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Dr. Bob is Robert Hsiung, MD,
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Posted by rutt on January 6, 2004, at 15:45:49
In reply to Re: Long Term Klonopin Usage » psychlover, posted by zeugma on January 5, 2004, at 2:51:08
> > I just read something about how people who are taking benzos (like Klonopin) for panic attack (like I am) don't try and make behavioral changes (I guess that means get specific therapy) to address their panic disorder and rely instead on the meds. I for one have been almost panic free on Klonopin, esp. before I lowered my dose, and I have not gone for therapy specifically to treat the panic.
> >
>
> When I was undergoing CBT I was experiencing numerous periods of increased anxiety, and CBT dogma (as expressed in David Burns's book "Feeling Good" (which my therapist asked me to buy after the first session)) says that benzodiazepines make it too easy for anxiety sufferers because they do not have to "face their fears" while on the meds. Burns instead touts SSRI's as a non-addicting adjunct to therapy that won't interfere with the CBT process.
>
> Well, whether SSRI's are "addicting" or not is a matter of terminology: I have seen people go through withdrawals on SSRI's that looked nasty, caused a lot of missed work, and were protracted over a period of months. AND they don't seem to work as well!
>
> The irony is that if I had Klonopin at the time the therapy itself would have been a lot more productive. Burns makes it sound in his book that people on benzos are like junkies living only for their next high, completely indifferent to whatever 'issues' they had previously as the next dose of drug fills their veins. I still need to work out my issues, and what is more I am actually more aware of them than ever, because I'm less likely to become anxious over trivial things. I think that people with severe anxiety need medication to get through the therapeutic process, and that people like Burns don't understand that severe anxiety is no more the product of a bad 'cognitive schema' than severe depression is.
>
>
> > Anyone else with the same experience?
>
> Hi zeugma,
I started my CBT therapy while on klonopin. I definately believe that the klonopin helped my therapy for panic attacks, and high anxiety in that I needed my panic to stop before I could effectively absorb CBT. I haven't really had any luck with ssri's. Many sources say that the best treatment for panic and anxiety are a combination of a benzo- and CBT. Once the CBT is absorbed, the benzo can be tapered. This is highly individual of course.
best wishes
>
Posted by psychlover on January 6, 2004, at 16:25:47
In reply to Re: Long Term Klonopin Usage, posted by rutt on January 6, 2004, at 15:45:49
To you folks who discussed the use of Klonopin during CBT therapy:
I am wondering if the CBT therapy actually made a difference for you. Were you able to get off your meds or reduce the dose at all? Did it have any effect on you at all?
Thanks!
Posted by ian24 on January 6, 2004, at 18:24:14
In reply to Re: Long Term Klonopin Usage, posted by Mr. Scott on January 5, 2004, at 22:37:02
Mr Scott and someone else have judged that their friens and Mother have terrible memory problems and that it is due to benzodiazapine use. How do you know it wasn't alcohol or an ssri or anything? You don't .
Posted by zeugma on January 6, 2004, at 18:25:48
In reply to Re: Long Term Klonopin Usage, posted by rutt on January 6, 2004, at 15:45:49
Hi rutt,
I intuitively felt that the strategy of using a benzo in conjunction with CBT would work well, but I could not get either my pdoc or my CBT therapist to see it that way. My anxiety skyrocketed during the therapy, to the point where I actually made a plan to hospitalize myself if my fears became so intense that i'd be tempted to kill myself just to be rid of them. And my pdoc was dismissive of my anxiety and told me the issues were merely 'psychological.' It still leaves a bitter taste in my mouth. I discontinued the CBT because it was not causing my anxiety to go down and I had to find another way to get on with my life. My pdoc relented and wrote me a script for Klonopin after my neuropsychologist called him advising a change of course.
It's still a little bitter for me. I got a letter from my CBT therapist a few days ago, where she expressed the opinion that i terminated therapy too soon. Not quite- i terminated therapy before i had the chance to see my life collapse from excess anxiety. She knew that I was taking Klonopin because I told her in our last conversation. It's obvious that i have serious social anxiety issues (she agreed with my diagnosis by the way) and a small amount of Klonopin (.25 mg/day) isn't going to make them all go away. What infuriated me was that the treatment wasn't coordinated properly, and I attribute this to misconceptions about the nature of anxiety on the part of both CBT therapists (at least certain ones) and psychiatrists (at least my psychiatrist, and many others too I suspect).
