Psycho-Babble Medication Thread 375357

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Clonazepam Tolerance

Posted by Guy on August 8, 2004, at 14:20:52

I suffer from extreme anxiety and insomnia. Am just starting clonazepam. Can anyone tell me if I have to worry about tolerance in the long haul? Can I stay on this med for the rest of my life? I've just read an article by Professor Heather Ashton, a British physician, that states: "There is little evidence that benzdiazepines retain their effectiveness after a few months. In fact, long-term benzodiazepine use may aggravate anxiety disorders." Any opinions greatly appreciated. By the way, I've tried a ton of anti-depressants, all to no avail.

 

Re: Clonazepam Tolerance

Posted by mair on August 8, 2004, at 15:47:46

In reply to Clonazepam Tolerance, posted by Guy on August 8, 2004, at 14:20:52

My own experience has been positive, but I take such small doses, always at bed time to make it easier for me to sleep. I've been doing this for at least 6 years or so and have noticed no lessening of effect. Sometimes, if I'm more agitated than usual, I just increase my dose some, but only temporarily.

I can have pretty bad anxiety sometimes, but not usually at night. For daytime anxiety I use xanax when needed. The klonopin is really just more to address insomnia, some of which may be caused by Wellbutrin, which has an agitating effect.

I hope this helps.

Mair

 

Re: Clonazepam Tolerance

Posted by Ame Sans Vie on August 8, 2004, at 16:05:17

In reply to Re: Clonazepam Tolerance, posted by mair on August 8, 2004, at 15:47:46

Heather Ashton is a very prominant benzophobe fear-mongerer -- the leader in her field. ;-)

I've taken Klonopin at high doses (currently 12mg/day) for over three and a half years with no tolerance developing.

~Michael

 

Re: Clonazepam Tolerance

Posted by Viridis on August 8, 2004, at 21:02:52

In reply to Clonazepam Tolerance, posted by Guy on August 8, 2004, at 14:20:52

Clonazepam seems to be unusual among benzodiazepines, in that a large proportion of patients seem to be quite comfortable with the same dose for years. I take 1 mg/day and have not yet (after about 4 years) had to up the dose. My pdoc likes it because it often remains effective at the same dose indefinitely, and has had patients on the same amount for over a decade.

 

Re: Is this drug combo SAFE? (update)

Posted by Squiggles on August 8, 2004, at 21:24:06

The addition of lithium to imipramine
is beginning to show very positive results:
-increased appetite
-calmness
-better mood
-better, longer sleep

This is after a week. It would be miraculous
if imipramine could be withdrawan altogether,
especially after a 20 year daily ingestion.
Especially, since that drug is hard and may
be the cause of the "pain after eating".
I believe that might merit a gastroenterology
look, after the gall bladder operation. As it
stands depression has been considered the cause
of it. Maybe the next appointment can clarify
this detail.

But what a miraculous and yet tragic thing
it would be if lithium works, in the absence
of imipramine, and is the last drug to be tried
after a series of just about every drug in
the psychiatric pharmacological apothecary.

Squiggles

 

Re: Is this drug combo SAFE? (update)

Posted by Squiggles on August 8, 2004, at 21:35:10

In reply to Re: Clonazepam Tolerance, posted by Viridis on August 8, 2004, at 21:02:52

Ditto Viridis,

But have you ever tried getting off it
after taking it for some years?

I found it first impossible, and
then nearly fatal.

I must take it for the rest of my life,
whether i need it or not it seems.

Squiggles

 

Re: Is this drug combo SAFE? (update) » Squiggles

Posted by Ame Sans Vie on August 8, 2004, at 22:03:57

In reply to Re: Is this drug combo SAFE? (update), posted by Squiggles on August 8, 2004, at 21:35:10

> But have you ever tried getting off it
> after taking it for some years?
>
> I found it first impossible, and
> then nearly fatal.
>
> I must take it for the rest of my life,
> whether i need it or not it seems.

I'm sorry to hear that... surely there's *something* you could do? What about tapering with phenobarbital? That seems to be the most efficient way to taper since phenobarbital allows for such miniscule doses.

~Michael

 

Re: Clonazepam Tolerance » Guy

Posted by Kon on August 9, 2004, at 0:09:20

In reply to Clonazepam Tolerance, posted by Guy on August 8, 2004, at 14:20:52

Tolerance to anti-anxiety effects does not appear to occur. See abstracts below. From the Farnsworth review:

"Studies of psychotropic drug use and abuse demonstrate that individuals using benzodiazepines for treatment of a medical illness rarely demonstrate tolerance to the therapeutic action of the medication or escalate dose."

