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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 20 of 20. This is the beginning of the thread.
Posted by cherylann on May 14, 2004, at 10:01:46
I have moderate/severe depression accompanied by anxiety/panic attacks. The only AD's that work for me are the sedating (remeron, doxepin etc). Since they also make my butt the size of Texas, I decided to stop the remeron I was taking. Probably not very smart.
Now, I'm just taking 1 mg of klonopin at night to sleep. It's taken away most of the anxiety, but is also having an AD effect. Not the full effect I'd like, as I am slowly pulling away from friends and committments again, but it's there none the less.
I guess my question is could this mean I've got some underlying physical condition? I've had my thyroid checked and it was normal.
I'm just curious why klonopin would have this effect.
Posted by MGOLDW on May 14, 2004, at 10:29:00
In reply to Why is klonopin acting like an AD?!, posted by cherylann on May 14, 2004, at 10:01:46
Klonopin (Clonazepam) is not an AD. Klonopin is a "benzo", a minor tranquilizer that works great in relieving anxiety. As all Benzodiazepines, it has an antidepressant effect BUT it is NOT recommended for depression related anxiety. This is because one of the SE of benzos is depression. Not to mention dependance and adiction. In my opinion, benzos should only be taken as needed to controlo anxiety attacks while the full effect of an AD is reached. Talk to your doctor, maybe a different SSRI would work for you. Good luck.
Posted by linkadge on May 14, 2004, at 10:48:50
In reply to Re: Why is klonopin acting like an AD?!, posted by MGOLDW on May 14, 2004, at 10:29:00
Klonazepam also has an atypical effect of causing
an increase in serotonin transmission.Linkadge
Posted by finelinebob on May 14, 2004, at 13:58:37
In reply to Why is klonopin acting like an AD?!, posted by cherylann on May 14, 2004, at 10:01:46
The ultimate answer/evasion: your mileage may vary.
Could it be that in relieving the anxiety that you feel, klonopin is taking away stresses that make you feel depressed? Particularly in the case of going off an AD that perhaps wasn't doing you any good ... may have actually been making you feel worse?
You didn't say how long you've been off your AD. If this is all something that has happened over a relatively short period of time, you might be experiencing some readjusting of your body to the lack of those meds. Don't mean to "rain" on you here -- I just want to point out that over the short term you might be experiencing a "bounce" that may not have any long-term traction. If it doesn't, then don't attribute too much to what took you up **or** down.
What other ADs have you tried, cherylann?
flb
Posted by sdb on May 14, 2004, at 16:12:09
In reply to Hold on, posted by linkadge on May 14, 2004, at 10:48:50
Where did you read, Klonopin would increase serotonergic transmission? Is there an abstract?
Posted by rod on May 14, 2004, at 16:38:04
In reply to Why is klonopin acting like an AD?!, posted by cherylann on May 14, 2004, at 10:01:46
The only thing I know about klonopin which could explain this is: klonopin is an effective treatment of "neuroleptic malignant syndrome". I dont know how, but it seem to have dopamine stimulating activity, indirectly i guess.
And YES, it also has a mild AD effect for me.
And Xanax makes me worse, which is claimed to have an AD effect. hmm, not for me!Roland
Posted by linkadge on May 14, 2004, at 17:11:55
In reply to Re: Why is klonopin acting like an AD?!, posted by rod on May 14, 2004, at 16:38:04
Look up clonazepam on this site:
http://sl.schofield3.home.att.net/medicine/psychiatric_drugs_chart.htmlLinkadge
Posted by patricia leahy on May 14, 2004, at 22:16:42
In reply to Hold on, posted by linkadge on May 14, 2004, at 10:48:50
>sorry to be so dense on this subject but i take klonopin for just panic attacks, what do you mean by "atypical effect of causing an increase in serotonin transmission" enlighten me PLEASE, need someone who knows these things. thanks ahead of time
Klonazepam also has an atypical effect of causing
> an increase in serotonin transmission.
