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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 29. This is the beginning of the thread.
Posted by J Kelly on April 10, 2016, at 9:59:08
I know many here suffer from anxiety. I have been taking Klonopin for many years for an old nerve injury. Ive taken anywhere from .5mg per day to 3mg per day. I'm currently taking .5mg as needed up to 3xday.
My query is this. Is Klonopin really useful for acute episodes of anxiety?
About a year ago, I realized I no longer needed Klonopin for my injury. I tried to discontinue it. In the meantime I developed escalating anxiety. I'm now having acute anxiety attacks. Usually mid morning to mid afternoon. Sometimes later.
My pdoc and my therapist are both telling me Klonopin is the best benzo for anxiety but I'm unsure. They say it is the longest acting. I want to try Xanax but my pdoc is saying no.
Is Xanax a better med for acute anxiety attacks?
To further confuse things I'm starting Nardil next week and my understanding is that Nardil is good for anxiety.
So, if I still need a benzo for anxiety should I push for another or is Klonopin as good as any? I've never tried another benzo.
Thanks,
Jade
Posted by Christ_empowered on April 10, 2016, at 10:39:54
In reply to Anxiety, posted by J Kelly on April 10, 2016, at 9:59:08
I dunno about "best"...clonazepam is really "in" right now. My problem w/ it is that it can most definitely dampen mood, sometimes cause straight up depression more often than other bzd tranquilizers. It also tends to be difficult to taper.
Me, personally...I'd wake up w/ terrible anxiety on klonopin. Part drug induced depression, part tolerance to the anti-anxiety effects.
Lots of docs won't Rx valium, and if they do they won't Rx sufficient doses, but...Valium acts faster, lasts a good long while, and is easier to taper...if your doc will give you enough to cover your anxiety.
I don't think Klonopin is the best for acute anxiety. My former pdoc told me to put a tablet under my tongue and let it dissolve for faster onset. Kinda sorta helped, but it may have been a placebo effect. They do make those dissolving clonazepam wafers now, or they did for a while there, so maybe there's something to that.
Some docs are avoiding xanax but Rx-ing Ativan. Psychiatry moves more in trends than in anything science-based, so...yeah. Ativan is effective for acute anxiety, its just somewhat lower potency than xanax.
I hope you find a workable solution.
Posted by SLS on April 10, 2016, at 13:38:07
In reply to Anxiety, posted by J Kelly on April 10, 2016, at 9:59:08
I agree with C_E.
Did your doctor explain his decision? Some doctors feel that Xanax (alprazolam) is more habit-forming than other benzodiazepines. Interestingly, Xanax can have a mild antidepressant effect while Klonopin (clonazepam) can produce mild-moderate depression.
I would just mention that there is a long-acting version of Xanax called Xanax XR. If your anxiety is episodic rather than chronic, the original short-acting version might be better as a PRN. Acute anxiety attacks in the form of panic attacks sometimes respond to propranolol.
Did you experience these episodes of acute anxiety before you began taking Klonopin? If not, it is likely that you are experiencing Klonopin withdrawal symptoms. Personally, I found Klonopin to be more difficult to discontinue than Ativan (lorazepam). Some doctors switch patients to Valium (diazepam) to prevent withdrawal and then gradually taper the Valium.
