellent sedative properties and it can do wonders to stop obsessive worries.(Based on my own experience)
Now if you want to stop those obsessive worries, stop the medication valium and try klonopin (clonazepam) at once. Stopping valium abruptly will not be a problem, if you substitute it with clonazepam because clonazepam will cover all those withdrawal symptoms of valium. Clonazepam has unique anti-obsessive properties and unlike diazepam it will not aggravate depression. I don't advocate a benzo monotherapy for you because obviously depression has taken dominance in you and benzo monotherapy alone can't bring relief to depression once it takes dominance. So
consult with your treating physician whether he can prescribe ANAFRANIL (Clomipramine) for you instead of trimpramine and nortryptiline. Anafranil will kick in within days or sometimes it may take as long as two to three weeks. Not more than it. Then slowly you can cut down the dosage of clonazepam. If you take 6 mg of diazepam now, the equivalent clonazepam dosage is 1 mg.
Trimipramine can't treat your depression if you have dominating obsessive worries. I have a similar experience in my life. I was obsessing too much and consequently developed major depression. My doc put me on 150 mg of Elavil (Amitryptiline) with no effect. What helped me at that time is clonazepam combined with fluoxetine. I don't recommend fluoxetine to you because it can aggravate your agitation. Or you will have to take fairly high amount of clonazepam which will counteract the agitation of fluoxetine and adequately control the activation. But if your goal is to come off benzos completely, anafranil is the best option. Be brave! it is only a matter of time. Yes!! only a matter of time.
HIBA
Posted by Julia on October 22, 2002, at 3:56:57
In reply to Re: HELP please DESPAIR dreadful,benzo withdrawal??, posted by hiba on October 22, 2002, at 1:23:23
Hiba,thanks for your advice, I will ask about clomipramine.Only I understand it has more side effects than other tricyclics? Do you have any knowledge about the advisability of stopping or continuing SAM-e? I just don't want to miss anything that might help the depression, but don't want to aggravate the anxiety.But I worry so much about whether to take it or not that it probably negates any benefit. It is so difficult to get definitive advice re SAM-e as so much evidence is anecdotal.Julia
Posted by hiba on October 22, 2002, at 5:02:11
In reply to Re: HELP please DESPAIR dreadful,benzo withdrawal?? » hiba, posted by Julia on October 22, 2002, at 3:56:57
Dear Julia,
What is the generic name of SAM-e ? I am not staying in U.S. So I don't understand what is that medication. If you can reveal it's generic name I think I can help.
Regarding ANAFRANIL, it belongs to the class of tricyclic antidepressants and it does have more side effects than those newer antidepressants like fluoxetine and fluvoxamine. But its efficacy is much superior to the newer ones. Don't worry over those side effects. Your body will get adjusted to it after continuous use. Besides I don't think you will have to be on it for a long time. What you just need at this time is a medication to treat obsessive worries and depression that followed benzo withdrawal. Benzo withdrawal symptoms very rarely persist beyond two months. Besides day by day the intensity of withdrawal lessens. So to be on anafranil for a couple of months after the last of dose of benzo and a slow taper from anafranil itself will solve your problem. I am sure, because I have enough experience. I have volunteered for a detoxification centre in India and have seen so many cases like you. Only those who stopped their benzo intake abruptly was coming to the centre for treatment with severe withdrawals. Still they were no more available for follow up after a couple of months. I remember tegretol, was the main medication used to stabilize the patients. In the cases of depression with significant obsessive worries Anafranil was being used with very nice results.
Take care Julia,
HIBA
Posted by Julia on October 22, 2002, at 5:39:12
In reply to Re: HELP please DESPAIR ?? to Julia, posted by hiba on October 22, 2002, at 5:02:11
> Dear Julia,
>
> What is the generic name of SAM-e ? I am not staying in U.S. So I don't understand what is that medication. If you can reveal it's generic name I think I can help.
>
> Regarding ANAFRANIL, it belongs to the class of tricyclic antidepressants and it does have more side effects than those newer antidepressants like fluoxetine and fluvoxamine. But its efficacy is much superior to the newer ones. Don't worry over those side effects. Your body will get adjusted to it after continuous use. Besides I don't think you will have to be on it for a long time. What you just need at this time is a medication to treat obsessive worries and depression that followed benzo withdrawal. Benzo withdrawal symptoms very rarely persist beyond two months. Besides day by day the intensity of withdrawal lessens. So to be on anafranil for a couple of months after the last of dose of benzo and a slow taper from anafranil itself will solve your problem. I am sure, because I have enough experience. I have volunteered for a detoxification centre in India and have seen so many cases like you. Only those who stopped their benzo intake abruptly was coming to the centre for treatment with severe withdrawals. Still they were no more available for follow up after a couple of months. I remember tegretol, was the main medication used to stabilize the patients. In the cases of depression with significant obsessive worries Anafranil was being used with very nice results.
> Take care Julia,
> HIBASAM-e is S-adenosyl methionine, it is not an a/d as such but an amino acid which has been found to have antidepressant properties.It is sold as a food supplement but is used quite a lot in Europe and the US,(but I am from the uk where no-one has heard of it)It can make bipolar patients manic and is said to cause anxiety in some people,but it is also said that it can work in some cases of treament resistant depression.Hence by dilemma and indecision.Today my thoughts are racing, I am detatched from reality and am very agitated.I wonder if I should get off the diazepam faster to get it over with.I kniw i just cannot stand being as I am much longr.Julia
Posted by hiba on October 23, 2002, at 0:26:44
In reply to Re: HELP please DESPAIR ?? to Julia » hiba, posted by Julia on October 22, 2002, at 5:39:12
Dear Julia,
Untill you are being stabilized, there will be enough mood swings. From agitation to depression. From anxiety to tranquillity. Good day will be followed by a very bad day, and if there is a bad day the next day will be much brighter. And there is nothing to worry over this if you won't catastrophize.
Meanwhile what was the problem that led you to take diazepam ?
Once I have been given zoloft (Lustral in U.K) to treat me off depression. An additional benzo (Klonopin) was given to counteract the agitation of zoloft. I felt nauseous, and tired of the sexual side effects of zoloft and consequently stopped it and kept on taking klonopin 0.5 mg twice daily. Surprisingly it kicked very well and I was on the same dosage for over a year without any complication. Klonopin effectively stabilized my mood and kept depression away. I still regret, I left that medication because of the fear of being dependent on it. Dependence was acceptable because it was helping me tremendously without any side effects at all.
So don't write off all benzos because you had a bad experience with one benzo. There are more than a dozen benzos in European market and almost all of them have their own unique properties. Adinazolam and alprazolam have unique antidepressant properties. Clonazepam and clorazepate have anti-convulsant and mood stabilizing properties. Diazepam is a very old benzo which is only of little clinical indication now. Unfortunately you tried the wrong one for your condition. It doesn't mean that all benzos should be dumped along with diazepam. There will be benzos which can help. Really help.
HIBA
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