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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 16 of 16. This is the beginning of the thread.
Posted by schleprock on October 4, 2012, at 17:33:15
Been on 1.5 mg of clonazepam and 150mg of Lyrica for about, and while at least one (or maybe both together) have been pretty good for anxiety, I've recently been experiencing a mood decrease (major, though not meloncholic, depression, and definitely chemically triggered.) I'm fairly certain that one of these meds (or maybe both together) are responsible. But I'm going to have to stay on at least one of these (was originally hoping to stay on Lyrica and drop the benzo.) So any ideas on which may be the greater culprit (probably Lyrica, but I'd rather it not be.)? And, of course, which should be my next step? Would I be better off adding something on for mood w/o stopping anything, or substitute one for something similar (I'm leaning towards Buspar or Neurontin; could either of these worsen depression?)
Posted by vbs on October 4, 2012, at 17:49:09
In reply to Residual depression, which med should I stop?, posted by schleprock on October 4, 2012, at 17:33:15
I would think add on an AD if you're not taking one.
Posted by JONO_IN_ADELAIDE on October 4, 2012, at 17:49:21
In reply to Residual depression, which med should I stop?, posted by schleprock on October 4, 2012, at 17:33:15
Add mirtazepine 30mg at night to control the anxiety
If you want to drop the benzo, do it slowly, and increase the Lyrica to 300mg per day.
If you want to drop the Lyrica, then consider changing your benzo to Xanax, same dose, 1.5mg per day.
Posted by schleprock on October 4, 2012, at 17:51:19
In reply to Residual depression, which med should I stop?, posted by schleprock on October 4, 2012, at 17:33:15
> Been on 1.5 mg of clonazepam and 150mg of Lyrica for about, and while at least one (or maybe both together) have been pretty good for anxiety, I've recently been experiencing a mood decrease (major, though not meloncholic, depression, and definitely chemically triggered.) I'm fairly certain that one of these meds (or maybe both together) are responsible. But I'm going to have to stay on at least one of these (was originally hoping to stay on Lyrica and drop the benzo.) So any ideas on which may be the greater culprit (probably Lyrica, but I'd rather it not be.)? And, of course, which should be my next step? Would I be better off adding something on for mood w/o stopping anything, or substitute one for something similar (I'm leaning towards Buspar or Neurontin; could either of these worsen depression?)
"Been on 1.5 mg of clonazepam and 150mg of Lyrica for about a month" is what I wished to say.
Posted by ChicagoKat on October 4, 2012, at 18:08:13
In reply to Residual depression, which med should I stop?, posted by schleprock on October 4, 2012, at 17:33:15
> Been on 1.5 mg of clonazepam and 150mg of Lyrica for about, and while at least one (or maybe both together) have been pretty good for anxiety, I've recently been experiencing a mood decrease (major, though not meloncholic, depression, and definitely chemically triggered.) I'm fairly certain that one of these meds (or maybe both together) are responsible. But I'm going to have to stay on at least one of these (was originally hoping to stay on Lyrica and drop the benzo.) So any ideas on which may be the greater culprit (probably Lyrica, but I'd rather it not be.)? And, of course, which should be my next step? Would I be better off adding something on for mood w/o stopping anything, or substitute one for something similar (I'm leaning towards Buspar or Neurontin; could either of these worsen depression?)
I'm betting you're right and it's the Lyrica. But, though I know Klonopin can worsen depression it never did in me. You can certainly get your pdoc to change you to another benzo, and I'd recommend giving Neurontin a try. It's less likely to cause depression. But you might want to change one drug at a time so you have a better chance at finding the culprit. I'd try changing the Lyrica to Neurontin first.
Kat
Posted by ChicagoKat on October 4, 2012, at 18:17:32
In reply to Re: Residual depression, which med should I stop?, posted by JONO_IN_ADELAIDE on October 4, 2012, at 17:49:21
> Add mirtazepine 30mg at night to control the anxiety
>
If you add mirtazapine, I'd do so at a lower dose b/c it has better sedating/anxiolytic properties at lower doses. But then, why add another med when the other two can be easily switched to alternatives?> If you want to drop the benzo, do it slowly, and increase the Lyrica to 300mg per day.
I would not recommend increasing the Lyrica; it truly can worsen depression and may well be the culprit. And the benzo can simply be changed to a different one.
>
> If you want to drop the Lyrica, then consider changing your benzo to Xanax, same dose, 1.5mg per day.IMO, Ativan is a much better choice, fewer drug interactions, fewer adverse effects, no hangover effect, eg, and no interaction with smoking. Frankly, Xanax is the worst benzo of all, IMO, except for those with panic disorder b/c it has the quickest onset of action.
Sorry to be so contrary, Jono, but I had to call it the way I see it, and besides, you didn't respond to any of my posts today :(
Kat
Posted by ChicagoKat on October 4, 2012, at 18:25:55
In reply to Re: Residual depression, which med should I stop? » JONO_IN_ADELAIDE, posted by ChicagoKat on October 4, 2012, at 18:17:32
> > Add mirtazepine 30mg at night to control the anxiety
> >
> If you add mirtazapine, I'd do so at a lower dose b/c it has better sedating/anxiolytic properties at lower doses. But then, why add another med when the other two can be easily switched to alternatives?
>
> > If you want to drop the benzo, do it slowly, and increase the Lyrica to 300mg per day.
>
> I would not recommend increasing the Lyrica; it truly can worsen depression and may well be the culprit. And the benzo can simply be changed to a different one.
> >
> > If you want to drop the Lyrica, then consider changing your benzo to Xanax, same dose, 1.5mg per day.
