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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 27. This is the beginning of the thread.
Posted by Questionmark on November 16, 2004, at 3:24:08
Is there anyone who has used Klonopin for SP/anxiety who did not find it worthwhile enough to continue?
If so, please elaborate: your DX, reasons for not continuing, med history, med regimen at the time, etc.
Also, is there anyone who has used and benefitted from Klonopin but quit, and who would generally or completely advise against using the drug due to its withdrawal syndrome or any other reason(s)?
i would highly appreciate any responses and input. Thank you.
Posted by darkhorse on November 16, 2004, at 6:46:18
In reply to Klonopin lack-of-success stories?, posted by Questionmark on November 16, 2004, at 3:24:08
> Is there anyone who has used Klonopin for SP/anxiety who did not find it worthwhile enough to continue?
> If so, please elaborate: your DX, reasons for not continuing, med history, med regimen at the time, etc.
> Also, is there anyone who has used and benefitted from Klonopin but quit, and who would generally or completely advise against using the drug due to its withdrawal syndrome or any other reason(s)?
> i would highly appreciate any responses and input. Thank you.Hi,
I tried hard to love clonazepam,as I suffer from SP,GAD and(depressive episodes),and tried different doses (.5,1,1.5,2mg),due to its reputation for its efficacy, but NO WAY, it gave me heavy sedation ,fatigue,apthy,and depressive syndroms.However my experience with xanax, lorazepam and bromazepam (Lexotan),was the opposite : no tiredness,no apthy,no depressive syndroms and more sociable , focused and anxiety-free.
Just my experience,
Adam
Posted by DanielJ on November 16, 2004, at 7:17:32
In reply to Klonopin lack-of-success stories?, posted by Questionmark on November 16, 2004, at 3:24:08
Again, this experience is from my sons Schiz. associated anxiety/anger problems. # weeks on Klonopin was a waste of time. He took one and 15 minutes later he went to bed. Shortly after waking and eating he wanted another Klonopin (habit-forming). We held back on the Klonopin as much as possible during this period because he wanted it and it made hime very sleepy. After a week in the crisis center the pdoc switched him to Zoloft. A year and a half later he is still taking Zoloft and it is working well.
Posted by ed_uk on November 16, 2004, at 8:16:12
In reply to Re: Klonopin lack-of-success stories?, posted by DanielJ on November 16, 2004, at 7:17:32
Darkhorse, I was wondering why you were currently taking lorazepam. You see, I got the impression that you slightly prefered bromazepam.
Ed
Posted by darkhorse on November 17, 2004, at 7:02:21
In reply to Re: Klonopin lack-of-success stories?, posted by ed_uk on November 16, 2004, at 8:16:12
> Darkhorse, I was wondering why you were currently taking lorazepam. You see, I got the impression that you slightly prefered bromazepam.
>
> Ed
Hello ed,Actually I like both...you see I like to use lorazepam when I'm very stressed and need to "forget" about what is bothering me..but I do not like to take it long- term..it is better than bromazepam in times when you want to forget about problems and get through work.
However,I prefer bromazepam when I'm not stressed,but want to make new changes in my life (so it is a kind of a different stress I guess) and want to be more " aware" of what I'm doing,and I prefer to use bromazepam when I need long- term benzo,because it is very easy to dicontinue it,and I reserve lorazepam for as needed and never long term ......
I hope this can make sense!! but you see I like both....+ I sometimes stop them and take Alprazolam (for a week or 2) when I feel that I have depressive syndromes,because it gives an antidepressant/euphoric protection, instead of going the antidepressant long and windinig road...
BTW, do you know that in Japan they have few TCA "AD" medications and that they treat depressives & anxieties with benzodiazepines,and never had this big fuzz and hassel of "withdrawal" issues !!
....they hardly prescribe TCA AD's...the first SSRI was introduced was Fluvoxamine in 2000!Regards,
Adam
Posted by Questionmark on November 18, 2004, at 14:10:40
In reply to Re: Klonopin lack-of-success stories?, posted by darkhorse on November 17, 2004, at 7:02:21
Thanks people.
Darkhorse, that's weird that you reacted so poorly to Klonopin but so well with lorazepam. Lorazepam made me significantly apathetic and drowsy-- more than Klonopin-- although i haven't ever been on either for very long. Does bromazepam have a long half-life? i have never heard of it.
Also, that's very interesting about Japan's use of benzo.s and antidepressants.
Anyone else?