So now I'm feeling a lot better than when I was struggling through CBT therapy, but trying to muddle through on my own. Anxiety is my case has been pretty unremitting through my entire life (I'm in my middle thirties), more unremitting than depression in fact, because I can recall being anxious as a child, before I became depressed. Recent research suggests that this is typical of the most chronic depressions.
i don't know, after this experience, if I will ever go back to CBT. I have been in therapy of one form or another for virtually all my life, and on balance it has done FAR more harm than good. And that is a generous estimate.
z
Posted by Siraris on January 6, 2004, at 18:48:00
In reply to Did CBT help you overcome panic attacks?, posted by psychlover on January 6, 2004, at 16:25:47
I did 7 sessions of CBT, and it helped at the time, but I wasn't really experiencing that much panic. I had gone an entire year at college beforehand literally never feeling any sort of panic the entire year. I went to CBT to try and clear things up so I could get off my medication.
This winter is when my anxiety came back FULL force and really reared it's head. Unfortunatly I thought it would subside, and didn't call my CBT right away and when I finally did she is on medical leave until the 20th of Janruary.
I am hoping I don't have to call her though. I am going to look into and persue NLP and see how that works. I've heard it works really well (There was something on dateline about it the other day). Hypnosis is proven to work, and I think it could really help in my situation.
Posted by utopizen on January 6, 2004, at 21:04:53
In reply to Re: Long Term Klonopin Usage, posted by Mr. Scott on January 5, 2004, at 22:37:02
It seems so simple I don't know why I never thought of it before, I guess b/c Klonopin was just something I envied for like 2 years until I finally saw a doc that would prescribe it- but my p-doc suggested switching to Xanax or Valium for my social anxiety, given that the Klonopin's effects on my social anxiety only really lasted for a few months.
I have a very good memory, so I can't say Klonopin ever affected it at all... in fact, benzos will increase your IQ if you have a clinically signifigant degree of anxiety to begin with. I tried to explain this to my p-doc, but he gave me a funny look and thought I meant that Klonopin was some smart drug. But I browsed the American Textbook of Psychopharmacology, and it said the same thing I tried to explain to him. Anxiety itself can impair intelligence, memory, and generally make you ridiculious. Anyone who has an anxiety disorder knows this as common sense.
Posted by psychlover on January 6, 2004, at 21:26:41
In reply to Re: Long Term Klonopin Usage, posted by ian24 on January 6, 2004, at 18:24:14
Well, I know in my mom's case it has nothing to do with alcohol or drugs of any kind because she never used any of that. I am not sure it is the Klonopin which has caused her loss of mental agility, but it certainly seems that way. 56 is not exactly old age, and my dad (also 56) is still sharp as a tack, or whatever the expression is. I know from my own limited experience with K, however, that my speed of recall and my memory seem a lot worse than they used to be since I started using Klonopin a year ago. I was always razor sharp, and now I sometimes have difficulty coming up with the word I want or remembering something that happened to me not very long ago. And that is consistent with the literature on side effects of Klonopin.
Posted by Siraris on January 6, 2004, at 21:50:52
In reply to Re: Long Term Klonopin Usage » ian24, posted by psychlover on January 6, 2004, at 21:26:41
Psych - 56 is old. My Mom is the same way, and she is not on any medication. She works out 3 times a week, she's never sick, and she's very intelligent. I know I'm nobody you should trust, but trust me on this. I have consulted with a lot of people on this subject, and they all say that around that age, anxiety + klonopin + age = bad brain. Your mom is not your Dad as well, EVERYONE is different.
Read utopziens post.
Posted by Siraris on January 6, 2004, at 21:57:45
In reply to Re: Long Term Klonopin Usage, posted by utopizen on January 6, 2004, at 21:04:53
Utopzien - I don't know what you're referring to when you say it's so simple, but let me tell you, I want to give you an E-Hug for what you wrote. It is exactly what every single person with anxiety disorder who is on medication and questioning it needs to hear.
