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Dr. Bob is Robert Hsiung, MD,
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Posted by viridis on October 30, 2002, at 5:09:17
In reply to Re: thanks Re: Klonopin as a dumb drug » viridis, posted by Franz on October 29, 2002, at 17:04:52
Hi Franz,
Like Hiba, my experience is that Klonopin is excellent for reducing ruminating thoughts without cognitive dulling or other side effects. Rumination is a form of obsessiveness, although there's also "true" obsessive-compulsive disorder (OCD), in which people do things like wash their hands every few minutes, check to see if a door is locked 50 times, etc. I know that for OCD, high doses of the SSRI Luvox (fluvoxamine) are sometimes used. Effexor, which you mentioned (it affects both serotonin and norepinephrine reuptake) might be used for it too, but I'm not sure about that. In any case, it doesn't sound like you're talking about OCD, although this may be what your therapist is thinking of.
My advice would be to see an experienced psychiatrist or psychopharmacologist. Of course, a lot of psychiatrists don't like benzos either, and you might be someone who could benefit from certain ADs (although most of these can cause medical dependency, like benzos and many non-psychiatric meds). You really need expert advice and treatment, and if the first psychiatrist's approach doesn't work, you may have to try others. Benzos like Klonopin are great for some of us, and your positive reaction to Xanax (alprazolam) suggests that you may be in that category -- this is something to discuss with someone who's qualified to diagnose mental illness and prescribe psychiatric medications. My experience is that therapists and GPs/family doctors often don't have a clue about these things, so I would go to a psychiatrist if at all possible.
Your therapist's "knee-jerk" negative reaction to benzos is common, and I'm guessing from what you've said that he isn't really familiar with the medication side of treating mental disorders. One thing, though -- I get the impression you might be from outside the U.S. (in part, because you mentioned bromazepam, which I don't think is commonly used here). In some countries such as Canada, Klonopin is marketed as "Rivotril" (and it probably has other names too). The generic name for it is clonazepam. If you are from another country, this might also explain the therapist's lack of recognition of "Klonopin".
In any case -- please try to see a psychiatrist!
Good luck!
Viridis
Posted by Squiggles on October 30, 2002, at 7:08:24
In reply to Re: thanks Re: Klonopin as a dumb drug » Franz, posted by viridis on October 30, 2002, at 5:09:17
Actually,
my doctor is a GP in one of the most prestigious
universities in Canada; when the area of
pharmacological expertise is not in his scope,
he consults some of the best researches in
psychiatry and pharmacology in the world; I
think that is common practice in teaching
hospitals, so whether you get a GP's advice
or a psychiatrist's you end up getting the same
information.An added advantage of being in the hands of
a GP is that he is more likely to know your
entire health condition and prescribe in that
context.Squiggles
Posted by viridis on October 30, 2002, at 11:33:01
In reply to Re: thanks Re: Klonopin as a dumb drug » viridis, posted by Squiggles on October 30, 2002, at 7:08:24
Hi Squiggles,
Your situation sounds ideal, and I know (second-hand at least) that being treated in a university/research setting often exposes you to open-minded doctors who are eager to seek out expert advice. I was thinking of the more common situation in which a person sees a GP who deals with hundreds of patients and conditions, and doesn't have time to learn about or research each one. In those cases, I think you're more likely to be successful going directly to a specialist.
I shouldn't condemn GPs across the board, because I'm sure some are excellent. Mine is not, nor have I been very impressed with others I've seen. And, I've seen some bad psychiatrists too. But, barring access to the kind of setting you're in, I'd still start with a psychiatrist.
By the way, I'm Canadian too, although I've lived in the states for years.
All the best,
Viridis
Posted by Rick on October 30, 2002, at 22:22:19
In reply to Re: thanks Re: Klonopin as a dumb drug » Squiggles, posted by viridis on October 30, 2002, at 11:33:01
Klonopin is just wonderful for me, not only for my social anxiety, but in other ways as well (some of which were completely unanticipated). I'm so glad it's available. However, one thing it *doesn't* seem to help me with is my compulsive and obsessive tendencies (I'm not talking about outright OCD). I still have plenty of ruminating thoughts, although they *are* a lot less likely to be worry-filled and fearful than before.