Posted by JayDee on November 18, 2004, at 15:08:17
In reply to Re: Klonopin lack-of-success stories?, posted by darkhorse on November 17, 2004, at 7:02:21
I don't know where you got your info? Did you live in Japan? SSRI's are widely used there.
They even have their own names; Pakishiru for Paxil for example. Japanese society is kinda screwed up right now. They have the highest suicide rate for industrilaized nations; Jr. high school girls having sex with 40 yr old men, Men who expect the women to provide, yet they cannot get jobs because of sexism. it's a serious clash of pre-industrial values and the changes nessicary with the compact city life many live there.
Posted by darkhorse on November 19, 2004, at 4:19:31
In reply to Re: Klonopin lack-of-success stories?, posted by Questionmark on November 18, 2004, at 14:10:40
> Thanks people.
> Darkhorse, that's weird that you reacted so poorly to Klonopin but so well with lorazepam. Lorazepam made me significantly apathetic and drowsy-- more than Klonopin-- although i haven't ever been on either for very long. Does bromazepam have a long half-life? i have never heard of it.
> Also, that's very interesting about Japan's use of benzo.s and antidepressants.
> Anyone else?
Well,everyone is different,just wanted to tell you my experience..
.
Bromazepam comes in 1.5,3 &6mg,and it is a potent benzo 3mg = 1mg Lorazepam,and ,like clonazepam,and lorazepam has a sustained action,and average half- life is 20 hours....it is much less sedative and can be taken as a single dose in the morning for daytime anxiety or before sleep for late- insomnia..the only disadvantge is that it sarts to work within 2-3 hours,so,unlike diazepam,lorazepam and alprazolam, is not the benzo of choice for acute,immediate relief.Depending on your situation it could be taken once,twice or 3 times a day....my own experience is that it makes me feel normal and motivated without feeling drugged and sleepy (Valium,Tranxene,Serax,Centrax),or a little euphoric (Xanax),or spaced out,tired and apathetic (Clonazepam),or amnestic (Lorazrpam)...but this is my experience.
Regards,
Adam
Posted by darkhorse on November 19, 2004, at 4:47:12
In reply to Re: Klonopin lack-of-success stories? » darkhorse, posted by JayDee on November 18, 2004, at 15:08:17
> I don't know where you got your info? Did you live in Japan? SSRI's are widely used there.
> They even have their own names; Pakishiru for Paxil for example. Japanese society is kinda screwed up right now. They have the highest suicide rate for industrilaized nations; Jr. high school girls having sex with 40 yr old men, Men who expect the women to provide, yet they cannot get jobs because of sexism. it's a serious clash of pre-industrial values and the changes nessicary with the compact city life many live there.Yes, I lived on and off in Japan in mid-90's till 2000.
And yes, it is true that they use benzos as first choice for depression/anxiety,then antidepressants as second choice,and you know what else? they use half-doses for AD's compared to USA & west.eg 25-75mg of tofranil,while in the west you can go up to 300mg...I noticed the same attitude in Qatar and Egypt..so go figure!!I did not say that they do not use SSRI, I just said that SSRI have been introduced as late as 2000...
As for your opinion about Jap society,I'm not going to discuss this but all I can say is that- having lived in very different societies- they are a very well-organized polite people and with all their technological development most still did not loose touch with nature,traditions and good manners...Regards,
Adam.
P.S. I think I read somewhere that the highest suicide rate for 2002 are in Finland,Switzerland,Sweden and Austria,and the least in Muslim countries...,and I think ,IMHO,that not every person who commit suicide suffers mental illness,some because of traditional principles and values(Japan),or do not do it for strong religious beliefs (Muslims)....just my opinion..
Posted by ed_uk on November 19, 2004, at 8:20:54
In reply to Re: Klonopin lack-of-success stories? » JayDee, posted by darkhorse on November 19, 2004, at 4:47:12
Hi Adam,
Most prescriptions for TCAs in the UK are for low doses. Part of the reason is because they're widely used for insomnia and neuropathic pain but even the doses used for depression are low. It's rare for anyone to take more than 75mg a day of most tricyclics eg. dothiepin and amitriptyline, the two most widely used TCAs. For a long time, dothiepin was the most popular AD in England! Lofepramine, however, is given at higher doses 140-210mg/day.
Ed
Posted by darkhorse on November 19, 2004, at 9:03:05
In reply to Re: Treatment in England, posted by ed_uk on November 19, 2004, at 8:20:54
> Hi Adam,
>
> Most prescriptions for TCAs in the UK are for low doses. Part of the reason is because they're widely used for insomnia and neuropathic pain but even the doses used for depression are low. It's rare for anyone to take more than 75mg a day of most tricyclics eg. dothiepin and amitriptyline, the two most widely used TCAs. For a long time, dothiepin was the most popular AD in England! Lofepramine, however, is given at higher doses 140-210mg/day.
