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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 19 of 19. This is the beginning of the thread.
Posted by banga on January 17, 2005, at 23:13:32
I just tried some of the klonopin I was given--my anxiety was starting to get very bad. .5 mg twice a day. No effect at all!
Does it take some time to work--some days? Or is this a very low dose? What does it mean if it doesn't work for me??
I will call my pdoc but hoped for some guidance here!
Posted by yxibow on January 17, 2005, at 23:53:10
In reply to HELP Onset of klonopin?, posted by banga on January 17, 2005, at 23:13:32
> I just tried some of the klonopin I was given--my anxiety was starting to get very bad. .5 mg twice a day. No effect at all!
> Does it take some time to work--some days? Or is this a very low dose? What does it mean if it doesn't work for me??
> I will call my pdoc but hoped for some guidance here!
The short answer is benzodiazepines like Klonopin are immediate in the sense of hours, and that is a very low dose.....Klonopin (clonazepam) produces a more subtle response to anxiety, in my experience any feeling of "effect" may be measured in hours. But that also means that it is a benzodiazepine that has a longer half life and can reach a more steady dosage.
It's also conceivable that if you had been on other benzodiazepines in the recent past such as Ativan or Valium or the like, your cross-tolerance may be such that .5mg (the smallest made dose of clonazepam) is not "enough" of an effect for what it is treating.
Similarly, you could also be a fast metabolizer of such medications, or it could be interacting with whatever else you take and decreasing its availability.
You may want to talk with your doctor about raising the dose slightly on your Klonopin
(carefully... there are people who are walking around with 4 or 8mg in their system but one has to think about other effects such as reaction time in driving and the like and there's no point building up a large dose if a smaller one can work because it will take longer to come down off of it properly. I know this from present experience but my situation required a larger dose.)And if Klonopin isnt for you, there's about a dozen other benzodiazepines such as Serax though generally the psych world favours Klonopin for a variety of reasons.
Hope that provides some information
Posted by johnnystats on January 18, 2005, at 6:56:36
In reply to HELP Onset of klonopin?, posted by banga on January 17, 2005, at 23:13:32
> I just tried some of the klonopin I was given--my anxiety was starting to get very bad. .5 mg twice a day. No effect at all!
> Does it take some time to work--some days? Or is this a very low dose? What does it mean if it doesn't work for me??
> I will call my pdoc but hoped for some guidance here!
>Most doctors start klonopin on a low dose to help with the sedation problems with the drug. I personally didn't like klonopin at all. Eventually it might get to be where the sedation is too much for you when the anti-anxiety effects kick in. If you can afford it, i'm a big fan of xanax xr. More and more doctors are prescribing it because it lasts all day and there's no highs and lows between doses. If it doesn't work don't worry...there's plenty of other benzos out there to try; you've just got to be patient. If the anxiety is severe though you may want to give your pdoc a call about increasing the klonopin. It never hurts to call.
Posted by banga on January 18, 2005, at 8:43:11
In reply to Re: HELP Onset of klonopin?, posted by johnnystats on January 18, 2005, at 6:56:36
Thanks for the responses--I do intend to call my pdoc, but in case I was mistaken--I was pretty sure the effect should be quite rapid--I didn't want to call her and sound like an alarmist.
It shouldnt be cross-tolerance as i have not hd benzos before.
The problem is is that she gave me this to use PRN--if I have severe anxiety, then take it for four days, then stop. I was not the slightest fatigued at this dose. She did mention that it is a small dose meant to take the "edge off," not necessarily eliminate anxiety, but it seemed to have NO effect.
Posted by CareBear04 on January 18, 2005, at 14:04:34
In reply to Re: HELP Onset of klonopin?, posted by banga on January 18, 2005, at 8:43:11
hi there--
i used to be on klonopin, but it took at minimum half an hour to kick in, and the effect was more subtle than the xanax i was also on. i prefer xanax because it has a more potent effect and i can feel it kick in, and knowing that it's working helps me relax. but i guess xanax is more addictive because most pdocs don't like to prescribe it. i don't like xanax xr much-- it's even more subtle than klonopin and i like to feel the drug kick in and even feel the wearing off. i get 4mg of xanax a day, though, so i can pop another as the doses wear off.one suggestion i have is klonopin wafers. with my insurance, the copay isn't too bad, especially compared to some other drugs like atypicals. for me, they seem to kick in faster than regular klonopin with an onset of closer to xanax. i almost prefer them more than xanax because xanax has a bitter taste so you need water to take it, whereas the wafers easily dissolve without water and seem to work as fast. i don't know if this is just my perception or whether it's accurate. anyone have a clue? i take klonopin wafers mostly at night at about 2mg, and they help me sleep.
good luck1
Posted by platinumbride on January 18, 2005, at 17:22:51
In reply to Re: HELP Onset of klonopin? » banga, posted by CareBear04 on January 18, 2005, at 14:04:34
I've read here of ppl taking the klonopin under their tongues.
