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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 21 of 21. This is the beginning of the thread.
Posted by tensor on January 14, 2013, at 17:15:48
Have taken clonazpeam for over a decade for anxiety and SP. 2mg. I don't think it really does enough anymore and anxiety is one of the core symptoms of my illness. If anxiety is relieved the other "features" often also resolve.
So I'm thinking of switching to another BZD (Yes, it has to be that). The three candidates as of now are diazepam, alprazolam (XR) and lorazepam. They are all of three different sub-classes. Which one would you think is the better one?
Thanks,
tensor
Posted by Phillipa on January 14, 2013, at 17:42:10
In reply to Instead of clonazepam, posted by tensor on January 14, 2013, at 17:15:48
I have taken all three in the past. Are you looking for something that is long lasting or doesn't it matter? Phillipa
Posted by Hugh on January 14, 2013, at 18:18:48
In reply to Instead of clonazepam, posted by tensor on January 14, 2013, at 17:15:48
> So I'm thinking of switching to another BZD (Yes, it has to be that). The three candidates as of now are diazepam, alprazolam (XR) and lorazepam. They are all of three different sub-classes. Which one would you think is the better one?
I've never tried clonazepam, but I've been on the other three. I took lorazepam almost every night for three years for insomnia. It has a much shorter half-life than clonazepam, and this might have contributed to all the problems I eventually developed with it -- tolerance and interdose withdrawal. I was on regular alprazolam. This worked well for me during some very stressful periods. I never took it long enough to develop any of the problems I had with lorazepam. Diazepam has a very long half-life, longer even than clonazepam. I found it much more sedating than the other two benzos. I felt very calm when I was on it, but also more depressed. It was a very calm, sluggish depression.
Posted by jono_in_adelaide on January 14, 2013, at 18:58:15
In reply to Re: Instead of clonazepam, posted by Hugh on January 14, 2013, at 18:18:48
Its very individual, so hard to make a hard and fast statement as to which would be best. All are good drugs, but some people will respond better to one than another. It might be best to just pick one and try it, and if that doesnt give you the results you're after, try another.
Adding an SSRI to your mix would probably be well worth trying as well.
Posted by tensor on January 15, 2013, at 0:04:53
In reply to Re: Instead of clonazepam » tensor, posted by Phillipa on January 14, 2013, at 17:42:10
> I have taken all three in the past. Are you looking for something that is long lasting or doesn't it matter? Phillipa
I have experience of them too, but not long term. I'd prefer once a day dosing.
/tensor
Posted by tensor on January 15, 2013, at 0:08:04
In reply to Re: Instead of clonazepam, posted by Hugh on January 14, 2013, at 18:18:48
> > So I'm thinking of switching to another BZD (Yes, it has to be that). The three candidates as of now are diazepam, alprazolam (XR) and lorazepam. They are all of three different sub-classes. Which one would you think is the better one?
>
> I've never tried clonazepam, but I've been on the other three. I took lorazepam almost every night for three years for insomnia. It has a much shorter half-life than clonazepam, and this might have contributed to all the problems I eventually developed with it -- tolerance and interdose withdrawal. I was on regular alprazolam. This worked well for me during some very stressful periods. I never took it long enough to develop any of the problems I had with lorazepam. Diazepam has a very long half-life, longer even than clonazepam. I found it much more sedating than the other two benzos. I felt very calm when I was on it, but also more depressed. It was a very calm, sluggish depression.
>
>Any idea which one that is least depressing?
Posted by tensor on January 15, 2013, at 0:11:49
In reply to Re: Instead of clonazepam, posted by jono_in_adelaide on January 14, 2013, at 18:58:15
> Its very individual, so hard to make a hard and fast statement as to which would be best. All are good drugs, but some people will respond better to one than another. It might be best to just pick one and try it, and if that doesnt give you the results you're after, try another.
>
> Adding an SSRI to your mix would probably be well worth trying as well.SSRIs does not work for me. Yeah, you're right. I think alprazolam does something with serotonin which may have some antidepressant properties. I need to read up on that.
