Psycho-Babble Medication Thread 48972

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Adding Klonopin to the mix and therapy

Posted by dove on November 17, 2000, at 11:56:50

My p-doc added Klonopin to my med cocktail yesterday. He believes it will help smooth out my continued ultra-rapid cycling, smother my panic attacks, soothe my anxieties, and keep my depression above the death-awaiting line.

Current med cocktail:
Adderall (20mgs am, 10mgs noonish, 10mgs early evening)
Amitriptyline (Elavil, 200mgs before bed)
Serzone (Nefazodone, 100mgs am, noon, pm, bedtime)
Neurontin (Gabapentin, 2,400 mgs spread throughout my waking hours)
Klonopin (Clonazepam, 0.5mgs x3 per day (1.5 mg total), dosage to be increased in three weeks)

Now, in addition to bringing my meds to a very expensive monthly price, and some significant difficulty remembering when to take what (a very complex med schedule to say the least), I am lacking the knowledge of how the combination of all these meds is really going to interact. Aren't the majority of these meds anticholinergic also? I always thought that everyone was trying to *avoid* anticholinergic meds?

Also, I'm looking for thoughts on panic and anxiety therapies. I've been in cognitive behavioral therapy with absolutely no positive results. Actually, my favorite therapist (the only female p-doc I see) has terminated our relationship and has transferred me to a psychologist who only works with panic and anxiety disorders. I was shocked when she told me, couldn't even speak or respond, which she understood and acknowledged. She explained to me that I was always welcome to return but she didn't feel she had the help that I required, and she didn't want to waste more of my time and money with approaches that just aren't working. Never-the-less, I did dissolve into silent tears at the thought of losing her expertise and rappaport.

So... I've just started panic and anxiety therapy with a new psychologist. It seems pretty intense and I'm pretty scared. I have to meet with the doc once per week, while we work through a handbook called "Mastery of Your Anxiety and Panic". I told him my goal is to "live without fear" with regard to going out in public, going to the dentist, riding in cars, ect....

The doc said he doesn't like to work with people on meds because they have a higher rate of relapse due to their reliance on the meds to ultimately save them. He's willing to try and help me, but has given me some uneasy vibes in terms of whether or not this therapy is going to work for me.

The doc mentioned that he has a 90% free of panic attacks rate, and the majority (80-90%) of those were med free. He also responded with surprise when I told him about actually physically fainting during a panic attack.

He is a strong proponent of patient/client education (which is awesome!) and tried to explain to me the "strangeness" of actually fainting during a panic attack; something to do with the sympathetic nervous system (fight or flight) and parasympathetic nervous system which subdues the nervous system??? And how they rarely coincide in a panic attack. Anyone have know what this actually means?

Thanks for everyone's precious time!!!

dove

 

Re: Adding Klonopin to the mix and therapy

Posted by Noa on November 17, 2000, at 13:01:55

In reply to Adding Klonopin to the mix and therapy, posted by dove on November 17, 2000, at 11:56:50

Wow, my first reaction was that adding the specialized therapy is terrific. But then, when I read the part about how he prefers patients to not take meds, well, I thought--well, that's all she needs is to be set up in a conflict between one doctor and the other!!!

how about asking this psychologist to confer with your pdoc? I guess, for myself, I would want to know that this therapy wasn't going to make me choose between two helpful treatment modalities.

 

Re: Adding Klonopin to the mix and therapy

Posted by stjames on November 17, 2000, at 15:12:01

In reply to Adding Klonopin to the mix and therapy, posted by dove on November 17, 2000, at 11:56:50

Does the psychologist have a problem with you being on meds for bi polar ?

