![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 26. This is the beginning of the thread.
Posted by Mr. Cushing on September 30, 2002, at 0:34:16
Hey all, I've been suffering from an anxiety disorder now for pretty much my whole life. I really didn't notice it untill about 5 months ago when it began to completely control my life. It's a constant anxiety and since I've had it for at least the last 10 years I know it's not GAD. I have panic attacks on my bad days and my good days I'm still completely on edge. I also suffer from chronic insomnia. So 5 months ago I decided that it was time I either get some help or I would go completely nuts and lose my mind.So first my doctor placed me on 50mg of Trazadone. Worked great for sleeping, did nothing to help me during the days.
Then my doctor decided to add Paxil (30mg) to the mix. I lasted for 3 months on that, I'm a fighter, believe me, but it made me into a zombie. All I was able to do was lie there on the couch and "pretend" like I was watching TV.
Then I was placed on Effexor XR. This is an amazing drug IF you're not as screwed up as I am. I feel great on this medication, no anxiety whatsoever. The bad part, I've got SEVERE insomnia again. Put it this way, at the moment I'm on 100mg of Trazadone (had to increase my dosage because of Effexor) and .25 of Clonazepam (was given this at the very beginning of my treatment in case I had a panic attack or was just too wound up). It's about 2:00am and I'm still WIDE awake.
So are there any medications that any of you people could suggest that might help me? I've been seeing good things about Lexapro for anxiety, did this work for anybody? Does it give you really bad insomnia like Effexor?
I'm going to thank you in advance for anybody that spends time reading my problem and actually provides some advice. This has to rate up there with one of the most depressing/frustrating periods of my life and I've done a lot of living so far.
Posted by viridis on September 30, 2002, at 2:51:12
In reply to Anxiety Disoder Medication, PLEASE help, posted by Mr. Cushing on September 30, 2002, at 0:34:16
If your problem is primarily anxiety, then you might talk to your doctor about benzodiazepines -- Klonopin, Xanax, Ativan, etc. A lot of doctors are afraid of these drugs because they're supposedly "addictive", but for people with genuine anxiety disorders (like me) they can work wonders, and are very safe if used as directed. I notice you're on an extremely low dose of Klonopin (clonazepam) -- maybe you could ask your doctor to increase the dose, and just try this for a while. Although individuals vary, the general consensus is that the real anti-anxiety effects kick in around 1 mg/day or so.
I had a terrible time with standard antidepressants like Prozac, Zoloft, Wellbutrin, etc., but Klonopin has been wonderful (1 mg/day, plus some other drugs for mood stability and ADD, but I think Klonopin is the cornerstone) . Xanax also helps me for occasional breakthrough anxiety.
The key is to find a doctor who really understands anxiety disorders (a psychiatrist or psychopharmacologist would be best). Of the benzos, doctors tend to be least afraid to prescribe Klonopin, and it's been the best benzo (for me) so that's the one I'd ask about first. It might be the answer (and you've already taken it, just at a very low dose), so it's certainly worth a try if you can get a higher-dose prescription.
Again, I stress that seeing a psychiatrist/psychopharmacologist is crucial. A lot of GPs are irrationally averse to prescribing benzos, even though for many people, they're the best anti-anxiety drugs around, with the fewest side effects.
Posted by JLM on September 30, 2002, at 7:25:38
In reply to Re: Anxiety Disoder Medication, PLEASE help, posted by viridis on September 30, 2002, at 2:51:12
> If your problem is primarily anxiety, then you might talk to your doctor about benzodiazepines -- Klonopin, Xanax, Ativan, etc. A lot of doctors are afraid of these drugs because they're supposedly "addictive", but for people with genuine anxiety disorders (like me) they can work wonders, and are very safe if used as directed. I notice you're on an extremely low dose of Klonopin (clonazepam) -- maybe you could ask your doctor to increase the dose, and just try this for a while. Although individuals vary, the general consensus is that the real anti-anxiety effects kick in around 1 mg/day or so.
