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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 40. This is the beginning of the thread.
Posted by Beeb on December 22, 2012, at 12:12:08
Hi. Originally I posted this in the advanced section, but since almost noone ever posts there this may be a better location.
This is my first post on this forum. I'll try to be brief.
I'm not in the USA and getting a (mandatory) referral to a specialist can be incredibly hard.
I've been trying to educate myself for quite some time now. It seems there is a lot that docs don't know about this drug.Originally I was prescribed this drug to treat neuropathic pain and for its muscle relaxant properties. I've been on it for years now, highest dose 4 mg a day as prescribed by my GP (repeat prescriptions).
I've tried to stop taking this drug but both that and starting to take this drug have been some of the biggest mistakes of my life !
Now to the specifics of my question.
I've never been able to take it at bedtime/for sleep. I used to take it during the day as a single dose but for quite some time I've been taking it in the evening to be able to sleep at all. Not that it really helps, it's more like a necessity.The drug has always had both sedative and stimulating properties. No problem when I took it during the day while I was engaged in bodybuilding, sedation was minimal if nonexistant. I can't exercise properly anymore but if I don't exercise for about two weeks the drug tends to become more sedating.
How the drug actually works is for the most part a mystery, it has some serotonergic properties and anti-absence and antimyoclonic action.
Obviously, when you affect one neurotransmitter you affect others as well. The literature does not make a distinction between the short term effects and the long term effects of the unique properties of this drug.I've been searching this forum for various phrases. HPA axis, cortisol and a few others.
It seems clonazepam definitely affects the HPA axis. Generally suppressing the HPA axis.The specifics are more mysterious.
HPA axis activity is complex, and suppression may (?) be specific. Also, won't it distort HPA axis function if you take it once a day ? Difference between short term use and long term use ?
I just can't tolerate taking it twice a day. If I do, the daytime dose will be more sedating, the evening dose will be more stimulating ! Not good for sleep, or metabolism in general.One post suggested that if it is not sedating in the evening it points to cortisol issues.
I may very well have an issues with glucocorticoids (cortisol) but I have learned that is an incredibly complicated matter.If possible, I'd like to learn more about its effect on the HPA axis (corticotropin releasing hormone, ACTH, glucocorticoids, catecholamines etc.). And normally, there are time dependent interactions between the various components of the HPA axis. I wonder how clonazepam interferes with that.
Also, what does it do with serotonin and the other neurotransmitters ? Some sources suggest serotonin depletion, some the opposite.
And there is the HPT axis, which interacts with the HPA axis.The weird thing is, clonazepam seems to speed up my metabolism ! When I take it in the evening, anyway.
I'll take any insight I can get. I'm male btw.
Posted by gadchik on December 22, 2012, at 13:02:04
In reply to clonazepam/Klonopin and HPA axis issues, posted by Beeb on December 22, 2012, at 12:12:08
Hello, Beeb. Im curious about these issues too. Ive also read that klonopin increases/decreases or just affects serotonin in some way. Ive taken it 4 years at .5mg nightime only.Ive felt the need to raise the dose lately,and I really dont want to. Ive tried to taper off,and its extremely difficult,for me. I havent been able to. And I did taper off of zoloft and remeron after 2 yrs of use. I hope someone can answer your ?s.
Posted by SLS on December 22, 2012, at 13:05:25
In reply to clonazepam/Klonopin and HPA axis issues, posted by Beeb on December 22, 2012, at 12:12:08
Hi.
Welcome.
I don't have answers to your questions right now.
I am curious, though. What would you do with the information? How would it affect your treatment decisions?
- Scott
Posted by SLS on December 22, 2012, at 13:57:13
In reply to Re: clonazepam/Klonopin and HPA axis issues » Beeb, posted by gadchik on December 22, 2012, at 13:02:04
> Ive also read that klonopin increases/decreases or just affects serotonin in some way.
Yup. Confusing, isn't it? I have seen the older studies, and they do report contradictory results.
When I discontinued chronic Klonopin (clonazepam) and went through withdrawal, I experienced severe "brain-zaps" that I don't recall experiencing with Ativan (lorazepam) discontinuation. It was reminiscent of SSRI / SNRI withdrawals. I wonder if this is an artifact of changes in 5-HT function produced by clonazepam. One would think that the brain-zaps would be consistent with a sudden decrease in 5-HT activity. Does this mean that clonazepam somehow enhances 5-HT neurotransmission?
This study is old, but looks pretty good:
http://www.ncbi.nlm.nih.gov/pubmed/520416
- Scott
Posted by Phillipa on December 22, 2012, at 15:27:23
In reply to Re: clonazepam/Klonopin and HPA axis issues, posted by SLS on December 22, 2012, at 13:57:13
I also took klonopin but for some reason switching to another benzo solved the problems of withdrawal Phillipa
Posted by Beeb on December 22, 2012, at 16:55:44
In reply to Re: clonazepam/Klonopin and HPA axis issues » Beeb, posted by SLS on December 22, 2012, at 13:05:25
> Hi.
