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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 psychosage on June 1, 2004, at 0:55:14
I am wondering what is the rationale for a stim/benzo combo like Dexedrine/Klonopin or whatever have you.
I am BP with depression/some anxiety.
Do non ADHD people take this?
If yes, do any of you take a mood stabilizer and/or antidepressant too?
I am more curious about Klonopin than the stim part because of past history I should stay away from amphetamines/ritalin. I do take provigil though.
Posted by florence on June 2, 2004, at 13:47:02
In reply to Stimulant/Benzo combo - Chemist or anyone?, posted by psychosage on June 1, 2004, at 0:55:14
> I am wondering what is the rationale for a stim/benzo combo like Dexedrine/Klonopin or whatever have you.
>
> I am BP with depression/some anxiety.
>
> Do non ADHD people take this?
>
> If yes, do any of you take a mood stabilizer and/or antidepressant too?
>
> I am more curious about Klonopin than the stim part because of past history I should stay away from amphetamines/ritalin. I do take provigil though.
>
> I have depression and chronic fatigue. I have taken provigil for about 2 years. I recently quit remeron (it sure helped my insomnia but not my mood really) I noticed a decline in my mood (crying, depressed, irritable) about 5 hours after taking provigil. So my pdoc gave me Xanax to help with this. Provigil didn't seem to be working lately, I am in bed with relentless fatigue so she let me try Ritalin and then Adderall XR. The drop in mood happened again-just like with provigil; possibly worse! I asked for Klonopin but it isn't helping very much so I have gone back to Xanax. My understanding is that Xanax is shorter acting; Klonopin is longer acting. BUT in my case, the klonopin took alot longer to take effect than the Xanax. I do not have ADHD but the combo of Adderall and Klonopin is given all the time. I feel absolutely NO mood lifting effects of Provigil, Adderall XR, or Ritalin so I am still searching for another antidepressant. I hope others can help you better than me. It is HARD to find people without ADHD that take Adderall and Klonopin..I do not have any anxiety. But my fatigue is so bad that I was willing to try stimulants. But I ALWAYS need to take Xanax along with them.
Posted by Anthony Quest on June 4, 2004, at 1:44:25
In reply to Re: Stimulant/Benzo combo - Chemist or anyone?, posted by florence on June 2, 2004, at 13:47:02
I took Dexedrine along with Benzos but the benzos only at night right before bed so I don't think that is your situation.
If the stimulants are necessary in order for you to function but the side effects are decreased mood and depressive symptoms why not instead of using a benzo to treat do the following:
1- try all different stimulants to determine if you can avoid the negative effects (including Desoxyn).
2-try alternative to Benzos to help your mood, i.e. an anti-depressant.
3- instead of using stimulants to stay away, try Xyrem. Most narcoleptics after switch to Xyrem cut WAY Down on stimulants. Maybe this can work for you?
Posted by Keith Talent on June 4, 2004, at 10:01:01
In reply to Stimulant/Benzo combo - Chemist or anyone?, posted by psychosage on June 1, 2004, at 0:55:14
> I am wondering what is the rationale for a stim/benzo combo like Dexedrine/Klonopin
The stimulant makes one more sociable (such as in Social Phobia), can fix the anergic (lack of drive) component of Major Depressive Disorder and improves focussing ability (whether it was a symptom of a disorder or not). The benzodiazepine reduces the anxiety ideally to zero or fairly close to it. The anxiety can occur in many patterns, in many disorders. The benzos used in this context are not taken to cause sleep - the aim is for a steady concentration in the brain. This is why clonazepam is the gold standard - it has a half-life in the blood of about 40 hours. If taken twice daily, the concentration in the brain and blood will stay within a nice, narrow, therapeutic range. The stimulants and the benzodiazepines are not, as you might at first think, opposites. I used to think of it this way before reading about the combination at places like this one. You may have seen how often this topic of discussion arises, especially in the context of Social Phobia. The drug companies aren't interested in promoting any drug that is off-patent, so good and useful drugs are often never introduced to young physicians and psychiatrists, leading patients to suffer. I'm not saying that some of the new drugs aren't great, just that some of the oldies are goodies.
> I am BP with depression/some anxiety.
Do you mean Borderline Personality Disorder or one of the Bipolar Disorders? If the latter, there is some longstanding research that amphetamines, when given to patients with manic episodes in hospital, help to control the mania rather than cause/make it worse. If the former, drugs with even a moderate abuse/dependence potential like these would probably be denied to you (because borderlines abuse substances).