/tensor
Posted by Hugh on January 15, 2013, at 10:24:10
In reply to Re: Instead of clonazepam » Hugh, posted by tensor on January 15, 2013, at 0:08:04
> Any idea which one that is least depressing?
For me it was the alprazolam.
Posted by jono_in_adelaide on January 15, 2013, at 16:54:19
In reply to Re: Instead of clonazepam » jono_in_adelaide, posted by tensor on January 15, 2013, at 0:11:49
If SSRI's dont work for you (they dont seem to do much for me either0 then a dose of mirtazapine, say 30mg at bedtime, would be well worth trying, it has potent anxiolytic as well as antidepressant properties
I'd go alprazolam and mirtazapine and see where that gets you.
Posted by Phillipa on January 15, 2013, at 19:46:30
In reply to Re: Instead of clonazepam, posted by jono_in_adelaide on January 15, 2013, at 16:54:19
Xanax definitely but it's more than once a day dosing. Phillipa
Posted by jono_in_adelaide on January 15, 2013, at 20:04:35
In reply to Re: Instead of clonazepam, posted by Phillipa on January 15, 2013, at 19:46:30
Isnt there an XR Xanax in the US that you can take once a day Phillipa?
We dont have it in Australia, mores the pitty, but I seem to remember reading of it.
Posted by Phillipa on January 15, 2013, at 20:54:08
In reply to Re: Instead of clonazepam, posted by jono_in_adelaide on January 15, 2013, at 20:04:35
Jono yes there is and I did take it once. The problem I experienced with it was after having it in my system all day I didn't sleep. I just use benzos at night for sleep. Phillipa
Posted by jono_in_adelaide on January 15, 2013, at 21:54:52
In reply to Re: Instead of clonazepam » jono_in_adelaide, posted by Phillipa on January 15, 2013, at 20:54:08
I think I'd like an "one pill, once a day" Xanax, because it avoids the temptation to think "I'm having an especialy rough day today, I'll just take an extra pill to get me through" and pretty soon you're Elvis
Posted by tensor on January 15, 2013, at 23:56:48
In reply to Re: Instead of clonazepam, posted by jono_in_adelaide on January 15, 2013, at 16:54:19
> If SSRI's dont work for you (they dont seem to do much for me either0 then a dose of mirtazapine, say 30mg at bedtime, would be well worth trying, it has potent anxiolytic as well as antidepressant properties
>
> I'd go alprazolam and mirtazapine and see where that gets you.In the past I took mirtazapine for over a decade, didn't do anything good anymore. I don't have any luck with conventional antidepressants, my combo now is Seroquel+Lamictal+benzo and some modafinil when I feel for it although its effect nowadays is nothing compared to what it used to be.
Thanks for your input.
Posted by tensor on January 16, 2013, at 0:11:41
In reply to Re: Instead of clonazepam, posted by jono_in_adelaide on January 15, 2013, at 21:54:52
> I think I'd like an "one pill, once a day" Xanax, because it avoids the temptation to think "I'm having an especialy rough day today, I'll just take an extra pill to get me through" and pretty soon you're Elvis
I prefer those meds you take once a day, I would hate have to take a pill at noon (although not a deal breaker). There is the extended release alprazolam.
I read in the great "the prescriber's guide" by Stahl that "Clonazepam is a long-acting alprazolam-like anxiolytic and alprazolam XR is an even longer-acting clonazepam-like anxiolytic."I take clonazepam now and have done so for a very long time, I get by with once a day dosing. I take 2mg. Not sure what the equivalency for alprazolam is, literature suggests somewhere between 2-4mg.
/tensor
Posted by Phillipa on January 16, 2013, at 19:06:50
In reply to Re: Instead of clonazepam » jono_in_adelaide, posted by tensor on January 16, 2013, at 0:11:41
I'm thinking four mg? Valium is lmg of xanax to 20 of valium? Phillipa
Posted by jono_in_adelaide on January 16, 2013, at 19:41:55
In reply to Re: Instead of clonazepam » tensor, posted by Phillipa on January 16, 2013, at 19:06:50
Yes, i think you're right Phillipa, 1mg of clonazepam is ~ 2mg of alprazolam - which means the 2mg clonazepam tabs we have in Australia must pack a hell of a punch!