>
> IMO, Ativan is a much better choice, fewer drug interactions, fewer adverse effects, no hangover effect, eg, and no interaction with smoking. Frankly, Xanax is the worst benzo of all, IMO, except for those with panic disorder b/c it has the quickest onset of action.
>
> Sorry to be so contrary, Jono, but I had to call it the way I see it, and besides, you didn't respond to any of my posts today :(
> Kat
>
>I take part of it back, re-read the original post and the poster sounds pretty down. Adding an AD would be a good idea, and Remeron (mirtazapine) is a good choice...start at 15mg/day, see how that goes, go up to 30mg/day only if not responding well enough to 15. May not need a benzo or Lyrica/Neurontin on Remeron. But if had to pick one would pick a benzo, Ativan would be my choice.
Kat
Posted by JONO_IN_ADELAIDE on October 4, 2012, at 18:52:14
In reply to Re: Residual depression, which med should I stop?, posted by ChicagoKat on October 4, 2012, at 18:25:55
Sorry about not responding to your thready yet kat, I'll get there :)
I suggested Xanax because there is (some) evidence that it has a mild antidepressant effect, which none of the other benzodiazepines do.
i agree that mirtazapine is more sedating at lower doses, but the anti anxiety effect is mediated via the 5HT2A receptor, where as the sedation is mediatedthrough the histamine receptor, so not sure that its more anxiolytic at lower doses, that said, starting at 15 and increase to 30 only if requried is a good plan - the lowest effective dose is the correct one!
Anyway, we can all agree all of the time!
Viva le difference!
Posted by schleprock on October 4, 2012, at 18:54:34
In reply to Residual depression, which med should I stop?, posted by schleprock on October 4, 2012, at 17:33:15
Sorry, probably should have mentioned that I'm on 150 mg of Nortriptyline; it's just that I mentioned it so many times.
What I'd really like to do is get rid of the clonazepam and substitute it with something else that's not a benzo (I was initially taking clonazepam for about two years, then decided to stop and felt so much better for about 10 months. At that time i thought I really didn't need it, and was very reluctant to continue it.)
It's upsetting because this is really the first time since about may that I was for the most part able to go a month without any major anxiety\depression problems. This is just as likely to be due to my gradually increased dosage of clonazepam as starting Lyrica.
Posted by JONO_IN_ADELAIDE on October 4, 2012, at 19:02:57
In reply to Re: Residual depression, which med should I stop?, posted by schleprock on October 4, 2012, at 18:54:34
If you're taking 150mg of nortriptyline, and want to give up the benzo, I'd
1. Add an SSRI such as sertaline into the mix
2. Try Buspar for the anxiety, or increase the Lyrica to betwen 300mg and 600mg per day
Posted by phillipa on October 4, 2012, at 19:12:20
In reply to Re: Residual depression, which med should I stop?, posted by JONO_IN_ADELAIDE on October 4, 2012, at 19:02:57
Klonopin caused suicidal thoughts but wasn't so doc said stop and went back on xanax and right away felt fine. Phillipa
Posted by ChicagoKat on October 4, 2012, at 20:23:36
In reply to Re: Residual depression, which med should I stop?, posted by schleprock on October 4, 2012, at 18:54:34
> Sorry, probably should have mentioned that I'm on 150 mg of Nortriptyline; it's just that I mentioned it so many times.
>
> What I'd really like to do is get rid of the clonazepam and substitute it with something else that's not a benzo (I was initially taking clonazepam for about two years, then decided to stop and felt so much better for about 10 months. At that time i thought I really didn't need it, and was very reluctant to continue it.)
>
> It's upsetting because this is really the first time since about may that I was for the most part able to go a month without any major anxiety\depression problems. This is just as likely to be due to my gradually increased dosage of clonazepam as starting Lyrica.I still recommend changing the Lyrica to Neurontin and changing the Klonopin to Ativan, one after the other.
Posted by Hugh on October 4, 2012, at 21:05:34
In reply to Residual depression, which med should I stop?, posted by schleprock on October 4, 2012, at 17:33:15
There's a good chance that clonazepam is the culprit. Benzos can work well for months or years before some of those taking them start to develop tolerance and/or interdose withdrawal. If you do decide to drop the benzo, taper it very, very slowly. This site has excellent information about benzo withdrawal symptoms and tapering plans.
Posted by schleprock on October 4, 2012, at 21:44:14
In reply to Residual depression, which med should I stop?, posted by schleprock on October 4, 2012, at 17:33:15
Does anyone know the mechanism by which Lyrica could worsen depression? Does it has some kind of indirect effect on the neurotransmitters that we're all familar with?
Posted by Beckett on October 4, 2012, at 22:17:47
In reply to Re: Residual depression, which med should I stop?, posted by schleprock on October 4, 2012, at 21:44:14
I can't say which med you should stop. Klonopin has been known to increase depressive symptoms in some. Myself included. I happen to think, though, that Xanax is more difficult to discontinue than other benzos for some people. That's a personal opinion, one shared by my pdoc.
About buspar, I feel it is an under-utilized add-on to anti-depressants. I don't know if it takes as long to kick in as an add-on as it does when treating anxiety. Does anyone here know?
Posted by phidippus on October 7, 2012, at 14:12:01
In reply to Residual depression, which med should I stop?, posted by schleprock on October 4, 2012, at 17:33:15
Clonazepam can cause depression, as can Lyrica. Clonazepam actually interferes with serotonin release.
>I'm leaning towards Buspar or Neurontin; could either of these worsen depression?
Buspar is not likely to cause depression, however Neurontin (Gabapentin) can (it's Lyrica's brother).
Eric
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