>
> I had a terrible time with standard antidepressants like Prozac, Zoloft, Wellbutrin, etc., but Klonopin has been wonderful (1 mg/day, plus some other drugs for mood stability and ADD, but I think Klonopin is the cornerstone) . Xanax also helps me for occasional breakthrough anxiety.
>
> The key is to find a doctor who really understands anxiety disorders (a psychiatrist or psychopharmacologist would be best). Of the benzos, doctors tend to be least afraid to prescribe Klonopin, and it's been the best benzo (for me) so that's the one I'd ask about first. It might be the answer (and you've already taken it, just at a very low dose), so it's certainly worth a try if you can get a higher-dose prescription.
>
> Again, I stress that seeing a psychiatrist/psychopharmacologist is crucial. A lot of GPs are irrationally averse to prescribing benzos, even though for many people, they're the best anti-anxiety drugs around, with the fewest side effects.I would strongly disagree that benzo's have few side effects. So does Wyeth, the original manufacturer of Ativan. Since all benzo's are basically similar this information should be valid for all of them:
"PATIENT INFORMATION LEAFLETLORAZEPAM TABLETS
GENUS PHARMACEUTICALS
A Wyeth CompanyPlease read this leaflet carefully before you start to take your medicine. It provides important information about your medicine. If you have any questions or are not sure about anything, ask your doctor or pharmacist.
WHAT IS IN YOUR MEDICINE?
The name of your medicine is Lorazepam Tablets. The capsule-shaped tablets come in two strengths: blue tablets containing 1mg of the active ingredient lorazepam or yellow tablets containing 2.5mg lorazepam.
Lorazepam Tablets also contain lactose (67mg per 1mg tablet; 65.5mg per 2.5mg tablet), microcrystalline cellulose, polacrilin potassium, magnesium stearate and the following colouring: Blue tablet: indigo carmine, El3Z; Yellow tablet: tartrate, E102.
Both the 1mg and the 2.5mg tablets are supplied in packs of 100 tablets. However, your doctor may prescribe a different number of tablets for you.
Lorazepam is a member of a group of medicines called benzodiazepines. It can help to relieve anxiety.
MARKETING AUTHORISATION HOLDER: Genus Pharmaceuticals, Huntercombe Lane South, Taplow, Maidenhead, Berkshire SL6 0PH.
MANUFACTURER: Wyeth Medica Ireland, Little Connell, Newbridge, Co. Kildare, Republic of Ireland.
WHAT DOES YOUR MEDICINE DO?
Lorazepam is prescribed as short-term therapy for anxiety, or sleeping difficulties due to anxiety. It may also be used as a sedative before surgery or operative dental treatment.
BEFORE YOU TAKE YOUR MEDICINE
YOU SHOULD NOT TAKE LORAZEPAM IF:
You have severe breathing a chest problems.
You are allergic to benzodiazepines or any of the ingredients in Lorazepam Tablets (see the list under "What is in your medicine").
You have "myasthenia gravis" (very weak or tired muscles).
You have serious liver problems.
You suffer from "sleep apnoea" (breathing problems when you are asleep).
You are breast feeding, since the drug may pass into breast milk.
TELL YOUR DOCTOR OR PHARMACIST IF:
You are pregnant or trying to become pregnant (see below).
You abuse or have in the past abused drugs or alcohol.
You have a personality disorder If so, you have a greater chance of becoming dependent on lorazepam.
You have any kidney or liver problems.
You have suffered from depression before since it could re-occur during treatment with lorazepam. You are suffering from depression, since lorazepam may increase any suicidal feelings which you may have.
You suffer from breathing problems.
You suffer from an eye problem called glaucoma.
You are taking any other medicines, including those which have not been prescribed a doctor, since they may affect the way Lorazepam works. Lorazepam may also affect the way other drugs work.
In particular, you should tell your doctor if you are taking any other sedative, anti-anxiety drugs, antidepressants, strong pain killers (e.g. methadone), drugs for epilepsy antihistamines, drugs for mood or mental disorders (e.g. chlorpromazine), loxapine or clozapine. The dose of these drugs may need to be reduced before you can take Lorazepam.
