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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 12 of 12. This is the beginning of the thread.
Posted by linkadge on July 26, 2011, at 21:05:40
Is there any evidence of clonazepam being effective for mood stabilization (long term) in bipolar?
Linkadge
Posted by crazyjoe on July 26, 2011, at 21:50:25
In reply to Clonazepam maintainance in bipolar, posted by linkadge on July 26, 2011, at 21:05:40
not sure but i think it might be considered more of a mood stabilizer than some benzos
Posted by Christ_empowered on July 26, 2011, at 22:04:17
In reply to Clonazepam maintainance in bipolar, posted by linkadge on July 26, 2011, at 21:05:40
I read a case study once where they used Klonopin as a mood stabilizer after Haldol (yes, for some reason, they used HALDOL...in Bipolar I) had caused TD (you'd think they would've seen that one coming...).
I think they used 4-5mgs/day. I can't seem to find the case study right now, though.
Posted by morgan miller on July 26, 2011, at 22:41:26
In reply to Clonazepam maintainance in bipolar, posted by linkadge on July 26, 2011, at 21:05:40
I do know of bipolar patients taking it, but I don't know of any cases where it is the main mood stabilizer.
For me, it numbed my emotions far more than any SSRI or mood stabilizer(I usually don't take very high doses of either lithium or depakote). I couldn't keep taking it and didn't like the roller coaster I felt like I was on when using it.
Posted by morgan miller on July 26, 2011, at 22:44:31
In reply to Re: Clonazepam maintainance in bipolar, posted by Christ_empowered on July 26, 2011, at 22:04:17
> I read a case study once where they used Klonopin as a mood stabilizer after Haldol (yes, for some reason, they used HALDOL...in Bipolar I) had caused TD (you'd think they would've seen that one coming...).
>
> I think they used 4-5mgs/day. I can't seem to find the case study right now, though.That's a high dose, probably necessary if using on patients that needed haldol. I always worry about memory issues and tolerance building with klonopin. My buddy is up to 6 mgs after about 5 or 6 years of being on it. He started at .5 twice a day.
Posted by Phillipa on July 27, 2011, at 0:28:06
In reply to Re: Clonazepam maintainance in bipolar, posted by morgan miller on July 26, 2011, at 22:44:31
First it depresses me but it's used in seizures up to 20mg. So theoretically would this be considered a mood stablizer? Phillipa
Posted by SLS on July 27, 2011, at 7:32:35
In reply to Clonazepam maintainance in bipolar, posted by linkadge on July 26, 2011, at 21:05:40
> Is there any evidence of clonazepam being effective for mood stabilization (long term) in bipolar?
>
> LinkadgeI experienced a manic reaction to Parnate + desipramine in 1988. It was pretty heavy-duty. Depakote was not available at the time. Lithium did almost nothing acutely. Adding clonazepam to lithium reduced mania, but I cannot judge the therapeutic value of the lithium. Before the advent of using anticonvuslants as mood stabilizers, adding a BZD to lithium was often employed. Lorazepam was of no help to me. Clonazepam was, for me, clinically more of an anti-manic.
One difference between clonazepam and the other BZDs is the effects it has on serotonin release. Whether or not release of serotonin is enhanced or diminished has not yet been proven conclusively. Interestingly, clonazepam does not bind to GABA-B receptors as lorazepam and diazepam. Clonazepam is of little value to reduce rigidity in serotonin syndrome. Somewhere in here might be an explanation as to why clonazepam produces depression in some individuals.
- Scott-------------------------------------------
Neuropharmacology. 1995 Oct;34(10):1327-33.
Serotonin turnover rate, [3H]paroxetine binding sites, and 5-HT1A receptors in the hippocampus of rats subchronically treated with clonazepam.
Lima L, Trejo E, Urbina M.
SourceLaboratorio de Neuroquímica, Instituto Venezolano de Investigaciones Científicas, Caracas, Venezuela.
AbstractSelective central benzodiazepine agonists, such as clonazepam, are known to modify serotonin and 5-hydroxyindoleacetic content in the brain. In order to further study the effect of this benzodiazepine on serotonin turnover rate, rats received clonazepam, 10 mg/kg for 10 days, and the concentrations of serotonin and 5-hydroxyindoleacetic acid were determined in the hippocampus after inhibition of monoamineoxidase with pargyline. The results indicate a reduction in the turnover rate of the monoamine. In addition, the systemic administration of clonazepam produced a decrease in the Bmax of [3H]DPAT binding to 5-HT1A sites in the hippocampus. By contrast, this effect was not observed if clonazepam was delivered into the dorsal raphe nucleus by osmotic minipumps. The binding of [3H]paroxetine to 5-HT reuptake sites was increased by the treatment with clonazepam. The present observations indicate that clonazepam produces a reduction of serotonin turnover rate in the hippocampus of the rat concomitant with a down-regulation of 5-HT1A binding sites, probably by an effect at the forebrain projections. There is also an up-regulation of the serotonin transporter, which might contribute to a reduction in the synaptic availability of serotonin during clonazepam treatment.
