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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 50. This is the beginning of the thread.
Posted by cache-monkey on March 14, 2005, at 14:18:42
Hey all,
I had a panic attack in early January. Full-blown. Prior, I had been suffering from GAD and cyclothymia/soft BP. I had been using Xanax 0.25 prn before Jan, and immediately after the panic attack I started taking Xanax at 1-1.5 mg/day.
About 10 days later, my p-doc switched me to Klonopin, which makes sense from a number of perspectives. (Longer half-life => theoretically less rebound anxiety, less addiction potential.) The first two weeks, due to some stressful on-site job interviews, I started Klonopin at 1 mg/day (divided up over the day) and took Xanax at about 1 mg/day while on-site. While home, I'd go off Xanax and feel alright, but still with a lot of anxiety.
I went up to 1.5 mg/day on the Klonopin a couple weeks ago and haven't taken any Xanax for about 3+ weeks. My anxiety gradually worsened and neared panic status again last week. I also have been feeling very slowed down (that might be a consequence of upping my Lithium to 900 mg/day -- that's the only other drug I'm on right now.) Finally, I broke down and took a Xanax (0.25 mg) and boom anxiety gone.
So it seems that 1.5 mg/day of Klonopin is not nearly as effective as a slightly lesser amount of Xanax. My understanding was that they are supposed to be about equivalent in terms of dosages (0.5 mg X = 0.5 mg K).
Is it the case that it just varies between individuals? I.e., for some is Xanax just more effective at a comparable dose? Is a bezo just a benzo?
I'm a little averse to going up further on the Klonopin and would like to consider switching benzos with my p-doc. I'm thinking of Xanax XR, but am worried about the eventual taper, which I think is harder with Xanax. How about Ativan? Valium?
[Alternatively, some of my anxiety might be attributable to being in a "mixed state". I'm having trouble getting the Lithium to a therapeutic dose due to thirst and tiredness, so adding Depakote is another possibility...]
Any advice would be greatly appreciated.
Thanks,
cache-monkey
Posted by vegansf on March 14, 2005, at 15:16:42
In reply to Klono not nearly as effective as X? (Oth. Benzos?), posted by cache-monkey on March 14, 2005, at 14:18:42
I think if klonopin doesn't do anything at 2mg...or makes you feel worse...it's not going to help going up on the dose. It's just not that kind of drug. Maybe talk to your doctor about going on a low dose of the new anti-psychotics. That's what most drs. are doing now it seems. So, Xyprexa, Seroquel... If you're concerned about weight gain, Zyprexa (sp?) shouldn't be your first choice. Go for the Seroquel maybe. It helps with sleep, jitteriness. Check them out. They don't work for me, but have worked wonders for nearly everyone else I know.
Posted by mattw84 on March 14, 2005, at 15:50:13
In reply to Klono not nearly as effective as X? (Oth. Benzos?), posted by cache-monkey on March 14, 2005, at 14:18:42
Lorazepam might be worth a try, but the short half life can lead to rebound anxiety. Xanax is 100% the best benzo for panic attacks -- but as you noted, it is of the most difficult to discontinue use of. If you go that route I would try for an "as needed" basis, rather than taking it continually.
Ativan can be sublingual - under the tongue - to provide really quick relief. Xanax taken orally is just about as quickly effective, but klonopin is a very long acting benzo -- and may just not be the right one for your situation. Try to avoid chronic use of any of these if you can, withdrawals are killer (unfortunately sometimes literally). Best of luck!
Matt
Posted by lunesta on March 14, 2005, at 15:52:43
In reply to Klono not nearly as effective as X? (Oth. Benzos?), posted by cache-monkey on March 14, 2005, at 14:18:42
You might want to ask for Klonopin Wafers which disolve on the tongue and are similar in quickness to xanax. You may have a generic also. Generally, xanax .5 = klonopin .5, they are equal. many factors can play into it though.