------------
Psychopharmacol Bull. 1998;34(2):199-205.

Long-term experience with clonazepam in patients with a primary diagnosis of panic disorder.

Worthington JJ 3rd, Pollack MH, Otto MW, McLean RY, Moroz G, Rosenbaum JF.

Department of Psychiatry, Massachusetts General Hospital, Boston 02114-3117, USA.

This study examined the use patterns and efficacy of the high potency benzodiazepine (HPB) clonazepam in panic patients who were treated and followed naturalistically in the Massachusetts General Hospital Longitudinal Study of Panic Disorder. Of 204 patients followed over a 2-year period, 46 percent were receiving clonazepam alone or in combination with an antidepressant. Treatment was not controlled at initial evaluation or during the followup period. The main variables assessed in this analysis included global severity of the panic disorder and stability of clonazepam dose. All treatment groups tended to improve over time without significant differences in outcome between groups. Clonazepam doses remained stable over time. Results of this study suggest that treatment of panic disorder with the HPB clonazepam achieved and maintained a therapeutic benefit similar to that obtained with alternative pharmacologic treatments, without the development of tolerance as manifested by dose escalation or worsening of clinical status.
-------------
Psychiatr Serv. 2003 Jul;54(7):1006-11.
Lack of relationship between long-term use of benzodiazepines and escalation to high dosages.

Soumerai SB, Simoni-Wastila L, Singer C, Mah C, Gao X, Salzman C, Ross-Degnan D.

Department of Ambulatory Care and Prevention, Harvard Medical School, Boston, MA, USA. ssoumerai@hms.harvard.edu

OBJECTIVE: The objective of this study was to determine whether long-term benzodiazepine use is associated with dose escalation. METHODS: The authors examined changes in dose and the frequency of dose escalation among new and continuing (at least two years) recipients of benzodiazepines identified from a database containing drug-dispensing and health care use data for all New Jersey Medicaid patients for 39 months. Independent variables included age; Medicaid eligibility category; gender; race or ethnicity; neighborhood socioeconomic variables; chronic illnesses, such as schizophrenia, bipolar illness, panic disorder, and seizure disorder; and predominant benzodiazepine received. Logistic regression analyses were conducted to determine the association between the independent variables and escalation to a high dosage (at least 20 diazepam milligram equivalents [DMEs] per day for elderly patients and at least 40 DMEs per day for younger patients). RESULTS: A total of 2,440 patients were identified, comprising 460 new and 1,980 continuing recipients. Seventy-one percent of continuing recipients had a permanent disability. Among all groups of continuing recipients, the median daily dosage remained constant at 10 DMEs during two years of continuous use. No clinically or statistically significant changes in dosage were observed over time. The incidence of escalation to a high dosage was 1.6 percent. Subgroups with a higher risk of dose escalation included antidepressant recipients and patients who filled duplicate prescriptions for benzodiazepines at different pharmacies within seven days. Elderly and disabled persons had a lower risk of dose escalation than younger patients. CONCLUSION: The results of this study did not support the hypothesis that long-term use of benzodiazepines frequently results in notable dose escalation.

------------------------
J Fam Pract. 1990 Oct;31(4):393-400.
Benzodiazepine abuse and dependence: misconceptions and facts.
Farnsworth MG.

Department of Psychiatry, Ramsey Clinic, St Paul-Ramsey Foundation, Minnesota 55101.

Benzodiazepines can be prescribed for a number of medical conditions. Many physicians are reluctant to prescribe benzodiazepines out of fear of producing dependence in patients and incurring the disapproval of their peers. Studies of psychotropic drug use and abuse demonstrate that individuals using benzodiazepines for treatment of a medical illness rarely demonstrate tolerance to the therapeutic action of the medication or escalate the dose. Eighty percent of benzodiazepines are prescribed for 6 months or less, and elderly women are the most common long-term users of low-dose benzodiazepines. In contrast, recreational use of benzodiazepines is associated with polysubstance abuse, lack of medical supervision, rapid tolerance to the euphoric or sedating side effect, and escalation of dose. Most recreational users of benzodiazepines are young men. Documentation of indication for use, collection of drug-abuse history, close monitoring, and drug holidays can improve the management of this class of medication.