James

 

Re: Adding Klonopin to the mix and therapy

Posted by JohnB on November 18, 2000, at 1:51:59

In reply to Adding Klonopin to the mix and therapy, posted by dove on November 17, 2000, at 11:56:50


> Also, I'm looking for thoughts on panic and anxiety therapies.

dove,
I assume you know about the Panic Disorders board located at:
http://www.algy.com/pdi/BBS/index.html


 

Re: Adding Klonopin to the mix and therapy

Posted by JohnL on November 18, 2000, at 6:08:05

In reply to Adding Klonopin to the mix and therapy, posted by dove on November 17, 2000, at 11:56:50

> My p-doc added Klonopin to my med cocktail yesterday. He believes it will help smooth out my continued ultra-rapid cycling, smother my panic attacks, soothe my anxieties, and keep my depression above the death-awaiting line.
>
> Current med cocktail:
> Adderall (20mgs am, 10mgs noonish, 10mgs early evening)
> Amitriptyline (Elavil, 200mgs before bed)
> Serzone (Nefazodone, 100mgs am, noon, pm, bedtime)
> Neurontin (Gabapentin, 2,400 mgs spread throughout my waking hours)
> Klonopin (Clonazepam, 0.5mgs x3 per day (1.5 mg total), dosage to be increased in three weeks)
>
Dove,
I sure empathize with you. I'm not sure anything I can comment on will be of any help, but I'll share my thoughts just in case. You can consider them or discard them at your discretion.

My favorite pdoc, now retired, kept records of what medicines achieved excellent results in his patients. Dr Jensen does the same thing. I was surprised to see how closely the records of both match each other. They only differ by a few percentage points. Anyway, here is a chart of which drugs got excellent results in what percent of patients in the anxiety/panic group:
Antidepressants 48% of patients got excellent results (37% were serotonin ADs)
Benzodiazepines 24%
Lithium 22%
Stimulants 14%
Antipsychotics 13%
Depakote 11%
Tegretol 3%
Lamictal 0%
Neurontin 0%
Thyroid 24% (if tests were borderline or a family history was present)
Stimulants often required a small dose antipsychotic addition to reverse anxiety or phsychosis.
Beta adrenergic blockers were not recorded but were helpful, mostly with palpitations.

Three comments on this chart. First, many of these things that actually got excellent results have no clinical justification for treating anxiety/panic. But they worked. That's important as I see it. Lithium for example. Who would have ever thought? Second, when the correct medicine was found, the patients usually not only experienced excellent results, but they experienced rapid results in anywhere from one day to three weeks. The longer a drug took to work, the less likely it was to eventually give excellent results. Third, if 47% of patients got excellent results with antidepressants, well that means 53% didn't. You could perhaps be in that 53% group. Otherwise I would think Serzone and/or Amitriptyline would be giving better results than they are.

With all this in mind, one has to wonder if any of your current meds are really the correct ones? Klonopin is I think a fine choice for two reasons. First, it is a benzo, it is commonly used to treat anxiety/panic, and according to the chart it has one of the highest statistical probabilites of working well. Second, it is also a mood stabilizer, which differentiates itself from other benzos. So it theoretically has the potential to benefit your panic and your cycling simultaneously. Also, in a clinical trial a 3mg dose was shown to accelerate the response to an SSRI, with major improvement noticed in one week. Of course, as a disclaimer, this med can actually worsen symptoms in a small subset of patients, but in that respect so can any other med.

With Adderall in the mix, I am very tempted to point to antipsychotics.

When all is said and done, and the dust has settled, it wouldn't surprise me at all if your cocktail ended up being something like Klonopin + Adderall + small dose Zyprexa or Risperdal, with none of the other current meds. If a fourth med were included, my guess based simply on the chart would be either Lithium or Depakote.

Again, I empathize with you. There's a lot to think about and consider. Though I think Klopopin is an excellent move, I also question the role of the other meds. Though they may be helping somewhat, they are obviously not providing excellent results, and that logically indicates they are probably not the correct meds. I think when the correct meds are tried, you will eventually find your cocktail includes fewer drugs yet with greater benefits. Hopefully Klonopin will lead in that direction. Antipsychotics and/or Lithium/Depakote/Tegretol could be considered to replace the other current meds.

Hope something here might be helpful. It's a tough one, no question about it.
John

ps...As to therapy, it's well established that medicine+therapy is more effective than either alone. Mostly what I've heard is that therapy can provide effective techniques to control panic episodes, but can't cure them. Being able to take of control of them, rather than them taking control of you, is the usual goal in panic therapy. I've never heard of anyone being cured of panic in therapy. They learn how to manage it. I could be wrong, but I feel panic such as yours is an organic chemistry phenomenon. If that's true, then therapy could indeed help manage panic episodes, but not cure them. The correct medicine that fixes whatever chemistry is awry is what will eventually cure it completely. Until that happens though, I would think therapy would be helpful in learning coping techniques to get yourself through the tough moments as smoothly as possible.