Posted by Phillipa on March 14, 2005, at 18:35:30
In reply to Re: Klono not nearly as effective as X? (Oth. Benz, posted by lunesta on March 14, 2005, at 15:52:43
Sounds like rebound anxiety. What about the long acting xanax? I've never taken it. I like valium. It's beginning to sound like my mantra. Fondly, Phillipa
Posted by yxibow on March 14, 2005, at 20:27:27
In reply to Klono not nearly as effective as X? (Oth. Benzos?), posted by cache-monkey on March 14, 2005, at 14:18:42
> I went up to 1.5 mg/day on the Klonopin a couple weeks ago and haven't taken any Xanax for about 3+ weeks. My anxiety gradually worsened and neared panic status again last week. I also have been feeling very slowed down (that might be a consequence of upping my Lithium to 900 mg/day -- that's the only other drug I'm on right now.) Finally, I broke down and took a Xanax (0.25 mg) and boom anxiety gone.Xanax is much more quicker acting and tends to give an immediate euphoria rather than Klonopin which is much more subtle, so that makes sense that you felt that on the spot. Three weeks should be enough for rebound withdrawal although if you've been taking it for a long time that may not be true. Some of the anti-benzo crowd claims months to years but that's not really scientifically proven from what I know.
> Is it the case that it just varies between individuals? I.e., for some is Xanax just more effective at a comparable dose? Is a bezo just a benzo?I would say any drug varies between individuals... a benzodiazepine is not always just a benzodiazepine, although they all act similarily with different half lifes, and different sub-bindings at GABA and can vary suchlike in their makeup: (hypnotic/sedative [strongly so, e.g. Dalmane, Halcion], anxiolytic [e.g. Xanax, Ativan], anticonvulsant/antitremor [e.g. Klonopin]). But as said before, all do hit all those sub-receptors, some may be better than others or more immediate.
>
> I'm a little averse to going up further on the Klonopin and would like to consider switching benzos with my p-doc. I'm thinking of Xanax XR, but am worried about the eventual taper, which I think is harder with Xanax. How about Ativan? Valium?Taper is harder with Xanax although the XR may be less of a problem. Ativan is also quick acting and shorter half life; Valium may be longer. There are people living and breathing with much higher doses of Klonopin (I happen to be on a higher dose for my particular disorder, although I'm not advocating it one way or another -- one has to be vigilant and adjust patterns behind the driving wheel) -- epileptics (the original model for Klonopin ages ago) can taper up to 20mg of Klonopin a day, although for anxiety 8mg is usually a ceiling and I'm not suggesting one goes near there without proper consideration.
Since you've been used to using Xanax, Xanax XR might eliminate the multiple daily dosing of Xanax usually required (Klonopin can be taken once, perhaps twice a day). On the other hand XR is also just an excuse for patent extension and is more expensive.
Tidings
Posted by FredPotter on March 14, 2005, at 22:07:27
In reply to Re: Klono not nearly as effective as X? (Oth. Benz, posted by yxibow on March 14, 2005, at 20:27:27
Why do people put themselves through the unpleasantness of Xanax withdrawl? Why not just keep taking it? I've been taking benzos since they were invented (over 40 years) and I'm in pretty good shape (I'm only a sample of one I know)
Posted by Phillipa on March 14, 2005, at 22:11:45
In reply to Re: Klono not nearly as effective as X? (Oth. Benz, posted by FredPotter on March 14, 2005, at 22:07:27
Fred I agree. I've been on them over 30yrs also. Never any problem with abuse, or side effects. Fondly, Phillipa
Posted by yxibow on March 14, 2005, at 22:54:15
In reply to Re: Klono not nearly as effective as X? (Oth. Benz » FredPotter, posted by Phillipa on March 14, 2005, at 22:11:45
I've been on them for extended periods, but there are several reasons one might want to withdraw temporarily or permanently for another choice of medication:
1) benzodiazepines do affect cognition and if one is sensitive one may have a difficulty or hazard driving as the dose increases.
2) in a significant number of people, tolerance is built up -- I wouldn't characterise benzodiazepines as addictive but more as habit-forming. "drug holidays" may be necessary to reverse this cycle and then re-introduce the medication.