>
> EdHi Ed,
Thanks for the useful info....I do not know why all american books which deal with psychotropics states normal doses for TCA's are to reach 150mg,and increase if no response to 250-300mg,and that 50-75mg are considred low,ineffective dose ??...do u have an explanation for this?
Adam.
Posted by ed_uk on November 19, 2004, at 9:20:55
In reply to Re: Treatment in England » ed_uk, posted by darkhorse on November 19, 2004, at 9:03:05
HI!
English textbooks also state that the TCAs (except nort)should be dosed at 150mg/day in order to determine efficacy. In practice, however, doctors usually use lower doses because they are easier to tolerate. Pharmacists are always complaining that GPs prescribe doses which are too low!
Look at this....
Cochrane Database Syst Rev. 2003;(3):CD003197. Related Articles, Links
Low dosage tricyclic antidepressants for depression.Furukawa T, McGuire H, Barbui C.
Dept of Psychiatry, Nagoya City University Medical School, Mizuho-cho, Mizuho-ku, Nagoya, Aichi, Japan.
BACKGROUND: Tricyclic antidepressants are still extensively prescribed worldwide. Evidence for the recommended dosage of tricyclics, however, is poor. OBJECTIVES: To compare the effects and side effects of low dosage tricyclic antidepressants with placebo and with standard dosage tricyclics in acute phase treatment of depression. SEARCH STRATEGY: Electronic search of the Cochrane Collaboration Depression, Anxiety and Neurosis Controlled Trials Register (CCDANCTR), incorporating results of group searches of MEDLINE (1966-), EMBASE (1980-), CINAHL (1982-), PsycLIT (1974-), PSYNDEX (1977-) and LILACS (1982-1999) and hand searches of major psychiatric and medical journals. Reference search and SciSearch of the identified studies. Personal contact with authors of significant papers. SELECTION CRITERIA: All randomised controlled trials 1) comparing low dosage TCA (=< 100 mg/d on average at the end of trial) with placebo or 2) comparing low and standard dosages of the same TCA, in acute phase treatment of depressive disorder DATA COLLECTION AND ANALYSIS: Two independent reviewers examined eligibility of the identified studies, and extracted data for outcomes at 1 week, 2 weeks, 4 weeks, 6-8 weeks and later. Main outcome measures were relative risk of response in depression (random effects model), according to the original authors' definition but usually defined as 50% or greater reduction in severity of depression according to the last-observation-carried-forward intention-to-treat method, and relative risks of overall dropouts and dropouts due to side effects. Other outcome measures included worst-case-scenario intention-to-treat analysis of response as defined above (in which dropouts were considered non-responders in the active treatment group and as responders in the comparison group), and standardised weighted mean scores of continuous depression severity scales (usually calculated by last-observation-carried-forward method). MAIN RESULTS: 35 studies (2013 participants) compared low dosage tricyclics with placebo, and six studies (551 participants) compared low dosage tricyclics with standard dosage tricyclics. Low dosage tricyclics, mostly between 75 and 100 mg/day, were 1.65 (95% confidence interval 1.36 to 2.0) and 1.47 (1.12 to 1.94) times more likely than placebo to bring about response at 4 weeks and 6-8 weeks, respectively. Standard dosage tricyclics failed, however, to bring about more response but produced more dropouts due to side effects than low dosage tricyclics. REVIEWER'S CONCLUSIONS: Treatment of depression in adults with low dose tricyclics is justified. However, more rigorous studies are needed to definitively establish the relative benefits and harms of varying dosages.
Ed
Posted by KaraS on November 19, 2004, at 15:31:13
In reply to Re: Treatment in England, posted by ed_uk on November 19, 2004, at 9:20:55
Ed,
Excuse me for barging in here but would you mind telling me more about lofepramine? All I know is that it's a TCA that is used a lot in the UK and that it's on the stimulating side. Would you compare it to desipramine or is it not that stimulating? How strong are the anticholinergic and/or antihistaminic effects? Does it promote a lot of weight gain or cause insomnia for most people? Have you tried any other TCAs that you could compare it to in terms of efficacy and side effects? Have you ever tried reboxetine or milnacipran? If so, how would you compare it to either of them?
Sorry for asking so many questions but I'm very curious.