> Do non ADHD people take this?
All the time.
> If yes, do any of you take a mood stabilizer and/or antidepressant too?
I take sertraline (Zoloft) as well as clonazepam and dextroamphetamine, but there are plenty of people who are on mood stabilisers with a stim and a benzo. Stimulants were the first drugs used to treat depression. Now, if they're used for this, it's usually in combination with another antidepressant. Some people develop enormous tolerance to stimulants, which is a problem for treating a lifelong condition like MDD. Others stay on the same, low and effective dose for decades.
> I am more curious about Klonopin than the stim part because of past history I should stay away from amphetamines/ritalin. I do take provigil though.
Have you asked yourself why you started taking stimulants? Were there any particular symptoms that you were trying to self-medicate away? Studies have now established that, for example, people with ADHD who never get treated have a much, much greater risk of becoming stimulant abusers than the general population. People with treated ADHD, on the other hand, have a lower risk of abuse. I've never taken modafinil (Provigil), but it sounds from discussions here like glorified coffee. I wouldn't deny yourself a potentially life-transforming treatment just because you tried to treat yourself as a youngster, rather than get professional help.
Hope all works out well for you,
Keith.
Posted by Viridis on June 4, 2004, at 23:58:15
In reply to Stimulant/Benzo combo - Chemist or anyone?, posted by psychosage on June 1, 2004, at 0:55:14
I find that Klonopin and Adderall go very well together, and as someone else has pointed out, it's not the "upper-downer" situation that some people see it as. Klonopin reduces my anxiety without any side effects, and Adderall helps me focus (I have ADD). Klonopin seems to control depression for me by reducing anxiety, and Adderall also acts as an antidepressant, as well as helping me feel relaxed. I've never had any inclination to abuse either -- any more than the prescribed amount of benzos just makes me sleepy, and too much Adderall makes me irritable.
I do take Lamictal as well, which I find very mild and helpful for smoothing things out.
Posted by bobbiedobbs on June 6, 2004, at 16:36:41
In reply to Re: Stimulant/Benzo combo - Chemist or anyone?, posted by florence on June 2, 2004, at 13:47:02
Just starting Klonopin. I'm worried about fatigue. My doc will not prescribe Adderal as others on this site have recommended. He says just take it to the point where the side effects kick in. My gut is that I may be able to more fully get the benefits of this med, if I can mute the sleepiness.
Any suggestions?
I guess I'll start the medication, give it a week, and if still zonked, get on my hands and knees and beg for Adderal, if that doesn't work, just ramp up the coffee.
Posted by Viridis on June 8, 2004, at 0:12:11
In reply to Re: Stimulant/Benzo combo - Chemist or anyone?, posted by bobbiedobbs on June 6, 2004, at 16:36:41
I found that sleepiness and other mild side effects caused by Klonopin went away completely after a week or two, but the anti-anxiety effects remained. This seems to be the pattern for many people. At the beginning I split the dose into 4X daily, then twice, but fairly quickly went to single dose (1 mg) in the morning. Dividing the dose seemed to minimize sleepiness/clumsiness while helping greatly with anxiety.
Klonopin has a very long half-life (duration of action), so many people take it before bed. For me, it wore off by about the middle of the next day, but this dosing strategy seems to be successful for quite a few users.
As with nearly all these meds, dosage seems to be highly individual-specific. 1 mg seems pretty "standard", but some people need more, while others get by with as little as 0.25 mg. If it continues to make you really tired, maybe a lower dose would be appropriate.
Good luck!
Posted by PaulbWell on June 8, 2004, at 16:45:39
In reply to Re: Stimulant/Benzo combo - Chemist or anyone? » bobbiedobbs, posted by Viridis on June 8, 2004, at 0:12:11
These two Classes of meds go well together. For me Clonazepam 2-4mgs lasts all day and Methylphenidate 30-60mgs lasts 4 hours, a dose when swallowed
Posted by Viridis on June 9, 2004, at 6:26:24
In reply to Stimulant/Benzo combo - Chemist or anyone?, posted by psychosage on June 1, 2004, at 0:55:14
I should add that Klonopin goes very well (for me) with Adderall, and also mixed well with Provigil, although the latter just didn't help much with ADD (but it was energizing without anxiety).
This is the end of the thread.
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