I now do the same thing and usually feel myself slowly getting calmer within 10 minutes.The taste is good! Kind of minty.
And yeah, that is a bit of a low dose, but I remember when I first started the drug, it really knocked me out. Now I need 1 mg to "chill out". Do you take any sleeping pills or, as someone else said, other benzos?
Good luck.....anxiety is the pits
Diane
Posted by johnnystats on January 18, 2005, at 18:00:22
In reply to Re: HELP Onset of klonopin?, posted by banga on January 18, 2005, at 8:43:11
> Thanks for the responses--I do intend to call my pdoc, but in case I was mistaken--I was pretty sure the effect should be quite rapid--I didn't want to call her and sound like an alarmist.
> It shouldnt be cross-tolerance as i have not hd benzos before.
> The problem is is that she gave me this to use PRN--if I have severe anxiety, then take it for four days, then stop. I was not the slightest fatigued at this dose. She did mention that it is a small dose meant to take the "edge off," not necessarily eliminate anxiety, but it seemed to have NO effect.>That usually means you don't have a good pdoc. Only 4 days for severe anxiety? That's not going to take the edge off of anything. I used to take benzos PRN for anxiety, but found out that taking them every day allows them to accumulate in your system so your anxiety slowly diminishes. You were right to not call her right away though...often pdoc's will take that as a red flag for addiction to benzos.
Posted by banga on January 18, 2005, at 19:43:41
In reply to Re: HELP Onset of klonopin? » banga, posted by johnnystats on January 18, 2005, at 18:00:22
That's why she said to never take the benzos less than 3 days, it won't work out she said if I take it only for a day. I actually feel she is very reasonable, I have been to 7 pdocs so I have something to compare to. Many pdocs woudn't even consider giving a benzo at all, esp. to someone with an addiciton history. I am sure she wants to feel out how we go with this. While we are putting together a med combo for me, I see her every two weeks so I get to check in with her very frequently if things aren't going as hoped. I fel quite comfortable with her, and as opposed to experiences with some other pdocs, she takes my opinion very seriously. And she was not negative when I mentioned that one recource for information-gathering are the experienes people describe on this board.
She was also the first to understand how much anxiety affects my life. Most other clinicians saw it as a side nuisance symptom to the depression, rather than a debilitating experience.
Posted by CareBear04 on January 18, 2005, at 20:03:13
In reply to Re: HELP Onset of klonopin?, posted by banga on January 18, 2005, at 19:43:41
banga, when you say that pdocs don't like to give out addictive drugs to those with addictive personalities. i've heard that and am sure it's legitimate and for good reason, but do you know how addictive personality is defined? i've never experimented with street drugs or had a problem with alcohol. i've been on benzos and controlled sleeping pills for years without feeling like i need them. sure, i'm physically dependent and getting tolerant, but i haven't increased the doses or gone to different drs for scripts. the same is true of the narcotic painkiller percocet. i've been on it since october, and i would gladly be off it if i can do it without too much pain. now the exception is adderall. i don't know if i have a proclivity for uppers because i'd never had them before or experimented with ecstasy or meth or anything. but after months, i'm physically dependent on adderall-- i take it first thing in the morning just to function and concentrate and be alert. my mood is brighter because of it, and adderall seems to calm some anxiety and racingness to help me be more productive. the thought of going off of it or finding myself with a new dr who won't prescribe it makes me really uncomfortable and nervous. i'm afraid my mood will crash and that i'll be incapacitated with fatigue and inattentiveness and just general downness. does that make me addicted? and if i'm addicted because of the wonderful drs who have gotten me hooked, does that make me an addictive personality?
would appreciate your input. thanks a lot!
Posted by jasmineneroli on January 18, 2005, at 23:02:48
In reply to Re: HELP Onset of klonopin?, posted by banga on January 18, 2005, at 19:43:41
Hi:
Klonopin isn't really a good benzo to give PRN only, since it's not fast acting, but has a longer half-life than other benzo's.
