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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 14 of 14. This is the beginning of the thread.
Posted by tensor on September 24, 2006, at 17:57:40
I can't get my head straight on what to do next. I have problem with recurring depression, SP and anxiety. It seems to be a fact that clonazepam triggers depression, it seems to be a s/e. That fact would fit my story disturbingly well. After my first depression i did fine on 15mg remeron for over two years, when i started with clon the problems with relapses begun. Is this a coincidence? Going off clonazepam is not an easy undertake, i almost did it a half year ago, but at 0.5mg the anxiety and the social phobia were too bad so i restarted with 2mg/d, i couldn't function in my work and socially without it.
Things are not made easier with the fact that there are no warranties that the relapses would stop if i decided to wash-out clonazepam, and also facing anxiety and SP that inhibits me to eat out among people, not being able to say phrases longer than ten words because of the fear of blushing and the feeling of restricted airways and not being able to finish the phrase.
So they way i see it, it's either stop clonazepam or put my fate in lamictal, this is a decision that i have to take within the next two days.What would you do? Anyone recognise the clonzepam-depression connection?
/Mattias
----------------------------------
remeron 15mg
nortriptyline 175mg
clonazepam 2mg
Posted by blueberry on September 24, 2006, at 18:40:30
In reply to CLONAZEPAM, posted by tensor on September 24, 2006, at 17:57:40
Though all benzos can cause or worsen depression, clonazepam seems to be the most guilty one here at pbabble. But the benzos are all very different. Perhaps all you need is to switch to another one. Xanax has a modest amount of antidepressant action to it. It's just my opinion, but three possible choices in order of preference would be:
Xanax
Diazepam (valium)
Lorazepam (ativan)
All of them are good for anxiety and social functioning, though they all have their own particular characteristics that vary from person to person.Clonazepam caused my deep depression to go even deeper than I ever thought possible. Ativan did somewhat, but not as bad as clonazepam. I have not tried valium. Xanax actually lifts my depression when in deep despair.
Posted by fca on September 24, 2006, at 18:42:18
In reply to CLONAZEPAM, posted by tensor on September 24, 2006, at 17:57:40
Tough question--are you satisfied with the nortriptyline--it potentiates the clon and increases the sedative effect--is it the clon increases clinical depression or are you struggling with sedation (somnolence. flatness, etc)--if you decide it is the clon have you considered lyrica (off label) rather than lamictal--why lamictal--sorry for questions rather than answers--maybe later
Posted by bassman on September 24, 2006, at 18:44:15
In reply to CLONAZEPAM, posted by tensor on September 24, 2006, at 17:57:40
Oh, absolutely! At 1.5 mg Klonopin I was tired/depressed all the time; at 1 mg it was somewhat better and at 0.5 mg/day, little depression. Personally, I think a better (safer) option would be to replace the Klonopin with a different benzo, rather than going to more exotic meds. If uk ed is around, he might suggest Valium. I'll save him the trouble. :>} Actually, my suggestion would be Xanax, although everyone is SO afraid of it. xyzbow (?) might suggest going to 0.5 mg Klonopin and using Xanax as needed. Hope I didn't piss you guys off putting words in your mouths...I just read your posts carefully.
The only downside I see with Xanax is eventual withdrawal, if you're having trouble with withdrawing from Klonopin. The opposite argument is to treat the problem causing limited functioning now, worry about withdrawal when and if the time comes.
Posted by willyee on September 24, 2006, at 19:16:25
In reply to CLONAZEPAM, posted by tensor on September 24, 2006, at 17:57:40
Yess i agree klonopin is capable of this,mainly cause it does seem to poteinate most drugs its subsiding.
However,and im saying this thinking back hard as i can,i remember reading that klono was unique among this class because it was also noted that long term use showed some mood stabaility,so it was considered to be an option as a mood stablizer.
I find klonopin to be less depressing when its been taken a few days in small amounts and built up,however for a single quick panick type relief xanax seems to be the better choice,klonopin can help in this area too,but again i personaly believe its best use is to let it accumalte in small amounts.
Posted by tensor on September 24, 2006, at 19:21:37
In reply to Re: CLONAZEPAM, posted by blueberry on September 24, 2006, at 18:40:30
Hi guys,
> Xanax
> Diazepam (valium)
> Lorazepam (ativan)
> All of them are good for anxiety and social functioning, though they all have their own particular characteristics that vary from person to person.