 

Re: Clonazepam Tolerance

Posted by Southern Girl on August 9, 2004, at 3:20:12

In reply to Clonazepam Tolerance, posted by Guy on August 8, 2004, at 14:20:52

In my opinion, tolerance to klonopin is very rapid...I've been taking it for a few months and get migraines if I go just one night without taking my 1mg...everyone else seemed to have a positive response to this, but any drug in the benzo category, in my opinion, causes a very repid tolerance.

 

Re: Clonazepam Tolerance » Southern Girl

Posted by Ame Sans Vie on August 9, 2004, at 6:00:18

In reply to Re: Clonazepam Tolerance, posted by Southern Girl on August 9, 2004, at 3:20:12

> In my opinion, tolerance to klonopin is very rapid...I've been taking it for a few months and get migraines if I go just one night without taking my 1mg...

I think you might be confusing tolerance with dependence. No doubt Klonopin causes dependence, as evidenced by your withdrawal symptoms upon missing a dose, but it very rarely causes the development of tolerance.

> everyone else seemed to have a positive response to this, but any drug in the benzo category, in my opinion, causes a very repid tolerance.

I'd say that's true for every other benzo available in the U.S. *except* Klonopin, actually.

~Michael

 

Re: Is this drug combo SAFE? (update) » Ame Sans Vie

Posted by Squiggles on August 9, 2004, at 6:50:29

In reply to Re: Is this drug combo SAFE? (update) » Squiggles, posted by Ame Sans Vie on August 8, 2004, at 22:03:57

My doctor does not seem very enthusiastic
about taking me off this drug. Perhaps,
it is a necessary part of my treatment.
I don't want to do it on my own. Phenobarbitol
is no longer used for withdrwal, i think.
Valium was suggested by Dr. Heather Ashton.
The question is "why should one get off" and
if one should get off you doctor will do it.

Anyway, my initial point was that clonazepam
is particularly difficult to withdraw from
in comparison to other benzos, after taking
it for many years.

Squiggles

 

Re: Is this drug combo SAFE? (update) » Kon

Posted by Squiggles on August 9, 2004, at 7:02:05

In reply to Re: Clonazepam Tolerance » Guy, posted by Kon on August 9, 2004, at 0:09:20

In my experience, clonazepam is truly
marvelous in that an escalation of dose
is not necessary to maintain the same
effect for many (7-10 even) years. In
this respect it is not like Valium and
Xanax and some other benzos.

However, cessation, even gradual, is
very dangerous. Is it possible that
there are brain changes made by taking
this drug for so long. There is no
TOLERANCE but there is withdrawal syndrome
and sequalae which can last for years.

Maybe there's a PubMed article on this aspect.

Squiggles

 

Re: Is this drug combo SAFE? (update) » Squiggles

Posted by SLS on August 9, 2004, at 7:08:06

In reply to Re: Is this drug combo SAFE? (update), posted by Squiggles on August 8, 2004, at 21:24:06

> The addition of lithium to imipramine
> is beginning to show very positive results:

Yay!

Stay well.


- Scott

 

Re: Clonazepam Tolerance » Ame Sans Vie

Posted by Glydin on August 9, 2004, at 21:39:17

In reply to Re: Clonazepam Tolerance » Southern Girl, posted by Ame Sans Vie on August 9, 2004, at 6:00:18

A hearty "Completely Right", ASV. Tolerance is needing higher and higher doses to achieve the same results.

I am always very dismayed by the lack of understanding in the factors of the use (proper or improper) with benzos. It is especially unsettling when found in a community that should be as informed as possible especially if they actually USE this class of meds. Dealing with the misunderstandings of the general public is bad enough----

> > In my opinion, tolerance to klonopin is very rapid...I've been taking it for a few months and get migraines if I go just one night without taking my 1mg...
>
> I think you might be confusing tolerance with dependence. No doubt Klonopin causes dependence, as evidenced by your withdrawal symptoms upon missing a dose, but it very rarely causes the development of tolerance.
>
> > everyone else seemed to have a positive response to this, but any drug in the benzo category, in my opinion, causes a very repid tolerance.
>
> I'd say that's true for every other benzo available in the U.S. *except* Klonopin, actually.
>
> ~Michael
>
>

 

Re: Clonazepam Tolerance » Guy

Posted by Glydin on August 9, 2004, at 21:47:28

In reply to Clonazepam Tolerance, posted by Guy on August 8, 2004, at 14:20:52

Klonopin has been great for me. I made the mistake of looking at the site you noted early on in my illness and that was a big mistake for me. The info there actually caused me to discontinue my use after three weeks, despite great results I was achieving. Needless to say, I became a bigger mess than before.

