Posted by grapebubblegum on May 26, 2001, at 8:29:04
Please forgive me if you've read some of this elsewhere. I've cut and pasted my comments from other threads to try to crystallize the issue I'd like your insight on. You may recall that I was very confused by my doctor's occasional advice to take clonazepam .5 mg (or even .25 mg) three times per day vs. her alternating misgivings that I might get too dependent on that and need increasing dosages of it, and her advice to continue on SSRI's instead with clonazepam only prn:
A discussion elsewhere on the board and a link to the bearpaw page on panic disorder is inspiring me to open my mind to another approach to my struggle with this disorder. My doctor gives me some leeway to make lateral changes in my meds, i.e. adjusting the dosages of the meds (currently Paxil and Klonopin) she has prescribed. She believes that people need to get to know their own reactions to meds and does not discourage some tweaking thereof. In return, I keep her informed. I think she is pretty smart - how else can a patient and doctor really work out what is best for the patient with input only from the doctor? The patient has a valuable opinion in all of this, and has a viewpoint the doctor cannot fully tap into without the patient's interaction with his/her plan of treatment.
I have found in retrospect that the SSRIs may have been causing me more problems than I thought. I was up to a high dose of zoloft (200 mg per day) and STILL had breakthrough panic attacks for a while, plus, as soon as I went over 100 mg. of zoloft I had the feeling of music playing or conversations going around in my head (not delusional stuff, just the usual tune in your head but louder and more disruptive.) Then my legs were so restless I was stretching and flexing them all night, and while I did sleep, I had that half-asleep feeling all night.
When I switched to Paxil for the above reasons, I immediately noticed a return to better sleep. I was not restless, but if I did happen to awaken in the night, I'd have a feeling of, "I'll just stay up and play on the computer for an hour" which is NOT like me. Then when I recently cut my Paxil dose in half (down to 10 mg. per day - is that even therapeutic?) even BEFORE I got smart enough to add in the clonazepam, I noticed a return to truly restful sleep like I haven't had in six months. And besides getting my sexual function back, I am not craving carbs constantly or feeling half-rested all the time. It will take a lot to get me back on those SSRI's again. I'm not trying to badmouth them as much as I am just chronicling my own recent epiphany. I've been on and off them (more off than on) for the last ten years, and I've used four different kinds, and I can see that there really is value in them but I am starting to see now that maybe it was like using a sledgehammer to hammer in a poster brad. They served their purposes but I wonder if there was some overkill.
Currenly I'm ramping down the Paxil and taking very small amounts of Clonazepam (12.5 mg three times a day, believe it or not, has a strong beneficial effect on me). I can tell you that it took TWO DAYS ONLY of cutting my Paxil in half from 20 mg to 10 mg per day to restore my orgasmic function with my partner.
I am just so fed up with the various SSRI side effects. I wonder if my doc and I have been barking up the wrong tree by using them. Like I said, I don't consider myself "depressed" in the classic sense, or maybe not in any sense. That is a label that has always been ascribed to me, but it is often said that anyone suffering panic attacks will eventually seem depressed in the aftermath.
Cam, my basic question is: since there is a strong family history of bipolar disorder (my father and my son) do you think it's possible that my tendency toward very sporadic panic attacks represents something other than the classic depression that SSRIs are meant to treat, as I understand it? It's true that I've noticed some moderately challenging depression features in myself at times, including OCD thoughts (not actions), some obsessive self-blame and some interpersonal irritability that is relieved with SSRI treatment, (are these not all more anxiety than depressive features?) but I've never felt "depressed" as I understand the word to be defined. Now that I'm taking such small doses of Klonopin and very little Paxil, I've never felt better. (Yes, I get a little irritable with others but I think it's well within the realm of what's normal for humans.) Do you think the hype about dependency on benzodiazepines is overblown (I remember you said that tolerance does develop to clonazepam's sedative effects but not its anxiolytic effects and that is what spurred me to go ahead and try this. Sure enough, after only a week, the sedation is much less of a problem but I don't feel that familiar "aura" of a panic attack looming every evening like I used to before I started using the klonopin regularly.) I had not previously understood that klonopin doesn't reach peak concentration for four hours and this is why I thought that a three x per day regimen, as my doctor has suggested off and on (she waffles on it) might make sense.
Just looking for your thoughts, if you have any, on the subject of SSRIs vs. benzodiazepines, particularly the clonzepam-class ones, for panic disorder.
poster:grapebubblegum
thread:64311
URL: http://www.dr-bob.org/babble/20010522/msgs/64311.html