>
> Welcome.
>
> I don't have answers to your questions right now.
>
> I am curious, though. What would you do with the information? How would it affect your treatment decisions?
>
>
> - Scott
>Withdrawing has not only been incredibly difficult if not impossible, I have found it can be a very rough drug to be on.
Every bit of information helps.
Clonazepam is a bit like the blood in my veins. :(
You can't just do without.While attempting to withdraw, I have found that the neurological, endocrinological and metabolic effects can be particulary gruesome.
Not to mention that's a psychotropic drug.
And I took it as a muscle relaxant !
Posted by Beeb on December 22, 2012, at 17:08:42
In reply to Re: clonazepam/Klonopin and HPA axis issues, posted by SLS on December 22, 2012, at 13:57:13
> > Ive also read that klonopin increases/decreases or just affects serotonin in some way.
>
> Yup. Confusing, isn't it? I have seen the older studies, and they do report contradictory results.
>
> When I discontinued chronic Klonopin (clonazepam) and went through withdrawal, I experienced severe "brain-zaps" that I don't recall experiencing with Ativan (lorazepam) discontinuation. It was reminiscent of SSRI / SNRI withdrawals. I wonder if this is an artifact of changes in 5-HT function produced by clonazepam. One would think that the brain-zaps would be consistent with a sudden decrease in 5-HT activity. Does this mean that clonazepam somehow enhances 5-HT neurotransmission?
>
> This study is old, but looks pretty good:
>
> http://www.ncbi.nlm.nih.gov/pubmed/520416
>
>
> - ScottThere is so much 'out there'. It seems that the anti absence and myoclonic actions of clonazepam (its specialty) are mediated through GABAB/serotonin (connection). There are many articles about the relationship between serotonin and GABAB.
The 'thalamic nucleus reticularis' may be the key.
See also thalamus.
A few links, some very technical stuff:http://link.springer.com/article/10.1007%2FBF02740750?LI=true
http://www.ncbi.nlm.nih.gov/pubmed/7931539
http://www.sciencedirect.com/science/article/pii/S0387760497001071
If you like: edoc.unibas.ch/212/1/DissB_7136.pdf
Posted by Beeb on December 22, 2012, at 17:10:44
In reply to Re: clonazepam/Klonopin and HPA axis issues, posted by Beeb on December 22, 2012, at 17:08:42
Still, I'd like some substantial information about the HPA (and HPT) axis.
While it may act on the brain, it does so much more.
And there's the 'peripheral benzodiazepine receptor'.
Posted by Beeb on December 22, 2012, at 17:11:40
In reply to Re: clonazepam/Klonopin and HPA axis issues, posted by Phillipa on December 22, 2012, at 15:27:23
> I also took klonopin but for some reason switching to another benzo solved the problems of withdrawal Phillipa
May I ask which one ? Diazepam certainly doesn't work for me.
Posted by gadchik on December 22, 2012, at 19:09:51
In reply to clonazepam/Klonopin and HPA axis issues, posted by Beeb on December 22, 2012, at 12:12:08
I would like to know why some people can taper off klonopin, high dose,after years of use,and have no issue with it? Then others,such as me,have such a problem trying to taper down from a small dose. What is it about my brain vs the brain that doesnt experience withdrawal?
Posted by Phillipa on December 22, 2012, at 20:45:59
In reply to why some brains can withdraw and others not???, posted by gadchik on December 22, 2012, at 19:09:51
Gadchik I am still on valium & xanax albeit a lower dose and most like will die still taking it. I'm not worried about it it's such a low dose. Think of it as synthroid as told would have to take every day of my life. Yes it has to be adjusted infrequently. Just was tested and no changes needed. I found an old bottle of xanax in my handbag cause I never change them and the script was for 4mg a day couldn't believe it. Now taking .25mg a night and 7.5mg of valium at night. Lower dose now than then. P
Posted by SLS on December 22, 2012, at 21:28:45
In reply to why some brains can withdraw and others not???, posted by gadchik on December 22, 2012, at 19:09:51
> I would like to know why some people can taper off klonopin, high dose,after years of use,and have no issue with it? Then others,such as me,have such a problem trying to taper down from a small dose. What is it about my brain vs the brain that doesnt experience withdrawal?
Would you consider using Trileptal (oxcarbazepine), an anticonvulsant, to help you discontinue Klonopin? I have no experience with this strategy myself, but their are anecdotes of its effectiveness.
http://www.ncbi.nlm.nih.gov/pubmed/18821451
Several years ago, I suggested that anticonvulsants might be helpful when it occurred to me that there could be a kindling process involved in BZD and SSRI/SNRI withdrawal
http://www.dr-bob.org/babble/wdrawl/20050214/msgs/460726.html
To answer your question, I don't know.