Still most benzodiazepines are probably among the safest psychiatric medication on the market, both in terms of side effects and overdosage, probably because among other things as noted by the previous posters, they have a long history -- the prototype Librium (chlordiazepoxide) hit the shelves in 1960.
Posted by Ritch on March 15, 2005, at 0:14:36
In reply to Klono not nearly as effective as X? (Oth. Benzos?), posted by cache-monkey on March 14, 2005, at 14:18:42
> Hey all,
>
> I had a panic attack in early January. Full-blown. Prior, I had been suffering from GAD and cyclothymia/soft BP. I had been using Xanax 0.25 prn before Jan, and immediately after the panic attack I started taking Xanax at 1-1.5 mg/day.
>
> About 10 days later, my p-doc switched me to Klonopin, which makes sense from a number of perspectives. (Longer half-life => theoretically less rebound anxiety, less addiction potential.) The first two weeks, due to some stressful on-site job interviews, I started Klonopin at 1 mg/day (divided up over the day) and took Xanax at about 1 mg/day while on-site. While home, I'd go off Xanax and feel alright, but still with a lot of anxiety.
>
> I went up to 1.5 mg/day on the Klonopin a couple weeks ago and haven't taken any Xanax for about 3+ weeks. My anxiety gradually worsened and neared panic status again last week. I also have been feeling very slowed down (that might be a consequence of upping my Lithium to 900 mg/day -- that's the only other drug I'm on right now.) Finally, I broke down and took a Xanax (0.25 mg) and boom anxiety gone.
>
> So it seems that 1.5 mg/day of Klonopin is not nearly as effective as a slightly lesser amount of Xanax. My understanding was that they are supposed to be about equivalent in terms of dosages (0.5 mg X = 0.5 mg K).
>
> Is it the case that it just varies between individuals? I.e., for some is Xanax just more effective at a comparable dose? Is a bezo just a benzo?
>
> I'm a little averse to going up further on the Klonopin and would like to consider switching benzos with my p-doc. I'm thinking of Xanax XR, but am worried about the eventual taper, which I think is harder with Xanax. How about Ativan? Valium?
>
> [Alternatively, some of my anxiety might be attributable to being in a "mixed state". I'm having trouble getting the Lithium to a therapeutic dose due to thirst and tiredness, so adding Depakote is another possibility...]
>
> Any advice would be greatly appreciated.
>
> Thanks,
> cache-monkey
>I'd feel averse to increasing K as well beyond 1.5mg. I would consider switching to Ativan a try (since it is also an effective antimanic like K), and just keep some Xanax on hand PRN if it doesn't work out. If a lot of your anx. is rooted in mixed bipolar, then Depakote would be a good add.. I've found a mix of benzo + Depakote + gabapentin to work rather well for anxious bipolar mixed stuff.
Posted by cache-monkey on March 15, 2005, at 1:27:07
In reply to Re: Klono not nearly as effective as X? (Oth. Benz, posted by vegansf on March 14, 2005, at 15:16:42
Well, I'm not up to 2mg yet. Thing is that I feel that 1.5mg is doing very little. It's interesting to know that dose escalation isn't always effective with K.
As far as the atypical APs, weight gain is a big concern for me. I gained 20 lbs in about 2 months on my one SSRI trial. I've heard that most of the APs can lead to weight gain, plus a potential of diabetes (which runs in my family). So Zyprexa's kind of out. Seroquel I don't know so much about.
I'd been thinking of Depakote before going the AP route, though, since Depakote is "first-line" for BP, and is particularly recomended for mixed states and dysphoria (which I think maybe part of my anxiety really is). There's a potential weight issue there, too, but keeping the dosage low might help.
I'll look more into Seroquel, though. Thanks for the tip.
Best,
cache-monkey> I think if klonopin doesn't do anything at 2mg...or makes you feel worse...it's not going to help going up on the dose. It's just not that kind of drug. Maybe talk to your doctor about going on a low dose of the new anti-psychotics. That's what most drs. are doing now it seems. So, Xyprexa, Seroquel... If you're concerned about weight gain, Zyprexa (sp?) shouldn't be your first choice. Go for the Seroquel maybe. It helps with sleep, jitteriness. Check them out. They don't work for me, but have worked wonders for nearly everyone else I know.