Benzodiazepines, including Lorazepam, may cause damage to the foetus if taken during early pregnancy. Therefore, do not take this medicine if you are pregnant or might become pregnant without consulting your doctor. If you take this medicine during late pregnancy or during labour, your baby, when born, may be less active than other babies, have a low body temperature, be floppy, or have breathing or feeding difficulties for a while. Your baby's response to the cold might be temporarily impaired also. If this medicine is taken regularly in late pregnancy, your baby may develop withdrawal symptoms after birth.
The 2.5mg Lorazepam Tablet contains the colour tartrazine (E102) which can cause allergic reactions, including asthma. Allergy to tartrazine is more likely if you are also allergic to aspirin. Each tablet also contains the equivalent of 0.25mg of potassium. Too much potassium may be harmful if you are on a low potassium diet.
THINGS TO NOTE BEFORE TAKING YOUR MEDICINE
Tell your doctor or pharmacist that you are taking Lorazepam before taking any other medicine or if you enter hospital for treatment.
Some people feel sleepy or drowsy during the day when taking Lorazepam. Do not drive or use machinery until you are sure you are not affected.
You should avoid alcohol while you are taking Lorazepam, since this may make you very drowsy. The beneficial effect of Lorazepam may be less apparent after several weeks of use. If you are given Lorazepam for more than 4 weeks, your doctor might want to take blood samples occasionally to check your blood and liver, since drugs like Lorazepam have occasionally affect blood and liver function.
Lorazepam is usually prescribed for short courses of treatment, lasting from a few days to 4 weeks including a dose reduction at the end. This reduces the risk of becoming dependent on Lorazepam, or suffering unpleasant effects when you stop taking it (See "Stopping Your Medicine", below).
TAKING YOUR MEDICINE
Your doctor will tell you how many tablets to take, and how often to take them. The label on your medicine should also tell you. However, if it doesn't, or you are not sure, ask your doctor or pharmacist (chemist).
If you have been given Lorazepam tablets for anxiety or sleeping problems, treatment will usually last from a few days to 4 weeks and will usually include a dose reduction at the end.
Lorazepam tablets should be swallowed with water.
Adults (and children over 13 years of age):
Anxiety: 1 to 4mg daily in divided doses. Your doctor will tell you how often to take your tablets.
Sleeping Problems: 1 to 2mg before going to sleep. You should make sure that you will be able to sleep for 7 to 8 hours before taking your tablets.
Before Surgery: 2 to 3mg the night before your operation and 2 to 4mg one or two hours before your operation.
Children (between 5 and 13 years of age):
Before Surgery: The dose is usually between 0.5 and 2.5mg (depending on your child's weight) at least one hour before your child's operation.
Lorazepam is not recommended for the treatment of anxiety or sleeping problems in children. Nor is it recommended for children below 5 years of age.
Elderly: Older patients may be given lower doses. They may respond to half the usual adult dose or less.
WHAT TO DO IF YOU FORGET TO TAKE A TABLET
If you forget to take a tablet for anxiety, you should take it as soon as you remember if it is less than 3 hours since your usual time. If more than 3 hours has passed from when you usually take your tablet, don't worry, just take your next tablet when it is due.
NEVER TAKE A DOUBLE DOSE OF TABLETS
If you forget to take a tablet for sleeping problems, only take it if you will be able to sleep for 7 to 8 hours afterwards.
WHAT TO DO IF YOU TAKE TOO MANY TABLETS
If anyone has an overdose of Lorazepam tablets (that is more than the doctor has prescribed) seek medical help immediately, either by calling your doctor, or going to the nearest casualty department. Always take the labelled medicine container with you, even if there are no tablets left.
STOPPING YOUR MEDICINE
After you have finished your prescribed treatment with Lorazepam, your doctor will decide whether or not you need further treatment.
