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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 10 of 10. This is the beginning of the thread.
Posted by Comet on February 22, 2006, at 13:33:41
This is a bit long with a couple of questions but I wanted to get some feedback from either current or former Lex or Klonopin users for GAD/Panic and Insomnia.
History: Mid 30's. I've first had panic attacks in my early 20s. In my 20's I was mostly able to control the panic and generalized anxiety with exercise, avoidance of caffeine and alcohol etc. Occasionally had to resort to intermittent use of Xanax (every few years - usually only a few days or weeks at a time). About 6 months ago I was having a bad time with GAD. Under a lot of stress, no time to exercise, lack of sleep, too much caffeine - led to panic coming back. Went to doc - this time he prescribed Klonopin. The K worked fairly well at controlling GAD (but had a sense it wouldn't work as well for a flat out panic attack)- but this time, I stayed on it for a number of months. My dosage was .5 mg a day taken at night. I slept well and had no problems. 6 months later I let my prescription run out when I wasn't feeling stressed or anxious. Within two weeks my anxiety returned full force accompanied by the worst insomnia I've ever had. My ears were ringing so bad it was a living nightmare, I was up all night and had to work all day - after a couple of weeks I was litterally walking into walls. After a few weeks of this I was pretty despondant. Went to a new doctor who put me back on K. Immediately, everything was OK again. Doc suggested that K should only be used for the short term and strongly urged me to try Lexapro as a treatment for the GAD.
The Lexapro: So about 10 days ago I decided to try the Lexapro (in part because I've always suspected that I'm at least mildly dysthymic as well). Dosage 10mg. First week was pretty bad. Agitation, fogginess, wanted to come out of my skin, and the dreaded loss of orgasm. The worst part was the inability to concentrate (I'm in grad school and this is a major problem). Also, just to deal with the side effects, I went up in K to 1mg/day. Three days ago I switch from taking the Lex in the morning to the Lex at night. This has definitely helped with the fogginess during the day. But I'm still taking more K or Ambien to sleep at night. So, here are my Questions.
1. It seems like the K was working just fine. I know docs seem to be wary of longterm use - but at least I was functioning well with no side effects that I was aware of. Maybe I should have just insisted with sticking with the K and trying to wean down slowly.
2. It's been almost two weeks on the Lex without noticible improvement but with definite side effects (though most are subsiding, except the anorgasmia). Will this actually work so that I can drop the K. Currently cutting back to .75mg and will stay on that for a week or two before going to .5.
3. But the main question - should I stick with the Lex at all or just rely on the K for now since I know that it works with no side effects. I feel like I've made a mistake by getting on Lex now.
4. I would definitely like to drop at least one of these drugs and eventually both. Any suggestions on which one to drop and how to do so would be most welcome.
Thanks and sorry for the long post.
Posted by blueberry on February 22, 2006, at 17:35:05
In reply to Lexapro/Klonopin - GAD and Insomnia, posted by Comet on February 22, 2006, at 13:33:41
If you are fortunate enough to find something that works with few or no side effects, I think maybe it is best not to mess with it. Some people have been on K for many years with continued effectiveness, improved lives, and no dose escalation.
Docs don't want you to be on a benzo for a long time. But they are perfectly fine putting you on an antipsychotic or antidepressant for a long time, both of which I personally think tinker with the brain chemistry much more profoundly than benzos do. Compare withdrawals from K, effexor, or zyprexa after say maybe 5 years on any one of them. They would all be viscious. Why they single out benzos I have no idea.
The tinnitus, insomnia, and rebound anxiety were common withdrawals. If you want to get off K, you could do it very slowly over a period of months. Low doses of some calming herbs and some magnesium glycinate and maybe some taurine supplements can help take the edge off.
If you are used to the way K helps you out, I don't think lexapro will come anywhere near as good. Maybe others might disagree, not sure, but I don't think the ssri's come anywhere near the benzos. And like you said, the side effects that go along with them kind of take away from the quality of life that docs are supposed to be trying to improve, not hinder. Doesn't sound to me like K was hindering you in any way.
Posted by Comet on February 22, 2006, at 19:52:21
In reply to Re: Lexapro/Klonopin - GAD and Insomnia » Comet, posted by blueberry on February 22, 2006, at 17:35:05
Thanks Bluberry that was helpful. I'm wondering if I should ride out the Lex for another couple of weeks to see if I get any benefit - or cut my losses and talk with the doc about a program on K for a bit?
PS - I like my doctor and trust her, which is one of the reasons I agreed to try the Lex - but so far I can't say I'm happy about my decision. If anyone else has struggled with this decision, I'd love to hear about it.
Posted by Phillipa on February 22, 2006, at 20:33:35
In reply to Re: Lexapro/Klonopin - GAD and Insomnia » Comet, posted by blueberry on February 22, 2006, at 17:35:05
Blueberry I couldn't agree with you more. Benzos have always worked for me and the SSRI's SSNRI's have created enormous anxiety. Neccesitating me stopping the meds. And I've never had to increase the doses of benzos. Fondly, Phillipa
Posted by Greif on February 22, 2006, at 21:57:48
In reply to Re: Lexapro/Klonopin - GAD and Insomnia » blueberry, posted by Phillipa on February 22, 2006, at 20:33:35
I have years of experience with Benzo/ssri combo. I would suggest(based on friends and doctors comments) that Lex should be started as low as 2.5 mg/day and increased gradually. You may find 5 mg is fine or you may reach 20. I know of many who have tried Lex for anxiety with very little success. in fact for many it increases the anxiety. I take 2mg K and 5 mg Lex and I dont deviate from this level. I have not built tolerance to the K and have no desire to increase doseage. I have been on Xanax /paxil and Ativan/celexa. Your comfort level will be the result of patient experimentation. 10mg of Lex and throw sex drive (ability) out the window for me. As far as sleep goes,Benzos have never provided more than 7 hours of sleep for me. I will take 1/4 mg of Zanax on occasion if I wake up at 4 AM and am wide awake though fully sedated by K.