But clearly clonazepam can have this benefit for some, as Hiba and Viridis attest.
Rick
Posted by Squiggles on October 31, 2002, at 6:13:58
In reply to Re: Klonopin as a dumb drug - Hiba, Viridis, Franz, posted by Rick on October 30, 2002, at 22:22:19
The strange thing i found about Klonopin,
is that i never felt a thing taking it,
only when not taking it.Squiggles
Posted by Amberlin on October 31, 2002, at 20:03:09
In reply to Re: Klonopin as a dumb drug - Hiba, Viridis, Franz » Rick, posted by Squiggles on October 31, 2002, at 6:13:58
I'm a definite addict.
This month i took more than prescribed, and yes I realize that this is wrong, but I couldn't handle the stress. I couldn't handle the weekends and not having anything to do, so I would just knock myself out.So, I can't refill it until it's authorized...meaning I took too much and ran out. Withdrawal time again. (I know, it's my own fault.)
Posted by Squiggles on October 31, 2002, at 20:14:35
In reply to Re: Klonopin as a dumb drug - Hiba, Viridis, Franz, posted by Amberlin on October 31, 2002, at 20:03:09
Hmmmmmmmmmmm.
Squiggles
Posted by viridis on October 31, 2002, at 23:57:01
In reply to Re: Klonopin as a dumb drug - Hiba, Viridis, Franz, posted by Amberlin on October 31, 2002, at 20:03:09
Hi Amberlin,
It sounds like you're in a bad pattern. You aren't necessarily an "addict", but you definitely have a problem that you need to solve ASAP. It's great that you recognize the problem and want help. Can you talk to your doctor about it?
My first thought was that maybe you just need a higher dose of Klonopin, but if you're taking it to knock yourself out, that's definitely not how these drugs are supposed to be used. Some people are prone to abusing benzos and should avoid them, although most people with pure anxiety disorders don't seem to fall into this category. So, maybe there's more going on here?
The question is -- is Klonopin an appropriate medication for you, and just at too low a dose, causing you to "overcompensate" by totally obliterating stress (and yourself) on weekends? Or are you a bad candidate for benzos because of a built-in tendency to escalate the doses?
Please talk to your doctor about this and/or find some alternate treatment that's better for your condition. What you're doing will just make things worse in the long run. There's no reason that you should have to live this way, and obviously you recognize this.
Posted by Franz on November 1, 2002, at 1:42:42
In reply to Re: Klonopin as a dumb drug - Hiba, Viridis, Franz, posted by Amberlin on October 31, 2002, at 20:03:09
are you doing any kind of psychotherapy?
Posted by Amberlin on November 1, 2002, at 7:37:58
In reply to Re: Klonopin as a dumb drug - Hiba, Viridis, Franz » Amberlin, posted by Franz on November 1, 2002, at 1:42:42
> are you doing any kind of psychotherapy?
Yes, but with the system here where I live, MD, and when you don't have insurance, you accept what care they offer you. I haven't seen my therapist in two months. They don't seem concerned.
Posted by Amberlin on November 1, 2002, at 7:40:32
In reply to Re: Klonopin as a dumb drug - Hiba, Viridis, Franz, posted by viridis on October 31, 2002, at 23:57:01
Problem is that I can't see my doctor until Dec 24 :(. That's how the system works when you get assistance from the state because you don't have health insurance. I get 10 minutes with him max. He doesn't seem concerned, which is annoying in the first place.
Posted by Amberlin on November 1, 2002, at 7:41:29
In reply to Re: Klonopin as a dumb drug - Hiba, Viridis, Franz » Amberlin, posted by Squiggles on October 31, 2002, at 20:14:35
Hmmmmmmmmmm???
Posted by Squiggles on November 1, 2002, at 8:01:45
In reply to Re: Klonopin as a dumb drug - Hiba, Viridis, Franz, posted by Amberlin on November 1, 2002, at 7:41:29
What is the difference between a *dumb* drug
and a *smart* drug; it sounds like something
rap chemists made up;
Squiggles
Posted by Franz on November 1, 2002, at 10:05:36
In reply to Re: Klonopin as a dumb drug - Hiba, Viridis, Franz, posted by Amberlin on November 1, 2002, at 7:40:32
> Problem is that I can't see my doctor until Dec 24 :(. That's how the system works when you get assistance from the state because you don't have health insurance. I get 10 minutes with him max. He doesn't seem concerned, which is annoying in the first place.