 

Re: Adding Klonopin to the mix and therapy

Posted by Janice1 on November 20, 2000, at 19:45:18

In reply to Adding Klonopin to the mix and therapy, posted by dove on November 17, 2000, at 11:56:50

hi dove,

something really simple and obvious, but quitting caffeine completely really helped my anxiety levels and panic attacks to lower. I wish you luck. Janice

 

Re: Adding Klonopin to the mix and therapy

Posted by dove on November 21, 2000, at 15:16:30

In reply to Re: Adding Klonopin to the mix and therapy, posted by stjames on November 17, 2000, at 15:12:01

>
>how about asking this psychologist to confer with your p-doc? I guess, for myself, I would want to know that this therapy wasn't going to make me choose between two helpful treatment modalities.
>
>Does the psychologist have a problem with you being on meds for bi polar?
>

I spoke with my regular p-doc yesterday, and he spoke to the "specialist", and they're both on the same line with regard to my meds, keeping them I mean. The p-doc did state that he believes my panic and anxiety disorder has a definitive biological and somatic base, and the specialist concurs, for now at least.

>
>I assume you know about the Panic Disorders board located at:
http://www.algy.com/pdi/BBS/index.html
>

No, I hadn't seen this site yet, and thank you for the link. I have been reading through all the information and following links, and will hopefully have a better understanding of the different approaches of therapy.

>
>When all is said and done, and the dust has settled, it wouldn't surprise me at all if your cocktail ended up being something like Klonopin + Adderall + small dose Zyprexa or Risperdal, with none of the other current meds. If a fourth med were included, my guess based simply on the chart >would be either Lithium or Depakote.
>

The Klonopin is definitely doing something, and so far that something hasn't been negative in any way. I've been breaking the 0.05 mgs in half. So, instead of taking 1.5 mgs per day I'm taking 0.75 mgs per day, is that amount too low to really work? My p-doc says that 1.5 mgs per day is a very low dose. Even the 0.75 dosage makes me feel a little drowsy, but that was expected anyway.

However, it is *really* dampening the daily bipolar cycling, I mean REALLY!!! I still don't know how much time should pass between dosing though. I asked my p-doc and he told me that it's pretty "fool-proof", just space them throughout the day?! Before bed, early evening, noon, what, and when?

On another note, my Mom was just dxed with Lymphoma, and will be starting chemo and radiation Dec. 4th, my birthday is Dec 7th, my old best friend of 15 years is getting married Dec 10th and she wants me to fly out to Denver on the 7th, as I'm her personal assistant--after turning down her request to stand up for her in the wedding itself--and the babysitter (my beautiful Mother) for my five (5) children is unavailable, as she will be starting chemo, and I'm petrified of flying, especially since my panic attacks seem to be heating up quite significantly!

I will be meeting with the panic/anxiety specialist this evening, I only hope I don't break down into a bundle of tears and blubbering! Thank each and every one of you for responding, I cannot express how thankful I am for the warmth and concern shown by so many of you. Sometimes I think about how much energy is put into each other, how much thought, and I'm completely blown away! All of you are truly unique and magnificent individuals and I am so glad to have you for my "team-mates"!!!

Bless you all :-)

dove

P.S. And a big warm hello to Janice, haven't seen you around for a bit and am glad, as always to see you!!!

 

Re: Adding Klonopin to the mix and therapy

Posted by Noa on November 22, 2000, at 15:19:34

In reply to Re: Adding Klonopin to the mix and therapy, posted by dove on November 21, 2000, at 15:16:30

Hi, Dove.

well, I am very glad to hear the two docs agree that you should continue your meds and make no major changes.

I am sorry to hear about your Mom. I hope her treatment is successful.

You really do have an awful lot on your plate all at once. You might be able to figure a way to juggle it all, but it might come down to realizing you can't be all things to everyone and it is ok to not do it all if trying to do it all is going to take too much out of you.

Have a Good Thanksgiving.


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