Psycho-Babble Medication Thread 86777

Shown: posts 1 to 19 of 19. This is the beginning of the thread.

 

klonapin 0.5

Posted by undead on December 13, 2001, at 5:34:18

I AM CURRENTLY PRESCRIBED 0.5 MG TABS OF CLONAZAPINE(KLONAPIN),AND I DONT GET ANY EFFECT FROM TAKING 1 OF THEM, LIKE IM SUPPOSED TO, UNLESS I CRUSH IT FIRST.WHY IS THIS? 0.5 MGS IS A VERY SMALL DOSE OF KLONAPIN TO BE ON, I THINK..

 

Re: klonapin 0.5

Posted by tina on December 13, 2001, at 8:23:32

In reply to klonapin 0.5, posted by undead on December 13, 2001, at 5:34:18

YOu may be a little impatient. If you're used to benzos that act faster like xanax or ativan, you may be expecting the klonopin to work as fast. It doesn't. It takes longer and it's more subtle.
I let it dissolve under my tongue most of the time.
If it works for you, keep crushing it. I don't think it in any way, changes the effects at all.

> I AM CURRENTLY PRESCRIBED 0.5 MG TABS OF CLONAZAPINE(KLONAPIN),AND I DONT GET ANY EFFECT FROM TAKING 1 OF THEM, LIKE IM SUPPOSED TO, UNLESS I CRUSH IT FIRST.WHY IS THIS? 0.5 MGS IS A VERY SMALL DOSE OF KLONAPIN TO BE ON, I THINK..

 

Re: klonopin 0.5 mg » undead

Posted by Elizabeth on December 13, 2001, at 16:07:53

In reply to klonapin 0.5, posted by undead on December 13, 2001, at 5:34:18

Careful about spelling on this one -- there are drugs named *clonidine* and *clozapine* which are often mixed up with Klonopin. The generic name of Klonopin is "clonazepam" (pronounced "klohn (or "klahn") - AZ - uh - pam").

I don't know why crushing the tablets makes it work better. It might be absorbed faster, so that the peak effect is higher and therefore you notice it. Some formulations may contain binders that make their absorption slower or even less efficient. I'm pretty much positive that Cam would know about this.

0.5 mg is a low-end dose, but not unbelievably low -- like, many people find it to be adequate to take 0.5 mg two or three times daily (I think most people can take Klonopin twice a day, although I personally find that I need it three times a day). One thing about Klonopin (compared with other benzos like Valium or Xanax) is that its effects can be subtle -- if it's working, there should be an *absense* of anxiety, but not necessarily a noticed effect. The effect also tends to take a while -- don't expect immediate relief, it might take as much as an hour for your anxiety to improve. If you're taking it regularly, it also might take a while before it accumulates in your body to a point that will be effective for you. Ask your doctor what to expect.

You might need to go up to a higher dose, but I suggest keeping a "symptom diary" where you keep track of your anxiety symptoms each day and see whether they decrease with the Klonopin (perhaps only after having been on the Klonopin for a few days or even weeks). Like I said, it can be subtle.

-elizabeth

 

Re: klonapin 0.5 » undead

Posted by Cam W. on December 13, 2001, at 16:22:56

In reply to klonapin 0.5, posted by undead on December 13, 2001, at 5:34:18

Undead - I agree with everything that Elizabeth said. By crushing the tablets you are increasing the surface area, making the drug easier to absorb. You will notice a quicker effect by doing this, but the effect may not last as long. This may just be a matter of symantics though, since the half-life of Klonopin is fairly long anyway (18h to 80h, depending on how your body pharmacokinetically handles the drug - ie. rate of absorption, distribution, metabolism and excretion).

I know of people who are taking a quarter of a 0.5mg tablet daily for anxiety related to bipolar disorder, and this is enough for them. Benzodiazepine doses are very individualized, so 0.5mg per day is enough for many people. You want the drug to ease the anxiety; this does not mean that you necessarily have to "feel it", as in giving you a buzz, or in any way altering your perception. Ideally, a benzo should take the edge off without having you feel otherwise different. - Cam

 

Re: klonopin 0.5 » Cam W.

Posted by Elizabeth on December 13, 2001, at 20:34:31

In reply to Re: klonapin 0.5 » undead, posted by Cam W. on December 13, 2001, at 16:22:56

> By crushing the tablets you are increasing the surface area, making the drug easier to absorb.

Duh! Thank you for explaining this. I should have been able to figure it out myself (really, I think I should have known it from somewhere or other), but it's always nice when someone who has a real grasp of this stuff intervenes with the answer!