I´m talking about psychotherapy, not a 10 min
visit to a MD, the difference is clear right?There must be some kind of help available.
Posted by Amberlin on November 1, 2002, at 10:55:05
In reply to Re: Klonopin as a dumb drug - Hiba, Viridis, Franz » Amberlin, posted by Franz on November 1, 2002, at 10:05:36
I spoke to my therapist today but she will be out of town next week.
I'm holding out until I get health insurance the middle of this month, and then I can switch back to a private practice for a psychiatrist..but I'll stick with my current therapist.
Thanks for the concern, everyone. I'm stopping the abuse of my Klonopin right now..and will discuss a higher dose with my doctor on Monday. I'll just have to put a call in to get a response. I hate communicating that way instead of face to face, but I guess that is how it has to be sometimes.
Posted by Franz on November 2, 2002, at 17:55:56
In reply to Re: thanks Re: Klonopin as a dumb drug » Franz, posted by viridis on October 30, 2002, at 5:09:17
Thanks to all.
I have almost decided to give Klonopin a try (does it help with indecision and motivation hehe).
I have an appointment with a general doctor which I will consult. If I have not a response I will go to a psychiatrist.
Can Klonopin be used on demand or is it better to use a small dose every day?.
One thing that makes me consider alprazolam is its supposed antidepressive properties, although I understand you need a high dose for that and I do not want to take a dose that can make me sleepy or cause dependence problems more easy.
I did a search and found clonazepam:Clonazepam was introduced in the US in 1976 and in
Japan in 1981. The mechanism of clonazepam's ac-
tion has not yet been established. With a high affinity
for central benzodiazepine receptors, clonazepam is
a facilitator of gamma-aminobutyric acid system, and
also increases central synthesis of serotonin,
dopamine and noradrenaline, and mimics the effect of
the neurotransmitter glycine. This is a combination
of effects that may offer antidepressive action.Clonazepam has been recognised as a useful augmen-
tation (i.e. adding a medication onto the existing, on-
going drug treatment) for the treatment of
prolonged depression.
http://www.depression.org.uk/main/pdf/treatmedication8.pdfDoes not look like the antibenzo groups from UK right?.
But the question is, how is that it was introduced in 1976 and we know about it so late?. Marketing strategies?. They have a target now for panic?.
...increases central synthesis of serotonin,
dopamine and noradrenaline,?Never heard of that!. Is that documented anywhere?. Maybe at high doses?.
...mimics the effect of
the neurotransmitter glycine?Why not to take glycine then?.
About the thread on generics and brand name, I have tried brand name and generic alprazolam and I think there is a difference, but maybe it is subjective and also dependent on time because how you feel the effect depends on the amount of times you have used it (mean you will feel the same drug acting different at different times).
Posted by viridis on November 3, 2002, at 0:39:09
In reply to Re: thanks Re: Klonopin as a dumb drug »All » viridis, posted by Franz on November 2, 2002, at 17:55:56
Hi Franz,
It sounds like you have a good plan. I would definitely try Klonopin, and it probably can be used on an as-needed basis. My main concern would be that it can cause side effects (I experienced sleepiness, clumsiness, and short-term memory loss for the first couple of weeks that I took it, but then these completely went away -- all were mild anyway). So, if you only take it sporadically, you might get the side effects. The tradeoff is that regular use has a high likelihood of causing dependency (like many other medications, including antidepressants). You'll just have to try it and see how it affects you.
I do take Xanax (alprazolam) as-needed, maybe once every week or two. It's great for "breakthrough" anxiety, and as long as I keep the dose at 0.5 mg or lower, it works very well. Above this dose, I feel very sleepy. I'm definitely not dependent on Xanax, although I probably am dependent on Klonopin. But whenever I take Xanax, I can feel it, whereas daily Klonopin is undetectable, except that the anxiety is under control and I can think clearly.
