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Re: klonopin 0.5 Elizabeth

Posted by Cam W. on December 14, 2001, at 17:26:35

In reply to Re: klonopin 0.5 Cam W., posted by Elizabeth on December 14, 2001, at 13:16:17


> What about nordiazepam, BTW?

Sorry, I don't know this one, off the top of my head. Is it a metabolite of diazepam? I do know that "nor-" means "desmethyl-", which would be diazepam that is lacking a methyl group, making it more water soluble; and thus, easier to excrete. I do not know of any marketed product of nordiazepam, nor do I know anything of it's kinetics.

> > Chlorazepate is wonderful for those with schizophrenia who have daytime anxiety problems, when nothing else works.
> That's the one I think I'd want to try if I were going to take benzos around-the-clock. (Why schizophrenia in particular, out of curiosity?)
Short answer: cause it worked before.
I think that I see it used a lot in schizophrenia, but this may just be a quirk of the couple of psychiatrists, in my area, who use it. For example, I asked why it was used in someone with very severe PTSD and schizophrenia who is taking 900mg of Clozaril a day. This person (Q), is a refugee from a wartorn country (losing side), and maintains own apartment, has our social welfare system figured out, and "sends" money home (from a meager long term disabilities cheque). The doc told me Q's story, and said that 15mg of Tranxene in the morning relieved all of Q's PTSD symptoms (those that weren't controlled by the Clozaril). I had seen Q floridly psychotic, complete with persecutory delusions and audiovisual hallucinations. I saw Q two months later (after starting Clozaril and Tranxene) and the change was incredibly remarkable. I here that Q may be getting a paying job, but unfortunately the prescriptions medications cost approx. $3000.00/month, so Q cannot make too much money or will lose drug coverage < sigh >. Anyway, the doc told me that he gave Q Tranxene, because it had worked in a similar case that he treated, but it hadn't worked as well as it did for Q. It is nice to have a success story every now and then.

> But isn't Valium pretty short-acting (despite its long half-life and those of its active metabolites)?
In the short term, maybe Valium seems to be short-acting, but once steady state is reached (approx. 7 days), a constant blood level and antianxiety effects and muscle relaxing effects seem to be maintained. The problem with Valium is that it may cause motor side effects at the initiation of therapy that disappear fairly quickly. Many people, especially in the 1960s equated the motor side effects, with therapeutic effect. When the motor stuff disappeared, they assumed the anti-anxiety stuff was returning, thus took more Valium until they were wobbly again....leading to addiction problems and then media hype, blah, blah, blah.

> By "psychological" you mean nonspecific/related to expectation effects, right? (Isn't anxiety in general "psychological?")
Many would say that anxiety is psychological, but the more I learn about brain process and neural interconnections; the more I realize that there is no magic in the world. Nature does everything as simply as possible. As for anxiety, there are a number of routing problems (perhaps mainly in the neural circuits between the locus ceruleus and raphe nuclei). Therefore anxiety may have started as a psychological reaction to an event, but the brain has taken that "anxious" thought and translated it into an electrical signal, using neurons primarily of the serotonergic kind. This anxious thought was filtered through the thalamus to the frontalcortex and hypothalamus (and amygdala), with ongoing modifications via online processing in the hippocampus formation and it's connections, including information updates to the cerebellum and back, (with or without basal gangliar input). The anxious thought is not resolved and is stored in a layer (layer 3?, 5?) of the prefrontal cortex.

In other words, I tend to look at psychologial reactions as biochemical influences on the electrical conduction along neurons. In the case of 0.125mg of clonazepam, if the effect is psychological, very similar (but probably not "exactly" the same) neural pathways and brain structures are active, as if the clonazepam dose were actually effective (ie you would see an enhancement of GABAergic-neuronal activity, resulting in decreases in electrical activity of the above anxiety circuits (and others).

> > You would never guess that mania almost destroyed this person's life.
> I hope that one day someone will say something like that about me (substitute "depression" for "mania").

Me too, Elizabeth, me too. (Hey, I you've accomplished a lot for someone "dealt such a shitty hand". You truly know the meaning of hard work and perseverence. I'd like to work with you on producing a non-fictional tome, the ultimate look at mental illness from the inside...a Kay Jamison-like book, but on depression...and better written).

- Cam (investigator extrordinaire)




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