Anxiety and concentration can almost not be distinguished because they are so closely related. My problem with anxiety, is I concentrate on my body, and what I'm thinking (bad thoughts) and I get panic and anxiety. If I don't think the bad thoughts, if I don't concentrate on my body, I am fine. I have talked to many many people lately about my issues, and I have found that people without anxiety disorder, do not think the thoughts that we think, which is why they aren't anxious.
I have been searching these boards for weeks now looking for someone to say that Klonopin is bad, and causes memory problems, but from what everyone has been telling me (professionals) anxiety is the culpret behind my cognitive issues. Your post only reaffirms the latter.
I would like to hear more about whats going on with you. You say you are taking Klonopin, but have a great memory, so you are not being effected in any way cognitively? What did you find in the American Textbook of Psychopharmacology, and could you tell me where I could find the same information? I have access to quite a few books, and I'd like to look this up for myself.
If you want to, I'd like to talk to you more directly. You can email me at SirarisTMO at yahoo dot com if you want.
Thanks again for your great post.
Posted by psychlover on January 6, 2004, at 22:31:16
In reply to Re: Long Term Klonopin Usage, posted by Siraris on January 6, 2004, at 21:57:45
Siraris,
You are of course right that everyone is different. It's a good point.
Also, I am happy that you feel so relieved from reading Utopizen's post. It feels good to know that someone else has had the same experiences and feels the same way.
One more thing, I know exactly what you mean when you talk about thinking about being anxious causing the anxiety. Same thing happens here, or it does when I am not on enough meds (Klonopin and whatever else). But I always thought that was a sign of obsessive thinking (OCD without the C), which is what my pdoc said I have. What do you think about that?
All the best,
plover
Posted by psychlover on January 6, 2004, at 22:41:52
In reply to Did CBT help you overcome panic attacks?, posted by psychlover on January 6, 2004, at 16:25:47
Hey, what a coincidence!
This article about scanning the brains of people who underwent CBT for depression vs. those who took meds just came out today. It's very interesting. From the Boston Globe. Enjoy!
What do people think about this article? I think the findings are fascinating, but I see that the CBT proponents see this as proof that meds are unnecessary, which is definitely not the case for everyone.
All the best,
psychlover
Posted by Dr. Bob on January 6, 2004, at 23:36:15
In reply to Did CBT help you overcome panic attacks?, posted by psychlover on January 6, 2004, at 16:25:47
> I am wondering if the CBT therapy actually made a difference for you...
I'd like follow-ups regarding CBT to be redirected to Psycho-Babble Psychology. Here's a link:
http://www.dr-bob.org/babble/psycho/20040102/msgs/297458.html
Thanks,
Bob
Posted by Kon on January 6, 2004, at 23:45:56
In reply to Re: Long Term Klonopin Usage, posted by Mr. Scott on January 5, 2004, at 22:37:02
>in fact, benzos will increase your IQ if you have a clinically signifigant degree of anxiety to begin with.
When one is preoccupied by their anxiety, one has less ability to focus on a task but there is no evidence I've come across suggesting long-term benzo use will increase one's IQ. If you have any such studies, please post them. In fact, a number of studies suggest that long-term psychotropic drug use (including benzos)can cause cognitive problems even in anxious individuals; that is, anxious patients who aren't on medication score higher on cognitive/memory tests than anxious patients that have been on long-term psychotropic drug treatment (including benzos). Moreover, a number of studies suggest improvement in memory/cognition tests following withdrawl of benzos. See studies below.
--------------------------------------------------
Psychol Med. 1999 Mar;29(2):421-8.Anxiety, depression, psychotropic drug use and cognitive impairment.
Paterniti S, Dufouil C, Bisserbe JC, Alperovitch A.
Institut National de la Sante et de la Recherche Medicale, Unit 360, Paris, France.
