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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 18 of 18. This is the beginning of the thread.
Posted by g_g_g_unit on March 26, 2012, at 20:46:07
I've read that Clonidine is a selective alpha-2 agonist that's capable of both suppressing and stimulating noradrenaline release at different doses. I'm also aware that it has an extremely long half-life (Wikipedia says 12-33 hours?).
I really can't tell what effects I can attribute to it. It helps with sleep onset (0.2-0.3mg), but I don't sleep particularly well. I also find that the next day, I feel a little blunted in certain respects - I'm less irritable and also feel less physically anxious but at the same time kind of 'dead'. Is it usual to expect some carryover effect into the next day?
As for its interactions with Parnate, it's hard to say. As I've mentioned, there's a blunting of physical stimulation, but I can't really tell what effect it's having on the mental stimulation-side of things. I feel kind of blank and overstimulated at times, which I tend to associate with too much noradrenaline, so either the Clonidine's not helping or potentiating that side of things?
Posted by SLS on March 26, 2012, at 21:10:28
In reply to anyone with Clonidine experience?, posted by g_g_g_unit on March 26, 2012, at 20:46:07
> I've read that Clonidine is a selective alpha-2 agonist that's capable of both suppressing and stimulating noradrenaline release at different doses.
This is interesting. Would you be able to recommend a source of information on this?
Clonidine is depressogenic - even in people who have no history of mental illness. I would sooner choose guanfacine (Tenex) as a sympatholytic. It works in a similar fashion, but I don't think depression is as much of a problem with it.
- Scott
Posted by psychobot5000 on March 26, 2012, at 23:00:12
In reply to anyone with Clonidine experience?, posted by g_g_g_unit on March 26, 2012, at 20:46:07
> I've read that Clonidine is a selective alpha-2 agonist that's capable of both suppressing and stimulating noradrenaline release at different doses. I'm also aware that it has an extremely long half-life (Wikipedia says 12-33 hours?).
>
> I really can't tell what effects I can attribute to it. It helps with sleep onset (0.2-0.3mg), but I don't sleep particularly well. I also find that the next day, I feel a little blunted in certain respects - I'm less irritable and also feel less physically anxious but at the same time kind of 'dead'. Is it usual to expect some carryover effect into the next day?
>
> As for its interactions with Parnate, it's hard to say. As I've mentioned, there's a blunting of physical stimulation, but I can't really tell what effect it's having on the mental stimulation-side of things. I feel kind of blank and overstimulated at times, which I tend to associate with too much noradrenaline, so either the Clonidine's not helping or potentiating that side of things?
>
>
I have taken clonidine for anxiety, and your experience matches mine. In answer to your question: yes, it's usual to expect some carryover effect the next day.It was not useful for me. Made me feel fatigued and, as you describe, blunted and dead. I hated it so much that I didn't try guanfacine next, as Scott suggested, though it's probably a good idea to give that one a shot.
Posted by g_g_g_unit on March 27, 2012, at 1:04:58
In reply to Re: anyone with Clonidine experience? » g_g_g_unit, posted by SLS on March 26, 2012, at 21:10:28
> > I've read that Clonidine is a selective alpha-2 agonist that's capable of both suppressing and stimulating noradrenaline release at different doses.
>
> This is interesting. Would you be able to recommend a source of information on this?Here's a link to a post written by a psychiatrist explaining Clonidine's contradictory dual-actions:
http://definitivemind.com/forums/showthread.php?t=83
>
> Clonidine is depressogenic - even in people who have no history of mental illness. I would sooner choose guanfacine (Tenex) as a sympatholytic. It works in a similar fashion, but I don't think depression is as much of a problem with it.
>
>Unfortunately Tenex isn't available in Australia. I wonder what else I can try using for sleep. Are you aware if Lyrica produces a rebound effect akin to benzodiazepines? (I believed I noticed a similar phenomenon with Neurontin, which also produced apathy, flatness and depression in me).
Otherwise, I suppose there's Klonopin, but it would take some convincing of my doctor on my part, and that also runs the risk of inducing depression, correct?