>
> Linkadge
Posted by patricia leahy on May 14, 2004, at 22:25:44
In reply to Why is klonopin acting like an AD?!, posted by cherylann on May 14, 2004, at 10:01:46
>i only have GAD, only, anyway pdoc just recently increased my dosage from .5mg a day to one and a half a day. my question last month when i first started was has anyone on this ever had increased sex drive? no one dared to venture answering that one, lol. but since being on klonopin i feel like my old self almost still working on it.
I have moderate/severe depression accompanied by anxiety/panic attacks. The only AD's that work for me are the sedating (remeron, doxepin etc). Since they also make my butt the size of Texas, I decided to stop the remeron I was taking. Probably not very smart.
> Now, I'm just taking 1 mg of klonopin at night to sleep. It's taken away most of the anxiety, but is also having an AD effect. Not the full effect I'd like, as I am slowly pulling away from friends and committments again, but it's there none the less.
> I guess my question is could this mean I've got some underlying physical condition? I've had my thyroid checked and it was normal.
> I'm just curious why klonopin would have this effect.
Posted by Viridis on May 15, 2004, at 1:46:52
In reply to Why is klonopin acting like an AD?!, posted by cherylann on May 14, 2004, at 10:01:46
Severe anxiety definitely can cause depression. Klonopin is extremely effective at relieving anxiety. So, it's hardly a stretch to see how Klonopin can act as an AD. It's certainly the most effective AD (and anti-anxiety med) I've ever tried. My psychiatrist agrees that benzos can be wonderful ADs for some people (in others, they intensify depression -- it seems to depend partly on whether the depression is caused by anxiety, or vice-versa).
I've tried a wide range of so-called ADs (various SSRIs, Wellbutrin, etc.) for extended periods at various dosages and simply could not tolerate any, nor did they help much with depression. Yet others respond very well to them. I've had the best AD effects by combining Klonopin, Adderall, and Lamictal. But Xanax, and then Klonopin, were the first meds that actually shut down the spiraling depression that used to plague me at least several times a year.
And yes, Klonopin can affect serotonin levels and transmission. There was a thread about this a few months ago that cited peer-reviewed scientific papers, although I haven't looked it up lately.
Posted by cherylann on May 15, 2004, at 10:03:51
In reply to Re: Why is klonopin acting like an AD?! » cherylann, posted by finelinebob on May 14, 2004, at 13:58:37
I've been off remeron for about 2 months now.
I've tried so many different AD's, prozac, paxil, zoloft, celexa, wellbutrin, effexor, doxepin, and remeron. The only ones that seem to work are the sedating ones. I've had good success with remeron/fish oil, but the weight gain got to me.
Then I read this evil book called Depression is a Choice and I got the idea that I didn't need meds anymore. Now, I'm just kidding about the evil part. I'm sure it's helped a lot of people.
My doc is at the end of his rope as far as meds go. He even suggested sam-e, which I tried for 2 weeks and made me more depressed. His last suggestion was lamictal, which scares me, as I've heard weird things about it and it seems to be stimulating, which I don't do well with.
Sorry for rambling, but thankyou for your post
Posted by finelinebob on May 15, 2004, at 10:28:47
In reply to Re: Why is klonopin acting like an AD?! » finelinebob, posted by cherylann on May 15, 2004, at 10:03:51
Have you tried any other TCAs like nortriptyline, desipramine or imipramine? There was a thread a couple of weeks back that might be helpful to read: http://www.dr-bob.org/babble/20040510/msgs/345436.html . From what I gathered on that, doxepin is much more sedating than other TCAs. And wellbutrin and effexor may both affect norepinephrine, but they also work on seratonin and dopamine, too. Almost all the rest in the list you noted are SSRIs. There are a lot of people on this board who see good results from either TCAs or MAOIs.
hth,
flb
Posted by linkadge on May 15, 2004, at 14:46:16
In reply to Re: Why is klonopin acting like an AD?! » cherylann, posted by finelinebob on May 15, 2004, at 10:28:47
Thats the biggest crock I have ever heard.