I believe that Klonopin was originally marketed as an anti-epileptic drug (and the doses that epileptics took were huge compared to those for the anxiety/panic population). My understanding is that its anti-epileptic properties fade over time, whereas its anti-anxiety properties persist, so it shifted over to being an anxiolytic as doctors recognized its usefulness for anxiety patients and moved on to other drugs for epileptics.
I can't comment much about glycine, except to say that many substances can't cross the blood-brain barrier (i.e., just swallowing them doesn't automatically allow them into to your brain, which has a very controlled-access policy for many chemicals). Maybe glycine falls into this category, or maybe it's modified to some other chemical before it gets there.
Re: generics: among generic versions of Klonopin I've noticed a difference (Teva seems most effective). I've never noticed this with any other generic drugs, and Squiggles found the same thing. With alprazolam, I've only taken the Teva generic, and it works fine. A while back (months ago) there was a thread in which many people complained about the lower potency of certain generic brands of alprazolam, so there may be something in the manufacturing process that makes a difference.
Good luck with Klonopin -- just give it a while before you make a final judgement. It's very subtle, but effective for many.
All the best,
Viridis
Posted by Squiggles on November 3, 2002, at 7:37:14
In reply to Re: thanks Re: Klonopin as a dumb drug, posted by viridis on November 3, 2002, at 0:39:09
I was wondering about your name: Viridis:
Is that a Greek name?
Squiggles
Posted by viridis on November 3, 2002, at 14:54:15
In reply to Re: thanks Re: Klonopin as a dumb drug »All » viridis, posted by Franz on November 2, 2002, at 17:55:56
Hi Franz,
I was curious about your question regarding glycine, so I did a little more investigating, since my previous answer was just speculative. I'm not an expert on neurophysiology, but I am a biologist (different area of research), so these things get me interested. I've only done a quick scan of the available information, but here's what I've found so far.
First a bit of background -- glycine is an amino acid. Amino acids are the "building blocks" of proteins, and there are 20 different ones that are linked together in different combinations to make different proteins. Then there are others that aren't used to make proteins, but play other roles in the body. Glycine is one of the "non-essential" amino acids, meaning that although it's very important, it can be synthesized in the body from other amino acids (particularly serine). So, it's unlikely that a person would be deficient in glycine unless they have an extremely protein-deficient diet. Contrary to my earlier speculation, glycine crosses the blood-brain barrier easily.
Some amino acids also act as neurotransmitters, chemicals that carry messages from one nerve cell to another. They're released from one cell and bind to a specific receptor on the membrane of another cell, which in turn causes various changes in that cell (these can include how the receiving cell sends chemical messages to yet other cells). Glycine is one of the neurotransmitter amino acids. Another is GABA (gamma-aminobutyric acid). GABA is synthesized in the brain from another amino acid, glutamate, and there seems to be some argument about whether GABA can cross the blood-brain barrier and if so, how easily.
The effects of neurotransmitters vary depending on which cell receives them, and there can be various ways in which the process can work abnormally -- not enough or too much of a given neurotransmitter may be released, the receptors for the neurotransmitter on receiving cells can be faulty or too few in number, or the cell may respond abnormally to the neurotransmitter.
With respect to clonazepam, it and other benzodiazepines appear to work primarily by enhancing the binding of GABA to specific receptors on certain brain cells. GABA has a "damping" effect on the excitability of these cells by controlling the flow of ions across the membrane (especially chloride ion in the case of GABA receptors affected by benzos) . Various conditions (including epilepsy and excessive anxiety/panic) appear to result from overexcitability of these cells, perhaps due to flaws in the GABA receptors. By enhancing the affinity of the GABA receptors for GABA, benzos correct this problem.
I'm not sure where glycine fits into this; there is some mention of clonazepam also acting like glycine as a neurotransmitter, but most of the literature I've looked at so far focuses on clonazepam's interaction with a particular subtype of GABA receptor.
There are lots of commercial sites that promote oral glycine and GABA as treatments for anxiety, and who knows -- maybe that could work for some people. But given the ready availability of glycine in the diet, the body's ability to make more, and the questions about whether oral GABA can even get into the brain, I'm skeptical. On top of that, if the problem lies with the receptors for these substances, I'm not sure that flooding the brain with more of them would help much anyway. This is speculation on my part, but I have tried taking oral GABA in the past and never noticed any effect.
Anyway, that's what I've pieced together so far. Good luck with your treatment!