BACKGROUND: Numerous studies have shown that anxiety and depression are related to cognitive impairment, but the concomitant association between anxious symptoms, depressive symptoms and cognitive function has not been investigated, and, most studies have not considered psychotropic drug use as a possible confounding factor. METHODS: We assessed the independent association between depression, anxiety, psychotropic drug use and cognitive performance in 457 men and 659 women, aged 59-71 years living in the community. Data on demographic background, occupation, medical history, drug use and personal habits were obtained using a standardized questionnaire. The Spielberger Inventory Trait and the Center for Epidemiologic Study-Depression (CES-D) scales were used to evaluate anxious and depressive symptomatology respectively. Cognitive assessment included six traditional tests covering the main areas of cognitive functioning. RESULTS: In men, anxious and depressive symptomatologies had independent significant associations with most cognitive abilities, independent of psychotropic drug use. In women, the association between anxiety or depression and cognitive functioning was less strong and disappeared after adjustment for psychotropic drug use. Psychotropic drug use was associated with lower cognitive scores in both sexes. In men with high CES-D scores, we found positive correlations between anxiety level and cognitive scores. CONCLUSIONS: The study showed that anxiety, depression and psychotropic drug use were significantly and independently associated with cognitive functioning in elderly men. The high prevalence of psychotropic drug use in women with or without psychological disorders may explain its major effect in women. Results suggested that anxiety may partly compensate for some negative effects of depression on cognitive functioning.
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Psychol Med. 1994 Feb;24(1):203-13.Lack of cognitive recovery following withdrawal from long-term benzodiazepine use.
Tata PR, Rollings J, Collins M, Pickering A, Jacobson RR.
Department of Psychology, St George's Hospital Medical School, University of London.
Twenty-one patients with significant long-term therapeutic benzodiazepine (BZ) use, who remained abstinent at 6 months follow-up after successfully completing a standardized inpatient BZ withdrawal regime, and 21 normal controls matched for age and IQ but not for anxiety, were repeatedly tested on a simple battery of routine psychometric tests of cognitive function, pre- and post-withdrawal and at 6 months follow-up. The results demonstrated significant impairment in patients in verbal learning and memory, psychomotor, visuo-motor and visuo-conceptual abilities, compared with controls, at all three time points. Despite practice effects, no evidence of immediate recovery of cognitive function following BZ withdrawal was found. Modest recovery of certain deficits emerged at 6 months follow-up in the BZ group, but this remained significantly below the equivalent control performance. The implications of persisting cognitive deficits after withdrawal from long-term BZ use are discussed.
Posted by psychlover on January 7, 2004, at 0:13:45
In reply to Re: Long Term Klonopin Usage, posted by Kon on January 6, 2004, at 23:45:56
Uh-oh. The second study you cited that showed that congnitive function did not improve after discontinuation from long-term benzo use, even after 6 months, is especially disconcerting. This is what I intuitively felt was the case, but I am rather disturbed that this study seemed to confirm that hypothesis.
Do you have any other studies that also concur with this finding (that discontinuation of benzos does not result in improvement of cognitive function to pre-treatment levels)? I would very much like to read them.
Thanks,
psychlover
Posted by Siraris on January 7, 2004, at 0:15:05
In reply to Re: Long Term Klonopin Usage, posted by Kon on January 6, 2004, at 23:45:56
*The study showed that anxiety, depression and psychotropic drug use were significantly and independently associated with cognitive functioning in elderly men.*
Elderly men... do you think that's even relevant to this situation? I am not elderly, I'm in my early 20's. When I am elderly, I expect to lose cognitive abilities because my brain is old. My Grandmother is 92 and is losing her cognitive abilities because she's ELDERLY. She takes no medication whatsoever and is not sick in any way.
Regarding both tests, what evidence do they have of the cognitive abilities of these patients before the testing.
In the second test, how do they know that the Benzo's were causing the cognitive ability loss and not the fact that they were anxious and depressed? It says nowhere that they were anxiety and depression free.
I mean granted here are two studies of people on Benzo's, but they don't seem to be very good if you ask me. If you show me a test where they found that 50 people had a 120 IQ before taking Benzos, and then started taking them and their IQ dropped to 110, then I'd say Benzos are the issue.
Posted by Siraris on January 7, 2004, at 0:17:45
In reply to Re: Uh-oh, that study is disturbing » Kon, posted by psychlover on January 7, 2004, at 0:13:45
From what I have heard from other people on this board, that when they are having issues with a medication, Benzos for example, and they get off them, they say their cognitive abilities came right back. Search on Dr-Bob for Klonopin + Memory.
