Shown: posts 1 to 16 of 16. This is the beginning of the thread.
Posted by JackT on May 26, 2003, at 12:54:56
I was wondering if anyone had some opinions on these two benzos specifically for social phobia. I already understand that Klonopin is longer acting and therefore easier to take. From what I understand from many of the previous posts, Klonopin seems to be the best choice. Do these drugs have different pharmocological actions or just different half-life times?
Also, what drugs are being used to help with the lows that sometimes accompany the benzos?
Posted by Squiggles on May 26, 2003, at 17:37:51
In reply to Xanax vs Klonopin ... for Social Phobia, GAD, posted by JackT on May 26, 2003, at 12:54:56
Although all benzos are supposed to be the
same chemically, their half-life varies. I
find it odd that just this variable is responsible
for such different subjective effects, but
it does.Klonopin is hardly noticeable and much better
for long range anxiety or GAD. Xanax is
excellent for acute panic or sudden anxiety
from any number of causes. It is not the fastest
benzo, but one of the fastest. It's only
drawback real drawback is that it does not take
long before you reach tolerance. There is also
a bit of a hang-over effect the next morning
with it; don't know how to eliminate that --
coffee?Squiggles
Posted by Jack Smith on May 26, 2003, at 18:16:49
In reply to Xanax vs Klonopin ... for Social Phobia, GAD, posted by JackT on May 26, 2003, at 12:54:56
> I was wondering if anyone had some opinions on these two benzos specifically for social phobia.
Xanax seems to have a mild AD effect. I believe it does on me and there are studies to back this up, I will list them below. The problem with xanax is its short duration. It only lasts about 4-6 hours, I think less on me. It has an advantage over klonopin in that it kicks in faster but klonopin lasts quite a bit longer, but in my mind lacks any real punch like xanax, that is probably why xanax is more widely abused. Hopefully, these problems will be remedied by Xanax XR purportedly coming out in June.
Also, Xanax is a triazolobenzodiazepine, which, in chemical terms, means that it has a ring with three nitrogen atoms in it in the same place
where ordinary BZs have a ketone group (oxygen atom). What the significance of this is, I have no idea but it seems that this class of benzos have an AD effect(e.g., adinazolam, still used in Europe, I believe, as an antidepressant).JACK
A comparison of the safety and efficacy of alprazolam and desipramine in
moderately severe depression.
Remick RA, Fleming JA, Buchanan RA, Keller FD, Hamilton P, Loomer F,
Miles JEFifty-four patients (34 outpatients, 20 inpatients) fulfilling Research
Diagnostic Criteria for Definite Major Depressive Disorder were enrolled
in a double-blind study comparing the antidepressant effects of
alprazolam versus desipramine. The mean daily dose of alprazolam and
desipramine at study termination was 3.78 mg and 208 mg respectively. As
there were no significant demographic or clinical differences between
outpatients and inpatients, both groups were combined in data analysis.
Using the Hamilton Depression Rating Scale (HAM-D) both drug groups
showed highly significant improvement beginning with the first week of
active drug treatment. HAM-D scores continued to decrease through study
termination (six weeks of active drug). There were no significant
differences when comparing alprazolam and desipramine (outpatients,
inpatients, or both groups combined) on any of the subjective or
objective psychometrics used in this study. Clinically, only twelve of
thirty-four outpatients (35.3%) were felt to be "markedly or moderately"
improved, suggesting that neither the outpatient alprazolam nor
desipramine patients did particularly well with drug treatment. In terms
of drug safety there was no difference between the alprazolam and
desipramine in the number of excessive or serious drug side effects.
However, five of twenty-nine alprazolam patients had to discontinue
therapy because of excessive drowsiness, and two of the alprazolam
outpatients had motor vehicle accidents directly related to this adverse
event. Alprazolam appeared as effective as desipramine in the
pharmacotherapy of this group of depressed outpatient and inpatients.
Alprazolam compared to amitriptyline in the treatment of major
depression.