Viridis
Posted by Alan on November 3, 2002, at 16:28:40
In reply to Re: Convinced At last ! Thank you Squiggles..., posted by hiba on October 29, 2002, at 9:58:34
> This is a sudden shock for me. I found the instance of "Protracted withdrawal syndrome" associated with benzodiazepines in the latest version of MARTINDALE THE COMPLETE DRUG REFERENCE. Although the reference they given is Dr. Ashton,( the figure most benzo lovers don't approve,) I think there should be some fact in it. I know the importance of "MARTINDALE" in the world of medicine.
> So, you are right in this regard dear Squiggles, the existence of long and unusual withdrawal symptoms should not be necessarily a benzophobic hypothesis. I appreciate your determination to stand for what you found right. It is only because of that I went through MARTINDALE once again.
> HIBA
>
===============================================Dear Hiba,
The recitiation of Ashton's conclusions about PWS carries with it two problems (besides the fact that it is the only source cited by MARTINDALE as I understand it). It is the same problem that manifests itself when being used as a reason by some that bzds are dangerous in that the risks outweigh the benefits re: treatment of chronic anxiety with bzds.
1)Ashton's writings are based on her own personal observations of other's *selected* research, not *her own* scientific research. That is why her rhetoric is consistent with and always qualified with "perhaps", "suggests", "MAY conclude", etc. It is not science or research per se.
2)Ashton is also basing her conclusions on her own personal practice...and purely through the prism of an "addictionologist". One knows what problems what one gets into generalising for the general population based on a small sample or an individual's experience.
Alan
Posted by Squiggles on November 3, 2002, at 16:59:30
In reply to Re: Convinced At last ! » hiba, posted by Alan on November 3, 2002, at 16:28:40
A man who carries a cat by the tail
learns something he can learn in no
other way.
Mark Twain
Hee hee.Squiggles
Posted by Rick on November 3, 2002, at 17:49:04
In reply to Re: thanks Re: Klonopin as a dumb drug »All » viridis, posted by Franz on November 2, 2002, at 17:55:56
> Can Klonopin be used on demand or is it better to use a small dose every day?In general it's more effecive to use a small dose daily. If you still have occasional breakthrough anxiety, a small-dose of quick-acting Xanax would be useful. As you can see, I'm recommending exactly the protocol Viridis is using. Even if you develop dependency, coming off low-dose clonazepam with a slow taper is usually not much of a problem. (Note that I said "usually," not "never.")
I think it's preferable to NOT physically "feel" the drug, as you likely would with as-needed use, but instead to have the clonazepam in the "background," unobtrusively guarding against anxiety. And -- while there is no guarantee -- sleepiness and other side effects are likely to go away as your body adjusts to them. But the chemically-mediated anti-anxiety effects will remain. If you're like most maintenance dose clonazepam users, you will reach an ideal dose from a few months of experimentation (maybe even sooner), and will thereafter maintain about the same dose, or even find that you can decrease it somewhat. In summary, using clonazepam as-needed you will probably develop tolerance to the side effects but not to the theraputic effects.
> But the question is, how is that it was introduced in 1976 and we know about it so late?.
Clonazepam's original indication (and still its only official indication in many countries) was as an anti-epileptic, as Viridis pointed out. But it has been widely studied for anxiety disorders since the early eighties.
>Marketing strategies?
That's certainly not the case now, since clonazepam is off-patent. In fact, that's why there's so much more focus on SSRI's. With generic versions dominating the benzo marketplace, the original benzo developers (e.g., Roche for clonazepam), have no financial incentive to find new indications; promote the safety of the drugs and defend against benzophobia; or research new uses.
(There is indeed benzo research going on, but for a new variety that will hopefully be more precise in which GABA receptors are targeted -- the goal being to maintain the anti-anxiety effects while eliminating the side effects.)
Clonazepam, in particular, is effective in an extremely wide array of "unofficial" indications, including several anxiety disorders (e.g., GAD, OCD adjunct, gold-standard benzo for social anxiety); bipolar adjunct; tremor of various etilogies; pain, including TMJ; Restless Legs Syndrome; and more.
> Why not to take glycine then?