Posted by Glydin on February 23, 2006, at 6:55:32
In reply to Lexapro/Klonopin - GAD and Insomnia, posted by Comet on February 22, 2006, at 13:33:41
I was on Klonopin as a single med for three years and began Lexapro about a year ago. The startup on Lex was rather intense for a few weeks and the startup was eased by increasing (briefly) my Klonopin dose. Lexapro has been wonderful for me and I rarely use Klonopin - the use being basically as needed.
My diagnosis is GAD with panic - I struggled with garden variety anxiety of ruminations and have had agoraphobia. I had untoward effects from SSRI's, Wellbutrin, and Cymbalta in the past - thus the single therapy K for years. I fought the idea that depression was part of my mix and felt depressive symptoms only happened with ill controlled anxiety. The truth was, I did have depression although anxiety IS my primary problem.
Take my experience with a grain of salt, I'm a bit of a psych meds unicorn and my results don't appear to be typical of internet mental health consumer posters.
Hope you work things out for yourself.
Posted by Comet on February 23, 2006, at 11:33:30
In reply to Re: Lexapro/Klonopin - GAD and Insomnia » Comet, posted by Glydin on February 23, 2006, at 6:55:32
Sounds like you have similar issues. May I ask how long it took for the Lex to feel like it was making a difference? Also, when and how did you cut back on the K? Was that difficult, or easier on the Lex?
Posted by Glydin on February 23, 2006, at 15:02:44
In reply to Re: Lexapro/Klonopin - GAD and Insomnia, posted by Comet on February 23, 2006, at 11:33:30
My timeline went like this: The startup time was about 2-3 weeks with a gradual easing of those effects over the third and fourth weeks. Klonopin helped but did not fully cover the increased anxiety of startup. Despite that, it was bearable. Full therapeudic effects happened about 6-8 weeks – again, it was gradual. I began at 10 mgs and had one dose increase to 20 mgs a few months in – 10mgs was good but 20 mgs works really well for me and is where I’ve remained. It will be a year on March 22nd .
I continued with routine daily K use for about three months of the Lex start -- thinking I would be a combo person. I, and my doc, decided to try weaning the K to see how it went. I did it over about a month’s time and it went well. I use it now rarely at night to ease some muscle tension issues that I still have from time to time and am sure I always will as I think it’s just “me”. K isn’t known for it’s muscle relaxant properties at anxiety controlling dosing but it works well for me in that capacity.
I do think being on the Lex was helpful to the K weaning for me because the Lex did seem to be controlling the anxiety “muck” well. I think the timing of the wean down was important and probably contributed to it being successful.
If you care to ask me anything else….please do – I’m open as book on experiences in MY psych world (smile)
Posted by Comet on February 23, 2006, at 17:01:24
In reply to Re: Lexapro/Klonopin - GAD and Insomnia » Comet, posted by Glydin on February 23, 2006, at 15:02:44
Thanks Glydin - I appreciate the input. I guess there doesn't seem much point on staying on the Lex with all its side effects unless I can dump the K. And even then I'm not sure it's the right way to go.
I think I'll stick out the month's supply that I was given and see how I'm feeling towards the end of the month. I will say that the side effects are diminshing a little bit every day - so that at least is a positive development.
But it's hard to tell whether the Lex is having any affect on the GAD while I'm still taking the K. I reduced the K a little the other day and feel OK - if that holds up for a week I'll bring it down to .5 mg.One question I have for you, when you talk about full therapeutic affect are you referring to reducing anxiety or lifting depression or both? Also, when you went to 20 mgs, was it because you were still anxious, still depressed or both?
Posted by Glydin on February 23, 2006, at 19:28:10
In reply to Re: Lexapro/Klonopin - GAD and Insomnia, posted by Comet on February 23, 2006, at 17:01:24
> One question I have for you, when you talk about full therapeutic affect are you referring to reducing anxiety or lifting depression or both? Also, when you went to 20 mgs, was it because you were still anxious, still depressed or both?
>
~~~ You are very welcome. I found this board four years ago. As time went on, while my big goal was to find a workable tolerable treatment, another goal was to be able to share some positive results. So, thank you for the opportunity.Full effects referred to my symptoms for both depression and anxiety. It felt like a new world for me. The reason for my increasing dose happened during a time I was having some pain issues due to doing "something" to my back. Dealing with this impacted my mood and emotional status. I was not doing the fast swirl down the drain, but I could feel the foundation I had built was getting a little shakey, so it was prudent to increase the Lexapro dose and go from there. Worked well and I did revisit some of the side effects I found at startup, they were brief, not as intense and passed quickly.
This is the end of the thread.
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