Thanks,
Kara
Posted by ed_uk on November 20, 2004, at 14:57:31
In reply to Re: Treatment in England - lofepramine » ed_uk, posted by KaraS on November 19, 2004, at 15:31:13
To Kara,
I find lofepramine (Gamanil) very easy to tolerate, easier than SSRIs in fact. Lofepramine is a norepinephrine reuptake inhibitor like desipramine. It is partially metabolised to desipramine. It is much less dangerous in overdose than other TCAs. It is also much less cardiotoxic. Liver damage is a very rare side effect (but other TCAs cause liver damage occasionally too, it's not clear that there's anything special about lofepramine here). Personally, I don't find it stimulating or sedating- it's fairly neutral for me. Some people find it stimulating. The anticholinergic side effects are very weak. I don't have any! It doesn't generally cause any weight gain. It's antihistamine effect is negligible. It causes insomnia for some people. Out of the TCAs I've tried amitriptyline and dothiepin. They were both intolerable. Never tried reboxetine or milnacipran though. Reboxetine is on the market in England as Edronax. Milnacipran is not available here.
Regards,
Ed.
Posted by KaraS on November 20, 2004, at 16:43:46
In reply to Re: Treatment in England - lofepramine » KaraS, posted by ed_uk on November 20, 2004, at 14:57:31
Hi Ed,
Thanks for getting back to me.
> I find lofepramine (Gamanil) very easy to tolerate, easier than SSRIs in fact. Lofepramine is a norepinephrine reuptake inhibitor like desipramine. It is partially metabolised to desipramine. It is much less dangerous in overdose than other TCAs. It is also much less cardiotoxic. Liver damage is a very rare side effect (but other TCAs cause liver damage occasionally too, it's not clear that there's anything special about lofepramine here).
I wonder why lofepramine is singled out for this then? Do you have to have routine liver tests?
>Personally, I don't find it stimulating or sedating- it's fairly neutral for me. Some people find it stimulating. The anticholinergic side effects are very weak. I don't have any! It doesn't generally cause any weight gain. It's antihistamine effect is negligible. It causes insomnia for some people.Desipramine gave me tachycardia. So did Nortriptyline. They were both very powerful for me. I wonder how this one would effect me. Otherwise it seems too good to be true. No wonder it's used a lot in the UK. Wonder why it never made it here in the U.S.
>Out of the TCAs I've tried amitriptyline and dothiepin. They were both intolerable. Never tried reboxetine or milnacipran though. Reboxetine is on the market in England as Edronax. Milnacipran is not available here.I've tried doxepin, low dosage amitriptyline (that was horrible stuff - so incredibly sedating) and low dosage maprotiline. Maprotiline was very tolerable. It was slightly sedating and it helped me to sleep. Still too much anticholinergic effect for me but better than any of the other sedating TCAs.
I really need to start taking something noradrenergic and/or dopaminergic. The lofepramine has been very effective for you? Do you combine it with anything else? If I can't come up with something else that is good to try next, then I will probably try Parnate.
-K
Posted by ed_uk on November 20, 2004, at 18:12:40
In reply to Re: Treatment in England - lofepramine » ed_uk, posted by KaraS on November 20, 2004, at 16:43:46
Hi Kara,
Lofepramine was introduced many years after the early TCAs like imipramine. I think this is why it got singled out because of rare reports of liver disease. No, I've never had a liver test while I've been on it (2 yrs). Lofepramine causes tachycardia just like desipramine. If tachycardia was a problem it could be combined with a low dose of a beta blocker (eg. atenolol). My heart rate is very fast but this doesn't cause me any problems, my BP is normal. Lofepramine has helped to relieve my depression. I also take citalopram for anxiety and OCD.
All the best,
Ed
Posted by Iansf on November 20, 2004, at 19:05:51
In reply to Re: Treatment in England - lofepramine and Kara, posted by ed_uk on November 20, 2004, at 18:12:40
> Hi Kara,
>
> Lofepramine was introduced many years after the early TCAs like imipramine. I think this is why it got singled out because of rare reports of liver disease. No, I've never had a liver test while I've been on it (2 yrs). Lofepramine causes tachycardia just like desipramine. If tachycardia was a problem it could be combined with a low dose of a beta blocker (eg. atenolol). My heart rate is very fast but this doesn't cause me any problems, my BP is normal. Lofepramine has helped to relieve my depression. I also take citalopram for anxiety and OCD.
>
> All the best,
> Ed
I noticed several countries that used to sell loferpramine stopped importing it. Do you know of any controversy surrounding lofepramine that might have prompted this?