The number of Lorazepam Tablets and how often you take them should always be reduced slowly before you stop taking them altogether. This allows your body to get used to being without your tablets, and reduces the risk of unpleasant effects when you stop taking them. Your doctor will tell you how to do this.
On stopping Lorazepam, you may experience symptoms such as headaches, muscle pain, anxiety, tension, depression, restlessness, sweating, confusion or irritability. Your original sleeplessness may also return. If you suffer from any of these symptoms, ask your doctor for advice.
Do not stop taking your tablets suddenly. This could lead to more serious symptoms such as a loss of the sense of reality, feeling unreal or detached from life, and unable to feel emotion. Some patients have experienced numbness or tingling of the arms or legs, vomiting, tinnitus (ringing sounds in your ears), twitching, hallucinations, convulsions and hypersensitivity to light, sound and touch. If you suffer from any of these symptoms, ask your doctor for advice immediately.
THINGS TO BE AWARE OF WHILST TAKING YOUR MEDICINE
Occasionally, you may have unwanted effects whilst taking Lorazepam. These are usually not serious and do not last long. However, you should tell your doctor if any of the following symptoms are severe or become troublesome:
daytime drowsiness
dizziness
reduced alertness
sleep problems
confusion, depression
memory loss or forgetfulness
numbed emotions, fatigue
muscle weakness
poor muscle control
stomach upsets, nausea, changes in appetite
headaches
problems with vision
skin problems
changes in sex drive
If you experience any of the following more rare unwanted effects, you should tell your doctor immediately. (These effects are more likely to occur in children and elderly patients):
restlessness
agitation
irritability
aggressiveness
violent
anger
nightmares
hallucinations
personality changes
abnormal behaviour or false beliefs
You should tell your doctor or pharmacist if you have any other unwanted effect not mentioned above.
Other rare unwanted effects (which you may not be aware of whilst taking Lorazepam) include blood or liver function changes, or low blood pressure.
STORING YOUR MEDICINE
You should not take Lorazepam after the expiry date shown on the label.
Lorazepam Tablets should be kept in a cool, dry place. They should be stored safely, where children cannot see or reach them.
Return any unused tablets to your pharmacist. Only keep them if your doctor tells you to.
REMEMBER this medicine is only for YOU. Only a doctor can prescribe it for you. Never give it to anyone else. It may harm them, even if their symptoms are the same as yours.
Leaflet prepared: 21 January 1998 · CI 5682-1"
Care to see something extremely humorous in a morbid sort of way? Its an old advertisement for Ativan:
http://www.benzo.org.uk/images/ativan77.jpg
More benzo info at:
http://www.benzo.org.uk/bdi.htm
Posted by viridis on September 30, 2002, at 10:07:32
In reply to Re: Anxiety Disoder Medication, PLEASE help, posted by JLM on September 30, 2002, at 7:25:38
Of course benzos can have side effects, just like almost any other medications. For me, these were mild and disappeared completely in a couple of weeks. And, there's no doubt that regular use can produce dependency, so that if one wants to go off them after an extended period of use, it should be done gradually. A few people do even become "addicted" to them. But the latter is very rare for those with real, biologically-rooted anxiety disorders. The fact remains that this group of drugs has been proven extremely safe and (as has been pointed out ad nauseum on this forum) a World Health Organization review of decades of studies shows that short and long-term use of drugs in this class is safe and warranted in many cases.
Numerous antidepressants (e.g., Effexor, SSRIs such as Paxil, Zoloft, etc.) have been shown to cause severe "discontinuation syndomes" for some users. These drugs are great for some patients, but others (like me) experience very serious side effects that don't diminish over time. Lifestyle changes etc. can also help tremendously in some cases of anxiety, but some people just need benzos to get their brain chemistry back to normal.
Showing a package insert that lists all the possible side effects of a medication is rather alarmist, and potentially misleading -- I could pull out the insert for almost any prescription drug (and most over-the-counter ones too) and find some small percentages of people who had all sorts of scary-sounding reactions. Of course you should be aware of these possibilities (and that's one of the reasons you have to get a prescription from a doctor), but if you want to go this route, you might as well avoid all medication of any kind altogether.
