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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 22 to 46 of 46. Go back in thread:
Posted by viridis on March 2, 2003, at 19:12:31
In reply to Tolerance more to sedative and anticonvulsive , posted by mattdds on March 2, 2003, at 18:45:23
I'll just second Matt on pretty much all of his points. It's frustrating to hear the word "addiction" used so casually (and inappropriately) -- one person in this thread even had a doctor comparing Klonopin to heroin!
Here are some definitions, from the American Society of Addiction Medicine website:
The American Society of Addiction Medicine (ASAM), the American Academy of Pain Medicine (AAPM), and the American Pain Society (APS) recognize the following definitions and recommend their use:
Addiction: Addiction is a primary, chronic, neurobiological disease, with genetic, psychosocial, and environmental factors influencing its development and manifestations. It is characterized by behaviors that include one or more of the following: impaired control over drug use, compulsive use, continued use despite harm, and craving.
Physical Dependence: Physical dependence is a state of adaptation that often includes tolerance and is manifested by a drug class specific withdrawal syndrome that can be produced by abrupt cessation, rapid dose reduction, decreasing blood level of the drug, and/or administration of an antagonist.
Tolerance: Tolerance is a state of adaptation in which exposure to a drug induces changes that result in a diminution of one or more of the drug's effects over time.
What people are describing with Klonopin is almost always physical dependence. This is common with many drugs that are used for all kinds of conditions. In the list of "hardest-to-quit" meds recently released by the World Health Organization, SSRIs and Effexor figured prominently in the top 10 (benzos didn't), with Paxil at #1, as I recall. It's just that with meds that are still under patent, the preferred term for withdrawal is "discontinuation syndrome", and no one would suggest you were ever addicted.
When I started Klonopin about a year and a half ago, my psychiatrist told me that if I took it for an extended period of time I would have to slowly taper off it. Early on, I talked about quitting it, and he said fine, but chances are I'd go back to my previous, frequent high anxiety state. He considers this much worse for my mental and physical health than use of Klonopin, and I agree. I quickly developed complete tolerance to the sedative and dulling effects, but the same dose (1 mg/day) continues to have the same anxiolytic effect as in the beginning. Apparently, this pattern is pretty standard for people with anxiety disorders, and many take the same dose for years.
If I'm an addict, I sure don't feel like one.
Posted by SBOATRN on March 2, 2003, at 19:56:39
In reply to Re: KLONPIN daily for life?, posted by utopizen on March 2, 2003, at 18:42:48
> I'm 19, too. Do you really want to be anxious now? You won't even have to worry about thinking about worrying about going off Klonopin until you're at least 40, and by then nothing matters because you're fat and old anyway.
Well, I'm OVER 40 and I'm not fat. I don't think I'm old and I have things that still matter alot in my "old age". I realize your point, just wish you could have picked another way to make it !!
Posted by viridis on March 2, 2003, at 20:45:10
In reply to Nothing matters after forty ??? » utopizen, posted by SBOATRN on March 2, 2003, at 19:56:39
My feelings too (not yet 40 but getting close...and not fat yet either).
But hey, when you're 19, 40 does seem old. In the 60s, wasn't it the conventional wisdom that you can't trust anyone over 30?
Anyway, I'm really not too offended; it just reminds me how differently I thought about things when I was that age.
Posted by KrissyP on March 2, 2003, at 22:29:42
In reply to Tolerance more to sedative and anticonvulsive , posted by mattdds on March 2, 2003, at 18:45:23
BECAUSE THAT IS WHAT SOME IDIOTIC, UNPROFESSIONAL, DEAF PSYCHIATRISTS HAVE INSTILLED IN MY HEAD-
just my experience:-)
Kristen
> Guys,
>
> People routinely take benzos for decades, without loss of its ANTIANXIETY effect. This is an important distinction to make, as there are different effects of benzos (e.g. anxiolytic, anticonvulsant, and sedative). The tolerance you are all so freaked about is more to the sedative and anticonvulsant effects, and NOT so much to the antianxiety effects. Furthermore, the anxiolytic properties are what most of us are interested in, right? This is pretty well documented in the literature. I will look for some references, but did learn this in my pharmacology class in dental school.
>
> Yes, if you take benzos for extended periods of time, you will likely become dependent on them. I don't understand why this is so disturbing. This doesn't mean they stop working, it just means you need to taper when you come off them. What is it that people don't get about this? If you come off of most psychoactive drugs (even the pristine and free of sin SSRI's and atypical neuroleptics that seem to be so en vogue these days) without a good slow taper, you are going to get withdrawals! This is true of Paxil, Celexa, Seroquel, and even with drugs that aren't psychoactive, like B-blockers and Coumadin. Why is this aspect, dependence requiring a SLOW taper, so magnified with only the benzos? Honestly, in my opinion, if you go off a benzo without a taper and experience withdrawals, you only have yourself to blame. These effects can be minimized or even eliminated with a good slow taper. Read about this in Goodman & Gilman's pharmacology, where they say that withdrawals from diazepam and clonazepam are virtually nonexistent in slow tapers (1-2 months, gradually).