It's much more effective used in a small dose, continuously, IMO.
It takes about 45 mins to have an effect on me. I don't suddenly feel calm. I gradually mellow down.
But when I take the same amount at the same time each day, I feel calm all the time.
I only take .25mg-.5mg per day. My best dosing arrangement was .25mg at lunch time and another .25mg around 8 or 9pm. I kinda felt a steady-state anti- anxiety result. The downside for me at that amount/timing, was that I found it difficult to rouse in the morning.I have also found that dissolving under the tongue to work much quicker.
Good luck!
Jas
Posted by platinumbride on January 19, 2005, at 5:07:50
In reply to Re: HELP Onset of klonopin? » banga, posted by johnnystats on January 18, 2005, at 18:00:22
I don't mean to add to your problems, but for me and my own crummy anxiety, neurontin and klonopin work well together.
Neurontin's effects don't start immediately, so maybe a faster acting benzo like ativan or xanax would be better to start the day with, but the neurontin, for me personally, extends the power of the benzo.
Please don't give up because the relief you will feel will be formidable once you get the right doseage and or combo.
I hear that klonopin is the benzo of choice....at least at first because of the long half-life. But if it is not for you, it is not for you!
Anecdote: People swear by the sleeping pills ambien and dalmane (flurazepam). I could swallow the whole bottle and have nothing but dry mouth in the morning - after I have been awake all night!!!! So, those just don't cut it for me.......NEXT, I say :-).
I am sure you will find the right thing for you....please keep in touch.
Diane
Posted by banga on January 19, 2005, at 11:00:17
In reply to addictive personality? please define » banga, posted by CareBear04 on January 18, 2005, at 20:03:13
Hi there!
Let me clarify things a little. The term "addictive personality" is not an official diagnosis. This is a term that some pop psychologists use to describe people who tend to pick something-whether a substance, or exersise, or food, or work--and overdo it--they need more and more, and it interferes with life. It is a controversial theory that there are "addictive personalities".What we talk about "addiction" or "addict". we mean specifically a problem with alcohol, drugs, marihuana, etc. The official modern term is "chemical dependency." this then specifies it is a drug or alcohol that one is addicted to.
Dependence (addiction) to a substance means having three of the following:
1) tolerance--you need more and more to get the same effect
2) withdrawal--negative physical consequences if you stop, or you take more of the substance to aviod the withdrawal
3) substance is often taken in larger amounts than intended
4) there is a persistent desire or unsuccessful efforts to cut down
5)you spend lots of time trying to get more of the substance, or using it (ex. chain smoking), or recovering from periods of withrawal.
6) you start to give up social or occupational actvities because of your addiction
7) You continue to use it even though you know it harms your body and mental health.So you see via the "official" guidelines, withdrawal and fear of withdrawal is only part of the problem--there is also increased tolerance, and it disturbs/takes over your life in a bad way.
This is what pdocs fear will happen for people who have once been chemically dependent (addicted) to one thing--they may have a biological vulnerability to also become addicted to another strong substance(like a barbituate), because it is shown by studies that they are vulnerable to such "cross-addiction". Chemical Dependency is NOT a personality trait, it is a disease, just as mental illness is---a screw-up in your biology, your brain has an abnormal response to a drug/alcohol, leading to addiction.
BUT remember this is a formal definition--many people have asked on this board--aren't I addicted if I have withdrawal symptoms, and fear that I can't do without my med? It is a good question. But TECHNICALLY for it to become a true addiction, it would mean you take more and more and more, even if it hurts your life in some way (you withdraw from people, stop caring for yourself, break your bank account buying more and more....)
So using a softer definition, many meds can be addictive-including antidepressants which docs swear are not addictive, etc.
Where I would worry is if you start feeling you need more and more, are taking more than the prescribed amount, and it starts negatively influencing your life. That is then a dangerous situation.
Posted by banga on January 19, 2005, at 11:02:16
In reply to Re: HELP Onset of klonopin?, posted by platinumbride on January 19, 2005, at 5:07:50
Thank you everyone for your comments. I see my pdoc on Monday, maybe I will take it until then, get a sense of whether it is helpful.