My friend is Bi-polar and was on Paxil, and complained of being foggy and having memory problems, and she said as soon as she stopped taking the paxil she regained her abilities. She said the other issues were just related to her ADHD most likely. If you were to talk to her, you'd be pretty impressed with her incredible vocabulary, her ability to paint, her singing, and the fact that I watched her visualize her health insurance card and remember 4 letters off it right in front of me.
Posted by Ame Sans Vie on January 7, 2004, at 5:30:27
In reply to Re: Uh-oh, that study is disturbing, posted by Siraris on January 7, 2004, at 0:17:45
I have to concur with Siraris' friend about Paxil -- my mental function was horribly impaired each of the three times some doctor forced it on me. Same goes for Luvox. I can remember this effect extremely vividly as it was just prior to my two-year agoraphobic shut-in that I last took Paxil, and I was attempting to take classes at the university at the time. Bad idea!
As for Klonopin, it's just over three years that I've been taking it on a pretty regular basis, at doses ranging from 4-20mg per day. Currently I take 8mg daily, which surprisingly does not cause even slight mental dysfunction, but I wonder if that could have anything to do with the 60mg Adderall XR I take every morning?
Posted by Kon on January 7, 2004, at 18:56:58
In reply to Re: Long Term Klonopin Usage, posted by Siraris on January 7, 2004, at 0:15:05
> Elderly men... do you think that's even relevant to this situation? I am not elderly, I'm in my early 20's. When I am elderly, I expect to lose cognitive abilities because my brain is old.
Yes, as you get older your cognitive abilities decrease but the study suggests that your cognitive abilities may decrease to a greater degree if you take such drugs long-term than if you don't. There are even a number of studies that suggest some increase incidence of dementia in long-term benzo users when compared to non-users.> Regarding both tests, what evidence do they have of the cognitive abilities of these patients before the testing.
Does it really matter? If performance on the cognitive/memory tests improves following withdrawl of the drug, doesn't that suggest the drug plays some role in the lower scores seen prior to withdrawl? What other explanation can you offer given that a control group did not show performance improvement?
> In the second test, how do they know that the Benzo's were causing the cognitive ability loss and not the fact that they were anxious and depressed? It says nowhere that they were anxiety and depression free.
But the test scores improved following withdrawl of benzos. If what you are saying is true, withdrawl of benzos and return of anxiety/depression should have resulted in decreased scores/performance. In fact, subjects improved their scores.
>If you show me a test where they found that 50 people had a 120 IQ before taking Benzos, and then started taking them and their IQ dropped to 110, then I'd say Benzos are the issue.Studies do suggest some cognitive/memory deficits following medication with benzos. In fact, benzos are used before operations for this purpose. But it has always been argued that such deficits are short-term simply because one hasn't adapted to the benzo or is due to the initial sedating effect of benzos (which goes away after a couple of weeks). The problem with this argument is that it can't explain the long-term decrement that occurs in long-term benzo users or their improvement in scores following withdrawl of benzo.
>Do you have any other studies that also concur with this finding (that discontinuation of benzos does not result in improvement of cognitive function to pre-treatment levels)? I would very much like to read them.Most show gradual improvement. The longest one I've come across was a follow-up at 3.5 years. After this longer time period, it does show that cognitive function was similar to control group. The studies suggest that the risk increases with longer duration of use and higher doses. Despite these risks, I still take clonazepam as-needed at a dose of < 2.0 mg because I still feel that benzos are safer choice for my anxiety than the alternatives.
Posted by Siraris on January 7, 2004, at 19:19:54
In reply to Re: Long Term Klonopin Usage, posted by Kon on January 7, 2004, at 18:56:58
I see you posting all these studies, could you post a link from where you are getting these? I'd like to see the website.
Posted by Kon on January 7, 2004, at 21:02:55
In reply to Re: Long Term Klonopin Usage, posted by Siraris on January 7, 2004, at 19:19:54
> I see you posting all these studies, could you post a link from where you are getting these? I'd like to see the website.