> You will notice a quicker effect by doing this, but the effect may not last as long.

Because the AUC remains fixed, right?

> This may just be a matter of symantics though, since the half-life of Klonopin is fairly long anyway (18h to 80h, depending on how your body pharmacokinetically handles the drug - ie. rate of absorption, distribution, metabolism and excretion).

My understanding is that the duration of action doesn't depend only on the half-life, but also on other factors such as volume of distribution. Still, clonazepam is a long-acting benzo (possibly the longest -- what do you think?) and even if you increase the rate of absorption, it's liable to be long-acting still.

> I know of people who are taking a quarter of a 0.5mg tablet daily for anxiety related to bipolar disorder, and this is enough for them.

0.125 mg? That's too weird. 1 mg is at typical daytime dose for me, 2 mg at bedtime; but for panic attacks, I need 2 mg of *Xanax* (and this is on an empty stomach) to get full relief. I knew that 0.5 wasn't that unusual, but when I hear of people taking 0.125 that just falls short of shocking.

> Benzodiazepine doses are very individualized

Isn't that the truth?!

> You want the drug to ease the anxiety; this does not mean that you necessarily have to "feel it", as in giving you a buzz, or in any way altering your perception. Ideally, a benzo should take the edge off without having you feel otherwise different.

Thank you -- this is what I was trying to say, but you said it much better.

-elizabeth

 

Re: klonopin 0.5

Posted by Cam W. on December 13, 2001, at 22:06:45

In reply to Re: klonopin 0.5 » Cam W., posted by Elizabeth on December 13, 2001, at 20:34:31

> > You will notice a quicker effect by doing this, but the effect may not last as long.
>
> Because the AUC remains fixed, right?

• Yes, the AUC for the individual.
>
> > This may just be a matter of symantics though, since the half-life of Klonopin is fairly long anyway (18h to 80h, depending on how your body pharmacokinetically handles the drug - ie. rate of absorption, distribution, metabolism and excretion).
>
> My understanding is that the duration of action doesn't depend only on the half-life, but also on other factors such as volume of distribution. Still, clonazepam is a long-acting benzo (possibly the longest -- what do you think?) and even if you increase the rate of absorption, it's liable to be long-acting still.
>
• Diazepam (Valium™), BTW whose main metabolite is oxazepam (Serax™ t1/2 = 5-15h), as well as the first benzodiazepine developed, chlordiazepoxide (Librium™), chlorazepate (Tranxene™), and flurazepam (Dalmane™) all have longer half-lives than clonazepam. Their half-lives are all on the order of 100h (including active metabolites).

• For the record, although it's not used much anymore (due to hangover effect), flurazepam is still one of the best hypnotics for those who have trouble staying asleep. Chlorazepate is wonderful for those with schizophrenia who have daytime anxiety problems, when nothing else works. Both are powerful benzos, though and can cause dependence problems with long term use. Chlordiazepoxide is still used during alcohol withdrawl (to help prevent DTs, I believe), as well being used to help a person to adjust to a life without booze (although there are some addiction concerns that I think are sometimes overstated, especially in those who are motivated to stop drinking). And Valium is Valium is Valium; it still is good, in a Prozac sense, to help wean those off of the shorter acting benzos.

> > I know of people who are taking a quarter of a 0.5mg tablet daily for anxiety related to bipolar disorder, and this is enough for them.
>
> 0.125 mg? That's too weird. 1 mg is at typical daytime dose for me, 2 mg at bedtime; but for panic attacks, I need 2 mg of *Xanax* (and this is on an empty stomach) to get full relief. I knew that 0.5 wasn't that unusual, but when I hear of people taking 0.125 that just falls short of shocking.
>
• The person I am referring to is being treated only with lithium for bipolar I (600mg Duralith qhs - sustained release); otherwise, perfectly functional. This person has tried a couple times to stop the clonazepam, but the anxiety always came back. The doc and I had shook our heads over this a few times. But hey, if it works, it works (I think that some of the anxiety may be psychological, but this person is holding a respectable, high paying job, and is good at it). You would never guess that mania almost destroyed this person's life.

- Cam

 

Re: klonopin 0.5 » Cam W.

Posted by Elizabeth on December 14, 2001, at 13:16:17

In reply to Re: klonopin 0.5, posted by Cam W. on December 13, 2001, at 22:06:45

> > Because the AUC remains fixed, right?
>
> • Yes, the AUC for the individual.

