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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 5 of 5. This is the beginning of the thread.
Posted by LilithLeigh on October 3, 2016, at 21:25:00
My new pdoc first reduced my dose of Effexor from 225mg to 150mg before adding 7.5mg mirtazapine and 0.25mg clonazepam twice a day. I asked for clonazepam because I couldn't leave my house to do any kind of exposure therapy. I had tried clonazepam before this on a temporary basis while going through a bad spell of stress in my life.
But when the mirtazapine was added, I felt like the clonazepam didn't work. Almost like its effects were blocked by being on Effexor and Remeron (mirtazapine). Is this possible?
I have been on effexor for a decade and every time was dose was lowered to 150mg (at doc's suggestion because of the rare serotonin syndrome) my depression came back.
My depression returned this time too when the dose was lowered even though Remeron was added. Then my pdoc upped the Remeron to 15mg and Effexor to my regular dose of 225mg. And the clonazepam was increased too to 0.5mg twice a day. I still feel a bit depressed and like the clonazepam is not working.
My anxiety has not reduced significantly at all. I am wondering if combining these three drugs or being on two AD's could somehow interfere with the efficacy of the benzo?
I have also read somewhere that clonazepam may trigger depression in people who've had depression before. Is this true?
Any suggestions for clonazepam alternatives if it comes to that?
I would like something long lasting like clonazepam.
Posted by porkpiehat on December 3, 2016, at 18:47:11
In reply to California Rocket Fuel and Clonazepam, posted by LilithLeigh on October 3, 2016, at 21:25:00
I think Klon has definitely contributed to my depression. But knowing this I keep my dose to .5/day at most.
I think people have compared Lyrica to Klonopin in terms of long-term anxiety management. Id be interested in knowing more myself.
Posted by Tony P on January 4, 2017, at 23:12:38
In reply to Re: California Rocket Fuel and Clonazepam » LilithLeigh, posted by porkpiehat on December 3, 2016, at 18:47:11
I have just switched from diazepam to clonazepam (at a much higher equivalent dose -- 4.5 mg/day), and I definitely find it depressing, sedating, interfering with memory and cognition.
I am also taking escitalopram (20 mg/day) and bupropion (Wellbutrin) 75 mg/day, and recently non-prescribed Ritalin 10-20 mg/day; the Wellbutrin & Ritalin help to balance the sedation from the clon, but I am cutting back the clon about .5 mg/week with dr's concurrence. Oddly, even at this relatively high dose of clon, I still experience intention tremor. At least I can drink as much coffee as I like!
Posted by Tony P on August 2, 2017, at 4:08:57
In reply to California Rocket Fuel and Clonazepam, posted by LilithLeigh on October 3, 2016, at 21:25:00
I have now been back & forth between clonazepam and diazepam three times. mostly in an effort to get off the benzos altogether. Just a few observations, remember these are mostly based on my personal experience, YMMV.
1) There is some confusion about the equivalent strength of clonazepam. Most sources give 1 mg clonazepam = 10 mg diazepam. However, Dr. Heather Ashton (www.benzo.org.uk), who is very experienced in withdrawal, uses 0.5 mg clonazepam = 10 mg diazepam. My own experience suggest a figure in between.
2) It's certainly possible in principle that there's an interaction between your other meds and clonazepam. The liver enzymes that remove clon. from your system can be affected both positively and negatively by other drugs. Consult a knowledgeable pharmacist, or do some research online if you feel up to the technicalities,
3) .5 mg clonazepam 2x a day is not a high dose in my book (nor in the opinion of the senior Dr. at my clinic). However, age, other meds, general health can affect this.
4) Clonazepam in my experience causes more drowsiness, memory loss and cognitive impairment than other benzodiazepines. Diazepam is better this way and has an even longer half-life.
5) All the benzodiazepines have a depressant effect and could therefore trigger depression. This mostly applies to higher doses,but I have been warned of this by my GP.
6) For a long-lasting alternative, I would recommend diazepam. It is preferred by my GP and Dr. Ashton (see above). It has an even longer half-life than clonazepam, although there is a little "shoulder" in the effects at about 6 hours, so I prefer small doses 4x a day.
7) Effexor works well for many people, but for me it causes great anxiety, needing benzodiazepines to combat this side effect. Ask your Dr. about taking Cymbalta instead, which for me is more effective without the anxiety.
Good Luck!
Posted by Tony P on October 4, 2017, at 10:38:45
In reply to California Rocket Fuel and Clonazepam, posted by LilithLeigh on October 3, 2016, at 21:25:00
I'm back on diazepam and I agree (per my personal experience) with everything LilithLeigh says, including my inability to tolerate Effexor, and Cymbalta being effective & low on side-effects. Unfortunately, the latter isn't covered by my drug plan.
This is the end of the thread.
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