Posted by cache-monkey on March 15, 2005, at 1:35:46
In reply to Re: Klono not nearly as effective as X? (Oth. Benz, posted by mattw84 on March 14, 2005, at 15:50:13
True, Ativan has a short half-life. Multiple dosing might eliminate that. Thing is that I have a lot of free-floating anxiety that sometimes turns into panic, so PRN isn't an option. I'm in therapy to try to get at the root cause of the anxiety. My goal with the benzos is to be on them for some non-short amount of time to give me a continuous buffer from which to address those roots.
It's also possible that adding Depakote reduces my anxiety (mixed state dysphoria?) to tolerable levels and I don't need the benzo continously. I actually hope this is the case, because as you point out withdrawal can really be tough. (But I do know that my dad took Valium for some time at a similar point in his life and didn't have any problems discontinuing.)
Thanks for the input,
cache-monkey
> Lorazepam might be worth a try, but the short half life can lead to rebound anxiety. Xanax is 100% the best benzo for panic attacks -- but as you noted, it is of the most difficult to discontinue use of. If you go that route I would try for an "as needed" basis, rather than taking it continually.
>
> Ativan can be sublingual - under the tongue - to provide really quick relief. Xanax taken orally is just about as quickly effective, but klonopin is a very long acting benzo -- and may just not be the right one for your situation. Try to avoid chronic use of any of these if you can, withdrawals are killer (unfortunately sometimes literally). Best of luck!
>
> Matt
Posted by cache-monkey on March 15, 2005, at 1:45:07
In reply to Re: Klono not nearly as effective as X? (Oth. Benz, posted by Phillipa on March 14, 2005, at 18:35:30
I guess it is a form of rebound anxiety, but not in the immediate classical Xanax sense. I think that Xanax worked to keep my anxiety/panic in check, and then slowly it crept back in after full discontinuation of Xanax and switch-over to Klonopin. Xanax XR is a a possibility. But, I've heard that (for whatever reason) Xanax is the hardest benzo to discontinue.
I'd been thinking about valium, and have seen you post on it in a variety of threads. Why do you like it so much? Do you find it sedating? How does it compare to any other benzos you've tried?
Any info would be greatly appreciated.
Best,
cache-monkey> Sounds like rebound anxiety. What about the long acting xanax? I've never taken it. I like valium. It's beginning to sound like my mantra. Fondly, Phillipa
Posted by cache-monkey on March 15, 2005, at 1:53:58
In reply to Re: Klono not nearly as effective as X? (Oth. Benz, posted by yxibow on March 14, 2005, at 20:27:27
<< Xanax is much more quicker acting and tends to give an immediate euphoria rather than Klonopin which is much more subtle, so that makes sense that you felt that on the spot. Three weeks should be enough for rebound withdrawal although if you've been taking it for a long time that may not be true. Some of the anti-benzo crowd claims months to years but that's not really scientifically proven from what I know. >>
I don't think this is withdrawal from the Xanax. It's like the constant anxiety from my pre-daily-benzo days came creeping back in and blossomed back into full-fledged near-panic-but-not-quite anxiety. I think it's just that the Klonopin isn't as effective for me, maybe due to the differences you mention below.
<< I would say any drug varies between individuals... a benzodiazepine is not always just a benzodiazepine, although they all act similarily with different half lifes, and different sub-bindings at GABA and can vary suchlike in their makeup: (hypnotic/sedative [strongly so, e.g. Dalmane, Halcion], anxiolytic [e.g. Xanax, Ativan], anticonvulsant/antitremor [e.g. Klonopin]). But as said before, all do hit all those sub-receptors, some may be better than others or more immediate. >>Hmm. Interesting to know. How does Valium fit into this spectrum?
Thanks for the info!