Posted by ed_uk on January 19, 2005, at 11:09:43
In reply to Re: HELP Onset of klonopin?, posted by banga on January 19, 2005, at 11:02:16
Hi,
I once took 2 mg of clonazepam. I don't think it did anything. If you want a medication for 'as required' use, Xanax or Valium might be preferable. Your pdoc might be uncomfortable prescribing either of these meds though.
Regards,
Ed.
Posted by banga on January 19, 2005, at 13:13:10
In reply to Re: HELP Onset of klonopin? » banga, posted by ed_uk on January 19, 2005, at 11:09:43
Thanks. I just called my pdoc and left a message--what I had hoped would be a calm message from me saying that it is not helping my total panicky anxiety, turned out to be me crying into the phone, and barely able to collect myself enough to describe what is going on. I can now add to my list "extreme tearfulness" as a significant symptom.
I don't know if my past alcohol dependence set up a certain tolerance to benzos of what. If a higher dose of Klonopin isn't the answer, I am back to Geodon.I had this odd idea that perhaps, after taking it 20mg a few days in a row, I could then take it every other day--perhaps that would get the edge off anxiety, but it wouldn't build up in my system to levels where akasthisia sets in--which, in my theory, is the cause of the initial antianxiety effects wearing off. When akathisia sets in, its agitating quality overrides any anxiolytic effects it had earlier.
I just started a mood chart, and I can see the influence of Geodon on my well-being is dramatic.What do you think?
Posted by yxibow on January 19, 2005, at 16:07:53
In reply to Re: Klonopinvs Geodon » ed_uk, posted by banga on January 19, 2005, at 13:13:10
>enough to describe what is going on. I can now add to my list "extreme tearfulness" as a significant symptom.
I wouldn't add everything up to a symptom; its just part of being caught in the throws of anxiety. I left all sorts of messages in the past on my pdocs phone when my problems were at worst.
> I don't know if my past alcohol dependence set up a certain tolerance to benzos of what. If a
Its conceivable I suppose in the theoretical, although a quite ancient benzodiazepine, Librium, is used to reduce alcohol dependence in a clinical setting.
>
> I had this odd idea that perhaps, after taking it 20mg a few days in a row, I could then take itI've personally tried Geodon and for an affective disorder (I'm assuming yours is) it can definately cause the akathisia. I would suggest to your doctor to add propranolol to cut the edge off of the akathisia if you were to continue the Geodon. Neuroleptics aren't really PRN medications and for a variety of reasons shouldnt generally be stopped and started randomly. Or you could try Seroquel or Zyprexa, which would not have the profile of akathisia of Geodon.
If you're merely taking it for "general anxiety" though, the Klonopin or an SSRI I would think would be better. But as you said, your mood has improved significantly so that's really the test of a medication, just have to mind the side effects.
Best wishes
Posted by phillipa on January 19, 2005, at 17:04:06
In reply to Re: Klonopinvs Geodon, posted by yxibow on January 19, 2005, at 16:07:53
I wonder why my pdoc wants me to take zyprexa to sleep? Why would you add a med with so many side effects. Phillipa
Posted by CareBear04 on January 19, 2005, at 18:04:30
In reply to Re: Klonopinvs Geodon, posted by phillipa on January 19, 2005, at 17:04:06
well, zyprexa is a heavy duty and potent sleeping med, at least in my experience, so much so that it makes you zombieish for the next day, too. i can't answer, though, why your doctor would add the drug given its many side effects. i'm sort of wondering the same thing for my situation. i can't remember what drugs you're on, but it seems like zyprexa is in the same class or doing the same things that your other meds should cover. i'm on zoloft and prozac as ADs, haldol, seroquel and other neuroleptics, and a bunch of sleeping meds. my dr yesterday gave me a script for remeron, another AD for sleep. i don't want it, and my instinct is not to take it. how many sedating drugs, and how many antidepressants do i need? geez! is this like what you're experiencing?
Posted by phillipa on January 19, 2005, at 18:33:09
In reply to Re: Klonopinvs Geodon, posted by phillipa on January 19, 2005, at 17:04:06
Well, I went back to my old pdoc and he suggested it since I have such a hard time sleeping even with meds. But, I'm afraid of a lot of things I've heard about him lately. So, I have an appointment with other pdoc in am who is definitely not a med giver. I take, at the moment l50mg of wellbutrin, 2mg of klonopin at night and l0-l5mg of chloral hydrate at night. To be honest, I wasn't taking this much to sleep until I returned to the old pdoc and he scared me. Fondly Phillipa
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