Posted by chad_3 on September 21, 2002, at 4:56:51
In reply to Re: Paxil - Remeron - Clonazepam Social Anxiety » k23d, posted by Rick on September 20, 2002, at 10:33:28
Rick -
Just wanted to say "Hi". : )
I agree with you on Klonopin being the single most effective anti-SP med purely working on SP.
My stance does differ a bit from you though on the idea that most people will do well on 1-1.5 mg/day taken alone. I think comorbidity in SP is the rule not the exception esepcially dysthymia, mild or mildly recurring depression, low energy, and apparently not uncommon is ADD, panic, depression. Usually I think is something in there limiting Klonopin alone.
I do also think you are a in fact as you say a pretty "pure SP" candidate - just as those in the Davidson studies. I think that Klonopin has a slighty androgenic effect and it tends to be preferred by males as a result - with Xanax anti-androgenic slightly and tending to be prefered by females. Long term use of Klonopin is in real world probably usually accompanied by an antidepressant of other similar agent - when used for SP, I think.
And in your case - I think you are simply a fantastic responder in low dose monotherapy to Klonopin - but are the exception not the norm.
That aside - I agree so much with you on most of your posts that I simply don't contribute. Keep healthy.
And Rick - I understand your career has gone better and better in past years - are you also married I thought you said that once ...
Those are impressive stats for significant generalized SP - and you are a success story. And I do back you 100% on the safety and efficacy of Klonopin - with a few differences and a special regard for Nardil for many who I feel have more symptoms than are treatable by Klonopin alone.
Oh - BTW - I think your SSRI views - especially I noticed now on Paxil - yes I agree. These SSRI's are not particuarly effective for social phobia IMO...
Stay well - stay healthy! I'm going to Vegas!!!
Chad
http://www.socialfear.com/> My experience mirrors anxiousgrrl's. Except for some possibe memory lapses, Klonopin has been nothing but a BIG success for my social phobia. Overall, I've had at least a 75-80% improvement over my pre-Klonopin days (why didn't I discover it sooner??!!) I have no side effects except good ones. (E.g., the longtime chronic low-level facial pain that I thought might be TMJ unexpectedly disappeared after I started Klonopin. It took me awhile to make the connection. I later found a study verifying this effect.)
>
> Nothing -- not even Nardil, and certainly not Paxil -- has shown higher response rate vs double-blind placebo in social phobia than clonazepam.
>
> If you're not depressed, don't bother with an AD and the side effects + poop-out. I've experimented with adding other agents to Klonopin (instead of the other way around), and some have indeed added a nice dimension (esp. Klonopin + Serzone + low-dose Provigil), but Klonopin is always the key. It MUST be taken regularly for the best benefit. And realize that a lower dose can often work *a lot* better than more. I started at 3 mg/day three+ years ago, and have gradually tapered to 1 mg, all first thing in the morning. (I used to taked divided doses. Don't take it at bedtime. Taking it in the morning will still alleviate evening insomnia without possible morning grogginess, and it will be at highest levels in your bloodstream when you need it most for social interaction.) That's all I've needed for the last eighteen months. My pdoc also said that I won't have trouble should I ever decide to taper off, as long as I stick to 3mg/day or less.
>
> BYTW, there is evidence that Klonopin *can* have some lasting benefits, as detailed in the attached abstract.
>
> Pursue this.
>
> Rick
>
> From: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9790154&dopt=Abstract
>
> J Clin Psychopharmacol 1998 Oct;18(5):373-8
>
>
> Discontinuation of clonazepam in the treatment of social phobia.
>
> Connor KM, Davidson JR, Potts NL, Tupler LA, Miner CM, Malik ML, Book SW, Colket JT, Ferrell F.
>
> Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina 27710, USA.
>
> Patients with social phobia who responded well to 6 months of open-label treatment with clonazepam were assigned to receive either continuation treatment (CT) with clonazepam for another 5 months, or to undergo discontinuation treatment (DT) using a clonazepam taper at the rate of 0.25 mg every 2 weeks, with double-blind placebo substitution. Clinical efficacy was compared between the CT and DT groups using three different social phobia scales. Benzodiazepine withdrawal symptoms were also measured. Relapse rates were 0 and 21.1% in the CT and DT groups, respectively. Subjects in the CT group generally showed a more favorable clinical response at midpoint and/or endpoint, although even in the DT group clinical response remained good. With respect to withdrawal symptoms, the rates were low in both groups (12.5% for CT and 27.7% for DT) with no real evidence suggesting significant withdrawal difficulties. At the end of 11 months of treatment with clonazepam, however, a more rapid withdrawal rate was associated with greater distress. This study offers preliminary evidence to suggest that continuation therapy with clonazepam in the treatment of social phobia is safe and effective, producing a somewhat greater clinical benefit than a slow-taper discontinuation regime. However, even in the DT group, withdrawal symptoms were not found to be a major problem. The study can be taken as supportive of benefit for longterm clonazepam treatment in social phobia, as well as being compatible with a reasonably good outcome after short-term treatment and slow taper.
>
> Publication Types:
> Clinical Trial
> Randomized Controlled Trial
>
> PMID: 9790154 [PubMed - indexed for MEDLINE]
>
poster:chad_3
thread:120479
URL: http://www.dr-bob.org/babble/20020914/msgs/120596.html