Posted by mattdds on August 29, 2003, at 10:17:31
In reply to Re: Klonopin for Parnate Insomnia » mattdds, posted by Budgie on August 29, 2003, at 0:32:28
Hi Budgie,
>>Thanks so much for the feedback; I'll talk about all of that with my doc when I see him next week.
No problem, hope some of it helps.
I'm about 2.5 weeks into the Parnate trial, the first week of which was only 20 mg. I just got to 40mg yesterday. I really want to see what this stuff can do, and may go up to 60 mg eventually. My doc was afraid to go any higher than 20 because of my extremely bad luck with other AD's (SSRI's, TCA's). So, far, other than the small amount of orthostatic hypotension, I don't really have any SE's. Amazing, this drug is so easy to take, and the diet is not too big a deal.
>>Do I understand correctly that you were on Klonopin first, before the Parnate?
Yes, I was on Klonopin first, and I have primarily anxiety problems (Panic Disorder, SA, GAD).
>>If that were the case, have you noticed an increase in energy from the P?
Oh yeah! You see, at first I was really worried about the Parnate being too activating. But to my surprise, The "stimulating" effects from Parnate, for me, have been extremely pleasant and tolerable. The only downside has been sort of a "crash" at about midday, when I feel sleepy for about an hour. This is not necessarily bad. I could never take naps before, now I am loving them. It's a really pleasant, soothing sleep!
>>I've never tried one before, but my SA is a problem that just won't go away. It's not intolerable- I encounter maybe 1-2 brief situations a day where it rears its ugly head. But sometimes those small encounters are enough to drain and deflate me for the rest of the day. So I'd like (ideally of course) to find something that doesn't make me too tired or blunt during the day, but just gives me a tiny bit of mellowness when I need it. Which is why I was wondering if just using it at night to combat the insomnia might have some residual benefits the next day?
I can relate to the "draining" social encounters. Klonopin is a very poor sedative, but a very potent anxiolytic. This is of course after a short period of becoming accustomed to the drug. You may have some initial startup effects like drowsiness, but that only lasts a week or so. In your case, perhaps *daytime* Klonopin in low-dose would give you *more* energy, because for me it reduces anxious fatigue, from events similar to what you describe (stressful social situations). So if you reduce the anxiety, you may have more energy. But, like I say, it's a poor sedative after a week, so not good for sleep long term.
So go with the Ambien for insomnia. IMHO, the efficacy and SE profile of Ambien are absolutely amazing! Gets you to sleep, with absolutely no trace of a hangover, and there is zero withdrawal (at least for me). I've taken it for months straight, and stopped cold turkey before. I had maybe 1 mildly rough night, but this was probably just a return of my poor sleeping habits.
Klonopin is different, you will need a slow taper to discontinue, like you would with Paxil or Effexor.
Other than the soothing antianxiety effect of Klonopin, I have absolutely *no* sedation (or any other SE's for that matter).
>>Also, having a few problems *ahem* in bed. The libido's kind of low, and the blood isn't quite flowing to my dude like usual. Low blood pressure?
Really? Parnate is supposed to be much better in that regard. But everyone is different. Have you noticed anorgasmia? Delayed orgasm? On SSRI's I thought I would have a stroke before....well, finishing. Not so on Parnate. I even feel *more* of an interest in sex now, whereas the SSRI's zombified me!
But I think you're talking about "getting up". Right? This could very likely be related to the low blood pressure, IMO.
I have noticed that my diastolic runs low - around 65-70, and my systolic hasn't changed much, around 120-125.
I've heard that the BP side effects resolve themselves later into it, especially if the dose is low. So perhaps the "bed" problems will resolve for you too, I hope.
>>Finally, what are your symptoms, and what other treatments have you tried/ are trying? I just started some CBT work for the SA, on the recommendation from some others on the board here, but I'm probably not taking it seriously enough yet.
I have primarily Panic Disorder, and get attacks in social situations. This leads to GAD and depressive episodes.
I would *strongly* encourage CBT. CBT resolved 80% of my social anxiety, especially all the anticipatory anxiety, and the Klonopin killed the rest of it. CBT is very synergistic with meds, for me too. Think of it this way, there are NO side effects to CBT, and you have absolutely nothing to lose from trying, so work hard with your therapist! It WILL pay off!
I still have some residual depersonalization / derealization from all the previous panic attacks (even though panic is totally controlled), but the Parnate seems to be mopping that up pretty nicely. It really sharpens your thinking, in my (short) experience.
I'm pretty excited about Parnate, it is by far the most tolerable AD I've ever taken. I do admit I'm starting to feel more confident and positive lately. This coming from a big sceptic about AD efficacy. I think Parnate has some "other" effects, like sharpened thinking, and frankly, euphoric effects.
One last thing. I kinda wanted to try Nardil, initially, with all the people on this board liking it so much for it's antianxiety effects. So at first I was kind of bummed that my pdoc wrote out for Parnate. Now, I'm glad I got Parnate. I figure with the Parnate-plus-Klonopin, I get the best of both worlds; fewer sexual and weight gain side effects and (from what I gather) side effects in general. Plus, the mild motivating, and sharpening effects it seems to have. CBT and Klonopin take care of any residual anxiety / tension. Ambien for sleep rules.
Best of luck, and keep me informed! I'm going to see how long I can go without pizza on this stuff!
Take care,
Matt
P.s. I don't know what makes me so incapable of writing a short post on the internet, sorry!
poster:mattdds
thread:254616
URL: http://www.dr-bob.org/babble/20030828/msgs/255292.html