Finally, I've found sites such as benzo.org.UK very one-sided, and the horror stories they relate simply don't square with my experiences or those of others I know. No drug is completely safe, and few are totally free of side effects, but I'd take benzos over SSRIs etc. any day, and there are many others here who would agree. Living with severe anxiety is incredibly draining, unproductive, and I'm sure has long-term health consequences of its own. It's important to rationally explore the full range of treatment options (including benzos) and get well as soon as possible.
Posted by BrittPark on September 30, 2002, at 11:52:18
In reply to Re: Anxiety Disoder Medication, PLEASE help, posted by viridis on September 30, 2002, at 10:07:32
Posted by FredPotter on September 30, 2002, at 16:26:58
In reply to Anxiety Disoder Medication, PLEASE help, posted by Mr. Cushing on September 30, 2002, at 0:34:16
I find Zopiclone good for sleep
Posted by FredPotter on September 30, 2002, at 16:29:45
In reply to Re: Anxiety Disoder Medication, PLEASE help, posted by viridis on September 30, 2002, at 2:51:12
> Again, I stress that seeing a psychiatrist/psychopharmacologist is crucial. A lot of GPs are irrationally averse to prescribing benzos
so are psychiatrists
Posted by FredPotter on September 30, 2002, at 16:34:53
In reply to Re: Anxiety Disoder Medication, PLEASE help, posted by viridis on September 30, 2002, at 10:07:32
I agree with you. It has been said they are "amongst the safest drugs in the whole of medicine". One point I should add - for me, they don't really work. Other myths: TCAs have more side effects that SSRIs
Posted by McPac on September 30, 2002, at 16:41:07
In reply to Anxiety Disoder Medication, PLEASE help, posted by Mr. Cushing on September 30, 2002, at 0:34:16
I had your exact same situation and low-dose Remeron (7.5-15mg/nighttime) helped my severe anxiety A LOT!!!
p.s. the low-dose Remeron works great for sleep; higher doses, in general, do not work as well for sleep.
Posted by Dinah on September 30, 2002, at 19:30:37
In reply to Re: Anxiety Disoder Medication, PLEASE help, posted by JLM on September 30, 2002, at 7:25:38
I need to go dig out my antibiotic package insert out of the trash. Now that's a scary one. But it doesn't occur to me not to take an antibiotic.
It wouldn't occur to me not to take my Klonopin either. I vary between .5 and 1.5 mg a day with no problem at all. I stopped it once completely, with less problems than Luvox. And while my doctor doesn't want me stopping it without tapering, in the past I have quit taking it on the days I didn't feel I needed it.
Everyone is different and some people might have more problems than others with klonopin. Same is true of everything else from peanut butter to iodine. My poor mother can't eat seafood anymore because of a severe reaction to the iodine in it. All those warnings and disclaimers on iodine tests were made for her. But that doesn't mean that millions of people can't successfully use iodine for imaging tests.
Posted by viridis on September 30, 2002, at 22:21:47
In reply to Re: Anxiety Disoder Medication, PLEASE help, posted by FredPotter on September 30, 2002, at 16:29:45
> Again, I stress that seeing a psychiatrist/psychopharmacologist is crucial. A lot of GPs are irrationally averse to prescribing benzos
so are psychiatrists
**********
You're right -- I just think the chances of a psychiatrist being rational and educated about benzos are greater, although I agree that many psychiatrists aren't.
The other thing (my subjective impression only) is that a psychiatrist who is reasonable about benzos is also more likely to consider their use for long-term maintenance. Some GPs may prescribe benzos, but my experience is that they tend to be of the "short-term use only" mindset, fearing that the patient will become "addicted". Yet, some people really need benzos long-term.
I guess it all hinges on finding an open-minded psychiatrist (or GP), which may take some trial and error.