Posted by g_g_g_unit on March 27, 2012, at 1:06:50
In reply to Re: anyone with Clonidine experience?, posted by psychobot5000 on March 26, 2012, at 23:00:12
> I have taken clonidine for anxiety, and your experience matches mine. In answer to your question: yes, it's usual to expect some carryover effect the next day.
>
> It was not useful for me. Made me feel fatigued and, as you describe, blunted and dead. I hated it so much that I didn't try guanfacine next, as Scott suggested, though it's probably a good idea to give that one a shot.Thanks for confirming. I was under the impression that Clonidine was short-acting, so nice to know I'm not imagining things.
Posted by SLS on March 27, 2012, at 7:06:10
In reply to Re: anyone with Clonidine experience? » SLS, posted by g_g_g_unit on March 27, 2012, at 1:04:58
Noradrenergic = norepineprine = (NE)
I have not actually recommended prazosin (Minipress) to anyone yet. It works wonders for my depression, but I don't want to go out "selling" a product without knowing how it affects other people first. Prazosin is a sympatholytic that works on a very different NE receptor than do clonodine or propranolol. So far, it is known to effectively treat PTSD disturbed sleep and nightmares. It also can reduce daytime anxiety and depression as well.You might want to try propranolol first if you have not done this. I wish I knew whether combining prazosin with propranol would produce untoward effects like unacceptably low blood pressure. Beta-blockers (propranalol) and alpha-blockers (prazosin) are often combined to treat cardiovascular disease (hypertension and congestive heart failre). Propranolol slows down the heart rate and rectifies conduction abnormalities. Prazosin acts as an "afterload" reducer to ease the workload on the heart. It does not affect heart rate.
The two drugs are generally safe to be taken together. You will just have to see how they effect your blood pressure and the degree to which orthostatic hypotension occurs when standing from a seated position.
Dosages of prazosin when used psychiatrically are rather low. I currently take 6 mg/day. I don't doubt that some people will do well at 3 - 4 mg/day. The lower, the better. Just have your doctor check your heart-rate for bradycardia and blood pressure. For me, my blood pressure was about 120/80 mm Hg. Prazosin is a rather gentle antihypertensive, especially at the lower dosages. Most side effects like dizziness, fatigue, and tiredness pass quickly
clonidine (Catapress) = NE alpha-2 receptor agonist (stimulator / presynaptic)
guanfazine (Tenex)
prazosin (Minipress) = NE alpha-1a/b/d receptor antagonist (blocker / postsynaptic)
propranolol (Inderal) = NE beta-1/2 receptor antagonist (blocker / postsynaptic)
- Scott
Posted by SLS on March 27, 2012, at 7:15:09
In reply to Re: anyone with Clonidine experience? » g_g_g_unit, posted by SLS on March 27, 2012, at 7:06:10
Sorry, I forgot to describe guanfacine and even managed to misspell it.
All of the following drugs reduce the fight-or-flight reaction by reducing the activity of neurons that use epinephrine and norepinephrine as a neurotransmitter / neuromodulator. They reduce the activity of the sympathetic nervous system, and are thus called sympatholytics.
Corrected:
clonidine (Catapress) = NE alpha-2 receptor agonist (stimulator / presynaptic)
guanfacine (Tenex) = NE alpha-2 receptor agonist (stimulator / presynaptic)
prazosin (Minipress) = NE alpha-1a/b/d receptor antagonist (blocker / postsynaptic)
propranolol (Inderal) = NE beta-1/2 receptor antagonist (blocker / postsynaptic)
- Scott
Posted by g_g_g_unit on March 27, 2012, at 8:03:55
In reply to Re: anyone with Clonidine experience? » g_g_g_unit, posted by SLS on March 27, 2012, at 7:06:10
Scott, my psychiatrist wasn't comfortable prescribing Prazosin because he'd never used it before (ditto with Memantine), which is why he went with Clonidine.
He has never been outright vindictive or cruelly withholding, but he certainly has a strong will and well-defined boundaries regarding what he does/doesn't like prescribing, i.e. at this point I've heard him express hesitancy in using a) high-dose SSRIs (due to withdrawal issues), b) Effexor (ditto), c) Ativan (tolerance issues and the subsequent need for dose escalations), and d) Klonopin (no reason given).