Eriksson B, Nagy A, Starmark JE, Thelander UIn a double-blind randomized study the therapeutic effect and safety of
alprazolam was compared with amitriptyline in 81 outpatients suffering
from major depression. Variable dosages of both drugs were used, the mean
final dose of alprazolam being 3.05 and that of amitriptyline 130 mg.
Both treatment groups improved steadily, assessed weekly with the use of
the Hamilton Rating Scale for Depression, and no significant differences
were found between the groups, either on comparison between single items
or total scores.
Alprazolam, amitriptyline, doxepin, and placebo in the treatment of
depression.Rickels K, Feighner JP, Smith WT
Five hundred four outpatients suffering from a major depressive episode
were randomly assigned to receive either amitriptyline, doxepin,
alprazolam, or placebo. The study was conducted in three treatment
centers during a six-week period. All three active medications produced
significantly more clinical improvement than did placebo, irrespective of
the patient's initial anxiety, depression, and psychomotor retardation
and irrespective of the patient's assignment to various subtypes of
depression, including the DSM-III melancholia subtype. Compared with
placebo, sedation was reported more frequently with all three
medications, whereas anticholinergic effects were reported more
frequently only for the two tricyclic antidepressants, but not for
alprazolam.
Posted by Squiggles on May 26, 2003, at 19:07:57
In reply to Xanax is Different--Might have AD effect » JackT, posted by Jack Smith on May 26, 2003, at 18:16:49
Dear Jack,
You de man. I knew there was a chemical
difference between benzos - i just *knew* it.
But everyone said all benzos are the same.This may be a deviation but since you're
knowledgeable about this matter, could you
tell me if this is the reason why withdrawing
from Xanax was such a breeze for me (2.0mg in
3 months approx. with anxiety, insomnia, weird
dreams, nervousness, etc.) while Klonopin
was hell on earth culminating in a close to
fatal seizure or stroke or both after almost
2 yrs. of trying to get off;It has been and probably will remain a mystery
to me. But i know that there is something
different about clonazepam.BTW, the Xanax was probably unnecessary in
lieu of the high Synthroid dose - at least
that is my theory.Thanks
Squiggles
Posted by djmmm on May 26, 2003, at 19:29:50
In reply to Re: Xanax is Different--Might have AD effect » Jack Smith, posted by Squiggles on May 26, 2003, at 19:07:57
> Dear Jack,
>
> You de man. I knew there was a chemical
> difference between benzos - i just *knew* it.
> But everyone said all benzos are the same.
>
> This may be a deviation but since you're
> knowledgeable about this matter, could you
> tell me if this is the reason why withdrawing
> from Xanax was such a breeze for me (2.0mg in
> 3 months approx. with anxiety, insomnia, weird
> dreams, nervousness, etc.) while Klonopin
> was hell on earth culminating in a close to
> fatal seizure or stroke or both after almost
> 2 yrs. of trying to get off;
>
> It has been and probably will remain a mystery
> to me. But i know that there is something
> different about clonazepam.
>
> BTW, the Xanax was probably unnecessary in
> lieu of the high Synthroid dose - at least
> that is my theory.
>
> Thanks
>
> Squiggleswell, most benzos ARE different, they can vary from acute anti-anxiety meds, to sleep aids, to anti-epileptics , to muscle relaxants
All benzos differ in potency (the degree at which they bind to specific receptors), half-life, and also in localization (within the brain), and selectivity to specific benzo receptors (which is why some are good muscle relaxants, while others are not, etc)
you may have had a harder time with Klonopin because it is a bit more potent than xanax. Your withdraw reaction to Klonopin may be indicative of something else, like epilepsy (Dr. bob has a section on this site about subsyndromal epilepsy)
Posted by Squiggles on May 26, 2003, at 19:46:12
In reply to Re: Xanax is Different--Might have AD effect, posted by djmmm on May 26, 2003, at 19:29:50
Thank you djmmm,
I will look it up; i believe that the clonazepam
may have changed my brain because the waves
of withdrawal just kept on and on after the
seizure despite reinstatement and addition
of the dose higher to the intitial one. I should
not rule out the possibility of lithium toxicity
with serotonin syndrome though as it was very
hot. Perhaps the lithium jumped up in the absence
of a stable dose of clonazepam; really wish
i knew some psychopharmacology;Ashton is right about this -
there can be indefinite motor protracted syndrome
from benzo withdrawal in general.Squiggles
Posted by Squiggles on May 26, 2003, at 20:00:57
In reply to Re: Xanax is Different--Might have AD effect, posted by djmmm on May 26, 2003, at 19:29:50
Sorry, i can't find the site; also one
more question - are you suggesting that
i have an underlying epileptic condition?