Posted by McPac on September 30, 2002, at 22:38:57
In reply to Re: Anxiety Disoder Medication, PLEASE help » JLM, posted by Dinah on September 30, 2002, at 19:30:37
In my prior post, I meant to say that the low-dose Remeron works great for my severe sleep problem...NOT for severe anxiety!!!
Posted by Alan on September 30, 2002, at 23:10:05
In reply to Anxiety Disoder Medication, PLEASE help, posted by Mr. Cushing on September 30, 2002, at 0:34:16
For heavens sake. www.benzo.org is one of the most notorious anti-benzo groups on the planet. Their hyprbole is reminiscent of tabloid journalism.
If you want unbiased information that is NOT politically or moralistically oriented and deals with something other than psudeo-science, find yourself a doctor that understands these medications and how they are to be managed.
It may take a while to find an enlightened one but you deserve to treat yourself with no less respect. If you are worried about the "A" word (addiction) read my next post as to the actual science behind the myth.
It seems as if it's going to take forever to re-legitimise these drugs now that AD's are so commercially driven.
I guess every drug has it's own life cycle.
Alan
Posted by Alan on September 30, 2002, at 23:14:33
In reply to Anxiety Disoder Medication, PLEASE help, posted by Mr. Cushing on September 30, 2002, at 0:34:16
Please read about the very important distinction between "addiction" and "medical dependence" in this excellent article.
If your doc doesn't understand this basic concept, fire them until you find someone that does. You deserve better. It's commonly accepted practice - especially by those docs that specialise in treating anxiety disorders.
http://panicdisorder.about.com/library/weekly/aa031997.htm
Best,
Alan
Posted by Alan on September 30, 2002, at 23:18:20
In reply to Anxiety Disoder Medication, PLEASE help, posted by Mr. Cushing on September 30, 2002, at 0:34:16
You may want to read an excellent post by our own elizabeth on the subject.
http://www.dr-bob.org/babble/20010618/msgs/67768.html
Happy reading.
Alan
Posted by MattDDS on September 30, 2002, at 23:32:04
In reply to Re: Anxiety Disoder Medication, PLEASE help, posted by viridis on September 30, 2002, at 10:07:32
I agree with viridis. For many people (myself included), benzos are vastly superior to any antidepressant for anxiety. Worry about addiction, etc. in most cases is unwarranted, and sometimes downright ridiculous. In my experience, Paxil withdrawal was **much** worse than withdrawing from any benzo! BTW, an interesting question: Why, with SSRI's, do they call it "discontinuation syndrome" (notice the benign connotation), while with benzos, it is "addiction" or "withdrawal"? Just an observation.
After a number of years of going through the antidepressant wringer, I have wound up on p.r.n. Klonopin. On average I will take it 3 times per week. Sometimes, when I am having a particularly difficult week, I will take more. This has worked for months to keep me quite stable.
For me, benzos have a somewhat curative effect. Seriously! If I try too long to "tough it out" without good relief from Klonopin, letting an anxiety spell drag on for too long, I become depressed. And we all know that depression drags in a whole other world of problems. Anyone else get this?
Viridis, how long have you taken Klonopin? Does it still retain it's magical effect on anxiety over time? Or do you find your dose escalating?
Great discussion guys. IMHO, the benzos are among the few drugs that REALLY get the job done.
Matt
Posted by octopusprime on October 1, 2002, at 1:04:19
In reply to Re: Anxiety Disoder Medication, PLEASE help » Mr. Cushing, posted by FredPotter on September 30, 2002, at 16:26:58
> I find Zopiclone good for sleep
my mileage on Zopiclone (Imovane) was not nearly as good as yours.
i didn't feel rested, and it's not really recommended for long term use. they taste nasty, too. i think i lasted a month before they brought out the big guns to cure the insomnia.
i think something a bit stronger might be in order for our anxious friend. i have depression w/anxiety, take celexa + seroquel (20 mg morning /12.5 mg night respectively). might help.
best of luck.