- Scott
Posted by Phillipa on April 10, 2016, at 19:44:52
In reply to Re: Anxiety » J Kelly, posted by SLS on April 10, 2016, at 13:38:07
Take both xanax once a day at night .75mg and a total of 10 mg of valium same time. Been on them since age 24 and haven't increased the doses. Xanax no longer works for anxiety but allows me to sleep. So doc says stay on them both. Phillipa
Posted by rjlockhart37 on April 10, 2016, at 22:29:08
In reply to Re: Anxiety, posted by Phillipa on April 10, 2016, at 19:44:52
xanax is more direct, and faster acting but also wears off within 2-3 hours, it is better in mood aspects, klonopin made me depressed, it took care of the anixety but it's effects on mood where depressing
xanax is more yea direct, and strong, but it has be repeately taken through out the day if your treating anxiety all day, now if you just need to take one to calm down that's a diffrent story it is an exellant chill pill
Posted by Chris O on April 11, 2016, at 2:16:16
In reply to Anxiety, posted by J Kelly on April 10, 2016, at 9:59:08
I guess it's impossible to give any real advice about any of these psychotropic drugs because our experiences vary so much (one person takes 100mg of Prozac and feels nothing; another takes 5mg and goes to the emergency room). For my severe anxiety disorder (or whatever the hell it is), I've taken both Klonapin and Xanax. I guess I did about a year on both of them. Neither did much except gloss over the top my anxiety and depression. I know I took 3mg a day of Klonapin for a number of months, but can't remember any specific grand benefit. I know I had some withdrawals, but nothing super memorable (like the electric zaps after quitting Effexor). Xanax was not "better" quantitatively than Klonapin for me; if anything, it was weaker. I can't remember my dosage level. I did not have huge withdrawals when I stopped taking Xanax, but then, it was not doing much for me anyway. I do think I am someone who could pull a Stevie Nicks with benzos, taking massive, massive doses. I guess it's good they don't seem to do much for me on one level, because it keeps me from experimenting with them much. For you, I think it's worthwhile to experiment if you are suffering. Why not? I saw one of the anti-benzo psychiatrists before. I don't know. I guess it depends on what you they see with their patients. I hope you get relief for your suffering soon. I hate panic attacks. I've had some really bad ones and they really bring to low places. Good thoughts.
Chris
Posted by J Kelly on April 11, 2016, at 8:06:33
In reply to Re: Anxiety, posted by Christ_empowered on April 10, 2016, at 10:39:54
> My problem w/ it is that it can most definitely dampen mood, sometimes cause straight up depression more often than other bzd tranquilizers.
I've been seeing this in some old posts and I'm wondering if this is what I'm experiencing as well. I don't "crave" Klonopin, and I'm never sure its really helping. In fact, I think it isnt. I am sure that I'm physically addicted to it. However, I'm reluctant to taper it right now for two reasons. One, in my Nardil research, I've found many people who say that the Nardil/Klonopin combo worked wonders for them. Two, I just began my Nardil trial this morn and it would seem unwise to subject myself to Klonopin w/d's while acclimating myself to Nardil.
> I don't think Klonopin is the best for acute anxiety.I suspect this is true at least for me.
> I hope you find a workable solution.
Thanks CE,
Jade
Posted by J Kelly on April 11, 2016, at 8:15:32
In reply to Re: Anxiety » J Kelly, posted by SLS on April 10, 2016, at 13:38:07
> Some doctors feel that Xanax (alprazolam) is more habit-forming than other benzodiazepines.I'm not sure, but I have the feeling this is the reason he's reluctant to prescribe it.
> Interestingly, Xanax can have a mild antidepressant effect while Klonopin (clonazepam) can produce mild-moderate depression.
I'd really like to try Xanax to see if it effects me in this way. I once doubled up on my Klonopin dose for a bad headache and it just made me feel depressed.
>
> Did you experience these episodes of acute anxiety before you began taking Klonopin?Not that I can remember.
> If not, it is likely that you are experiencing Klonopin withdrawal symptoms.
Maybe.
Thanks Scott.
Jade
Posted by J Kelly on April 11, 2016, at 8:18:18
In reply to Re: Anxiety, posted by rjlockhart37 on April 10, 2016, at 22:29:08
> xanax is more direct, and faster acting but also wears off within 2-3 hours, it is better in mood aspects, klonopin made me depressed, it took care of the anixety but it's effects on mood where depressing
>
> xanax is more yea direct, and strong, but it has be repeately taken through out the day if your treating anxiety all day, now if you just need to take one to calm down that's a diffrent story it is an exellant chill pill
>
>"Chill Pill". This is what I need :)
I'm gonna look into trialing Xanax if my pdoc will allow it.