Of course.

> • Diazepam (Valium™), BTW whose main metabolite is oxazepam (Serax™ t1/2 = 5-15h), as well as the first benzodiazepine developed, chlordiazepoxide (Librium™), chlorazepate (Tranxene™), and flurazepam (Dalmane™) all have longer half-lives than clonazepam. Their half-lives are all on the order of 100h (including active metabolites).

Yes, exactly. (What about nordiazepam, BTW?)

> • For the record, although it's not used much anymore (due to hangover effect), flurazepam is still one of the best hypnotics for those who have trouble staying asleep.

Benzos aren't very good in general for chronic insomnia, though -- they tend to stop working after a while. What I'd like to see is a longer-acting variation on Ambien. As it is, I need 40 mg of Ambien each night to get a full, relatively uninterrupted night of sleep (20 mg at bedtime, another 20 when I wake up 4 or 5 hours later).

> Chlorazepate is wonderful for those with schizophrenia who have daytime anxiety problems, when nothing else works.

That's the one I think I'd want to try if I were going to take benzos around-the-clock. (Why schizophrenia in particular, out of curiosity?)

> Chlordiazepoxide is still used during alcohol withdrawl (to help prevent DTs, I believe), as well being used to help a person to adjust to a life without booze (although there are some addiction concerns that I think are sometimes overstated, especially in those who are motivated to stop drinking).

Librium is the benzo that you don't feel, even more so than Klonopin. I've talked to some people about this, including a couple of alcoholics: it's not particularly sedating, you don't feel it kick in, but it covers for benzo or alcohol withdrawal very well. As such, I think it probably has very little abuse potential.

> And Valium is Valium is Valium; it still is good, in a Prozac sense, to help wean those off of the shorter acting benzos.

But isn't Valium pretty short-acting (despite its long half-life and those of its active metabolites)?

> • The person I am referring to is being treated only with lithium for bipolar I (600mg Duralith qhs - sustained release); otherwise, perfectly functional.

Klonopin is something of a mood stabilizer too (although I didn't realize it was at that low a dose).

> This person has tried a couple times to stop the clonazepam, but the anxiety always came back. The doc and I had shook our heads over this a few times.

Yeah, with something like that, I'd wonder if the person had a problem metabolizing the drug, or something like that.

> But hey, if it works, it works (I think that some of the anxiety may be psychological, but this person is holding a respectable, high paying job, and is good at it).

By "psychological" you mean nonspecific/related to expectation effects, right? (Isn't anxiety in general "psychological?")

> You would never guess that mania almost destroyed this person's life.

I hope that one day someone will say something like that about me (substitute "depression" for "mania").

-elizabeth

 

Re: klonopin 0.5 » Elizabeth

Posted by Cam W. on December 14, 2001, at 17:26:35

In reply to Re: klonopin 0.5 » Cam W., posted by Elizabeth on December 14, 2001, at 13:16:17

Elizabeth

> What about nordiazepam, BTW?

• Sorry, I don't know this one, off the top of my head. Is it a metabolite of diazepam? I do know that "nor-" means "desmethyl-", which would be diazepam that is lacking a methyl group, making it more water soluble; and thus, easier to excrete. I do not know of any marketed product of nordiazepam, nor do I know anything of it's kinetics.
>

> > Chlorazepate is wonderful for those with schizophrenia who have daytime anxiety problems, when nothing else works.
>
> That's the one I think I'd want to try if I were going to take benzos around-the-clock. (Why schizophrenia in particular, out of curiosity?)
>
• Short answer: cause it worked before.
• I think that I see it used a lot in schizophrenia, but this may just be a quirk of the couple of psychiatrists, in my area, who use it. For example, I asked why it was used in someone with very severe PTSD and schizophrenia who is taking 900mg of Clozaril a day. This person (Q), is a refugee from a wartorn country (losing side), and maintains own apartment, has our social welfare system figured out, and "sends" money home (from a meager long term disabilities cheque). The doc told me Q's story, and said that 15mg of Tranxene in the morning relieved all of Q's PTSD symptoms (those that weren't controlled by the Clozaril). I had seen Q floridly psychotic, complete with persecutory delusions and audiovisual hallucinations. I saw Q two months later (after starting Clozaril and Tranxene) and the change was incredibly remarkable. I here that Q may be getting a paying job, but unfortunately the prescriptions medications cost approx. $3000.00/month, so Q cannot make too much money or will lose drug coverage < sigh >. Anyway, the doc told me that he gave Q Tranxene, because it had worked in a similar case that he treated, but it hadn't worked as well as it did for Q. It is nice to have a success story every now and then.

