Posted by Rick on September 3, 2001, at 4:18:29
In reply to Dopamine and SP: a bit more, posted by kregpark@yahoo.com on September 3, 2001, at 3:00:15
Lots of interesting observations in your two posts on dopamine and social phobia/meds!
There IS one area where my viewpoint differs strongly from yours. Ironically, the disagreement stems from something we *agree* on, namely that Klonopin is very effective for Social Phobia. Before going on, please understand that I'm not actually disagreeing with *you* per se, but with something you briefly praised in a post earlier in this thread. (OK, I'm probably confusing you and any other readers thus far ...just read on and you'll understand.)
The disagreement surrounds your thanking Dr. Bob for including the Brazilian study on Klonopin in Social Phobia on his site. In my view, the fact that this article remains here is perhaps my major "beef" with Dr. Bob's site, for a number of reasons.
First of all, the article is becoming dated. Nothing wrong with that in and of itself, but it seems as if the "Social Phobia" link is just languishing there with no real attention given to it. It's basically an anecdotal report, not a rigorous study of any kind, when in fact several excellent and even pivotal studies on Klonopin for SP -- some of them placebo-controlled -- do exist. Heck, the Brazilian write-up even ends by saying their approach is under review! So, what did the review conclude??
Secondly, it does a disservice by dwelling on supposed Klonopin-driven disinhibtion episodes that I'm sure are not very typical. Some uninformed people who take that article at face value will probably stay away from Klonopin because they fear a personality change that will turn them into gun-toting gangsters like that one social phobic-turned-thug the authors cite.
Worst of all is the article's claiming 3-6 mg/day as the typical effective dosage range for Klonopin in Social Phobia. Frankly, I find it bordering on irresponsible to leave an article on the site that cites a MUCH higher than typical range as "average". Certainly , there are more than a few people who do better on a higher dose (I believe you said you take about 4 mg yourself -- which is still a lot less than 6), but any cursory review of posts on this board or others, or discussions with medical professionals, will tell you that most people do best on 3mg or less, and that a great many do just fine on 1 mg/day or less. And yes, I realize that body weight can make a difference, and that perhaps Brazilian clonazepam is less potent as a poster once suggested (although I tend to doubt that's the case).
I myself quickly ramped to 3 mg/day based on Dr. Davidson's 1994 placebo-controlled study of Klonopin, and fortunately discovered that I actually did a lot better-- and with virtually no sedation -- on 1.75-2.00. (Dr. Davidson's follow-ups showed that people tended to reduce their doses after awhile -- quite contrary to the popular "tolerance" beliefs -- and my own personal experience over two years mirrors that finding).
I wonder how many people ended up latching onto that article and ended up either unnecessarily over-medicating themselves or, worse yet, rejecting the very med (Klonopin) that could have helped them so much, simply because they felt doped up on a "typical dose" recommended by the authors. (Interestingly, Roche, maker of Klonopin, says that going from 2mg/day to 3mg does not generally confer additional benefit in Panic Disorder, one of Klonopin's two FDA-approved indications.)
I guess the fact that the article may have led some Social Phobics to that wonderfully-helpful med is a good thing, but I wish it could be done in a more enlightened fashion.
In summary, *some* people do need the 3-6 mg rangeof daily Klonopin given in the article, but citing a "low-end" dose that's too HIGH for *most* Social Phobics is doing a disservice!
I've posted about this several times over the last few years, and I'm dismayed to see that the "Social Phobia" link on this site still leads to that misleading and almost sensationalistic article. Better to remove the SP link altogether.
OK, I'm off my soapbox now.
Rick
poster:Rick
thread:36517
URL: http://www.dr-bob.org/babble/20010902/msgs/77506.html