Posted by Douglas on August 19, 1999, at 20:41:50
In reply to Re: Bones: Soc Anx/Klon: Horror Stories vs. Research, posted by Rick on August 19, 1999, at 17:07:26
> A Postscript, re safety of long-term Klonopin (clonazepam)use in Social Phobia:
>
>
> J Clin Psychopharmacol 1998 Oct;18(5):373-8
>
> Discontinuation of clonazepam in the treatment of social phobia.
>
> Connor KM, Davidson JR, Potts NL, Tupler LA, Miner CM, Malik ML, Book SW, Colket JT, Ferrell F
> Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina 27710, USA.
>
> Patients with social phobia who responded well to 6 months of open-label treatment with clonazepam were assigned to receive either continuation treatment (CT) with clonazepam for another 5 months, or to undergo discontinuation treatment (DT) using a clonazepam taper at the rate of 0.25 mg every 2 weeks, with double-blind placebo substitution. Clinical efficacy was compared between the CT and DT groups using three different social phobia scales. Benzodiazepine withdrawal symptoms were also measured. Relapse rates were 0 and 21.1% in the CT and DT groups, respectively. Subjects in the CT group generally showed a more favorable clinical response at midpoint and/or endpoint, although even in the DT group clinical response remained good. With respect to withdrawal symptoms, the rates were low in both groups (12.5% for CT and 27.7% for DT) with no real evidence suggesting significant withdrawal difficulties. At the end of 11 months of treatment with clonazepam, however, a more rapid withdrawal rate was associated with greater distress. This study offers preliminary evidence to suggest that continuation therapy with clonazepam in the treatment of social phobia is safe and effective, producing a somewhat greater clinical benefit than a slow-taper discontinuation regime. However, even in the DT group, withdrawal symptoms were not found to be a major problem. The study can be taken as supportive of benefit for longterm clonazepam treatment in social phobia, as well as being compatible with a reasonably good outcome after short-term treatment and slow taper.
>
> Publication Types:
>
>
> Clinical trial
> Randomized controlled trial
>
>
> Rick
> -----
> > Bones --
> >
> > Glad to provide my input. Hope you have/had a great vacation!
> >
> > Please keep in mind that I am talking about a person (myself) whose ONLY diagnosed clinical mental disorder is SOCIAL PHOBIA. That is not the typical profile of participants in this board. If I were BiPolar, I'd probably be afraid to take Klonopin. If I were depressed, I might be a bit more concerned about dependence (though I doubt that's rational). And if I had a history of alcohol or drug abuse, I'd steer miles clear of the stuff.
> >
> > But none of these special cautions apply to me. My sole clinical malady is irrational, troubling physical reaction in numerous social and business settings, which interferes greatlty with my daily functioning and personal progress.
> >
> > Please keep in mind that people who have had problems with a medication (and let's face it, this board IS primarily about medications) are going to be MUCH more likely to post than those who have had rousing success. (Note how one poster virtually had to *plead* for people to submit success stories.) They are (understandably) seeking advice and sympathy, or want to warn others about unfortunate (but not necessarily typical) personal reactions to meds.
> >
> > This board is a wonderful service, but as a market researcher I recognize it as self-selected, rather than scientifically-selected, sample, and it is very unwise to make decisions based on the "majority opinion" in such a biased sample. Marketers use focus groups (basically moderated gab sessions) to generate ideas, but NEVER act on those ideas without following up with large scale, scientifically-controlled research, which often provides starlingly different results than would have been expected after the focus groups (which often devolve into a follow-the-leader, "friendly mob" mentality).
> >
> > The most important thing to do in assessing the safety of Klonopin or any drug for you is is to talk to reputable professionals, and read about reputable research work. (Unfortunately, some "professionals" can be close-minded, old fashioned, uninterested, or driven more by the possibility of lawsuits than by patient well-being. It's not always easy to find a really good one!)
> >
> > Regarding Benzo safety, addiction, and withdrawal, PLEASE read the following link:
> >
> > http://panicdisorder.about.com/library/weekly/aa031997.htm?pid=2791&cob=home
> >
> > Most research I've read shows that meds are much more effective for SP than psychotherapy, and somewhat more effective than CBT (which I understand requires a GREAT amount of consistent time, effort, and commitment). I may still look into CBT, however, because it is said to be the best way to effect permanent canges in brain function for Socila Phobics.
> >
> > Incidentally, I'm doing so well right now that I take a little less (1.5 gr instead of 2.0)Klonopin on less-stressful days (about 50% of them). On extra-stressful days (25%), I take 2.5. I've had NO problem dealing with these dosage adjustments, and certainly no desire to "pop in another one" when stressed.