Because the klonopin was given to me after
the bipolar diagnosis - quite a few years
after; and it was not given in conjunction
with bipolar (as the Popoppoulos pair would
associate epilepsy with bipolar) but for
some anxiety at work. Therefore, i never
had any signs of epilepsy, as far as i know.Squiggles
tx - sorry to be a pest
Posted by Viridis on May 26, 2003, at 22:24:31
In reply to Xanax vs Klonopin ... for Social Phobia, GAD, posted by JackT on May 26, 2003, at 12:54:56
Just to echo what some other posters have said, I take both Klonopin (daily) and Xanax (as needed; frequency varies) -- they're quite different.
K (once I got past the initial, mild side effects) is essentially imperceptible, but helps greatly with anxiety and seems to last about 12 hrs for me. I haven't had to increase beyond 1 mg/day after about 2 years of use, and have zero side effects.
X is extremely helpful for "breakthrough" anxiety; typically I take about 0.5 mg. I also find it very helpful for occasional insomnia at 0.5 - 1.0 mg. Although it doesn't cause me any problems, I can definitely "feel" it (no euphoria, just a sense of calm). However, since I take it sporadically, it's unlikely that I've developed tolerance. Some weeks I may take it two or three days in a row, then not take it at all for a week or two. Its effects generally last about three to four hours for me.
I notice a definite lift in mood on days after taking X, and can certainly see how it could act as an antidepressant. I just don't want to take it regularly because there is some potential for dependency. Also, my pdoc prefers to keep the amounts prescribed fairly low on this one, especially since the Klonopin is effective. He considers both very good drugs for those with anxiety disorders, but is particularly cautious with Xanax. He also told me that the higher-ups monitor prescriptions for Xanax (alprazolam) fairly closely, since it has the worst reputation for dependency and abuse among the benzos. I'm quite comfortable with it though, and have never abused it, had cravings etc.
Having both K and X available has helped immensely with my anxiety and reduced my depression greatly.
Posted by Squiggles on May 27, 2003, at 6:54:24
In reply to Re: Xanax vs Klonopin ... for Social Phobia, GAD » JackT, posted by Viridis on May 26, 2003, at 22:24:31
Ditto ditto ditto; my feelings exactly.
One difference from your assessment of K and X:
X eventually gave me panic attacks because
it became addicting even at the "prescribed as
needed" basis for panic. I never ever abused
my prescription. It was merely a question of
time - i.e. 15 yrs. at no more than 2.0mg dose.Also, i would not consider it a good AD for me
because on the contrary, it made be blue after
its 2-4 hr. effect wore off.As for K - that is a different beast, but
i agree you hardly feel it. Actually, i
am not sure if it is the best thing to
give for anxiety but for epilepsy. The problem with
K imho, is that while you may not be an epileptic
getting on, you become one getting off.Squiggles
Posted by JackT on May 27, 2003, at 7:12:28
In reply to Re: Xanax vs Klonopin ... for Social Phobia, GAD » JackT, posted by Viridis on May 26, 2003, at 22:24:31
Thanks for all your posts; they were quite helpful.
Jack T.
Posted by SLS on May 27, 2003, at 7:25:07
In reply to Xanax is Different--Might have AD effect » JackT, posted by Jack Smith on May 26, 2003, at 18:16:49
> > I was wondering if anyone had some opinions on these two benzos specifically for social phobia.