Thanks rj,
Jade
Posted by J Kelly on April 11, 2016, at 8:21:27
In reply to Re: Anxiety, posted by Phillipa on April 10, 2016, at 19:44:52
> Take both xanax once a day at night .75mg and a total of 10 mg of valium same time. Been on them since age 24 and haven't increased the doses. Xanax no longer works for anxiety but allows me to sleep. So doc says stay on them both. Phillipa
Glad they still work for you for sleep. Did you or do you notice any difference between the two meds? What are they?
Thanks,
Jade
Posted by J Kelly on April 11, 2016, at 8:27:22
In reply to Re: Anxiety » J Kelly, posted by Chris O on April 11, 2016, at 2:16:16
> For you, I think it's worthwhile to experiment if you are suffering. Why not?
I agree :)
> I hope you get relief for your suffering soon. I hate panic attacks. I've had some really bad ones and they really bring to low places.
What has been most helpful to you for your panic attacks?
> Good thoughts.
Thanks Chris,Jade
Posted by SLS on April 11, 2016, at 9:33:02
In reply to Re: Anxiety » Christ_empowered, posted by J Kelly on April 11, 2016, at 8:06:33
> I've found many people who say that the Nardil/Klonopin combo worked wonders for them.
For anxiety disorders, mostly. Also, Klonopin does have some anti-manic effects. Obviously, it didn't work for you well enough.
> Two, I just began my Nardil trial this morn and it would seem unwise to subject myself to Klonopin w/d's while acclimating myself to Nardil.
I strongly agree.
- Scott
Posted by Phillipa on April 11, 2016, at 9:39:00
In reply to Re: Anxiety » Phillipa, posted by J Kelly on April 11, 2016, at 8:21:27
Jade for well over 20 years low doses of xanax almost instantly relieved my anxiety & panic if occurring worked wonderfully with no tiredness just an uplifting feeling. I highly recommend the short acting xanax and make sure the Greenstone Brand which I think is make by another company but a pharmacist years ago said stop buying the name brand as the same company makes this generic and it was and is exactly the same. Phillipa
Posted by Chris O on April 11, 2016, at 11:22:53
In reply to Re: Anxiety » Chris O, posted by J Kelly on April 11, 2016, at 8:27:22
Hi, Jade,
"What has been most helpful to you for your panic attacks?"
Truthfully? Isolating myself and staying away from the pressures of daily life. It's sad, but when I am forced to "keep up" and balance the pressures of survival, I panic. My anxiety disorder is pretty severe. "One of the worst I've ever seen..." according to the therapist I spent ten years with, but maybe she says that to everyone? No, I'm kidding, she probably doesn't.
Good luck with Nardil. Due partly to the recommendation of Scott and others on this site, I have had that on my shelf at least three separate occasions, but never got around to starting the trial, probably due to my anxiety disorder. I don't know. I'm just not convinced anything can help me anymore. I hope it works for you. Post on the board about it if you can. I'll check back in when I have time.
Sincerely,
Chris
Posted by J Kelly on April 11, 2016, at 13:55:11
In reply to Re: Anxiety » J Kelly, posted by Chris O on April 11, 2016, at 11:22:53
Hi again Chris,
>
> "What has been most helpful to you for your panic attacks?"
>
> Truthfully? Isolating myself and staying away from the pressures of daily life. It's sad, but when I am forced to "keep up" and balance the pressures of survival, I panic. My anxiety disorder is pretty severe. "One of the worst I've ever seen..." according to the therapist I spent ten years with, but maybe she says that to everyone? No, I'm kidding, she probably doesn't.I sure know this feeling. Wanting (or having) to hide and shut out the world. But duty calls. Then what? What if a family member needs my help? Anxiety and panic at the mere thought of having to go out to dinner or even attend a family function. It IS sad.
I'm sorry yours is so severe. I wish I could tell you there was a magic pill that cures this condition. I just don't know. I'm trialing Nardil and maybe at some point Xanax.