> >
> > I'm not worried about addiction. But even if I DID become addicted, so long as I have the means to keep obtaining the drug, so what? It's certainly not addiction in the sense of the high you get from alcohol, recreational drugs, or even nicotine. This is a theraputic medication that makes me feel normal. There are lots of people who need daily medication of some sort just to function physically, keep chronic pain at bay, or simply survive. Should we deny this to them because it is, de facto, addictive? Of course not. This is the (thankfully fading) mentality of doctors would deny heroin to a terminal cancer patient in excrutiating pain for fear of causing addiction.
> >
> >
> > Rick
> > ----
> > First Rick, thanks for all of your sagely advice; your time ane effort is sincerely appreciated.
> > >
> > > I've been reading messages re. Klonopin, and quite frankly people's severe reactions to the med. (in particular withdrawal) deeply concerns me. The impression I get is that this drug, works and works well, but you shouldn't stay on it for a prolonged period of time. Are you fearful about addiction??
> > >
> > > Also, on a more personal note - (I've never actually spoken to anyone with Social Anxiety before this, we're kind of a "secret society" - great shame), have you ever tried cognitive or behavioral therapy to combat your "shyness"?? How about psychotherapy? I would like to involve myself in cognitive/behavioral therapy. And also explore psychotherapy. The psychiatrist who prescribes my meds. (and that's about all he does), thinks therarpy is a great idea, (I would love to see a Jungian therapist but simply cannot afford it), he feels that it would help me to grow emotionally/spiritually but doesn't feel it will address my anxiety. Have you had Social Anxiety most of your life. I was a kind of shy kid. (Not untypical.) Around my friends and family I was extroverted - kind of a goofy tomboy. Lots of laughter. When I was 15, I was overwhelmed with panic attacks. (Bang - out of the blue.) Up until that point (Grade 11), I was a popular, well-balanced teen-ager. I had no diagnosis for these attacks - being religous, and given the time - I deducted (OCD - da, daah), that I must be demon possessed. Life was hell for about three years - I refused any help - God would heal me. There was no "safe" place - how can one escape the devil? My inability to find a "safe" place was actually my saving grace - I desensitised myself - I'd had so many panic attacks that I simply wasn't afraid of them any longer - and after three years - I decided that I must not be demon possessed. However, I was left with Social Anxiety - that feeling that something terrible is going to happen & the intense physical symptoms that panic attacks cause - racing heart, that anticipatory feeling that you're losing control; inability to think; all focus on maintaing the "facade" that everything is okay. My social anxiety has diminished - however I still blush around authority figures. (I work as an Executive Secretary - not a desirable quality); I have tremors; if I'm really socially anxious I struggle to focus and think - fogginess. And of course I still have OCD. (Which when intense is the most debilitating of any anxiety.)
> > >
> > > Life with anxiety has been a struggle - but Life is still very good.
> > >
> > > (Man, typing these threads are annoying ... I wish I could read/see what I've typed in it's entirety, without having to endlessly cursor.)
> > >
> > > Bye. (On vacation right now - a glorious lazy week.)
> > >
> > > > Bones -
> > > >
> > > > First off, according to sources such as rxlist.com, SELEGELINE IS NOT TO BE TAKEN WITH SSRI's! I know that sometimes these warnings are overstated, especially when we're talking very low doses of Selegeline, but I would NOT take a chance without proper guidance from a qualified expert.
> > > >
> > > > Also, if you end up taking Selegeline, realize that it switches from a selective (dopamine) to non-selective (dopamine and seratonin) irreversible MAOI at higher doses, and in that case the food and OTC drug restrictions required with Nardil must be observed with Selegeline as well. (I personally have no intention of moving in that direction. I want my aged cheese!) To be on the safe side, I'd caution even caution against a move as small as 5mg to 10mg without adding the food/drug restrictions, because I've read in several places that Benzo's can potentiate MAOI's (maybe that's one reason for my success with the combination?). Conversely Pindolol/Viskenis often used specifically to try to speed up and improve response from almost all types of AD's.
> > > >
> > > > Believe it or not Selegeline's primary, and only official, indication in the U.S. is as an adjunct medication in Parksinson's disease. I did a little surfing and found that it is indeed available in Canada. Other names for the same medication include Eldepryl and (apparently in Canada only) Parkinyl (sp?). It is also called l-deprenyl, and is favored by life-extensionists for protection against the natural deterioration of brain cells (thus the Parkinson's connection??). This popularity follows from a highly publicized German study showing an immense increase in life-expectancy among rats given Selegeline. This was later replicated, but to a lesser degree, in a Canadian study. Last year, a British study (which was widely criticized as methodologically flawed and filled with spurious conclusions) showed somewhat *decreased* life expectancy among PARKINSON'S PATIENTS who used Selegeline -- but importantly, this only applied to those who were concurrently taking the Parkinson's med levadopa (sp?).