> But isn't Valium pretty short-acting (despite its long half-life and those of its active metabolites)?
>
• In the short term, maybe Valium seems to be short-acting, but once steady state is reached (approx. 7 days), a constant blood level and antianxiety effects and muscle relaxing effects seem to be maintained. The problem with Valium is that it may cause motor side effects at the initiation of therapy that disappear fairly quickly. Many people, especially in the 1960s equated the motor side effects, with therapeutic effect. When the motor stuff disappeared, they assumed the anti-anxiety stuff was returning, thus took more Valium until they were wobbly again....leading to addiction problems and then media hype, blah, blah, blah.

>
> By "psychological" you mean nonspecific/related to expectation effects, right? (Isn't anxiety in general "psychological?")
>
• Many would say that anxiety is psychological, but the more I learn about brain process and neural interconnections; the more I realize that there is no magic in the world. Nature does everything as simply as possible. As for anxiety, there are a number of routing problems (perhaps mainly in the neural circuits between the locus ceruleus and raphe nuclei). Therefore anxiety may have started as a psychological reaction to an event, but the brain has taken that "anxious" thought and translated it into an electrical signal, using neurons primarily of the serotonergic kind. This anxious thought was filtered through the thalamus to the frontalcortex and hypothalamus (and amygdala), with ongoing modifications via online processing in the hippocampus formation and it's connections, including information updates to the cerebellum and back, (with or without basal gangliar input). The anxious thought is not resolved and is stored in a layer (layer 3?, 5?) of the prefrontal cortex.

• In other words, I tend to look at psychologial reactions as biochemical influences on the electrical conduction along neurons. In the case of 0.125mg of clonazepam, if the effect is psychological, very similar (but probably not "exactly" the same) neural pathways and brain structures are active, as if the clonazepam dose were actually effective (ie you would see an enhancement of GABAergic-neuronal activity, resulting in decreases in electrical activity of the above anxiety circuits (and others).

> > You would never guess that mania almost destroyed this person's life.
>
> I hope that one day someone will say something like that about me (substitute "depression" for "mania").

• Me too, Elizabeth, me too. (Hey, I you've accomplished a lot for someone "dealt such a shitty hand". You truly know the meaning of hard work and perseverence. I'd like to work with you on producing a non-fictional tome, the ultimate look at mental illness from the inside...a Kay Jamison-like book, but on depression...and better written).

- Cam (investigator extrordinaire)
;0)

 

Dalmane » Cam W.

Posted by Daveman on December 14, 2001, at 20:17:58

In reply to Re: klonopin 0.5, posted by Cam W. on December 13, 2001, at 22:06:45

For the record, although it's not used much anymore (due to hangover effect), flurazepam is still one of the best hypnotics for those who have trouble staying asleep.

Cam:

This comment reminds me of my one and only experience with Dalmane. It was given to me back in about 1982 by an emergency room doc after I went there having not slept for three days (wish I'd known then I was suffering from panic/anxiety-sigh- but I digress:) Anyway, I have to agree that it was the most powerful hypnotic I ever took, but boy it did leave a hangover! The docs just don't seem to prescribe it anymore, instead they give Ambien (3.5 hr. half-life) or Sonata (1.5 hour half-life) with the result being the mid-night awakenings so frequently reported on this Board.

Dave

 

Elizabeth Cam

Posted by Phil on December 15, 2001, at 8:26:44

In reply to Re: klonopin 0.5 » Elizabeth, posted by Cam W. on December 14, 2001, at 17:26:35

I'll give you guys $25.00 now for a copy of the book.
Phil

> • Me too, Elizabeth, me too. (Hey, I you've accomplished a lot for someone "dealt such a shitty hand". You truly know the meaning of hard work and perseverence. I'd like to work with you on producing a non-fictional tome, the ultimate look at mental illness from the inside...a Kay Jamison-like book, but on depression...and better written).
>
> - Cam (investigator extrordinaire)
> ;0)

 

benzos 'n' stuff » Cam W.

Posted by Elizabeth on December 15, 2001, at 11:25:21

In reply to Re: klonopin 0.5 » Elizabeth, posted by Cam W. on December 14, 2001, at 17:26:35

> > What about nordiazepam, BTW?
>
> • Sorry, I don't know this one, off the top of my head. Is it a metabolite of diazepam?