I added clonazepam to help anxiety but specifically social phobia, i have tried most of the common benzos and i found clon to be superior in that aspect. Another benefit in the long run is that clon produces none or very little euphoria, it feels very clean.>Tough question--are you satisfied with the nortriptyline--it potentiates the clon and increases the sedative effect--is it the clon increases clinical depression or are you struggling with sedation (somnolence. flatness, etc)--if you decide it is the clon have you considered lyrica (off label) rather than lamictal--why lamictal--sorry for questions rather than answers--maybe later
No, i'm not satisfied with nortrip right now, when it works it's ok, when i started with nortrip i did fine with 75mg, now five relapses later i take 175mg and no sign of improvement of mood. It feels like i take the extra 100mg to counteract the negative sides of clon.
It's clinical depression i'm talking about, i'm not going to work tomorrow. It's the endless relapses and the dose escalation that is the problem, and it worries me. The question is if it is clon that triggers the relapses.
No, i have not thought of lyrica, though it looks interesting, do you have any experiences to share? When we realized almost two years ago that my depression is treatment resistant and recurring, two candidates for mood stabilizing and hence prevent relapses were discussed. It was either lithium or lamictal, we opted lithium, which after a half year of dose raising and blood tests was abandoned./Mattias
Posted by Phillipa on September 24, 2006, at 21:46:05
In reply to Re: CLONAZEPAM, posted by blueberry on September 24, 2006, at 18:40:30
Tensor blueberry describes them perfectly. Love Phillipa
Posted by tensor on September 25, 2006, at 3:18:05
In reply to Re: CLONAZEPAM, posted by fca on September 24, 2006, at 18:42:18
if you decide it is the clon have you considered lyrica (off label) rather than lamictal--why lamictal--sorry for questions rather than answers--maybe later
How strong is the anxiolytic property of lyrica compared to benzos? Compared to e.g. Paxil? How about its antidepressant effect?
/Mattias
Posted by tensor on September 25, 2006, at 3:50:32
In reply to Re: CLONAZEPAM » fca, posted by tensor on September 25, 2006, at 3:18:05
How strong anxiolytic effect does lamictal have? Compared to BZD and SSRI? Wonder if it could be helpful at all if i decide to remove clon from my regime, or is lyrica a stronger candidate for this?
/Mattias
Posted by fca on September 25, 2006, at 11:32:50
In reply to CLONAZEPAM and possible substitues, posted by tensor on September 25, 2006, at 3:50:32
I can not answer your question as I have not used lyrica do not know people in the US who have. It has been approved in the UK and EU for use in generalized anxiety disorder. As you probably know it is a form of Neurontin that is much more concenterated and supposedly has fewer side effects because of the dose is much smaller. None of the pdocs I work with are currently using it--there are many posts on this Board that might be helpful. Same for Lamictal--I am not conversant with it--all I know is that is approved as an anticonvulsant, minimizes possibility of mania in bipolar and has a number of off label uses--good luck
Posted by Greif on September 25, 2006, at 12:28:42
In reply to Re: CLONAZEPAM and possible substitues, posted by fca on September 25, 2006, at 11:32:50
I have never tried K without SSRI (lex). The combo for me is perfect. 2mg K at night. 15 mg of Lex in the am. Never depressed or anxious. I will adjust Lex dose..10 not enough 20 creates insomnia and short term memory problems. Lex comes in an elixer form and you can adjust the mg until correct dose is achieved. I have had years of expereience with Xanax and miss the boost but will never go backm to it. In my experience, I had to keep increasing dosage every 3 months to achieve same effect. Could take a 2mg bar and not even feel it after 5 years. Would knock out most.
Posted by ed_uk on September 26, 2006, at 14:31:24
In reply to CLONAZEPAM and possible substitues, posted by tensor on September 25, 2006, at 3:50:32
Hi Mattias
Rather than thinking about stopping the clonazepam, perhaps you should consider reducing the dose?
Ed
Posted by tensor on September 26, 2006, at 14:40:11
In reply to Re: CLONAZEPAM and possible substitues » tensor, posted by ed_uk on September 26, 2006, at 14:31:24
Hi Ed,
i have found out that 2mg is the lowest therapeutic dose for me. When i started with clon i took 2x2mg daily but thanks to clons relatively long halflife i get away with 1x2mg/d.
I wonder if lamictal or lyrica would have any significant anxliolytic effect on me, enough to allow me to stop clon. I guess it's trial and error as usual..
/Mattias
Posted by ed_uk on September 26, 2006, at 16:12:10
In reply to Re: CLONAZEPAM and possible substitues » ed_uk, posted by tensor on September 26, 2006, at 14:40:11
Hi Mattias
Lyrica tends to be anxiolytic but I don't think there's much evidence to support the use of Lamictal in anxiety, it's more helpful for depressive symptoms.
Ed
This is the end of the thread.
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