Posted by Phillipa on January 16, 2013, at 21:36:21
In reply to Re: Instead of clonazepam, posted by jono_in_adelaide on January 16, 2013, at 19:41:55
Jono they are much stronger. experienced it for self. Phillipa
Posted by ChicagoKat on January 18, 2013, at 16:21:21
In reply to Instead of clonazepam, posted by tensor on January 14, 2013, at 17:15:48
It really is a matter of personal preference. I love Klonopin for sleep b/c it is so long lasting. But for anxiety during the day I prefer Ativan - no active metabolites, no hangover feeling (at least for me)
I personally cannot stand Xanax. It does next to nothing to help me and it gives me a yucky hangover feeling. But there are *lots* of people who love it. And it's good if you have panic attacks b/c it acts very quickly.
Valium I've never tried, and probably never will, b/c I'm gonna have to say goodbye to the benzos...sniff...I have so much tolerance to them...yes, I will admit I am completely physically addicted...that now it would take way too many tablets to have even a bit of an effect on me, and I kinda like my liver. My pdoc has switched me to Tegretol for anxiety and it's been great.
Kat
Posted by tensor on January 19, 2013, at 2:27:55
In reply to Re: Instead of clonazepam » tensor, posted by ChicagoKat on January 18, 2013, at 16:21:21
> It really is a matter of personal preference. I love Klonopin for sleep b/c it is so long lasting. But for anxiety during the day I prefer Ativan - no active metabolites, no hangover feeling (at least for me)
> I personally cannot stand Xanax. It does next to nothing to help me and it gives me a yucky hangover feeling. But there are *lots* of people who love it. And it's good if you have panic attacks b/c it acts very quickly.
> Valium I've never tried, and probably never will, b/c I'm gonna have to say goodbye to the benzos...sniff...I have so much tolerance to them...yes, I will admit I am completely physically addicted...that now it would take way too many tablets to have even a bit of an effect on me, and I kinda like my liver. My pdoc has switched me to Tegretol for anxiety and it's been great.
> KatI have switched from clonazepam to alprazolam and so far it has been good, I'm still tweaking the dose so I'm not sure where it will end up. Diazepam never felt strong enough for me, but I have never taken 40mg in a single dose -which would roughly corr. to 2mg clon- either so.. I guess it will take a week or so before I know how this will work out for me.
/tensor
Posted by ChicagoKat on January 21, 2013, at 8:44:10
In reply to Re: Instead of clonazepam » ChicagoKat, posted by tensor on January 19, 2013, at 2:27:55
> > It really is a matter of personal preference. I love Klonopin for sleep b/c it is so long lasting. But for anxiety during the day I prefer Ativan - no active metabolites, no hangover feeling (at least for me)
> > I personally cannot stand Xanax. It does next to nothing to help me and it gives me a yucky hangover feeling. But there are *lots* of people who love it. And it's good if you have panic attacks b/c it acts very quickly.
> > Valium I've never tried, and probably never will, b/c I'm gonna have to say goodbye to the benzos...sniff...I have so much tolerance to them...yes, I will admit I am completely physically addicted...that now it would take way too many tablets to have even a bit of an effect on me, and I kinda like my liver. My pdoc has switched me to Tegretol for anxiety and it's been great.
> > Kat
>
> I have switched from clonazepam to alprazolam and so far it has been good, I'm still tweaking the dose so I'm not sure where it will end up. Diazepam never felt strong enough for me, but I have never taken 40mg in a single dose -which would roughly corr. to 2mg clon- either so.. I guess it will take a week or so before I know how this will work out for me.
>
> /tensorGood luck with the alprazolam tensor! And it sounds as if you may be one of the lucky ones who can take a benzo for ages before tolerance to your particular dose sets in. I've been told I'm a 'fast metabolizer' and that is why I develop tolerance so damn quickly to meds. I asked my pdoc why he thought this was and he replied that I must have a good liver (we were kidding around by this point). So I replied that I had better get started fast and become a very heavy drinker! lol, he just shook his head and rolled his eyes heavenward. :D
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