Yes, and some other benzos too (Librium, Tranxene). I may have gotten the name wrong, though; for some reason it's spelled "nordazepam" in some places (I think it means the same thing, though: desmethyldiazepam). It's even marketed as a separate drug in other countries. It has a very long half-life. So Valium should be very long-acting -- but it's not (at least, not with a single use). Why not?

> • Short answer: cause it worked before.
> • I think that I see it used a lot in schizophrenia, but this may just be a quirk of the couple of psychiatrists, in my area, who use it.

Well, it [clorazepate, that is] seems like a fine drug. A friend of mine takes it (for anxiety) and says it's very long-lasting, which I think is always nice. I wonder what dose would be required for panic disorder, though.

> For example, I asked why it was used in someone with very severe PTSD and schizophrenia who is taking 900mg of Clozaril a day.

Oof, that's a nasty set of problems to have to face.

> This person (Q), is a refugee from a wartorn country (losing side), and maintains own apartment, has our social welfare system figured out, and "sends" money home (from a meager long term disabilities cheque).

Well, good for Q. I wish I could figure out *our* social welfare system (such as it is -- it's really mainly for disabled people and the extremely poor, and even then it's pretty meager) so I could get Medicaid (state-sponsored health insurance), but it's a tough battle.

> The doc told me Q's story, and said that 15mg of Tranxene in the morning relieved all of Q's PTSD symptoms (those that weren't controlled by the Clozaril). I had seen Q floridly psychotic, complete with persecutory delusions and audiovisual hallucinations. I saw Q two months later (after starting Clozaril and Tranxene) and the change was incredibly remarkable.

That's terrific! Although I wonder why Clozaril and not one of the atypicals.

> I here that Q may be getting a paying job, but unfortunately the prescriptions medications cost approx. $3000.00/month, so Q cannot make too much money or will lose drug coverage < sigh >.

That's a problem here, too: you go back to work, and even if it's only part-time, you might lose your benefits (and part-time employment seldom provides health care coverage).

> Anyway, the doc told me that he gave Q Tranxene, because it had worked in a similar case that he treated, but it hadn't worked as well as it did for Q. It is nice to have a success story every now and then.

Yeah, especially for someone who has illnesses that are so impairing. Gives me hope.

> • In the short term, maybe Valium seems to be short-acting, but once steady state is reached (approx. 7 days), a constant blood level and antianxiety effects and muscle relaxing effects seem to be maintained.

That makes sense. I don't hear of Valium being used constantly like that much, though -- the high-potency bzds seem to have largely replaced it. I guess that as a muscle relaxant it might be used that way still. I don't know. I tried it as a MR (for back pain) and wasn't impressed -- in fact, it seemed to have no effect at all (including side effects) up to 40 mg. But then, I'm weird.

> The problem with Valium is that it may cause motor side effects at the initiation of therapy that disappear fairly quickly. Many people, especially in the 1960s equated the motor side effects, with therapeutic effect.

Yes, it's like people today who assume their Klonopin isn't working because they can't "feel it kick in."

> • Many would say that anxiety is psychological, but the more I learn about brain process and neural interconnections; the more I realize that there is no magic in the world.

That was my point, really: I use the word "psychological" to refer to certain types of events that are experienced by the conscious mind, but really it's all "biological" in the end. Then there's the dichotomy between events related to external "experience" vs. events that come from inside ("endogenous" is the word some people use). I think this is largely misleading because there are really so many feedback loops between temperament (the ways in which a person tends to react to things, much of which most likely originates from inside the person) and external experience. And it's *all* biological: even the "placebo effect."

> In the case of 0.125mg of clonazepam, if the effect is psychological, very similar (but probably not "exactly" the same) neural pathways and brain structures are active, as if the clonazepam dose were actually effective (ie you would see an enhancement of GABAergic-neuronal activity, resulting in decreases in electrical activity of the above anxiety circuits (and others).

Again, I interpret "psychological" here to mean that the effect is caused not by the drug but by expectation, and that the neural processes underlying it are similar (though probably not identical) regardless. Am I totally missing it here, or are we on the same wavelength?

> > > You would never guess that mania almost destroyed this person's life.
> >
> > I hope that one day someone will say something like that about me (substitute "depression" for "mania").
>
> • Me too, Elizabeth, me too. (Hey, I you've accomplished a lot for someone "dealt such a shitty hand". You truly know the meaning of hard work and perseverence.

Well, thanks...I try. I don't see myself as having "accomplished a lot," though. I'm certainly nowhere near being the functional person I'd like to be.