>
> In sum, I am not convinced that in the majority of people there is much tolerance to the antianxiety effects of benzos. This is obviously possible in some, but I think it's the exception, rather than the rule. There is, however substantial tolerance to their sedative and anticonvulsant effects, but in my opinion, benzos should not be taken for these purposes long-term, because there are drugs which are much better suited for these concerns (e.g. zolpidem for sleep, valproate et. al for seizures)
>
> Finally, PLEASE explain why people have such a difficult time distinguishing between two simple words: ADDICTION and DEPENDENCE. These are two very different things. Addiction involves intense cravings and a compulsive need to take a substance, and antisocial behavior. Benzos do not do this, especially in people with diagnosed anxiety disorders. Please, why is this so difficult to use the appropriate language?
>
> Matt
>
Posted by Mikey_C on March 2, 2003, at 22:38:35
In reply to Re: Tolerance more to sedative and anticonvulsive » mattdds, posted by KrissyP on March 2, 2003, at 22:29:42
Ooooh... I just LOVE an aggressive woman LOL....
Posted by bluedog on March 2, 2003, at 22:41:10
In reply to Re: Tolerance more to sedative and anticonvulsive » mattdds, posted by viridis on March 2, 2003, at 19:12:31
Hi Viridis
I tend to agree with you and Matt. My social anxiety and major depression really started taking a turn for the better since my Pdoc placed me on a daily dose of Valium. The drowsiness was initially a problem but I can now take up to 30mg per day at 10mg 3x per day (I think 30mg of valium is roughly equivalent to about 6 mg of Klonopin) with NIL sedation, co-ordination or memory problems whatsoever YET it really king hits my social anxiety and the anxiolytic effects are as good as when I first started taking valium nearly a year ago now. Most days I really only take 10mg to 15mg and I reserve the doseages of 20mg to 30mg ONLY for those days where I know I am going to be placed into socially stressful circumstances. So I usually only take the equivalent of 2mg to 3mg of Klonopin each day. I did build up the doseages over an exteneded period of time and I feel absolutely no need nor desire to increase my doseages of the valium beyond what I already take. In fact I'm now considering a trial reducing my doseages to see if the anxiolytic effects remain effective at a lower daily dose and I will discuss this with my Pdoc when I next see him.
By the way my anxiety symptoms just so happen to be the usual trigger for my depressive symptoms so the Valium has also very noticeably reduced my depressive symptoms and I feel like I'm able to live my life again. (In fact it has worked against my depressive symptoms MUCH MUCH more effectively in COMBINATION with an SSRI rather than SSRI monotherapy. The combination has worked so well in fact that I've been able to reduce my AD dose of Lovan (generic Prozac) to the very low amount of 10mg daily without any return of my major depressive symptoms.
What's more the Valium has also helped enormously with my Chronic Fatigue Syndrome(CFS) and Valium is actually indicated in low daily doses as therapy for CFS and Fibromyalgia symptoms.
I should add that these drugs have of course not cured or completely eliminated my symptoms as no medication is capable of doing this but it has made my life much more manageable.
I just wish that the Psychobabble search option was up and running because there used to be a poster before my time called Elizabeth who wrote some absolutely EXCELLENT posts on the differences between addiction and medical dependance in relation to Benzodiazepine useage. She was aslo exrtremely knowledgeable about Benzo useage in general.
I think she stopped posting shortly after some of her very best posts on this subject because the anti-benzo posters at that time made life very difficult for her and started attacking her personally rather than sticking to the facts at hand. She never posted again on PB after the personal attacks were made against her and that I find a REAL shame. I really wish that Elizabeth would come back and contribute to this really great discussion.
I've tried the Google search option that Dr Bob suggested but it's no where near as efficient in trying to locate past posts as the PB search option. If I could find some of her really good posts back I would post a link to them right now!!! Can anyone help in this regard?
regards
bluedog
Posted by jrbecker on March 2, 2003, at 23:22:09
In reply to Re: I agree with Matt and Viridis. » viridis, posted by bluedog on March 2, 2003, at 22:41:10
Posted by KrissyP on March 2, 2003, at 23:53:55
In reply to Nothing matters after forty ??? » utopizen, posted by SBOATRN on March 2, 2003, at 19:56:39
SBOTRN, you say this:"Well, I'm OVER 40 and I'm not fat. I don't think I'm old and I have things that still matter alot in my "old age"."---
W a y t o g o! :-) For both of you, I'm 32, and at 19-40 is OLD. Wait til you get 30! I worry a lot about things that will or will not may happen when I'm 40, 50, or 60 for that matter. No one knows what the future holds so live pleasantly. Yesterday is history, Tomorrow is a mystery and today is a gift-that's why they call it the present.