Best,
cache-monkey
Posted by cache-monkey on March 15, 2005, at 2:06:21
In reply to Re: Klono not nearly as effective as X? (Oth. Benzos?) » cache-monkey, posted by Ritch on March 15, 2005, at 0:14:36
<< I'd feel averse to increasing K as well beyond 1.5mg. >>
That's what my gut's telling me. (Also because it's equivalent to 30 mg Valium.) But someone else said that one can go much higher...
<< I would consider switching to Ativan a try (since it is also an effective antimanic like K), and just keep some Xanax on hand PRN if it doesn't work out. >>
I'd actually been leaning toward Valium due to it's longer half-life. Any particular reason you suggest Ativan? Is it less sedating or something like that?
<< If a lot of your anx. is rooted in mixed bipolar, then Depakote would be a good add.. I've found a mix of benzo + Depakote + gabapentin to work rather well for anxious bipolar mixed stuff. >>
Still working out the source of my anxiety. A lot of it is early childhood/early adolescence stuff. But still part of my bipolarity. Good to know about the benzo+Depakote+Neurontin combo, although I hadn't heard such good things about Neurontin elsewhere on this board. Out of curiousity, which benzo did you end up using?
Thanks for all of the info!
Best,
cache-monkey
Posted by cache-monkey on March 15, 2005, at 2:10:21
In reply to Klono not nearly as effective as X? (Oth. Benzos?), posted by cache-monkey on March 14, 2005, at 14:18:42
Hey all,
Thanks so much for the input on my questions about benzos. I have another question: is there any consensus on which benzos tend to be more and less sedating? (E.g. I've heard that Valium tends to be more sedating than, say, Xanax.) Or, as with so many psychotropics, is this just something that depends on the person?
Thanks,
cache-monkey
Posted by Ritch on March 15, 2005, at 10:25:56
In reply to Re: Klono not nearly as effective as X? (Oth. Benzos?) » Ritch, posted by cache-monkey on March 15, 2005, at 2:06:21
> I'd actually been leaning toward Valium due to it's longer half-life. Any particular reason you suggest Ativan? Is it less sedating or something like that?
I was on lithium + Valium (or chlordiazepoxide) for nearly ten years. It's a good one, I never had to take more than 10mg a day. My dose was 5mg twice daily, sometimes just 2.5mg twice daily. I just found Valium a little depressogenic compared to Xanax, Klonopin, or Ativan. Even Librium (chlordiazepoxide) didn't feel as heavy. However, Valium is probably the best if you have a lot of muscle tension.
>
> << If a lot of your anx. is rooted in mixed bipolar, then Depakote would be a good add.. I've found a mix of benzo + Depakote + gabapentin to work rather well for anxious bipolar mixed stuff. >>
>
> Still working out the source of my anxiety. A lot of it is early childhood/early adolescence stuff. But still part of my bipolarity. Good to know about the benzo+Depakote+Neurontin combo, although I hadn't heard such good things about Neurontin elsewhere on this board. Out of curiousity, which benzo did you end up using?
>
> Thanks for all of the info!
>
> Best,
> cache-monkeyI'm on Depakote 250-375mg + Klonopin .5-1.0mg + tiny bit of Celexa every other day. The thing I like about the Klonopin is its slow "peakiness", and it slow accumulation and elimination. I can get panicky and I just double the dose for about two or three days then go back to the original dose and I seem to get this "coverage" of a week or so, and I don't notice the "return" to the original lower dose-it's kind of masked. I'm curious about pregabalin.. (low dose) in the mix.
Posted by cache-monkey on March 15, 2005, at 12:26:17
In reply to Re: Klono not nearly as effective as X? (Oth. Benzos?) » cache-monkey, posted by Ritch on March 15, 2005, at 10:25:56
> I'm on Depakote 250-375mg + Klonopin .5-1.0mg + tiny bit of Celexa every other day. The thing I like about the Klonopin is its slow "peakiness", and it slow accumulation and elimination. I can get panicky and I just double the dose for about two or three days then go back to the original dose and I seem to get this "coverage" of a week or so, and I don't notice the "return" to the original lower dose-it's kind of masked. I'm curious about pregabalin.. (low dose) in the mix.