He is certainly no dunce; he comes recommended as one of the best specialists in my city. I wonder if his training as a psychotherapist contributes to his lack of yielding to demand (which I have found in certain psychiatrists).
As someone who (I imagine?) has worked with strong-willed, highly capable professionals, do you have any advice for negotiating with psychiatrists? Due to social anxiety, this is something I find somewhat difficult.
Posted by Phillipa on March 27, 2012, at 9:51:55
In reply to Re: prazosin, 'willful' psychiatrists » SLS, posted by g_g_g_unit on March 27, 2012, at 8:03:55
I have a feeling pdocs are uncomfortable prescribing meds that are normally prescribed by docs who treat patients with cardiovascular conditions. Like an internist or cardiologist. Seems docs are all specialists in their fields today. Phillipa
Posted by Shes_Initforthemoney on March 27, 2012, at 15:16:31
In reply to anyone with Clonidine experience?, posted by g_g_g_unit on March 26, 2012, at 20:46:07
> I've read that Clonidine is a selective alpha-2 agonist that's capable of both suppressing and stimulating noradrenaline release at different doses. I'm also aware that it has an extremely long half-life (Wikipedia says 12-33 hours?).
>
> I really can't tell what effects I can attribute to it. It helps with sleep onset (0.2-0.3mg), but I don't sleep particularly well. I also find that the next day, I feel a little blunted in certain respects - I'm less irritable and also feel less physically anxious but at the same time kind of 'dead'. Is it usual to expect some carryover effect into the next day?
>
> As for its interactions with Parnate, it's hard to say. As I've mentioned, there's a blunting of physical stimulation, but I can't really tell what effect it's having on the mental stimulation-side of things. I feel kind of blank and overstimulated at times, which I tend to associate with too much noradrenaline, so either the Clonidine's not helping or potentiating that side of things?
>
>Hi,
I've been on Clonidine for awhile now, and after the initial start-up effects, I found .1mg 2x a day to be best. Any higher doses just seem to cause more side effects. It helps a little bit with sleep onset, but I have to take melatonin (Plus I am on Risperdal @ 4mg a day) with Clonidine in order for it to seem to work well.
I would say it helps often in the 30-40 percent range (and sometimes as high as 80-90) for my GAD.
But, only at the small dose I mention. I also use it mainly for keeping nightmares and intense and persistent dreaming out of my sleep.(Hyper-REM)It seems to have taken about 2 weeks of steady dosing, like I said, in order for it to be effective and side-effect free. Minipress (Prazosin) is similar I believe, but you may want to ask SLS about that.
Hope that helps...
Jay
Posted by torrid2 on March 27, 2012, at 18:10:01
In reply to anyone with Clonidine experience?, posted by g_g_g_unit on March 26, 2012, at 20:46:07
clonidine dropped my already low blood pressure so low I couldn't function
Posted by g_g_g_unit on March 28, 2012, at 23:42:31
In reply to Re: anyone with Clonidine experience? » g_g_g_unit, posted by Shes_Initforthemoney on March 27, 2012, at 15:16:31
Was next-day depression/'flatness' one of the side-effects that passed for you?
> >
>
> Hi,
>
> I've been on Clonidine for awhile now, and after the initial start-up effects, I found .1mg 2x a day to be best. Any higher doses just seem to cause more side effects. It helps a little bit with sleep onset, but I have to take melatonin (Plus I am on Risperdal @ 4mg a day) with Clonidine in order for it to seem to work well.
>
> I would say it helps often in the 30-40 percent range (and sometimes as high as 80-90) for my GAD.
> But, only at the small dose I mention. I also use it mainly for keeping nightmares and intense and persistent dreaming out of my sleep.(Hyper-REM)
>
> It seems to have taken about 2 weeks of steady dosing, like I said, in order for it to be effective and side-effect free. Minipress (Prazosin) is similar I believe, but you may want to ask SLS about that.
>
> Hope that helps...