:-(
- Scott
Posted by Phillipa on December 22, 2012, at 21:39:28
In reply to Re: why some brains can withdraw and others not??? » gadchik, posted by SLS on December 22, 2012, at 21:28:45
My use just goes down as my body doesn't seem to need it. Same thing happened to next door neighbor. She completely got off SSRI's lexapro about three years ago and now her xanax is also going down as doesn't seem to need it also. I used to dicontinue when didn't feel a need for it and never any withdrawal. I did this for months at a time. Strange but before I had a computer I didn't know so just stopped a med and was fine. I think now that the stuff is on the internet people feel they can never live without a med again. Granted meds like synthroid are an exception. Phillipa
Posted by jono_in_adelaide on December 22, 2012, at 21:40:37
In reply to Re: clonazepam/Klonopin and HPA axis issues, posted by Beeb on December 22, 2012, at 17:08:42
Would starting an SSRI a few weeks before starting a slwo taper be of assistance if seretonin plays a part in the withdrawl syndrome?
It would certainly be worth a try
Posted by SLS on December 22, 2012, at 22:14:45
In reply to Re: clonazepam/Klonopin and HPA axis issues, posted by jono_in_adelaide on December 22, 2012, at 21:40:37
> Would starting an SSRI a few weeks before starting a slwo taper be of assistance if seretonin plays a part in the withdrawl syndrome?
>
> It would certainly be worth a tryI think glutamate is the culprit. However, your idea might still be helpful.
- Scott
Posted by gadchik on December 23, 2012, at 8:49:29
In reply to Re: why some brains can withdraw and others not??? » gadchik, posted by SLS on December 22, 2012, at 21:28:45
Scott, I read the link about oxcarbazepine.I would like to try that. Also, the mention of ssri due to serotonin, is interesting. I just havent told my pdoc,and I would need her for the oxcarbazepine. I guess when I get really fed up, I will tell her. Im afraid to even mention going off k,dont know why. I guess, I fear she would go way too fast for me,or Id go crazy w/o it,and she might decide I no longer need it. I did also read that melatonin helps. I guess it depends on your brain,and all are different. And, like Philippa said, when you dont need it, perhaps its easier,and also reading about the horror stories influences it.
Posted by jono_in_adelaide on December 23, 2012, at 16:06:53
In reply to Re: why some brains can withdraw and others not??? » SLS, posted by gadchik on December 23, 2012, at 8:49:29
The Ashton protocol is very good for benzo withdrawl, transfer from your current benzo to an equal dose of diazepam or chlordiazepaoxde (very long acting benzos) and reduce by 1mg of diazepam or 2.5mg of chlordiazepoxide every 1-2 weeks.....the body wont notice these timy steps down, and whitdrawl should be painles
Clonazepam is high potency, 1mg is = to 10-20mg of diazepam, so make sure you get the diazepam doseage high enough.
Adding an SSRI or mirtazapine should help with the underlying disorder (or an anti glutamate drug as SLS suggests, or even both!)
Posted by sigismund on December 23, 2012, at 17:30:47
In reply to Re: clonazepam/Klonopin and HPA axis issues » jono_in_adelaide, posted by SLS on December 22, 2012, at 22:14:45
>I think glutamate is the culprit
I recall a link with a claim that methadone could be withdrawn really quickly and painlessly with high dose memantine.
That would be glutamate related?
I was sceptical but interested.
Posted by rjlockhart37 on December 23, 2012, at 20:09:21
In reply to Re: why some brains can withdraw and others not??? » gadchik, posted by SLS on December 22, 2012, at 21:28:45
Not sure if this is a direct subject....but benzodiapine withdrawl....nuerontin is the "goldstandard" at least for me....when i went off xanax from 6mg daily...it was a taper...then they put me on Nuerontin 800mg X 4 daily. There's something else called Gabitril...but its complicated with some doctors...lastly lyrica would be an option since its similar to nuerontin.
Clonazepam depresses a certain serotonin receptor...ill have to pull the source up where I read it...but it deceases some kinda of nuerotranmitter....it can make you vary depressed...you might want to ask about lorazepam...a bit less potent than klono but hey....it defintly could help....it also is a vary good muscle relexant, it makes you loosened up both nerves and muscles...i took it in 2005 and went through lots of dosages. Xanax XR could be an option if your still wanting to stay on benzos...depakote, tegretol, trileptal, lamictal would be good choices to stop agitation from klono...there also is plant called Muscimol which ... i have no idea how to get a hold of it but it works on GABA too...muscle relexant too....
hope this helps!
r
Posted by SLS on December 23, 2012, at 21:21:14
In reply to Re: clonazepam/Klonopin and HPA axis issues » SLS, posted by sigismund on December 23, 2012, at 17:30:47
> >I think glutamate is the culprit
>
> I recall a link with a claim that methadone could be withdrawn really quickly and painlessly with high dose memantine.