> I'd like to work with you on producing a non-fictional tome, the ultimate look at mental illness from the inside...a Kay Jamison-like book, but on depression...and better written).

I never read any of Jamison's work. But yeah, that would be interesting -- I've always wanted to write a book, but I feel like I'm too mentally disorganized. Plus it would be neat to combine perspectives with another person who's experienced the same kind of stuff. It would be interesting to write it in the form of a dialogue.

I feel like it's important that physicians realize that patients today expect more and more to be taken seriously and treated with respect by their doctors, and that there really are those of us (perhaps 10-20% of depressives) who don't respond adequately to the standard medications and who need to be able to try more creative approaches. I guess those are the two main issues that are gnawing at me right now. What about you -- what kinds of specific subjects would you like to write about?

-elizabeth

 

Re: Dalmane

Posted by Elizabeth on December 15, 2001, at 11:33:07

In reply to Dalmane » Cam W., posted by Daveman on December 14, 2001, at 20:17:58

> The docs just don't seem to prescribe it anymore, instead they give Ambien (3.5 hr. half-life) or Sonata (1.5 hour half-life) with the result being the mid-night awakenings so frequently reported on this Board.

I thought that Roche took Dalmane off the market -- does anyone know for sure?

Anyway, my trick is to take Ambien twice a night -- once when I go to bed, and then again when I wake up in the middle of the night. (Unfortunately, I need 20 mg of Ambien -- 10 just doesn't do anything -- and you can imagine how eager most doctors are to prescribe 40 mg of Ambien per night.) Other people might do better to take Sonata after awakening again.

-elizabeth

 

Re: Dalmane » Elizabeth

Posted by Mitch on December 15, 2001, at 15:18:33

In reply to Re: Dalmane, posted by Elizabeth on December 15, 2001, at 11:33:07

> > The docs just don't seem to prescribe it anymore, instead they give Ambien (3.5 hr. half-life) or Sonata (1.5 hour half-life) with the result being the mid-night awakenings so frequently reported on this Board.
>
> I thought that Roche took Dalmane off the market -- does anyone know for sure?
>
> Anyway, my trick is to take Ambien twice a night -- once when I go to bed, and then again when I wake up in the middle of the night. (Unfortunately, I need 20 mg of Ambien -- 10 just doesn't do anything -- and you can imagine how eager most doctors are to prescribe 40 mg of Ambien per night.) Other people might do better to take Sonata after awakening again.
>
> -elizabeth

Hi Elizabeth,

Roche no longer makes Dalmane. However, Mylan is making generic flurazepam and it is available. I was given flurazepam in the early 80's and it worked great-especially if you have trouble with early morning awakenings associated with depression. The "hangover" wasn't that bad actually. However, beware of alcohol! You can drink a beer the next day in the afternoon and it will knock you on your ass!

Mitch

 

Re: Dalmane » Mitch

Posted by Elizabeth on December 15, 2001, at 19:47:44

In reply to Re: Dalmane » Elizabeth, posted by Mitch on December 15, 2001, at 15:18:33

> Roche no longer makes Dalmane. However, Mylan is making generic flurazepam and it is available.

Any other makers? I'm boycotting Mylan. :-)

> I was given flurazepam in the early 80's and it worked great-especially if you have trouble with early morning awakenings associated with depression.

I'm sure. I'm interested in something that will get me through the night, but benzos don't seem like the answer because of the tolerance issue. (I need something that will work long-term; although I do have additional problems when I'm depressed, sleep disruption is a chronic problem for me.)

-elizabeth

 

Re: Dalmane » Elizabeth

Posted by Mitch on December 16, 2001, at 9:01:50

In reply to Re: Dalmane » Mitch, posted by Elizabeth on December 15, 2001, at 19:47:44

> > Roche no longer makes Dalmane. However, Mylan is making generic flurazepam and it is available.
>
> Any other makers? I'm boycotting Mylan. :-)

Probably not, but it might be worth a call to your pharmacy.

>
> > I was given flurazepam in the early 80's and it worked great-especially if you have trouble with early morning awakenings associated with depression.
>
> I'm sure. I'm interested in something that will get me through the night, but benzos don't seem like the answer because of the tolerance issue. (I need something that will work long-term; although I do have additional problems when I'm depressed, sleep disruption is a chronic problem for me.)
>
> -elizabeth

You might ask your doc about adding a low-dose of a sedative TCA at bedtime (10mg amitripytline, doxepin) or try a little Remeron (3-4mg). Of course, the usually inevitable hang-over problems will probably happen and you might not like that. I know what you mean about the tolerance issue with benzos. The Klonopin I take at bedtime helps, but I just don't get as drowsy as I used to, though it keeps panic at bay just as effectively.