> Jay
>
>
Posted by Shes_Initforthemoney on March 29, 2012, at 6:18:55
In reply to Re: anyone with Clonidine experience? » Shes_Initforthemoney, posted by g_g_g_unit on March 28, 2012, at 23:42:31
> Was next-day depression/'flatness' one of the side-effects that passed for you?
>
> > >Yes, a little bit of 'flatness' if I took too high of a dose. But at 0.1mg's, it took the edge off of anxiety caused by being on Effexor. Now I take it with my Prozac/Cipralex (Lexapro) combo + Dexedrine, and I don't have that "jump out of bed" feeling, but I also don't have the constant anxiety and rumination buzzing in my head. It is so NICE to have that anxiety clipped away.
Anymore questions...please ask away!
Take care,
Jay> >
> > Hi,
> >
> > I've been on Clonidine for awhile now, and after the initial start-up effects, I found .1mg 2x a day to be best. Any higher doses just seem to cause more side effects. It helps a little bit with sleep onset, but I have to take melatonin (Plus I am on Risperdal @ 4mg a day) with Clonidine in order for it to seem to work well.
> >
> > I would say it helps often in the 30-40 percent range (and sometimes as high as 80-90) for my GAD.
> > But, only at the small dose I mention. I also use it mainly for keeping nightmares and intense and persistent dreaming out of my sleep.(Hyper-REM)
> >
> > It seems to have taken about 2 weeks of steady dosing, like I said, in order for it to be effective and side-effect free. Minipress (Prazosin) is similar I believe, but you may want to ask SLS about that.
> >
> > Hope that helps...
> > Jay
> >
> >
>
>
Posted by stewie on March 30, 2012, at 10:13:44
In reply to anyone with Clonidine experience?, posted by g_g_g_unit on March 26, 2012, at 20:46:07
I'm sorry to say that Clonidine didn't work for me because I could never stay on the lowest dose. My doc had to keep making the dose higher, until I was just completely worthless the following day.
I really hope that you adjust to valium, which to my mind would be less blunting with time.
I'm having a lot of trouble finding something to help with sleep, as I am pretty wired on low-dose Abilify.
I hope things work out very soon for you.
Posted by phidippus on March 30, 2012, at 13:31:34
In reply to anyone with Clonidine experience?, posted by g_g_g_unit on March 26, 2012, at 20:46:07
>I also find that the next day, I feel a little >blunted in certain respects
Clonidine's long half life can lead to a stupor of sorts. More like extended morning blahs.
As for noradrenaline release, you need much more clonidine to achieve that affect.
Eric
Posted by psychobot5000 on March 30, 2012, at 18:15:57
In reply to Re: anyone with Clonidine experience? » g_g_g_unit, posted by Shes_Initforthemoney on March 29, 2012, at 6:18:55
It's worth noting that in my failed trial of clonidine, I never made it to two weeks--it made me too dead. With that in mind, giving it a shot for a couple weeks at .1 without dose escalation seems like a very reasonable idea, to me, something that might work.
Posted by g_g_g_unit on March 30, 2012, at 18:44:28
In reply to Re: anyone with Clonidine experience? » g_g_g_unit, posted by phidippus on March 30, 2012, at 13:31:34
> Clonidine's long half life can lead to a stupor of sorts. More like extended morning blahs.
>
> As for noradrenaline release, you need much more clonidine to achieve that affect.
>Are you aware of roughly how much Clonidine? I'm confused because I go to bed feeling anxious, wound up and with my heart pounding. I would have thought that Clonidine would ameliorate those kinds of effects.
I'm currently taking 0.2mg, which seems to be the bare minimum (in combination with 5mg of Valium) that I need to fall asleep, but the quality is so poor that I spend most of the next day feeling wiped out anyway.
Posted by phidippus on April 2, 2012, at 9:44:59
In reply to Re: anyone with Clonidine experience? » phidippus, posted by g_g_g_unit on March 30, 2012, at 18:44:28
Clonidine is not an anxiolytic. You're not going to reap much anti-anxiety benefit from it, especially since your pretty wound up as it is.
That's why I suggested Prazosin. It DOES have an anxiolytic effect. And as for delayed onsleep, I've never had trouble.
Eric
This is the end of the thread.
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