All the best,
Kristen
-------------------------------------------------I realize your point, just wish you could have picked another way to make it !!
I'm 19, too. Do you really want to be anxious now? You won't even have to worry about thinking about worrying about going off Klonopin until you're at least 40, and by then nothing matters because you're fat and old anyway.----------------------------------------------------------------
Well, I'm OVER 40 and I'm not fat. I don't think I'm old and I have things that still matter alot in my "old age". I realize your point, just wish you could have picked another way to make it !!
Posted by Guy on March 3, 2003, at 0:11:07
In reply to Re: KLONPIN users,help??, posted by KrissyP on March 2, 2003, at 17:47:01
Kristen,
People who take Seroquel or other anti-psychotics should be concerned about a permanent, debilitating movement disorder (tardive dyskinesia). This neurological damage may not manifest itself for years, even after you have stopped the med. Here is a link with info how to possibly prevent this disorder caused by major tranquilizers:
http://www.alternativementalhealth.com/articles/td.htm
Posted by KrissyP on March 3, 2003, at 0:15:58
In reply to Re: Tolerance more to sedative and anticonvulsive » KrissyP, posted by Mikey_C on March 2, 2003, at 22:38:35
Uhh oh.......lol I forgot what i said:-( please refresh my memory
Luv ya!
KristenOoooh... I just LOVE an aggressive woman LOL....
Posted by KrissyP on March 3, 2003, at 1:00:09
In reply to Re: Tolerance more to sedative and anticonvulsive » KrissyP, posted by Mikey_C on March 2, 2003, at 22:38:35
I went and looked-sorry, but that has been my experience LOL you said GO TO A DOCTOR like you were yelling it loud and clear-I got it now..;)
Kristen>
> Ooooh... I just LOVE an aggressive woman LOL....
Posted by SBOATRN on March 3, 2003, at 6:34:27
In reply to Re: Nothing matters after forty ??? » SBOATRN, posted by viridis on March 2, 2003, at 20:45:10
Thanks for a nice reminder... I was having a sensitive moment !!!
Posted by Jaynee on March 3, 2003, at 11:39:09
In reply to Re: Nothing matters after forty ??? » viridis, posted by SBOATRN on March 3, 2003, at 6:34:27
I will be starting a "NEW" life at 40. My daughter will graduate, and my husband and I are getting ready to travel and live some new adventures. Of course I will always be there for my daughter, financially, emotionally, etc, etc, she has been my life, but I feel that once she starts to create her own adult life, I will be more free to live mine.
I am really excited about turning 40. I am in great shape, and the most important thing of all, is not how I will look when I get old, but that I get old.
Would I rather be 19 again, no....to confusing.
Posted by viridis on March 3, 2003, at 13:13:25
In reply to Re: Nothing matters after forty ???, posted by Jaynee on March 3, 2003, at 11:39:09
I think you can change your life at almost any age. My father took early retirement at 55, stayed "retired" for about a month, then started a very successful consulting business. My mother recently retired and is now developing all sorts of hobbies and interests that she didn't have time for before. They're in their mid-sixties and now spend a fair bit of the year traveling (my father is still very active in consulting too). I think they're both happier than they've ever been before.
And my pdoc made some interesting changes: he was an English professor at a major university, then went to med school, practiced as a GP for years, and then trained as a psychiatrist when he was in his fifties. He says he's happiest now, loves what he's doing, and is great at it. He suffered from major depression along the way, so is actually experienced personally with some of the meds he prescribes.
Anyway, this is moving into the social arena, but it is encouraging to see that getting older can be a positive experience that opens up all sorts of new opportunities.
Posted by utopizen on March 3, 2003, at 13:27:32
In reply to Re: Nothing matters after forty ??? » Jaynee, posted by viridis on March 3, 2003, at 13:13:25
Sorry,
I was referring to the mating thing.
I've never dated or kissed a girl before, but um, I could easily model, so it's weird. I try really hard to avoid them with social anxiety disorder and all. They try to stare me down in class, and I act like I don't notice and look away, because I know I can't handle it.
So anyway, when you're 40, you're not as good looking, but you've been able to establish a partner that is in the same straights as you are, so you make this mutual commitment to survive sexually together in the similar way to people stranded on a desert island would do. Or at least that's my impression of why people continue to do things at 40. Anyway, all I know is that it's not fair to the female population at my college for me to continue this way.
If my doc doesn't put me on Klonopin tomorrow, I'm just telling him I'm seeing my GP and telling her I've never dated. She wouldn't let me leave the room without a script.