Mitch

 

Re: Dalmane » Mitch

Posted by Elizabeth on December 16, 2001, at 11:59:32

In reply to Re: Dalmane » Elizabeth, posted by Mitch on December 16, 2001, at 9:01:50

> You might ask your doc about adding a low-dose of a sedative TCA at bedtime (10mg amitripytline, doxepin) or try a little Remeron (3-4mg).

I may end up taking Remeron with the Effexor, in an AD dose (60 mg +). But anyway, all of those drugs are antihistamines, and every time I've tried to use an antihistamine as a hypnotic (e.g., atypical antipsychotics, trazodone, hydroxyzine), I've always rapidly become tolerant to the sedative effect.

> I know what you mean about the tolerance issue with benzos. The Klonopin I take at bedtime helps, but I just don't get as drowsy as I used to, though it keeps panic at bay just as effectively.

Klonopin, at the doses I take (1-2 mg), isn't sedating for me (I never found benzos very sedating), but it does help with sleep continuity which is really more what my problem is. It prevents "active dreaming" which is good since I don't know if Effexor will (it might even make it worse).

-elizabeth

 

RE: Benzo's -Cam, Elizabeth?

Posted by manowar on December 18, 2001, at 10:27:09

In reply to benzos 'n' stuff » Cam W., posted by Elizabeth on December 15, 2001, at 11:25:21

Hi guys,
I saw my pdoc yesterday, and thank the Lord; he gave me my Klonipin back. It is so hard to explain what the Klonipin does for me, but I’ll try my best. When I’m taking my Klonipin, it’s like I’m not always so preoccupied with how miserable I feel. It’s easier to get out of bed, to get dressed, to plan my day and to take action. For the last four weeks without my Klonipin, just getting out of bed, and taking a shower was a major undertaking. Doing ANYTHING made me completely miserable. I would just lie in bed all day. I didn’t want to read, talk to anyone, or even watch T.V. My tinitus was driving me insane. Noise of any kind irritated me.

Is this what a mood stabilizer does? I still don’t really understand completely what the definition of a mood stabilizer is. Any other mood stabilizer that I have tried put me in a fog, and diminished my cognitive abilities.

Also, it seems that the only times my depression has gone into remission, Klonipin was part of my drug regimen.

A few questions:
I presently take 1.5 mg a day of Klonipin. Would I get more of a benefit of the drug if I took a higher dose? What is the effective range of Klonipin to work as a mood stabilizer? I’ve heard that Klonipin can add to one’s depression, but I’ve also heard that it has AD properties—what gives?

I’ve always taken my dose at one time in the evening (because it makes me a bit drowsy, and it increases my appetite), and it seems to work well for me. However, my pdoc tells me that the drug looses its effect after 12 hours. Would I do better if I divided my dose?
How does Klonipin rank as a mood stabilizer?

Any links to refs would also be appreciated.

--Tim

 

Re: Benzos » manowar

Posted by Elizabeth on December 27, 2001, at 1:43:32

In reply to RE: Benzo's -Cam, Elizabeth?, posted by manowar on December 18, 2001, at 10:27:09

Hi Tim. Glad to hear that you're back on the Klonopin. Apologies for not writing; I haven't checked my Yahoo! account in a while because of the holidays.

It sounds like Klonopin does some of the same things for you that buprenorphine does for me, although benzos don't have that effect on me. (I'd be very pleased if they did: they don't seem to have any side effects for me.) I have trouble enjoying or feeling interested in things too, and buprenorphine helps a lot. None of the "mood stabilizers" I've taken (lithium, Depakote, Lamictal, etc.) has had this effect on me. (I didn't get side effects from them like you did, but they didn't have any beneficial effect, either.)

Mood stabilizers are just drugs that treat and prevent mania or hypomania, BTW. It sounds like you are *not* using Klonopin as a mood stabilizer.

> I presently take 1.5 mg a day of Klonipin. Would I get more of a benefit of the drug if I took a higher dose? What is the effective range of Klonipin to work as a mood stabilizer? I’ve heard that Klonipin can add to one’s depression, but I’ve also heard that it has AD properties—what gives?

