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Re: Questions to those who responded to Klonopin post. BRC

Posted by collegeguy on April 18, 2004, at 21:35:16

In reply to Questions to those who responded to Klonopin post., posted by BRC on April 18, 2004, at 18:27:57

1. How "potent" an antidepressant Remeron is is a matter of personal chemistry and the way the drug interacts with you. Just because someone else may find one chemical to be mild does not mean you will expreience the same effect. If you look at Remeron chemically, it is *more* potent than some of the other drugs, since it provides a boost of serotonin via two pathways: first, it blocks the reuptake of serotonin in the synapse like other SSRIs and second it also antagonizes (blocks the action of) the 5HT2A histamine receptor. It is because of this antihistamine effect that people on Remeron tend to experience more fatigue and weight gain. Remeron also blocks the reuptake of norepinephrine (like the SNRI Effexor and NDRI Wellbutrin), so it thus acts dually on the brain chemical systems. Good combo drugs with Remeron are Wellbutrin and Effexor (higher dose) because they help balance out norepinephrine and dopamine to negate some of Remeron's adverse side effects.

2. All benzodiazepines can cause "depression" (or rather, depression-like symptoms) if taken in doses too high because they "depress" activity of the nervous system. Xanax and Ativan are less likely to do this because they stay in the body for a shorter period of time compared to Valium and Klonopin. However, Klonopin is sort of a unique benzo drug in that it seems to have extra benefits aside from the normal anxiolytic action: people with anxiety disorders often find Klonopin is the most therapeutic of the benzo class and that it decreases anxiety without causing too much fatigue, etc--some even find it to be activiating, paridoxically.

3. Lexapro can be increased to more than 20 mg per day if your doctor feels a larger dosage of the medication is necessary. Initially clinical studies showed that a normal population received no significant increase in therapeutic effect with the 20 mg dose over the 10 mg dose, but everyone is different and you may need >> 20 mg per day of the drug. However, you should be especially watchful of side effects, as those are usually dose related, and perhaps even reevaluate the effectiveness of Lexapro as an antidepressant if you require such a high dose.

4. 4 mg daily of Klonopin is towards the high end of the normal dosage, but it is not uncommon (6 mg /day is probably the cut off before Klonopin dosing becomes greater than normal [multiply the highest dose Klonopin pills by 3 x per day]). Again, it is up to you and your doctor to determine whether you really need that much Klonopin (as the probability of a more difficult or longer withdrawal increases with dose). You should also be careful on long term benzo treatment to watch for any sort of dose dependence (i.e. the 4 mg/day dose starts to lose its effectiveness for you) that might necessate you going even higher.




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