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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 7 of 7. This is the beginning of the thread.
Posted by qbsbrown on March 28, 2004, at 15:16:35
I just started Paxil cr (12.5) and klonopin 1mg a day, for panic disorder and depersonalization. If (hopefully) this works, how will I know which is working? Obviously I'd only like to be on the paxil. But can I tell if it's working 'til I quit the klonopin?
I'd appreciate it
Posted by silmarilone on March 28, 2004, at 15:34:18
In reply to AD+BENZO- Which one is working?, posted by qbsbrown on March 28, 2004, at 15:16:35
Why would you rather be on paxil? Klonopin is safer and more effective, and we know the long term effects. Not to mention that Paxil has a very bad withdrawal syndrome for many people.
I'm taking Wellbutrin and klonopin. Wellbutrin works well for depression, and the klonopin helps with the anxiety side effects of the wellbutrin, plus my regular anxiety and mood swings.
> I just started Paxil cr (12.5) and klonopin 1mg a day, for panic disorder and depersonalization. If (hopefully) this works, how will I know which is working? Obviously I'd only like to be on the paxil. But can I tell if it's working 'til I quit the klonopin?
>
> I'd appreciate it
Posted by Viridis on March 28, 2004, at 18:56:26
In reply to Re: AD+BENZO- Which one is working? » qbsbrown, posted by silmarilone on March 28, 2004, at 15:34:18
I'd also feel safer with the Klonopin than Paxil, given the choice -- Klonopin and other benzos have a long history of safety, and generally are less dependency-inducing (although of course this varies among individuals). The World Health Organization recently ranked Paxil second among all medications in terms of number of reports of adverse withdrawal reactions, and Klonopin 15th (#1 was Effexor).
This doesn't mean that antidepressants are "worse" than benzos, and sudden withdrawal from benzos can actually be medically dangerous rather than just causing discomfort. Given the evidence and my experience though, I just feel safer with Klonopin.
Of course, it could be that you need both. You'll probably find out fairly soon, if your doctor is following the widely-used practice of prescribing a benzo to smooth out the transition to an SSRI, then encouraging you to discontinue the benzo. This is backwards (in my opinion), but some people do very well with SSRIs. I'm not one of them, but you could be.
Good luck!
Posted by qbsbrown on March 28, 2004, at 20:25:56
In reply to Re: AD+BENZO- Which one is working? » silmarilone, posted by Viridis on March 28, 2004, at 18:56:26
> I'd also feel safer with the Klonopin than Paxil, given the choice -- Klonopin and other benzos have a long history of safety, and generally are less dependency-inducing (although of course this varies among individuals). The World Health Organization recently ranked Paxil second among all medications in terms of number of reports of adverse withdrawal reactions, and Klonopin 15th (#1 was Effexor).
>
> This doesn't mean that antidepressants are "worse" than benzos, and sudden withdrawal from benzos can actually be medically dangerous rather than just causing discomfort. Given the evidence and my experience though, I just feel safer with Klonopin.
>
> Of course, it could be that you need both. You'll probably find out fairly soon, if your doctor is following the widely-used practice of prescribing a benzo to smooth out the transition to an SSRI, then encouraging you to discontinue the benzo. This is backwards (in my opinion), but some people do very well with SSRIs. I'm not one of them, but you could be.
>
> Good luck!SO you think that the klonopin alone is suitable? What about building up a tolerance? I was told to take one at night and in the morining. Why night, if I can fall asleep fine?
I know there's the argument about benzos masking the symptoms and ssris treating the root. But it seems that raising serotonin levels for a day is the same as lowering the central nervous system. If SSRIS were treating the root, you wouldn't have to take it everyday.
But are benzos glorified alcohol?
Posted by silmarilone on March 28, 2004, at 20:32:55
In reply to Re: AD+BENZO- Which one is working?, posted by qbsbrown on March 28, 2004, at 20:25:56
What some people don't understand is that not all benzos are alike. Klonopin does NOT produce euphoria, etc. like alcohol, and it takes quite a long time to start feeling the effects.
SOME benzos DO begin working soon and can give a euphoric feeling, hence the desire by some people to take xanax or ativan over klonopin, if they want to abuse a medication.
In my case and many others, I have taken klonopin for years at a time and have never had to increase the dose.
> But are benzos glorified alcohol?
>
>
Posted by qbsbrown on March 28, 2004, at 22:00:56
In reply to Re: AD+BENZO- Which one is working? » qbsbrown, posted by silmarilone on March 28, 2004, at 20:32:55
> What some people don't understand is that not all benzos are alike. Klonopin does NOT produce euphoria, etc. like alcohol, and it takes quite a long time to start feeling the effects.
>
> SOME benzos DO begin working soon and can give a euphoric feeling, hence the desire by some people to take xanax or ativan over klonopin, if they want to abuse a medication.
>
> In my case and many others, I have taken klonopin for years at a time and have never had to increase the dose.
>
> > But are benzos glorified alcohol?
> >
> >
>
>
Just saying that because they both slow the central nervous system.
I'm not against them by any means. I know they work great for my anxiety and depersonalization, but doesn't the raised serotonin help the OCD, depression, and panic disorder(I know the benzos prevent the panic attacks) better?
Posted by Viridis on March 29, 2004, at 0:58:42
In reply to Re: AD+BENZO- Which one is working?, posted by qbsbrown on March 28, 2004, at 22:00:56
Increasing the length of time that serotonin stays in your synapses might help, or it might make you feel terrible. You just have to try it and see. Serotonin isn't a magic "feel-good" neurotransmitter -- the interactions among the many neurotransmitters in the brain are very complex, and it's not possible (yet, at least) to predict the outcome of inhibiting the reuptake of serotonin for any given individual.
Also, serotonin does a lot of other things in the body -- hence the many side effects that SSRIs can cause.
GABA (gamma-aminobutyric acid) is another very important neurotransmitter, and if the receptors on certain brain cells can't bind to it properly, the cells go haywire, sending out "emergency" signals (causing anxiety). Benzos act to enhance binding of this regulatory neurotransmitter. I'm not sure how adjusting the action of one neurotransmitter is inherently better or worse than adjusting that of another.
Klonopin is favored as one of the safest of benzos, and remains the "gold standard" for treatment of panic attacks. For some people whose depression is the result of anxiety, benzos like Klonopin can be very effective, and Klonopin is also regarded by many as a mood stabilizer.
Tolerance to sedation, etc. typically develops quickly, but many patients stay at the same dose for years and continue to experience the same anti-anxiety effects (that's certainly been the case for me, and many of my pdoc's other patients). It rarely causes euphoria, etc.; I don't even notice it, and have no incentive to increase the dose or abuse it. It is likely to cause medical dependency with regular use, but this is true of all kinds of meds, psychiatric or otherwise.
In any case, it and other benzos are nothing like alcohol, although some of the pharmaceutical companies would like you to think so -- since their patents have expired, most benzos are dirt-cheap, unlike many of the newer antidepressants. That's a large part of the reason that benzos get such a bad rap.Once the next generation of anti-depressant/anti-anxiety meds comes out and the SSRIs etc. go off-patent, they'll probably be demonized too -- a shame, because these meds are very helpful for many people, just like benzos.
This is the end of the thread.
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