>
> Good luck with Nardil. Due partly to the recommendation of Scott and others on this site, I have had that on my shelf at least three separate occasions, but never got around to starting the trial, probably due to my anxiety disorder. I don't know. I'm just not convinced anything can help me anymore. I hope it works for you. Post on the board about it if you can. I'll check back in when I have time.Oh believe me I'll post... and don't give up :)
I hear Nardil is "the gold standard" for social anxiety. I'll let you know :)
Jade
Posted by J Kelly on April 11, 2016, at 14:01:24
In reply to Re: Anxiety » J Kelly, posted by Phillipa on April 11, 2016, at 9:39:00
> Jade for well over 20 years low doses of xanax almost instantly relieved my anxiety & panic if occurring worked wonderfully with no tiredness just an uplifting feeling. I highly recommend the short acting xanax and make sure the Greenstone Brand which I think is make by another company but a pharmacist years ago said stop buying the name brand as the same company makes this generic and it was and is exactly the same. Phillipa
Thanks Phillipa,
I'm gonna spend some time adjusting to Nardil and then try and talk my pdoc into switching me from Klonopin to Xanax. I think it might be a better fit for me. We'll see.
Thanks,
Jade
Posted by J Kelly on April 11, 2016, at 14:36:11
In reply to Re: Anxiety » J Kelly, posted by SLS on April 11, 2016, at 9:33:02
> Klonopin does have some anti-manic effects. Obviously, it didn't work for you well enough.
Words escape me.
;)
Jade
Posted by SLS on April 11, 2016, at 15:00:33
In reply to Re: Anxiety » J Kelly, posted by Chris O on April 11, 2016, at 11:22:53
I am frustrated for you, Chris.
How would you characterize your anxiety? What is your current diagnosis?
Your anxiety prevents you from trying the very drug (Nardil) that might finally quell that anxiety. Perhaps you can start taking Klonopin (clonazepam) before the Nardil. It might reduce your anxiety enough to follow-through with starting Nardil. Besides, the two drugs go together well to treat anxiety disorders.
What are your chief concerns regarding Nardil?
Have you tried the MAOI, Emsam? I don't think much of it in the treatment of depression. However, some doctors have found that it helps with anxiety disorders rather quickly at lower dosages. Still, I think your case is severe and chronic enough to use the more powerful medication - Nardil.
- Scott
Posted by Tabitha on April 11, 2016, at 15:29:06
In reply to Anxiety, posted by J Kelly on April 10, 2016, at 9:59:08
Personally I find xanax too sedating to be valuable. Sure it's calming, but then I can't get anything done and don't feel safe driving. Plus I get social disinhibition and say things I later regret. It's just about the same as taking a couple shots of whiskey. :-(
For me the best help for anxiety is getting my depression under control. I still have anxiety but it's more manageable.
I hope you get things straightened out. Anxiety is the pits!
Posted by J Kelly on April 11, 2016, at 16:49:31
In reply to Re: Anxiety » J Kelly, posted by Tabitha on April 11, 2016, at 15:29:06
> Personally I find xanax too sedating to be valuable. Sure it's calming, but then I can't get anything done and don't feel safe driving. Plus I get social disinhibition and say things I later regret. It's just about the same as taking a couple shots of whiskey. :-(
>
> For me the best help for anxiety is getting my depression under control. I still have anxiety but it's more manageable.I think this is going to be true for me as well. My problem with anxiety definitely followed the depression. Not the other way around. That being said, I would love to find something to take the edge off in the mean time.
>
> I hope you get things straightened out. Anxiety is the pits!Thanks Tabitha :)
Jade
Posted by Chris O on April 11, 2016, at 17:04:41
In reply to Re: Anxiety » Chris O, posted by SLS on April 11, 2016, at 15:00:33
Hey, Scott,
I appreciate your frustration, amigo. "How would I characterize my anxiety?" That is an excellent question. It is so all encompassing that I am not aware of it, basically. If you told me, "You have to find a job and survive, now," I would have a panic attack and be incapacitated. The only reason I am not incapacitated is because my wife takes care of a lot of things for me. Not that I don't do a lot despite my anxiety, but ... it's hard to describe my whole situation in these forums; plus, I often have to go do things and do not have time to write a long enough response.