PMID:
8570030
[PubMed - indexed for MEDLINE]
Posted by linkadge on July 27, 2011, at 11:00:12
In reply to Re: Clonazepam maintainance in bipolar, posted by SLS on July 27, 2011, at 7:32:35
Interesting, I'd never heard of lorazepam binding to gaba-b
Linkadge
Posted by SheilaC on July 27, 2011, at 11:04:12
In reply to Re: Clonazepam maintainance in bipolar, posted by SLS on July 27, 2011, at 7:32:35
I take 3mg of Klonopin a day and it does help tremendously! If I combine it with low dose Lithium it really seems to help and I don't have to take as much Lithium.
Right now I am trying Geodon, which does cause some anxiety or mania or something and Klonopin helps.
I have been taking it for years and I couldn't live without it. It has been a God send for me. It acts pretty quickly which is great.
It can depress me. But, as I said, right now I am taking Geodon and that revs me up, so I am not depressed.
I could see how it could help when combined with a traditional mood stabilizer for those of us that can't tolerate therapeutic or high doses.
If I had to take a high dose of Klonopin as my main stabilizer I would need an antidepressant along with it, but I believe it could work!
Posted by morgan miller on July 27, 2011, at 11:17:39
In reply to Re: Clonazepam maintainance in bipolar, posted by SLS on July 27, 2011, at 7:32:35
If klonopin is not helpful with serotonin syndrome, wouldn't that hint towards the fact that it might enhance serotonin is some way, and not suppress it? So that would explain why klonopin might act as an antidepressant in many, not a depressant, right? Correct me if I'm wrong.
Also, don't all benzos potential carry the risk of making the patient feel more depressed long term?
Posted by SheilaC on July 27, 2011, at 11:24:32
In reply to Re: Clonazepam maintainance in bipolar, posted by morgan miller on July 27, 2011, at 11:17:39
MM - my mother takes 1mg of Klonopin as needed - maybe only once a day and she swears it gives her an antidepressant feel.
I have never felt that even on low doses.
I take it more for anxiety and to help quell hypomania - but it never helps with my depression.
Posted by floatingbridge on August 1, 2011, at 10:01:59
In reply to Re: Clonazepam maintainance in bipolar, posted by SLS on July 27, 2011, at 7:32:35
Could clonazepam be given instead of alazopram XR for double-duty mood stabilization and anxiety control? The depressive qualities overridden enough by proper AD support?
Xanax is such a mood brightener. However, there is the darn stability issue....
Does this info contribute: my pdoc was doing some benzo higher math in his head. As he thought, he'd say things like, Xanax crosses the blood brain barrier, but there isn't any evidence of klonopin doing so, it is largely absorbed into the tissues and muscles..... That is if I followed him and recalled correctly. And he said in a different way than diazepam, which accumulates (in fat?).
So klonopin for siezures....
> > Is there any evidence of clonazepam being effective for mood stabilization (long term) in bipolar?
> >
> > Linkadge
>
> I experienced a manic reaction to Parnate + desipramine in 1988. It was pretty heavy-duty. Depakote was not available at the time. Lithium did almost nothing acutely. Adding clonazepam to lithium reduced mania, but I cannot judge the therapeutic value of the lithium. Before the advent of using anticonvuslants as mood stabilizers, adding a BZD to lithium was often employed. Lorazepam was of no help to me. Clonazepam was, for me, clinically more of an anti-manic.
>
> One difference between clonazepam and the other BZDs is the effects it has on serotonin release. Whether or not release of serotonin is enhanced or diminished has not yet been proven conclusively. Interestingly, clonazepam does not bind to GABA-B receptors as lorazepam and diazepam. Clonazepam is of little value to reduce rigidity in serotonin syndrome. Somewhere in here might be an explanation as to why clonazepam produces depression in some individuals.
>
>
> - Scott
>
> -------------------------------------------
>
> Neuropharmacology. 1995 Oct;34(10):1327-33.
> Serotonin turnover rate, [3H]paroxetine binding sites, and 5-HT1A receptors in the hippocampus of rats subchronically treated with clonazepam.
> Lima L, Trejo E, Urbina M.
> Source
>
> Laboratorio de Neuroquímica, Instituto Venezolano de Investigaciones Científicas, Caracas, Venezuela.
> Abstract
>
> Selective central benzodiazepine agonists, such as clonazepam, are known to modify serotonin and 5-hydroxyindoleacetic content in the brain. In order to further study the effect of this benzodiazepine on serotonin turnover rate, rats received clonazepam, 10 mg/kg for 10 days, and the concentrations of serotonin and 5-hydroxyindoleacetic acid were determined in the hippocampus after inhibition of monoamineoxidase with pargyline. The results indicate a reduction in the turnover rate of the monoamine. In addition, the systemic administration of clonazepam produced a decrease in the Bmax of [3H]DPAT binding to 5-HT1A sites in the hippocampus. By contrast, this effect was not observed if clonazepam was delivered into the dorsal raphe nucleus by osmotic minipumps. The binding of [3H]paroxetine to 5-HT reuptake sites was increased by the treatment with clonazepam. The present observations indicate that clonazepam produces a reduction of serotonin turnover rate in the hippocampus of the rat concomitant with a down-regulation of 5-HT1A binding sites, probably by an effect at the forebrain projections. There is also an up-regulation of the serotonin transporter, which might contribute to a reduction in the synaptic availability of serotonin during clonazepam treatment.
>
> PMID:
> 8570030
> [PubMed - indexed for MEDLINE]
This is the end of the thread.
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