Pub MEDLINE-For this topic just type "benzodiazepines memory" or "benzodiazepines cognitive" or "clonazepam memory", etc. It lists the abstracts of pretty well every study conducted in medicine and related health fields since the 1950s.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed
Posted by scott-d-o on January 7, 2004, at 22:28:48
In reply to Re: Long Term Klonopin Usage, posted by Kon on January 7, 2004, at 18:56:58
I'm not sure I understand the debate in this thread. If anything, Klonopin *protects* neurons from damaging excitatory neurotoxins like glutamate by potentiating GABA transmission. Any memory dysfunctions resulting from it's usage should cease upon withdrawal. If anything, the patient's brain cells will be in better condition after treatment than if they had never started it in the first place. This is, of course, assuming a *slow taper* off the medication.
Besides, if a patient is experiencing this side effect, their dosage is most likely too high. The patient needs to start tapering off until they can function normally. If the patient cannot find anxiety relief from benzodiazepines without experiencing memory dysfunction they should seek other types of medication (anti-psychotics maybe?), or cognitive behavorial therapy may also be helpful in the long-term.
scott
Posted by nobodyz on January 7, 2004, at 22:29:32
In reply to in the news: brain scans of CBT vs. meds patients, posted by psychlover on January 6, 2004, at 22:41:52
> Hey, what a coincidence!
>
> This article about scanning the brains of people who underwent CBT for depression vs. those who took meds just came out today. It's very interesting. From the Boston Globe. Enjoy!
>
> http://www.boston.com/news/nation/articles/2004/01/06/brain_mapping_may_guide_treatment_for_depression/
>
> What do people think about this article? I think the findings are fascinating, but I see that the CBT proponents see this as proof that meds are unnecessary, which is definitely not the case for everyone.
>
> All the best,
> psychlover
The above article is regarding depression and anti-depressants, not Klonopin and anxiety. Two totally different situations. :)
Posted by Siraris on January 7, 2004, at 23:34:01
In reply to Klonopin provides protection from neurotoxins, posted by scott-d-o on January 7, 2004, at 22:28:48
Scott -
thats the most interesting thing I've heard so far. I am going to bring this up to my pdoc as he would know more then I would about what you said.
I was just wondering where you got this information. I have been debating lately if my memory issues are related to anxiety or the medication I'm taking. I really would like to get rid of my meds, and I am taking more of an active approach to getting rid of my anxiety (IE CBT and persuing NLP as well). I think I can get my anxiety under control without the medication.
Will I get my memory and cognitive abilities back if I get off the Klonopin? What about Paxil, would you say that could be damaging to memory as well? I've never heard an analysis like this before.
Posted by scott-d-o on January 7, 2004, at 23:46:45
In reply to Re: Klonopin provides protection from neurotoxins, posted by Siraris on January 7, 2004, at 23:34:01
> Scott -
>
> thats the most interesting thing I've heard so far. I am going to bring this up to my pdoc as he would know more then I would about what you said.
>
> I was just wondering where you got this information. I have been debating lately if my memory issues are related to anxiety or the medication I'm taking. I really would like to get rid of my meds, and I am taking more of an active approach to getting rid of my anxiety (IE CBT and persuing NLP as well). I think I can get my anxiety under control without the medication.
>
> Will I get my memory and cognitive abilities back if I get off the Klonopin? What about Paxil, would you say that could be damaging to memory as well? I've never heard an analysis like this before.Hi Siraris,
Check this link out, hopefully it will answer your questions since it explains Klonopin's neuroprotective properties in layman's terms:
http://www.immunesupport.com/library/showarticle.cfm/id/3154/searchtext/klonopin/
Also check this one out if you would like to learn more about excitatory neurotoxins and the antioxidants which help prevent them from causing damage. Be aware though, it's quite lengthy.
http://www.offshorepharmacy.net/ias-excitotoxins.htm
Hope this helps,
scott
Posted by Siraris on January 8, 2004, at 0:00:12
In reply to Re: Klonopin provides protection from neurotoxins » Siraris, posted by scott-d-o on January 7, 2004, at 23:46:45
Thanks so much scott for your quick reply. I was wondering if you could just tell me, if I get off the meds will my memory come back? Also what could paxil play into my equation. I am on 1 mg of klonopin and 10 mg of paxil.
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