Consider the simplest case. Say that you are dangerously low on vitamine B6. You are going to
be in a state of clinical depression and all the will you have is not going to help one bit.For one reason or another we are depressed - we try desparetly to find the source but when we can't find it we turn to meds. You could spend your whole life choosing to be well and never get there.
Linkadge
Posted by University on May 15, 2004, at 23:49:11
In reply to Why is klonopin acting like an AD?!, posted by cherylann on May 14, 2004, at 10:01:46
Contrary to what others have said, clonazepam, IME, is EXCELLENT for anxiety-exacerbated depression. In fact, for me, 1mg--or even as little as .25mg of Klonopin has literally SAVED me from spiralling back into depression. That is, whilst my depression has been relieved and controlled by Prozac for many years now (touch wood), sometimes I get the occasional anxiety attack--that existential, free-floating anxiety that , IME, portends major depression unless it is stopped in its tracks. Klonopin brings such anxiety to its knees, and has thus thwarted many potential "breakthrough" depressions for me, I believe. I have taken it for over five years now--usually about 2mg per month for such anxiety instances. I find sublingual admin. to be best. I also find the brand Klonopin superier to the generics. So please don't be scared away from clonazepam because of benzo alarmists claiming addiction, etc. It's well known that those who find significant relief from neurotic anxiety from benzos like Klon. don't become tolerant or "addicted" per se. Indeed, I find that just knowing that I can quell anxiety in a few minutes with .5 mg clonopin usually is sufficient alone to stop my anxiety.
Posted by chemist on May 16, 2004, at 11:39:08
In reply to Re: Why is klonopin acting like an AD?! » cherylann, posted by Viridis on May 15, 2004, at 1:46:52
hi there, a couple of refs......
neuropharmacology 34:1327-1333 (1995)
eur. neuropsycopharmacol. 8:161-168 (1998)
all the best, chemist
Posted by Kon on May 16, 2004, at 19:46:15
In reply to Why is klonopin acting like an AD?!, posted by cherylann on May 14, 2004, at 10:01:46
There are some studies suggesting that klonopin can have AD effects, so your response is not unheard of. I've posted two klonopin AD studies below. However, there are also studies suggesting that klonopin may induce depression as a side-effect in some individuals. So it seems klonopin's response wrt depression is variable.
I don't think anybody really knows why klonopin can act as an AD in some subjects and induce depression in others. Klonopin's effect wrt serotonin also seems to vary. Some studies suggest a decrease in the activity of the serotonergic systems, others studies suggest an increase. I've posted a few quotes from studies below especially wrt decrease in serotonin. It seems pretty confusing (or at least I'm damn confused).
1. AD effects of klonopin:Acta Psychiatr Scand. 1988 Jan;77(1):81-6.
Treatment of depression with clonazepam.
The antidepressive effect of an anticonvulsant clonazepam was studied with maximum daily dose of 1.5 to 6.0 mg (mean 3.4 mg) in 27 patients with major depression (n = 18) or bipolar disorder (n = 9). Two of them dropped out at an early stage of the treatment, and the antidepressive effect of clonazepam was evaluated for the remaining 25 patients. A marked to moderate improvement was obtained for 21 patients (84%), and the onset of the antidepressive effect of clonazepam appeared within 1 week in most of the cases who responded to the therapy. The total scores on the Hamilton Depression Rating Scale and the Beck Self-Rating Scale were significantly reduced after the clonazepam treatment. Side effects occurred in 14 patients, but most of them were not severe. From these results, it is thought that clonazepam might be useful as an antidepressant for patients in whom conventional antidepressant treatment are contraindicated
Nihon Shinkei Seishin Yakurigaku Zasshi. 2002 Jun;22(3):97-101.