Believe me, that will not provide benefits even remotely similar to clonazepam. In fact, some preparations of glycine include Pangamic Acid, which carries risks including carcinogenity. (Not trying to scare anyone here...MOST glycine preparations are probably safe, except for TMG - Tri-Methyl-Glycine).
You should strongly consider a trial of daily small-dose clonazepam. As long as you haven't taken it more than a month, any possibility of withdrawal symptoms should be especially remote.
If, for some reason, you try it as-needed and either aren't finding sufficient relief, or don't like the side effects, keep in mind that your experience could be quite different with daily use.
Good Luck,
Rick
Posted by Alan on November 3, 2002, at 17:50:53
In reply to Re: Convinced At last ! » Alan, posted by Squiggles on November 3, 2002, at 16:59:30
http://www.guardian.co.uk/Archive/Article/0,4273,4201752,00.html
Of particular interest are the two paragraphs about the WHO's recitation of the statistical prioritisation of those drugs with the most complaints about withdrawal.
Alan
Posted by viridis on November 3, 2002, at 22:40:00
In reply to Re: Klonopin as a dumb drug (Completely OFF TOPIC » viridis, posted by Squiggles on November 3, 2002, at 7:37:14
Hi Squiggles,
It's not clear whether "Viridis' has a Greek or Latin origin. It isn't my real name, of course; I chose it as a pseudonym for this board for several reasons.
First, when I started lurking here, I considered myself pretty naive compared to some of the people on the board who have been through trials of many more psychotropic drugs than I have. I'm a biologist, so I tried to think of a name that subtly conveyed this limited experience and incorporated elements of my field. Scientific names of organisms have two parts: the genus, and the specific epithet, which is often descriptive (e.g., humans are Homo sapiens: Homo is the genus, and sapiens is the specific epithet, and together they form the scientific name). There are many organisms whose specific epithet is "viridis", which means "green". This is also everyday slang for "naive".
I also happen to like the color green, and on top of that, my wife and I are avid gardeners. Plus, green ("virid") connotes growth, something I'm trying to achieve, in part by learning from the experiences of others here.
So, that's an explanation (however convoluted) of how I came up with the name. Again, the exact source of the term is uncertain, but it probably has a Greek or Latin origin.
So -- how come you're Squiggles?
Best,
Viridis
P.S. I suspect we're entering the territory of Psychosocial Babble, somewhere I haven't been yet.
Posted by hiba on November 4, 2002, at 0:51:11
In reply to Re: Convinced At last ! » hiba, posted by Alan on November 3, 2002, at 16:28:40
Hello Alan,
Glad you are back in the forum once again.
Perhaps you might be wondering what my conviction is! It was just to state, the so called "protracted withdrawal" is mentioned in a renowned clinical manual. Still I didn't hesitate to reveal the doubtful nature of the given reference. Dr. Ashton's studies are being consistently challenged as they are mostly based on anecdotal evidences. "Martindale" professionals are very particular in collecting data from almost all available sources. That could be the reason.
"Protracted withdrawal syndrome" is still much controversial. Using a benzo in high doses for a considerably long period of time and stopping it abruptly may cause a longer than unusual withdrawal syndrome. This is arguably right. But such an usage and cessation is alien to clinical practice. Unsupervised usage of a drug and consequent complications are not an indicative of drug toxicity. Since we are discussing the medically supervised benzo usage, we have a better reason to neglect protracted withdrawal syndrome. It is not only how the drug treats you, it is how you treat the drug. If you want to abuse a drug, it shouldn't be a benzo or a narcotic. I have seen guys mixing phenergan(promethazine)with wine to augment the sedative high of the antihistamine.Benzophobia has done more than enough so far. Some practitioners were (or still?) prescribing hard antipsychotics to treat anxiety disorders because of the fear of benzo dependence. Once I got a prescription of Trazodone from an internist for sleeping problems. In PDR there is warning in block letter as "Trazodone is associated with priapism." Internist had justification. In low doses trazodone is safe. But many urologists believe drug induced priapism is not dose dependent. The reason for prescribing trazodone for sleep problems is its dissociation with dependence. But when the choice is an irreversible physical damage or a slight medical dependence, what makes sense is most important. That is all the fact about benzodiazepines.
Good luck Alan, Take care
HIBA
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