I'm curious about pregabalin, as well. Wonder when it'll finally be approved...Thanks for the info.
Peace,
cache-monkey
Posted by Phillipa on March 15, 2005, at 16:54:12
In reply to Re: Klono not nearly as effective as X? (Oth. Benzos?), posted by cache-monkey on March 15, 2005, at 12:26:17
I don't think you would need such a high dose of valium. I didn't have any trouble switching from 2mg klonopin to a total of l5mg valium a day. I like it because I think it works better for anxiety for me anyways. The long half-life is good too. I was hoping for the aaaaah I used to feel on valium, and the instant relief of anxiety. That's not happened this time. Fondly, phillipa
Posted by cache-monkey on March 15, 2005, at 17:54:42
In reply to Re: Klono not nearly as effective as X? (Oth. Benzos?), posted by Phillipa on March 15, 2005, at 16:54:12
Thanks, Phillipa. Out of curiosity, did you find Valium any more sedating than Klonopin? (I feel like the K is keeping me sleepy a lot of the day...)
Best,
cache-monkey> I don't think you would need such a high dose of valium. I didn't have any trouble switching from 2mg klonopin to a total of l5mg valium a day. I like it because I think it works better for anxiety for me anyways. The long half-life is good too. I was hoping for the aaaaah I used to feel on valium, and the instant relief of anxiety. That's not happened this time. Fondly, phillipa
Posted by Phillipa on March 15, 2005, at 19:15:10
In reply to Re: Klono not nearly as effective as X? (Oth. Benzos?), posted by cache-monkey on March 15, 2005, at 17:54:42
No, I thought klonopin made me feel dumb. Fondly, Phillipa
Posted by Maxime on March 15, 2005, at 20:03:08
In reply to Klono not nearly as effective as X? (Oth. Benzos?), posted by cache-monkey on March 14, 2005, at 14:18:42
I think Kolonopin should be in a class of its own because it is NOT like other BENZOS. It is an anti-convulsant first and foremost which is why it used for bipolar illness.
Just my 2 cents. ;)
Maxime
Posted by Phillipa on March 15, 2005, at 20:42:51
In reply to Re: Klono not nearly as effective as X? (Oth. Benzos?) » cache-monkey, posted by Phillipa on March 15, 2005, at 19:15:10
I agree with you Maxime. It doesn't affect you the same either. Fondly, Phillipa
Posted by cache-monkey on March 15, 2005, at 22:26:59
In reply to Re: Klono not nearly as effective as X? (Oth. Benzos?) » cache-monkey, posted by Phillipa on March 15, 2005, at 19:15:10
I sort of feel the same way. Plus I've been feeling a little more depressed as of late. I've heard that's been a problem for other people on K. I'm definitely going to suggest Valium next time I see my pdoc.
Thanks,
cache-monkey> No, I thought klonopin made me feel dumb. Fondly, Phillipa
Posted by cache-monkey on March 15, 2005, at 22:32:26
In reply to Re: Klono not nearly as effective as X? (Oth. Benz, posted by Maxime on March 15, 2005, at 20:03:08
Thanks Maxime. That's the difficulty for me with this decision: I'm soft BP, and some of the anxiety might be "mixed state" sorts of stuff. But I feel like the Klonopin just isn't cutting down very much on the anxiety (esp. as compared to a "comparable" amount of Xanax). Plus it might be slowing me down/making me a little depressed.
So I think I'm going to try for Valium (or maybe Ativan) and keep the BP stuff in check with Lithium and/or Depakote.
Anyway, thanks for the input.
I hope that you start feeling well again soon. I know it's hard, but try not to let the posts by a certain (now blocked) babbler get to you. I mostly lurk on this board, and have read a lot of your posts. You're really helpful to a lot of people, me included.
Best,
cache-monkey> I think Kolonopin should be in a class of its own because it is NOT like other BENZOS. It is an anti-convulsant first and foremost which is why it used for bipolar illness.
>
> Just my 2 cents. ;)
>
> Maxime
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