I experienced no tolerance. It was actually a drug that did what it promised - more than I can say for many others I trialed.

 

Re: Is this drug combo SAFE? » Glydin

Posted by Squiggles on August 10, 2004, at 6:56:12

In reply to Re: Clonazepam Tolerance » Guy, posted by Glydin on August 9, 2004, at 21:47:28

> Klonopin has been great for me. I made the mistake of looking at the site you noted early on in my illness and that was a big mistake for me. The info there actually caused me to discontinue my use after three weeks, despite great results I was achieving. Needless to say, I became a bigger mess than before.
>
> I experienced no tolerance. It was actually a drug that did what it promised - more than I can say for many others I trialed.

___________

I agree with you, with regard to Klonopin.
It was a mistake for me to try to come off
it. I don't think the whole site is
wrong about benzodiazepine addiction, and
I am sorry that you decided to go there.
I did withdraw with my doctor's "blessings"
however, in the same hope, if not with his
explicit approval.

It was an unfortunate experiment. And again,
it was the clonazepam that was difficult.
I was infact congratulated by my dr. for getting
off Xanax successfully.

Squiggles

 

Re: Is this drug combo SAFE? » Squiggles

Posted by Glydin on August 10, 2004, at 7:41:34

In reply to Re: Is this drug combo SAFE? » Glydin, posted by Squiggles on August 10, 2004, at 6:56:12

I think it is true we all must find our own way to what brings us to wellness. I think there is some good information at said site. The difficulity I have always had with it is the black or white nature of the basic concept - as in, NO ONE should EVER use benzo's long term. I think most all statements have room for at least the thought that views are not so finate.

I'll stop there. The last time a discussion about this site was held there was a bit of a brew-ha-ha about civility to those who supported this site's basic premise, so I'll leave it at: Benzo's have many pitfalls for some. For some, they right a wrong and give a functional life back - maybe I'm just a rare minority to getting functioning back because of the use of Klonopin.

 

Re: Is this drug combo SAFE? » Glydin

Posted by Squiggles on August 10, 2004, at 7:50:15

In reply to Re: Is this drug combo SAFE? » Squiggles, posted by Glydin on August 10, 2004, at 7:41:34

I agree with you.

I should add that in the 17-18 years
I have been taking clonazepam (RIVOTRIL),
my doctor has raised the dose two (2) times ONLY.
One time when I had reached tolerance
after about 7 years, and when I had
the head crash in withdrawal from it,
and that was done through collaboration.

That is quite impressive for a GABA drug.

And yes, I think that benzo.org has
ideologies which may interfere with
a discrimination between benzos. But
I see that elsewhere as well.

Squiggles

 

Re: Is this drug combo SAFE?

Posted by Glydin on August 10, 2004, at 8:08:24

In reply to Re: Is this drug combo SAFE? » Glydin, posted by Squiggles on August 10, 2004, at 7:50:15

"But I see that elsewhere as well."

^^^Very true and that view, generally, is found when one researches the use of benzo's. As I've said before, that was not good for me during my startup time 3ish years ago. Even on this board, where I've been long enough to note, one can see the tide ebb and flow - first they are great, then, they are the worse class of drugs ever made. I did have a good friend tell me once: Researching and attempting to seek "feel good" stories on the 'net doesn't usually work that well"... I've found that true.

 

Re: Is this drug combo SAFE? (update) » SLS

Posted by Squiggles on August 10, 2004, at 13:27:54

In reply to Re: Is this drug combo SAFE? (update) » Squiggles, posted by SLS on August 9, 2004, at 7:08:06

I feel like crying because I'm so
happy that the lithium is showing
a change for the better. It has
been so many years of miserable quality
of life. I hope this is it and I am
so grateful to my doctor.

The situation is perplexing because the
imipramine worked for so many yrs. albeit with
pretty heavy side effects. Then, almost
suddenly, it stopped working after another
drug try - Remeron -- stop and start
situation. Can't say that
the recent improvement is a result of


lithium
lithium and imipramine
imipramine petering out
or necessity of imipramine and an adjunct;

Psychiatry IS rocket science (to me at least:-)).

Squiggles


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