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Re: How much clonazepam is needed for SP?

Posted by Rick on June 24, 2001, at 18:41:32

In reply to How much clonazepam is needed for SP?, posted by Else on June 24, 2001, at 11:27:09

I completely agree with what Judy and Paul wrote, but with one big caution:

The Brazilian Social Phobia article in the Tips section of Psycho-Babble always gets me kind of angry, because it implies that typical doses are much higher than they normally are. Yet Dr. Bob insists on leaving this 1996 study as the sole Social Phobia link, even though is getting toasty and runs quite contrary to more stringent Klonopin studies and anecdotal reports.

Even 3 mg is considered a high dosage for most people. I did MUCH better on 1.5-2.0, and I'm not a small guy. I wonder how many people have read that misguided "3-6 mg" recommendation, took too much, and decided that Klonopin/Rivotril was ineffective or had too many side effects when in fact it could have been so beneficial at a lower doses.

Absolutely, a minority of people may require heftier doses, as is the case with Judy. And someone once suggested that perhaps generic clonazepam in Brazil is weaker than in the U.S. or Canada (for this med only, I insist on the brand). But the great majority of people should not require more than 3 mg.

Here is a Medline abstract of the definitive, placebo-controlled study on clonazepam for social phobia:

J Clin Psychopharmacol 1993 Dec;13(6):423-8

Treatment of social phobia with clonazepam and placebo.

Davidson JR, Potts N, Richichi E, Krishnan R, Ford SM, Smith R, Wilson WH.

Department of Psychiatry, Duke University Medical Center, Durham, North Carolina 27710.

Clonazepam and placebo were administered in a double-blind pilot study to 75 outpatients with social phobia. The mean maximum dose of clonazepam was 2.4 mg/day at endpoint (range, 0.5 to 3 mg). Treatment was continued for up to 10 weeks. The results of an intent-to-treat analysis indicated superior effects of clonazepam on most measures. Response rates for clonazepam and placebo were 78.3 and 20.0%. Drug effects were apparent on performance and generalized social anxiety, on fear and phobic avoidance, on interpersonal sensitivity, on fears of negative evaluation, and on disability measures. Significant differences were evident by week 1, 2, or 6, depending upon the rating scale used. Clonazepam was well tolerated in general, although unsteadiness and dizziness were more severe and persistent than was the case for placebo subjects.


----
> I have recently gone of the Zoloft I was taking to
> control my social phobia because I didn't like the
> side effects. Now I take two daily doses of Rivotril
> (Klonopin) 0.5mg. This barely affects my baseline anxiety
> and I haven't had the nerve to test it in a stressful
> social context yet. I have been told this dose is too
> small. Any opinions? I have been on it for two weeks only.


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poster:Rick thread:67661
URL: http://www.dr-bob.org/babble/20010618/msgs/67723.html