Posted by Beastress on March 3, 2003, at 19:56:33
In reply to Re: Nothing matters after forty ???, posted by utopizen on March 3, 2003, at 13:27:32
May you be forty too someday.
Posted by KrissyP on March 3, 2003, at 20:03:54
In reply to Re: Nothing matters after forty ??? » utopizen, posted by Beastress on March 3, 2003, at 19:56:33
Who was this intended for me? I'm confused.
Kristen> May you be forty too someday.
Posted by Beastress on March 3, 2003, at 20:29:47
In reply to Re: Nothing matters after forty ??? » Beastress, posted by KrissyP on March 3, 2003, at 20:03:54
Sorry for the confusion, my post was meant as a humorous reply to utopizen's latest post.
Posted by Dr. Bob on March 3, 2003, at 21:01:29
In reply to Re: Nothing matters after forty ???, posted by utopizen on March 3, 2003, at 13:27:32
> So anyway, when you're 40, you're not as good looking, but you've been able to establish a partner that is in the same straights as you are...
This is a fine discussion, but I'd like it to be redirected to Psycho-Social-Babble, thanks.
Bob
PS: And follow-ups regarding posting policies to be redirected to Psycho-Babble Administration.
Posted by KrissyP on March 3, 2003, at 21:30:40
In reply to Re: Nothing matters after forty ???, posted by Beastress on March 3, 2003, at 20:29:47
Posted by KrissyP on March 3, 2003, at 22:21:53
In reply to A word of caution, posted by exbenzouser on March 2, 2003, at 11:59:24
exbenzouser, here's my experience.....Yes, Klonopin can be used daily- I take 2mg at night for sleep only. I have had no side eefects although I don't know if weight gain is contributed partly to my use of Klonopin as I do not eat a lot of fruits and veggies, or exercise much-long story:-( Klonopin works for me.
Hope this helped,
Kristen------------------------------------------i want to know can klonpin be used daily like ssri's and are there side effects?weight gain? and DOES IT WORK FOR ANXIETY?,truthfull helpfull answers please,my point is im not getting good anti-anxiety results from 10 mg 4 weeks now on LEXapro,ssri,THANKS
Like many others who have responded here, I also found klonopin to be great for anxiety without noticeable side effects. However it also became a trap for me as I built up tolerance to it. Then when I realized I needed to get myself off of it I suffered very unpleasant withdrawal symptoms for weeks. I now know that this is one of the hardest drugs to withdraw from. For more information check out: http://www.benzo.org.uk/ . Some people seem to take it for years without any problem but I personally can't recommend it based upon my own experience.
About SSRI's, I haven't had any success with them either. But the one drug I have done the best on and am now back on it again is Nardil. I actually tolerate it better than any other type of AD. And it is effective for anxiety as well as depression and increases motivation. In fact, according to info that my doc showed me, it is the most effective drug for anxiety next to a benzo and I believe it. I would highly recommend giving it a try before becoming addicted to klonopin, speaking as one who has been there.
Larry
Posted by Dr. Bob on March 4, 2003, at 8:42:47
In reply to Redirect: Nothing matters after forty ???, posted by Dr. Bob on March 3, 2003, at 21:01:29
> > So anyway, when you're 40, you're not as good looking, but you've been able to establish a partner that is in the same straights as you are...
>
> This is a fine discussion, but I'd like it to be redirected to Psycho-Social-Babble, thanks.Here's a link:
http://www.dr-bob.org/babble/social/20030301/msgs/205784.html
Bob
Posted by Jack Smith on March 5, 2003, at 18:26:30
In reply to Re: KLONPIN users,help??, posted by mattdds on March 2, 2003, at 1:16:02
What time of day do you take it? Can you still enjoy a few beers every now and then?
Posted by Mikey_C on March 5, 2003, at 18:30:12
In reply to Questions re Klonopin » mattdds, posted by Jack Smith on March 5, 2003, at 18:26:30
Oh yeah, no problem... Hell, you can drink while you're on this medication if it's the only one you're taking.What time of the day you take it depends on how much you're taking. For people with horrible Social Phobias, they usually need a little bit of it every few hours throughout the day. For myself on the other hand, I just have a LOT of problems sleeping and I take 1mg before bed every night.
It takes 45 minutes or so to kick in, so if you don't feel anything at first wait an hour before you decide to take anymore.
Posted by KrissyP on March 5, 2003, at 19:24:29
In reply to Questions re Klonopin » mattdds, posted by Jack Smith on March 5, 2003, at 18:26:30
Hello, I'm not a regular drinker, but I take Klonopin and I have drank a few beers while on it, not much happened, except I felt great, of course. I also have drank margaritas on it-same effect:-) I take Klonopin at night.
Hope this helps?
Kristen
-------------------------------------------------What time of day do you take it? Can you still enjoy a few beers every now and then?
This is the end of the thread.
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