Posted by viridis on October 1, 2002, at 1:56:43
In reply to Re: Viridis, I think you're right on the money. » viridis, posted by MattDDS on September 30, 2002, at 23:32:04
Hi Matt,
I've been using Klonopin (1 mg/day) for a little over a year, so I'm not exactly a seasoned veteran. But I am a 30+ year "veteran" in terms of anxiety and depression -- I can remember feeling severely anxious and depressed when I was 7 years old, and from then on, on a regular basis. I've tried various ADs etc. over the last 12 years or so, usually with serious, unrelenting side effects. Klonopin (and Xanax) were the first drugs that provided real relief.
I started Klonopin at 1 mg/day and have stayed at that dose for the last 13 months. It still has the same anxiolytic effect, with no side effects that I can detect. My pdoc has asked several times if I needed to increase the dose (he's quite willing to do so), because when I first saw him my anxiety level was sky-high, I was having frequent panic attacks, and was seriously depressed. But so far I've declined, because the same dose continues to work well, just as it did initially.
I do take other meds; I take 0.25-0.5 mg Xanax once a week or so (or less often; it depends) for especially stressful situations, and I take 1200 mg Neurontin/day for mood stability (I'm not sure that the latter really does anything, but it has no side effects so I'm staying on it for now). I also take 5-10 mg Adderall/day for mild ADD. The Neurontin and Adderall were added after the benzos, because I still had some mood problems (plus the probable ADD). But Klonopin stopped the anxiety dead in its tracks, before I started the other meds.
I agree that anxiety can lead to depression, which in my case was often severe -- I had very intense, recurrent depresion for years, and it almost always started with a major bout of anxiety. SSRIs, Wellbutrin, etc. did little to help and caused intolerable side effects.
After beginning Klonopin, mild depression was still a problem, but nothing like before. Adderall (and maybe the Neurontin, a bit) has pretty much ended the depression and allowed me to focus better. But I think that Klonopin is the key, with the other meds just helping with "fine tuning".
I may be dependent on Klonopin by now, but so far no dose increases have been necessary, and if I have to stay on it the rest of my life I will.
P.S. I also agree with you about the "discontinuation syndrome" thing with the newer ADs -- funny how this term is never used with benzos, which for many people are easier to stop. I wonder if the term will continue to be used once they too go off-patent and brand-new meds are introduced?
Posted by McPac on October 1, 2002, at 8:28:48
In reply to Re: Viridis, I think you're right on the money. » MattDDS, posted by viridis on October 1, 2002, at 1:56:43
Do you (or did you) ever have terrible anger/temper/irrit/agitation problems and did the klonopin work for that?
Thanks.
Posted by viridis on October 1, 2002, at 11:24:01
In reply to Viridis, posted by McPac on October 1, 2002, at 8:28:48
Hi McPac,
I've never had much problem with anger, at least not outwardly (i.e., toward other people). I guess I could say I was often angry with myself, though. When I do (rarely) get angry at someone, it's usually measured, short-lived, and justified; this is true on or off meds. But pre-Klonopin I did experience intense frustration, obsessive worry, panic attacks, and periods of uncontrollable agitation and insomnia, regularly leading to severe depression. Overall, I'd say I was often "hyperreactive" -- small setbacks would seem like the end of the world and could send me into a tailspin.
I don't experience any of this with Klonopin, and it doesn't dull me out either, just makes me feel normal. A small dose of Adderall also helps smooth things out and got rid of the residual mild depression that remained after I started K.
BTW, during the brief period when I was taking Zoloft (at a tiny dose), I did have frequent bouts of bizarre, irrational anger. That ended as soon as I stopped the Zoloft.
Posted by McPac on October 1, 2002, at 13:12:56
In reply to Re: Viridis » McPac, posted by viridis on October 1, 2002, at 11:24:01
Viridis "BTW, during the brief period when I was taking Zoloft (at a tiny dose), I did have frequent bouts of bizarre, irrational anger. That ended as soon as I stopped the Zoloft."
>>>>>>>>>While you were on the Zoloft, was your anger 'explosive' (rage-like), sometimes from out of nowhere or sometimes over something that you knew was insignificant?