My chief concerns regarding Nardil are:
* It will somehow harm me due to the hypertensive crap.
* It will give my annoying side effects that outweigh any minor benefits and I will waste a year feeling dependent on a psychiatrist with all the humiliation that always entails for me.
* It will not help function better in the world in any significant way.Emsam--Yes, my psychiatrist suggested it many times. His experience was that for it to work well, it had to be taken in higher doses, which negates the anti-hypertensive aspects of the lower dose taking. One of the reasons I didn't try Emsam was because it was so damn expensive. But I'd be willing to try Emsam or Nardil, I guess. I don't know. Without my wife, I'd probably faced down that path anyway.
Klonapin I did try for a year or so, 3mg a day. As I said to Jade, it just kind of "glossed over" my anxiety and depression, not really helpful, kind of like I was slightly drowsy, anxious and depressed at the same time. Nothing grandly illuminating for me. Xanax did little as well. I think I was worse on Xanax, in retrospect. (more paranoid, more anxious, in some respects)
Posted by Phillipa on April 11, 2016, at 17:59:48
In reply to Re: Anxiety » SLS, posted by Chris O on April 11, 2016, at 17:04:41
Chris Paradoxical reactions to meds? Phillipa
Posted by Hugh on April 11, 2016, at 22:26:55
In reply to Anxiety, posted by J Kelly on April 10, 2016, at 9:59:08
If your anxiety is being caused by tolerance to Klonopin, then it's possible that switching to a shorter-acting benzo like Xanax could make your anxiety even worse. The following quote is from The Ashton Manual.
http://www.benzo.org.uk/manual/
Tolerance to the anxiolytic effects develops more slowly but there is little evidence that benzodiazepines retain their effectiveness after a few months. In fact long-term benzodiazepine use may even aggravate anxiety disorders. Many patients find that anxiety symptoms gradually increase over the years despite continuous benzodiazepine use, and panic attacks and agoraphobia may appear for the first time after years of chronic use. Such worsening of symptoms during long-term benzodiazepine use is probably due to the development of tolerance to the anxiolytic effects, so that "withdrawal" symptoms emerge even in the continued presence of the drugs. However, tolerance may not be complete and chronic users sometimes report continued efficacy, which may be partly due to suppression of withdrawal effects. Nevertheless, in most cases such symptoms gradually disappear after successful tapering and withdrawal of benzodiazepines.
Posted by Phillipa on April 11, 2016, at 23:04:08
In reply to Re: Anxiety, posted by Hugh on April 11, 2016, at 22:26:55
Hugh could not take klonopin felt suicidal after 1 day stopped it and switched back to xanax and instant relaxation. Lasted three times a day at .25mg for over 35 years. As started benzos age 24, did the ativan, times just went off them, valium, first one, and been on xanax for so many years just turned 70 and take only at night .75 with 10mg of valium. and fine all day. Never took an ad till about 18 years ago. Now just 25mg of luvox & 2.5mg of lexapro. That's it. Phillipa
Posted by Hugh on April 12, 2016, at 0:30:30
In reply to Re: Anxiety » Hugh, posted by Phillipa on April 11, 2016, at 23:04:08
I took Xanax at times, usually for insomnia, but occasionally for anxiety. It made me feel relaxed. Then I took Ativan almost every night for insomnia for three years. I was pleased with it, except that I had to increase my dosage twice because of tolerance. Then all hell broke loose. Lots of anxiety and depression from inter-dose withdrawal, terrible gastrointestinal problems, and a very unpleasant four-month taper. I did a crossover to Valium halfway through my taper. Some people can handle benzos long-term. I couldn't.
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