It's hard to say if you would benefit from a higher dose of Klonopin. The anergic depression syndrome that you described (and that we share) hasn't been classified or studied much at all. Anergia can be a symptom of depression; it's also one of the negative (deficit) symptoms of schizophrenia.

You might be helped by taking more Klonopin; the only real way to find out is to try it. The effective dose can differ tremendously from person to person. When I've taken it (for panic disorder and REM sleep behavior disorder) I've found 4 mg/day (1 in the morning, 1 in the afternoon, 2 at bedtime) to be the best dose for me, but some people get by on much less and some take quite a bit more.

> I’ve always taken my dose at one time in the evening (because it makes me a bit drowsy, and it increases my appetite), and it seems to work well for me. However, my pdoc tells me that the drug looses its effect after 12 hours. Would I do better if I divided my dose?

You could try it. Like I said, there isn't much information out there about the problem that you have, so you're pretty much stuck experimenting on yourself. Be thankful you've found something that works.

Best of luck to you!

-elizabeth

 

Re: Benzos » Elizabeth

Posted by manowar on December 31, 2001, at 16:19:34

In reply to Re: Benzos » manowar, posted by Elizabeth on December 27, 2001, at 1:43:32

Happy New Year Elizabeth,

I want to thank you for all the support you've given others and me on this site. I certainly appreciate it. --Now, no need to blush:)

> Hi Tim. Glad to hear that you're back on the Klonipin. Apologies for not writing; I haven't checked my Yahoo! Account in a while because of the holidays.
>
> It sounds like Klonipin does some of the same things for you that Buprenorphine does for me, although benzos don't have that effect on me. (I'd be very pleased if they did: they don't seem to have any side effects for me.) I have trouble enjoying or feeling interested in things too, and Buprenorphine helps a lot. None of the "mood stabilizers" I've taken (lithium, Depakote, Lamictal, etc.) has had this effect on me. (I didn't get side effects from them like you did, but they didn't have any beneficial effect, either.)

I guess the Klonipin works by generally calming my brain down by balancing the different sections out. I just don't know, but I do know this: It's my headliner, and it will be for the foreseeable future. They say that Klonipin can cause depression, but there has also been speculation that it has AD properties. I guess it’s different for different folks. I think part of my problem maybe GABA related –my pdoc agrees.

>
> Mood stabilizers are just drugs that treat and prevent mania or hypomania, BTW. It sounds like you are *not* using Klonipin as a mood stabilizer.

But they also can calm the Temporal Lobes, right? Aren't most mood stabilizers- anti-convulsants? Don't mood stabilizers also have AD properties? Esp. when used as augmenting agents?

> > I presently take 1.5 mg a day of Klonipin. Would I get more of a benefit of the drug if I took a higher dose? What is the effective range of Klonipin to work as a mood stabilizer? I’ve heard that Klonipin can add to one’s depression, but I’ve also heard that it has AD properties—what gives?

> It's hard to say if you would benefit from a higher dose of Klonipin. The anergic depression syndrome that you described (and that we share) hasn't been classified or studied much at all. Anergia can be a symptom of depression; it's also one of the negative (deficit) symptoms of schizophrenia.

Ironic you mention that. I was wondering if I might have sub clinical schizophrenia since I seem to have many of the negative symptoms. I asked my pdoc and he told me that schizophrenics don't cycle.

> You might be helped by taking more Klonipin; the only real way to find out is to try it. The effective dose can differ tremendously from person to person. When I've taken it (for panic disorder and REM sleep behavior disorder) I've found 4 mg/day (1 in the morning, 1 in the afternoon, 2 at bedtime) to be the best dose for me, but some people get by on much less and some take quite a bit more.

Thanks for the suggestion. I brought it up with my pdoc, and he suggested that I try augmenting the Klonipin with ?Clonzopine? (I forget the name-I haven’t gotten the script filled yet). He seems reluctant to add to the 1.5 mg a day dosage for the Klonipin. He thinks the Klonipin may be helping by improving my sleep and R.E.M. sleep, therefore working against my depression.—Interesting huh?

> > I’ve always taken my dose at one time in the evening (because it makes me a bit drowsy, and it increases my appetite), and it seems to work well for me. However, my pdoc tells me that the drug looses its effect after 12 hours. Would I do better if I divided my dose?
>
> You could try it. Like I said, there isn't much information out there about the problem that you have, so you're pretty much stuck experimenting on yourself. Be thankful you've found something that works.

I am, I am!

And I'm glad my pdoc isn't a benzophobe!

> Best of luck to you!
>
> -elizabeth

Thanks again,
--Tim


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