I have wondered myself if my Zoloft was actually causing my anger/irrit.
Posted by MattDDS on October 1, 2002, at 13:22:53
In reply to Re: Viridis, I think you're right on the money. » MattDDS, posted by viridis on October 1, 2002, at 1:56:43
Viridis (and other benzophiles),
It may be that I have selective attention for posts about success with Klonopin (or other benzos), but it almost seems like there is (in my extremely humble opinion) a subgroup of anxious / depressed patients for which benzos work almost miraculously for both anxiety and depression.
I have noticed this pattern: I start with a bout of severe anxiety and panic attacks, seemingly out of the blue. If this goes untreated, severe depression follows. The depression seems to stem from a hopeless perspective about the anxiety itself, and not necessarily about other events in my life. However, this does not imply that my depression is mild. Most psychiatrists would be more worried about my depression, and would tend (as they have until recently) to overlook the anxiety as a result of rather than a potential cause of my depression. I take the Beck Depression Inventory and my scores indicate severe depression. I even go on to develop the melancholic type with loss of libido, of interest and of appetite. The weird thing is antidepressants do not help, but worsen my depression. I imagine this is because SSRIs tend to cause anxiety as a side effect. However, a benzo stops this cycle starting with dose 1. A near miraculous effect for me!
Meanwhile, there are others (possibly representing another subgroup) who report intolerable side effects and worsened depression while taking benzos. For me, benzos have ZERO side effects. Better yet, they make me feel more energetic and motivated, yet calm at the same time. My sleep improves, even if I took them many hours before bedtime.
My point? Maybe there are two potential subtypes of depression. One that exists on it's own, and one that results from untreated anxiety. The former might tend to do better on AD's while the latter, better on benzos. Obviously there are many other types, and this is all my wacko speculation. But if this is true and benzos work for others on DEPRESSION like they do for me, it is extremely unfortunate that they are so often avoided because of unfounded fears of "addiction" and "tolerance" ( which is a whole other "babble").
Anyone feel the same way?
Matt
Posted by McPac on October 1, 2002, at 13:50:28
In reply to Re: Viridis, I think you're right on the money. » viridis, posted by MattDDS on October 1, 2002, at 13:22:53
That all makes perfectly logical and very plausible sense to me.
Great post.
Posted by viridis on October 2, 2002, at 2:23:33
In reply to Re: Viridis, I think you're right on the money. » viridis, posted by MattDDS on October 1, 2002, at 13:22:53
Hi Matt,
I think YOU'RE "right on the money". For years I dealt with GPs, therapists, and psychiatrists who viewed anxiety as secondary to depression. My (still current, unfortunately) GP even went so far as to tell me that there's no such thing as anxiety disorder -- anxiety is just a byproduct of depression, according to him. So, ADs are always the answer -- supposedly.
Then I found my current pdoc, and told him that I thought my depression (often very severe) was the result of uncontrolled anxiety. His response was that anxiety and depression are inextricably intertwined, and no one really understands the distinction or relationship between the two. But, he agreed that the anxiety component seemed dominant for me, and treated me accordingly, starting with benzos.
The result has been wonderful. He did slip in a low-dose SSRI (Zoloft), to see if that would help, once I was stabilized on Klonopin. Zoloft was a disaster for me, but he agreed that I should stop it as soon as I reported serious side effects, and has declined to try any other SSRIs. The mild depression that remained pretty much disappeared when he added a bit of Adderall to the mix.
So, I strongly agree that anxiety can precipitate depression, and so does my pdoc (at least tentatively). In any case, Klonopin has resulted in the single biggest improvement in my moods that I've ever experienced.
Posted by Phil on October 2, 2002, at 6:51:51
In reply to Re: Viridis, I think you're right on the money. » viridis, posted by MattDDS on October 1, 2002, at 13:22:53
Group 1 here. No matter what Stevie Nicks says, Klonopin is good.
I think she had a few problems keeping the dose under 8mg. Sorry, I digress.Thanks Matt
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