> > > >
> > > > Ironically, I took the Selegeline alone for four weeks for Social Phobia (I think my pdoc was using me as a guinea pig to see if dopamine defecit drives SP), and it had NO beneficial effect on my Social Anxiety by itself. But as you've seen from my other posts, using it in combo with Klonopin (and Visken/Pindolol) is quite a different story for me! There is currently a controlled study analyzing using low-dose Selegeline (alone) to treat SP; I'll be amazed if THAT produces positive results.
> > > >
> > > > Ahhh, Nardil. For a short time, I thought this was going to be my "answer". So did my pdoc, who is an MAOI "vet". It could very well work wonders for you (though be careful of the food and OTC drug restrictions, even though the hypertensive crisis dangers are greatly exaggerated per my pdoc, especially for men).
> > > >
> > > > Nardil was great at relieving Social Anxiety when it was "working", but unfortunately it only "worked" sporadically. For me, it was almost as if Nardil was working only when it made me feel a little high. My guess is that that's not how it's *supposed* to work. My theory is that it was simply "inebriating" me in a mild sense, thus lowering my inhibitions like alcohol, but without dumbing me down or tiring me more than a bit. I sometimes enjoyed this feeling, but started getting pretty nervous when I once felt like I was stuck in a dream for over 24 hours before escaping. I doubt these are typical reactions from Nardil. Oh yeah, it also made my do strange, involuntary jerky motions in bed sometimes.
> > > >
> > > > Then, after three weeks, I no longer got any benefit from Nardil. I was very disappointed then, but in retrospect glad it happened because the Klonopin effects are (at least so far) more -- and much more consistently -- beneficial, without making me feel strange in any way. I just feel "normal" physically, like the "real me" that's been afraid to "take the stage" because of social anxiety.
> > > >
> > > > As for side effects, I sure bucked the trend re Nardil's infamous weight gain. I embarked on my (first-ever) serious weight loss attempt almost simultaneously with starting the Nardil. But instead of balooning, my diet went unusually well; lost 1-3 pounds per week without too much trouble, for a total of 40 pounds loss to date. I'm glad I did'nt hear about the weight gain reputation until AFTER I started; maybe that would have psyched me out.
> > > >
> > > > But as for the other possible Nardil side effects, you name it - I got it (once dosage reached 45mg): complete anorgasma; dry mouth; constipation; an absolutely unbelievable transformation from hypertensive to hypotensive. (apparently this effect isn't quite THAT severe in most folks, although I have heard such complaints).
> > > >
> > > > And the postural hypotension (a common effect) was a real trip. I would often get super-dizzy upon standing, and actually fell to the floor three times (twice in the bathroom and once at my client's office!) A few other times people saw me wobbling or walking into walls, asked me to sit down, and asked if I was O.K. There was one (in my opinion) GREAT side effect: I no longer dreamed (or if I did, they were wiped from memory. My dreams tend to drive me crazy. (Interesting point, though: although the dreaming has returned with Klonopin, the dreams tend to be SO much less troubling and frantic than before.)
> > > >
> > > > ----
> > > > > Bones again ... I forgot to ask you. How did Nardil react with your Social Anxiety?? Were the side-effects atrocious? Did you gain enormous amounts of weight. (Vanity, vanity.)
> > > > >
> > > > > > > Rick, thanks for your advice. I had read your previous contribution about your marvellous concoction! I've never tried Klonopin and have stayed away from the "Benos" fearing addiction. (Although I tell you I've longed for them at times.) I don't think that Selegeline (sp??) has been approved for sale in Canada. I'll do a little more research. I remember reading about it earlier and thinking, hey this might be a great drug to augment the SSRI's with. (With the malaise, apathy, fogginess they seem to cultivate.) Anyway .. again, thanks for your advice ... there has to be a pharmacological answer!! (Not just a band-aid solution.)
> > > > > > > While everyone's different, I highly disagree with the posts by Cass and Yardena. I've tried Nardil (considreded the "gold standard" AD for Social Anxiety in research, despite the lack of the official FDA designation that Paxil spent big bucks to get); Xanax (a Benzo); and more.
> > > > > > >
> > > > > > > But now I'm on Klonopin, and it is nearly a wonder-drug for me, with no sedation after the first few days (carefully-timed, gradual dose-up schedule essential to ensure this) and NONE of those awful AD side-effects or weird sensations. And I've NEVER been able to think more clearly. (the latter effect could also be related to the low dose -- no food-restrictions required -- Selegeline that I am taking concurrently). And, unlike the AD's, it all happened so fast!