Clonazepam in the treatment of protracted depression: a hundred-case report
Clonazepam, which presently is recommended for the treatment of seizure disorders, has been reported to be useful as an adjunctive treatment for depression. The purpose of this paper was to examine the suitable adjunctive dose and the characteristics of clonazepam for the treatment of protracted depression. A hundred protracted depressive patients treated with clonazepam were studies by the retrospective method. A daily dose of 3.0 mg clonazepam as augmentation expressed high effectiveness (78.4%) on protracted depression. Most of the improved patients showed a rapid onset of action within two weeks. Gender, age, phase number, family history of psychosis, and clinical symptoms did not change the effectiveness of clonazepam treatment. A daily dose of at least 3.0 mg clonazepam as augmentation of ongoing antidepressant treatment should be considered for protracted depressive patients with suboptimal improvement. Unipolar depression was significantly more effective than bipolar depression on clonazepam treatment. The clear-cut difference in response to unipolar and bipolar depression suggests that the underlying abnormality in unipolar depression is not the same as that in bipolar depression. A continuance of clonazepam after improvement disturbed the recurrence of depression, and it seems that clonazepam augmentation has a preventive effect.
--------------------------------------------------
2. Klonopin and serotonin:From Moroz (2004):
"...in addition, unlike many other benzodiazepines, clonazepam up-regulates the serotonin-1 and serotonin –2 (5-HT1 and 5HT2) receptors. This serotonergic effect may underlie the drug’s antimyoclonic and some of its psychotropic effects."From Reiter et al. (1990):
"Its mechanism of action in these disorders is unclear but may be related to its affinity for benzodiazepines receptors or its serotonergic effects."Lima et al (1993):
"Clonazepam is one of the most potent benzodiazepines known to decrease the activity of the central serotonergic systems."Wagner et al. (1986):
"These data suggest that serotonin receptor changes seen after chronic clonazepam may occur as a compensatory response to decreases in the presynaptic release of serotonin."Pratt (1979):
"Clonazepam induces decreased serotoninergic activity in the mouse brain"
Posted by chemist on May 16, 2004, at 20:45:15
In reply to Re: Why is klonopin acting like an AD?!, posted by Kon on May 16, 2004, at 19:46:15
for what it's worth, i am confused myself....seems like there are some contradictory studies....to the best of my knowledge, the triazolo derivatives are better quantified with some AD properties, but the traditional 1,4- and 1,5-substituted benzos remain a mystery to me in re: AD activity....all the best, chemist
> There are some studies suggesting that klonopin can have AD effects, so your response is not unheard of. I've posted two klonopin AD studies below. However, there are also studies suggesting that klonopin may induce depression as a side-effect in some individuals. So it seems klonopin's response wrt depression is variable.
>
> I don't think anybody really knows why klonopin can act as an AD in some subjects and induce depression in others. Klonopin's effect wrt serotonin also seems to vary. Some studies suggest a decrease in the activity of the serotonergic systems, others studies suggest an increase. I've posted a few quotes from studies below especially wrt decrease in serotonin. It seems pretty confusing (or at least I'm damn confused).
>
>
> 1. AD effects of klonopin:
>
> Acta Psychiatr Scand. 1988 Jan;77(1):81-6.
>
> Treatment of depression with clonazepam.
>
> The antidepressive effect of an anticonvulsant clonazepam was studied with maximum daily dose of 1.5 to 6.0 mg (mean 3.4 mg) in 27 patients with major depression (n = 18) or bipolar disorder (n = 9). Two of them dropped out at an early stage of the treatment, and the antidepressive effect of clonazepam was evaluated for the remaining 25 patients. A marked to moderate improvement was obtained for 21 patients (84%), and the onset of the antidepressive effect of clonazepam appeared within 1 week in most of the cases who responded to the therapy. The total scores on the Hamilton Depression Rating Scale and the Beck Self-Rating Scale were significantly reduced after the clonazepam treatment. Side effects occurred in 14 patients, but most of them were not severe. From these results, it is thought that clonazepam might be useful as an antidepressant for patients in whom conventional antidepressant treatment are contraindicated
>
> Nihon Shinkei Seishin Yakurigaku Zasshi. 2002 Jun;22(3):97-101.