>
> That would be glutamate related?Yes. Good thinking.
> I was sceptical but interested.That is interesting. Memantine is a sort of modulator of glutamate NMDA receptors. It blocks a portion of this receptor and reduces signaling. It might help reduce "background noise", but I am not sure. There are three other subtypes of glutamate receptor. I think drugs like Trileptal (oxcarbazepine) might work better than memantine because they squelch overactive glutamatergic circuits by blocking the sodium channels of those glutamate neurons that use these other three receptors.
I would not rule-out the possibility that memantine might be effective for methadone withdrawal. I don't know enough about it. I'll keep my eyes open for more information on this.
- Scott
Posted by Beeb on December 24, 2012, at 13:08:42
In reply to Re: why some brains can withdraw and others not???, posted by jono_in_adelaide on December 23, 2012, at 16:06:53
> The Ashton protocol is very good for benzo withdrawl, transfer from your current benzo to an equal dose of diazepam or chlordiazepaoxde (very long acting benzos) and reduce by 1mg of diazepam or 2.5mg of chlordiazepoxide every 1-2 weeks.....the body wont notice these timy steps down, and whitdrawl should be painles
>
> Clonazepam is high potency, 1mg is = to 10-20mg of diazepam, so make sure you get the diazepam doseage high enough.
>
> Adding an SSRI or mirtazapine should help with the underlying disorder (or an anti glutamate drug as SLS suggests, or even both!)The Ashton protocol is overrated.
It works for SOME people.
Diazepam is not a miracle drug. Some people just cannot tolerate it at all. Like me.It's also not unusual that people will notice every tiny cut and suffer. To taper that way for a long time ? But then, how would you know if they had done well if they had quit 'cold turkey' or if they had done a fast taper ?
Serotonin, norepinephrine, gaba, glutamate are are related/connected. If you affect one you affect the other.
I've seen anecdotal reports of success with anticonvulsants. In theory, starting an SSRI could help. But just as well they could make things worse.
Posted by Beeb on December 24, 2012, at 13:31:56
In reply to why some brains can withdraw and others not???, posted by gadchik on December 22, 2012, at 19:09:51
> I would like to know why some people can taper off klonopin, high dose,after years of use,and have no issue with it? Then others,such as me,have such a problem trying to taper down from a small dose. What is it about my brain vs the brain that doesnt experience withdrawal?
Impossible to say.
But perhaps your past use of Zoloft and Remeron plays a role. Usually, there are some long lasting changes after extended use of the drugs.
They act primarily on serotonin, but indirectly on other neurotransmitters as well.
Endocrine and thyroid function may also be affected.
Posted by Beeb on December 24, 2012, at 13:38:32
In reply to Re: clonazepam/Klonopin and HPA axis issues » Beeb, posted by gadchik on December 22, 2012, at 13:02:04
> Hello, Beeb. Im curious about these issues too. Ive also read that klonopin increases/decreases or just affects serotonin in some way. Ive taken it 4 years at .5mg nightime only.Ive felt the need to raise the dose lately,and I really dont want to. Ive tried to taper off,and its extremely difficult,for me. I havent been able to. And I did taper off of zoloft and remeron after 2 yrs of use. I hope someone can answer your ?s.
0.5 mg is not that much, but this is a potent drug. Do you take it for sleep ?
Have you considered just stopping the drug, and starting something else that works for you/is therapeutically effective ?
If you can't taper, stopping the drug and possibly starting something else seems worth considering.
Posted by Beeb on December 24, 2012, at 13:41:46
In reply to clonazepam/Klonopin and HPA axis issues, posted by Beeb on December 22, 2012, at 12:12:08
If someone has a response to my original question it would be much appreciated !
Posted by gadchik on December 24, 2012, at 14:53:44
In reply to Re: clonazepam/Klonopin and HPA axis issues, posted by Beeb on December 24, 2012, at 13:38:32
Beeb, Klonopin was just added to my original regimen,with the zoloft and remeron. I was able to taper two, but saved the klonopin for last, which may have been a misstake. At this point,I dont know whether Im taking it for sleep or anxiety. I just know that I function very well on .5mg of it. I also wonder if I might function very well without it. And yes, I sometimes think,just chuck it, and see what happens, that perhaps the tapering is just prolonging bad things. Yet,everything I read says DO NOT STOP COLD TURKEY!!! I believe your original ? got lost in the shuffle. I want to know those things too.
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