>
> Xanax seems to have a mild AD effect.Hi.
There is a drug known as adinazolam (Deracyn) that is a benzodiazepine and used almost exclusively for treating depression elsewhere in the world. It is most similar structurally to alprazolam (Xanax); both of them being triazolobenzodiazepines. In addition to being a partial agonist at benzodiazepine receptors, adinazolam has been reported to promote the release of both norepinephrine (NE) and serotonin (5-HT). There are only three available triazolobenzodiazepines: alprazolam, adinazolam, and triazolam. Perhaps all three possess antidepressant properties, although I have never seen any such claim made of triazolam (Halcion).
I tried using adinazolam about 15 years ago when it was being investigated in the US for depression. It did not work for me, but it did for many others to the surprise of the investigators. I felt absolutely no sedative or anxiolytic properties.
Posted by djmmm on May 27, 2003, at 9:39:05
In reply to Re: Xanax is Different--Might have AD effect » djmmm, posted by Squiggles on May 26, 2003, at 20:00:57
> Sorry, i can't find the site; also one
> more question - are you suggesting that
> i have an underlying epileptic condition?
> Because the klonopin was given to me after
> the bipolar diagnosis - quite a few years
> after; and it was not given in conjunction
> with bipolar (as the Popoppoulos pair would
> associate epilepsy with bipolar) but for
> some anxiety at work. Therefore, i never
> had any signs of epilepsy, as far as i know.
>
> Squiggles
>
> tx - sorry to be a pestyou aren't a pest :) ... I was suggesting that you should consider looking into epileptic conditions, Your psychiatrist should have ruled out epilepsy even before meds. It is my understanding that all "organic" conditions should be definitively ruled out before treating the problem as "psychiatric"
You mention, serotonin syndrome, Klonopin and lithium have been known to contribute to serotonin syndrome, but having a seizure as a result of serotonin syndrome is rare.
Klonopin has caused, and can exacerbate seizures in people who have epilepsy, and seizures as a result of discontinuation of Klonopin typically only occurs in those who take Klonopin as an anti-epileptic.
You may just be one of the few people who experience the "rare/uncommon" side-effects of benzo withdraw/discontinuation.
here is the section on this site about epilepsy
http://www.dr-bob.org/tips/isse.html
Posted by Squiggles on May 27, 2003, at 9:59:24
In reply to Re: Xanax is Different--Might have AD effect, posted by djmmm on May 27, 2003, at 9:39:05
Thanks very much; it may have been
that the lithium was high; it was at
the time i got peripheral neuropathy,
daily diarrhea, and it was the hottest
summer on record - may have contributed
to lithium o.d - this is the problem with
polypharmacy imho -- it get more and more
complex.Squiggles
Posted by Squiggles on May 27, 2003, at 10:15:17
In reply to Re: Xanax is Different--Might have AD effect » djmmm, posted by Squiggles on May 27, 2003, at 9:59:24
My epilepsy score is 30 with olfactory 83 --
i would say that has been the most distinct
and obvious abbertation in my sensorium -
smelling things strongly or having olfactory
hallucinations at night. But it's not common.Squiggles
Posted by fanni on May 27, 2003, at 17:03:39
In reply to Re: Xanax is Different--Might have AD effect, posted by djmmm on May 26, 2003, at 19:29:50
i agree.ive been in awful shite states and ive taken xanax and it lifted me up.the same goes for zimovane,i dont take it very often,cos i dont want to get hooked,as its sooooo nice!but whenever i take it to sleep next day i wake up and im so relaxed,but up and buzzy at the same time.
Posted by Jack Smith on May 27, 2003, at 18:44:46
In reply to Re: Xanax is Different--Might have AD effect, posted by SLS on May 27, 2003, at 7:25:07
As previously posted, it looks like xanax xr is going to be available in june.
http://www.pharmalive.com/news/show_article.asp?articleID=85043&catid=8
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