>
> Clonazepam in the treatment of protracted depression: a hundred-case report
>
> Clonazepam, which presently is recommended for the treatment of seizure disorders, has been reported to be useful as an adjunctive treatment for depression. The purpose of this paper was to examine the suitable adjunctive dose and the characteristics of clonazepam for the treatment of protracted depression. A hundred protracted depressive patients treated with clonazepam were studies by the retrospective method. A daily dose of 3.0 mg clonazepam as augmentation expressed high effectiveness (78.4%) on protracted depression. Most of the improved patients showed a rapid onset of action within two weeks. Gender, age, phase number, family history of psychosis, and clinical symptoms did not change the effectiveness of clonazepam treatment. A daily dose of at least 3.0 mg clonazepam as augmentation of ongoing antidepressant treatment should be considered for protracted depressive patients with suboptimal improvement. Unipolar depression was significantly more effective than bipolar depression on clonazepam treatment. The clear-cut difference in response to unipolar and bipolar depression suggests that the underlying abnormality in unipolar depression is not the same as that in bipolar depression. A continuance of clonazepam after improvement disturbed the recurrence of depression, and it seems that clonazepam augmentation has a preventive effect.
>
> --------------------------------------------------
> 2. Klonopin and serotonin:
>
> From Moroz (2004):
> "...in addition, unlike many other benzodiazepines, clonazepam up-regulates the serotonin-1 and serotonin –2 (5-HT1 and 5HT2) receptors. This serotonergic effect may underlie the drug’s antimyoclonic and some of its psychotropic effects."
>
> From Reiter et al. (1990):
> "Its mechanism of action in these disorders is unclear but may be related to its affinity for benzodiazepines receptors or its serotonergic effects."
>
> Lima et al (1993):
> "Clonazepam is one of the most potent benzodiazepines known to decrease the activity of the central serotonergic systems."
>
> Wagner et al. (1986):
> "These data suggest that serotonin receptor changes seen after chronic clonazepam may occur as a compensatory response to decreases in the presynaptic release of serotonin."
>
> Pratt (1979):
> "Clonazepam induces decreased serotoninergic activity in the mouse brain"
>
Posted by cherylann on May 16, 2004, at 22:28:12
In reply to Re: Why is klonopin acting like an AD?! » Kon, posted by chemist on May 16, 2004, at 20:45:15
If maybe a little deep for my shallow mind, but I get the gist of it.
I will continue with the 1mg of klonopin as long as it works. If I decide to go off, the withdrawl can't be any worse than effexor.
Thankyou for all the great info!
Posted by chemist on May 16, 2004, at 22:38:03
In reply to Wow, excellent information!, posted by cherylann on May 16, 2004, at 22:28:12
> If maybe a little deep for my shallow mind, but I get the gist of it.
> I will continue with the 1mg of klonopin as long as it works. If I decide to go off, the withdrawl can't be any worse than effexor.
> Thankyou for all the great info!hello, from chemist....you have a good attitude, in my opinion: if it's working, find out as much as possible, and keep taking it....all the best, chemist
Posted by utopizen on May 16, 2004, at 23:41:03
In reply to Re: Why is klonopin acting like an AD?!, posted by Kon on May 16, 2004, at 19:46:15
>
> --------------------------------------------------
> 2. Klonopin and serotonin:> From Reiter et al. (1990):
> "Its mechanism of action in these disorders is unclear but may be related to its affinity for benzodiazepines receptors or its serotonergic effects."
>Why are doctors afraid to publish statements like, "Its mechanism of action in these disorders is unclear but may be related to its affinity for benzodiazpine receptors and a change from being lonely to having friends and a love life."
Most people, I think, become depressed over loneliness. It's easy to stress yourself out in tough times when you are lonely, this creates anxiety, and this combo creates depression. Cut out loneliness through the use of Klonopin in socially anxious patients, and depression is resolved through introduction of human interactions.
Too bad psychiatrists are afraid of words like "lonely."
This is the end of the thread.
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