John Mc
Posted by ed_uk on November 20, 2004, at 19:25:17
In reply to Re: Treatment in England - lofepramine and Kara » ed_uk, posted by Iansf on November 20, 2004, at 19:05:51
Hi John,
Strange thing is, lofepramine isn't controversial in England at all. I've tried to find out why it was discontinued in some countries but I never found out. The only thing I can think of it that there have been rare reports of hepatic disorders with lofep.
Ed
Posted by ed_uk on November 20, 2004, at 20:38:56
In reply to Re: Treatment in England - lofepramine and Kara, posted by ed_uk on November 20, 2004, at 19:25:17
Int Clin Psychopharmacol. 1993 Summer;8(2):83-6. Related Articles, Links
A prospective evaluation of the hepatotoxicity of lofepramine in the elderly.Kelly C, Roche S, Naguib M, Webb S, Roberts M, Pitt B.
Academic Department of Psychiatry, St Charles Hospital, London, UK.
Lofepramine has been acclaimed as an effective and safe antidepressant, particularly for the elderly. Recent case reports of hepatic toxicity following treatment with lofepramine, however, caused clinicians to question its use in a patient population who frequently have concomitant physical illness. From published data the incidence of serious side effects as well as the implications for its use remain unclear. In this study, 52 patients over the age of 65 years treated with lofepramine were monitored over a 12-week period. The results suggest that for the overwhelming majority of patients, any rise in liver enzyme activity is transient. It is recommended, however, that LFTs be monitored for the first 12 weeks of treatment.
Posted by ed_uk on November 21, 2004, at 7:34:22
In reply to Re: Treatment in England - lofepramine, posted by ed_uk on November 20, 2004, at 20:38:56
Hi,
Did desipramine help your depression? If it didn't then lofepramine probably won't. This is because it's metabolised to desipramine. The major advantage of lofep is that it's less cardiotoxic than desipramine in overdose. Side effects and efficacy are similar to desipramine.
All the best,
Ed.PS. Do you think you'll try Parnate?
Posted by KaraS on November 21, 2004, at 15:46:36
In reply to Re: Kara, posted by ed_uk on November 21, 2004, at 7:34:22
> Hi,
>
> Did desipramine help your depression? If it didn't then lofepramine probably won't. This is because it's metabolised to desipramine. The major advantage of lofep is that it's less cardiotoxic than desipramine in overdose. Side effects and efficacy are similar to desipramine.
>
> All the best,
> Ed.
>
> PS. Do you think you'll try Parnate?
Ed,
I didn't get onto a high enough dose of desipramine because of the tachycardia. It REALLY stimulated me a lot. Even though I can't tolerate an AD therapeutic dosage of it, I sometimes think I should add in a little bit of it to something else just for some much needed stimulation. BTW, how can lofepramine be less cardiotoxic than desipramine if it metabolizes to desipramine?I am seriously considering Parnate and probably will try it soon.
Kara
Posted by ed_uk on November 22, 2004, at 2:02:18
In reply to Re: Kara » ed_uk, posted by KaraS on November 21, 2004, at 15:46:36
Hi Kara,
You'd probably find lofepramine very stimulating!
It causes just as much tachy as desip but is less likely to cause arrhythmias in overdose. It is less toxic in overdose because the enzyme that converts lofep to desip gets saturated if a very high dose of lofep is given, this limits the amount of desip that can be formed.Regards,
Ed
Posted by KaraS on November 22, 2004, at 2:59:13
In reply to Re: Kara, posted by ed_uk on November 22, 2004, at 2:02:18
Posted by KaraS on November 23, 2004, at 14:18:05
In reply to Re: Kara, posted by ed_uk on November 22, 2004, at 2:02:18
Hi Ed,
I meant to ask you earlier about dothiepin. Why is that so popular in the UK? What is it's side effect profile? What advantages does it have over other TCAs?
Kara
Posted by ed_uk on November 25, 2004, at 7:48:29
In reply to Re: dothiepin » ed_uk, posted by KaraS on November 23, 2004, at 14:18:05
Hi Kara,
There doesn't seem to be any good reason why dothiepin is so popular. Its side effect profile resembles amitriptyline but it's a bit less anticholinergic. Its efficacy has been questioned though. You're not missing out on anything. Might as well just take a low dose of amitriptyline if you want to mimic the effect of dothiepin! It doesn't have any major advantages over other TCAs. Also, it increases the risk of developing coronary heart disease.
Regards,
Ed.
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