> > > > > > >
> > > > > > > If you've had alcohol or drug dependency problems, Benzos definitely aren't for you, but in most people they are very safe if used (and discontinued) PROPERLY. I'm really sorry to see the bad rap Klonopin sometimes gets when controlled studies have shown it to be the single most effective Social Anxiety medication for most people. Wish I had time to lead you to all the good, rational literature and the aforementioned studies, but I don't at the moment. But do see my posts a bit further up under "Social Phobia - Side Effects of Celexa".
> > > > > > >
> > > > > > > Good Luck. Hope you get to experience the (L-O-O-O-N-G AWAITED) relief I've been experiencing with Klonopin as my key med.
> > > > > > >
> > > > > > > Rick
> > > > > > > -------
> > > > > > > > > I haven't seen a lot written about Social Anxiety in Psychobabble. (Occasional references.) If you are reading this and have Social Anxiety. Can you tell me which med. has worked best for you?? (I also have OCD - but that's another "thread".) Thanks guys!!
> > > > > > > >
> > > > > > > >
> > > > > > > > I've taken the whole gamut of tranquilizers for social anxiety. Valium, Xanax, Klonopin, Lorazepam and others I can't even remember. They help a little with anxiety, but I hate the muddled cognitive skills (although I get that from depression, too). Inevitably, I become addicted. I don't like that either. Right now, I'm not on a sedative and still have the ever present battle with social anxiety. For me, it's a trade off, addiction or social anxiety. Neither is fun. Maybe it would be different for you. In the past, I have overdone it with tranquilizers. and the addictions may be partly my own fault. Coincidentally, I think I may also have OCD, although I haven't been diagnosed with it. I just thought I would give you my experiences. I hope that you find something that works for you. I hope you will share it if you do. Best wishes.
> > > > > > > >
> > > > > > > >
> > > > > > >
> > > > > > > -----
> > > > > > > > > I haven't seen a lot written about Social Anxiety in Psychobabble. (Occasional references.) If you are reading this and have Social Anxiety. Can you tell me which med. has worked best for you?? (I also have OCD - but that's another "thread".) Thanks guys!!
> > > > > > > >
> > > > > > > >
> > > > > > > > I've taken the whole gamut of tranquilizers for social anxiety. Valium, Xanax, Klonopin, Lorazepam and others I can't even remember. They help a little with anxiety, but I hate the muddled cognitive skills (although I get that from depression, too). Inevitably, I become addicted. I don't like that either. Right now, I'm not on a sedative and still have the ever present battle with social anxiety. For me, it's a trade off, addiction or social anxiety. Neither is fun. Maybe it would be different for you. In the past, I have overdone it with tranquilizers. and the addictions may be partly my own fault. Coincidentally, I think I may also have OCD, although I haven't been diagnosed with it. I just thought I would give you my experiences. I hope that you find something that works for you. I hope you will share it if you do. Best wishes.
> > > > > > > >
> > > > > > > >
Bones,
I agree with you about the "secret society". I have had social phobia for about 20 years and had not talked to anyone else about it until recently. I was ashamed to talk about it. I had always been a bit shy and not dated much because of that, but I could live with that. However, for whatever reason I started to have more and stronger physical symptoms. At my wedding I started sweating profusely, same thing at my sister's wedding. I started associating certain events or situations, usually where I am or perceive myself as being the center of attention (weddings, meetings at work, the boss popping in my office with several clients requesting an unexpected demo.,going around a room at the start of a class or seminar where you have to introduce yourself, parties, eating dinner with my girlfriend's family(I'm divorced now), etc. sadly the list could go on forever, but I think you get the idea), with having a social anxiety attack(rapid heart beat, inability to think clearly, intense sweating, unbearable desire to get out...). Believe me if it has ever happened to you, you know how humiliating and hopeless it feels. If a wedding I was to be in or another such event was coming up, I start worrying off and on about it until the event arrives. Finally after a particularly bad episode, as I mentioned in a previous thread, I sought professional help. I was simply fed up with living my life around this sickness. He prescribed Xanax, not to take regularly, but for anticipated events. 1.125 to 1.25 mgs an hour before works wonders. However I cannot always anticipate the events, and also the Xanax is mood altering. I just want to alleviate the physical symptoms and not feel 1/2 drunk. If you didn't see my first thread, I tried paxil for two weeks then quit because of the sexual side effects. Now I am on my first week of Celexa therapy. If this doesn't help, a previous post by Rick about Klonopin sounds promising.
If I have bored you to death, sorry. If anyone else has or had a similar problem, I would love to hear from you.
poster:Douglas
thread:10256
URL: http://www.dr-bob.org/babble/19990814/msgs/10389.html