![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 6 of 6. This is the beginning of the thread.
Posted by Fred23 on November 17, 2008, at 19:27:24
A few years ago, I had posed questions about my situation with high blood pressure, where I felt that stress and anxiety were a factor, and how to go about getting my GP to add anti-anxiety med(s) to the hypertension med(s).
He reluctantly tried Ativan, but after a few months wanted a psychiatrist to ratify its use. The one chosen seemed to be more used to getting psychopaths off the street, rather than dealing with nervous disorders, so nixed the idea. He wanted the try what the GP originally wanted, a SSRI. (I did get the the diagnosis of General Axiety Disorder.)
This was just after all that bad press about them getting those black box warnings, and the climate here was very anti-SSRI and pro-benzo.
In the meanwhile, many things happened, including being unemployed, and not having insurance to enable looking for another doctor.
After finally finding work, and getting insurance, I did find another doctor, who had more success in treating the high blood pressure. About the time to get a renewal for the hypertension med, due to a changing work situation, I started having panic attacks, at work, which had never happened to me before. The GP gave me three weeks of 10 mg Lexapro samples.
From the very first dose, things did get better. But, just a few days before the followup appointment, another dramatic change happened in the work environment, and the panic attacks started all over again. The GP said we could either increase the Lexapro dosage, or add something to it. Since I had already been reading about the treatments, and was aware that panic needs more of an SSRI than depression does, I went with the 20 mg of Lexapro, which he wrote out a formal prescription.
The 20 mg up from 10 mg started the cycle of side effects all over again, but after they settled, the intense morning situations still caused those heart pounding periods, so at the next followup he agreed to add a benzo to the mix, but preferably on a "prn" basis. Since I suggested Klonopin over Xanax, he actually wrote the presciption out for a period as long as the renewed Lexapro.
The Klonopin amount was written as 0.5 mg per day as needed, but he advised, and what I would do anyway, was to break them in half, and only take 0.25 mg, and not every day. (I am using the name brand, not the generic.)
In the meanwhile, I found that using SSRIs as the first line treatment for Panic Disorder, that due to the agitation (from the "activation"), the panic will likely get worse before it gets better. I had deliberately not wanted a benzo during the adjustment period, so that I could see what the SSRI by itself would do, to know if a benzo was needed to make up the difference. It may be that I need a few more weeks at the 20 mg of Lexapro to fully kick in, but I need to be able to function also, without appearin gto be a nervous wreck.
If I take the 0.25 mg of Klonopin in the morning, with the other meds, on Monday, Tuesday, and Wednesday, the long half-life seems to cover Thursday and Friday. So my question is, I take it for three days in a row, then skip it for four days, will each week start "fresh" so that its use is essentially "prn," or will I start developing a tolerance (habituation)?
Posted by Phillipa on November 18, 2008, at 0:05:51
In reply to Will 3 days on and 4 days off Klonopin result in t, posted by Fred23 on November 17, 2008, at 19:27:24
Seriously that is a very low dose see no harm in taking everyday til the lexapro kicks in and by the way you're lucky that SSRI's eliminate your anxiety. It would be for a short period from what you wrote. And sounds like you are under a lot of stress right now. Your idea would put you I think in some withdrawal and that would make your situation worse just my thoughts. Hopefully someone with lots of expertise will get on and give some more advise and the best of luck to you. Love Phillipa
Posted by Fred23 on November 19, 2008, at 19:06:33
In reply to Re: Will 3 days on and 4 days off Klonopin result in t » Fred23, posted by Phillipa on November 18, 2008, at 0:05:51
More searching yielded an answer in a different forum.
Over at http://www.medhelp.org/posts/show/299560?camp=36, about halfway down, is a post seen as "by RCA7591, Jun 02, 2008 02:37AM"
- - - excerpt of Ryan's post - - -
Klonopin is a poor "as-needed" choice, as the onset of action ranges from 45 minutes - 1 hour. The drug works more effectively when taken on a daily basis, as this holds the blood plasma level steady. If you take the Klonopin daily for a length of time, it must never be discontinued abruptly. When used "as-needed", it should never be used more than 2-3 times per week - dosed one time during each occurrence. This will prevent it from accumulating. It should be taken 1/2 to 1 hour prior to an event where an anticipatory reaction will be present.
- - - end of excerpt - - -
I'm trying to determine where I can use it "as-needed" or continuously.
In my case, the SSRI (Lexapro) is the first-line defense against the panic attacks, while the Klonopin is secondary.
Posted by Phillipa on November 19, 2008, at 19:49:45
In reply to Re: Will 3 days on and 4 days off Klonopin result in t » Fred23, posted by Phillipa on November 18, 2008, at 0:05:51
This is my experience only 37 years of benzo use and all worked well for me including xanax took it for years and no problem switching to valium. Valium has the longest half-life only need it once a day. Xanax yes four times a day but it lasted for many years. Klonopin made me depressed. Love Phillipa
Posted by Fred23 on December 21, 2008, at 15:09:31
In reply to Re: Will 3 days on and 4 days off Klonopin result in t, posted by Fred23 on November 19, 2008, at 19:06:33
> In my case, the SSRI (Lexapro) is the first-line defense against the panic attacks, while the Klonopin is secondary.
As it turns out, I need to take the 0.25 mg of Klonopin every workday, Monday through Friday. And that not taking any on Saturday and Sunday puts me too far behind on Monday, so I take 0.125 mg on Saturday and Sunday to keep the blood levels up.
My strategy is to use the Klonopin to "top up" what the Lexapro doesn't do, a la Stephen M. Stahl, M.D., Ph.D. (I haven't explained this to my doctor yet, who I won't see for a few months, when the refills need to be re-established.)
Another reason I want to keep the Klonopin usage low is that it offsets the "feel good" from the Lexapro. The Lexapro relieves the general anxiety I wasn't really seeking treatment for, and some of the more minor panic-like problems I was, but not the more severe paralyzing panic-like symptoms that the Klonopin does prevent.
So now I need to see how long the daily 0.25mg stays effective.
Posted by Fred23 on December 24, 2008, at 14:33:48
In reply to Re: Will 3 days on and 4 days off Klonopin result in t, posted by Fred23 on December 21, 2008, at 15:09:31
> So now I need to see how long the daily 0.25mg stays effective.
Well, it wasn't enough on Monday, as some software updates were done over the weekend, that threw a wrench into my work, along with some other things going wrong. That is what triggers the panic symptoms, and it was as if the Klonopin had no effect at all. I took another 0.25 mg, to bring the amount up to 0.50 mg, which even that didn't really calm enough.
So, either 0.125 mg for two days (Sat & Sun) is too much of a drop from 0.25 mg on week days, so that I'm too far "behind" on Monday.
Or, 0.25 mg/day is not enough, anyway.I'm trying to work through the lower doses so that if they don't work, I can tell the doctor that I did try them, and only the higher dosing works.
This is the end of the thread.
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.