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Re: Linky-link » paulk

Posted by Elizabeth on June 15, 2001, at 22:32:07

In reply to Re: Linky-link » grapebubblegum, posted by paulk on June 15, 2001, at 20:02:09

> Seriously, your pdoc doesn’t seem to be up on the seritinergic effects of klonopin. Klonopin is THE benzo of choice for long-term treatment.

Not necessarily, although it is definitely a first-line treatment for panic disorder or generalised anxiety. Most benzos have the potental to cause or exacerbate depression, though, including Klonopin; Xanax is often preferable for people with anxiety and depression, despite the need for frequent dosing.

> >Like, a quarter of the smallest strength tablet? Weird. I wonder if maybe you don't metabolise it normally or something. That's a very low dose even for someone who's taking it around the clock (although, as you note, taking it that way has the advantage of preventing panic attacks).
> Not that weird. I only need just a little - .25/day. Many others are in the same boat.

That's surprising. I took Klonopin for a few weeks at one point, and I needed 4 mg/day (1 mg in the morning and afternoon, 2 mg at bedtime). What do you take it for? (I was taking it for panic disorder and a REM sleep parasomnia.) And most people I know who take Klonopin for panic or anxiety disorders need at least 1 mg/day.

> DITTO – BULLS EYE – EXCELLENT POINT! I hope some docs read what you just said. ( I think this phenomena is called ‘kindling’ in the litature.)

Kindling refers to increased frequency of seizures in untreated epilepsy. (More generally it can refer to the same type of phenomenon in mood disorders or panic disorder.)

> I have seen folks deteriorate over time on very large dosages Benzos.

I haven't. But I have seen people take the same dose for years without problems and without needing to increase it.

> I Really don’t think it is good practice to use benzos per attack (unless its for someone who is bi-polar.)

Huh? Benzos are sometimes used to reduce psychomotor agitation in mania, but they're also used for various types of episodic anxiety. It's completely reasonable.

I think it makes more sense to take the benzo around the clock if you have frequent panic attacks. I take an antidepressant around the clock and Xanax as needed, because the antidepressant reduces the frequency of panic attacks.

> If it is a short acting benzo “as per needed” is a good way to get someone with PA in even bigger trouble.

That doesn't make sense to me. If you only take it as-needed, you don't need to be concerned about pharmacologic dependence if you ever want to go off it (or if you miss a dose). Anxiety patients, as a rule, don't abuse their medication (those who do are almost invariably abusing other drugs too).

Xanax has the additional advantage for as-needed dosing that it's fast-acting, so it can prevent an attack if you take it as soon as you feel the attack.

> Klonopin, for me, even at a VERY low dose makes all the difference in what I do when I lose my temper. It also prevents the panic attacks (although I didn’t have that many).

Benzos for anger? That's interesting. Some people with anger problems become disinhibited on benzos (like alcohol).

> Getting off higher dosages of Benzos can be nightmarish.

That's true if you take them around the clock. But then again, a lot of people really do need much higher doses. You're lucky -- maybe it's because you're taking it primarily for anger and never had frequent panic attacks.

> I watched a fellow patient go through the “cold wet sheet pack treatment” getting off Valium. I think switching to klonopin and tapering would have been a much better way.

That's the right way, yes: switch to a long-acting benzo, such as Klonopin or Tranxene, and then taper off *very* slowly. Any doctor who takes someone off benzos cold-turkey should have his license revoked, IMO.





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