![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 23 of 23. This is the beginning of the thread.
Posted by MB on December 12, 2002, at 15:57:56
I've been on Wellbutrin (again) along with Klonopin to take the *edge* (rage, anxiety, panic, neck cramps, blurry vision) off of the Wellbutrin. Anyway, the depression isn't any better. Could it be that the Klonopin is keeping the Wellbutrin from working? I've heard that benzos can make depression worse (except for Xanax...why *is* that by the way, why is Xanax different?).
MB
Oh, anyway, the doc says maybe Nardil next since SSRIs don't do well by me. Exactly how fat should I expect to get if I take Nardil (I gained 40 lbs on Paxil). I don't like the SSRIs because, after the akathisia (RLS), teeth grinding, neck cramps, headache, insomnia, tachycardia, and sweats are behind me I'm left an emotionless, fat, 14-hr-a-day sleeper who can't have an orgasm. Should I expect Nardil to be any better? I've also thought about ECT, shooting myself in the head, or becoming a heroin addict.
Any advice?
MB
Posted by Ritch on December 13, 2002, at 0:28:54
In reply to Can Klonopin decrease AD efficacy?, posted by MB on December 12, 2002, at 15:57:56
> I've been on Wellbutrin (again) along with Klonopin to take the *edge* (rage, anxiety, panic, neck cramps, blurry vision) off of the Wellbutrin. Anyway, the depression isn't any better. Could it be that the Klonopin is keeping the Wellbutrin from working? I've heard that benzos can make depression worse (except for Xanax...why *is* that by the way, why is Xanax different?).
>
> MB
>
> Oh, anyway, the doc says maybe Nardil next since SSRIs don't do well by me. Exactly how fat should I expect to get if I take Nardil (I gained 40 lbs on Paxil). I don't like the SSRIs because, after the akathisia (RLS), teeth grinding, neck cramps, headache, insomnia, tachycardia, and sweats are behind me I'm left an emotionless, fat, 14-hr-a-day sleeper who can't have an orgasm. Should I expect Nardil to be any better? I've also thought about ECT, shooting myself in the head, or becoming a heroin addict.
>
> Any advice?
>
> MB
>
>
Hey, Wellbutrin caused rage/anxiety/panic for me as well (and at doses of just 37.5mg or higher-even with Depakote on board). Before reaching for the pistol or the needle, I would reconsider Wellbutrin as your primary antidepressant (you said it wasn't working anyways). I've found with time that taking another med to *counter* something the first one caused hasn't worked very well (augment.. that's a different story).
Posted by cubbybear on December 13, 2002, at 0:35:18
In reply to Can Klonopin decrease AD efficacy?, posted by MB on December 12, 2002, at 15:57:56
Hello MB,
You raise a lot of questions. I can answer some.
1) Don't go for ECT at this point.There are many other AD medications around that could prove viable before you do something drastic like ECT.2) Don't become a heroin addict. That could leave you in physical agony if you can't get a quick fix; it could necessitate months of grueling detoxing and withdrawal, or land you in jail for the mere possession of this illegal drug, or for what you might do in desperation, in order to get it.
3) Don't shoot yourself in the head. It might seem like the easiest way out of your agony, but you have to believe that there IS a way out of the nightmare, and there ARE many people who would suffer if you take your own life. Is that what you really want to accomplish?
4) As far as I know, most benzos should not exacerbate depression; in fact, for some people, including myself, they are useful adjuncts to help relieve the anxiety that depressed people often have. Xanax happens to have a bit more anti-depressant attributes than most benzos.
5) Personally, I never took Nardil, and there are presently some difficulties in availability/supply, but I can speak from 18 years' experience with Parnate, another MAOI like Nardil. Parnate saved my life on many occasions. To be honest, it did lead to increased craving for carbohydrates and I did gain some weight. But I consider the MAOIs ADs far superior to the SSRIs in relieving depression and anxiety. When it comes to sexual side effects, the SSRIs are definitely worse. I experienced none with Parnate.
Now that I've said enough, you should wait and see what other people have to say, particularly those who have tried Nardil.
Posted by MB on December 13, 2002, at 11:47:21
In reply to Re: Can Klonopin decrease AD efficacy? » MB, posted by Ritch on December 13, 2002, at 0:28:54
> > I've been on Wellbutrin (again) along with Klonopin to take the *edge* (rage, anxiety, panic, neck cramps, blurry vision) off of the Wellbutrin. Anyway, the depression isn't any better. Could it be that the Klonopin is keeping the Wellbutrin from working? I've heard that benzos can make depression worse (except for Xanax...why *is* that by the way, why is Xanax different?).
> >
> > MB
> >
> > Oh, anyway, the doc says maybe Nardil next since SSRIs don't do well by me. Exactly how fat should I expect to get if I take Nardil (I gained 40 lbs on Paxil). I don't like the SSRIs because, after the akathisia (RLS), teeth grinding, neck cramps, headache, insomnia, tachycardia, and sweats are behind me I'm left an emotionless, fat, 14-hr-a-day sleeper who can't have an orgasm. Should I expect Nardil to be any better? I've also thought about ECT, shooting myself in the head, or becoming a heroin addict.
> >
> > Any advice?
> >
> > MB
> >
> >
>
>
> Hey, Wellbutrin caused rage/anxiety/panic for me as well (and at doses of just 37.5mg or higher-even with Depakote on board). Before reaching for the pistol or the needle, I would reconsider Wellbutrin as your primary antidepressant (you said it wasn't working anyways). I've found with time that taking another med to *counter* something the first one caused hasn't worked very well (augment.. that's a different story).
>
I've been reading that there is an availability issue with Nardil, so I may not go that route either. I can't handle anything that blocks H-1 receptors (which brings on the restless leg syndrome I've had since a kid) so the tricyclics are kinda out (plus, I can't even take Allegra or Zyrtec, the "non-drowsey" antihistamines, without passing out for days on end). The only thing left for me to try is the MAOI thing. I'm doing this through my GP, so anything experimental like taking a stim with memantine (to avoid tolorance and dependence like last time) or trying a foreign drug like moclobemide is out of the question. Looks like it's Parnate or ECT or au natural. You know, now that I think of it, I haven't been chemical free for over 15 years...and what I mean by that is no p-meds, no rec-drugs, no caffeine, no alcohol, no psychotropics of any kind. I wonder what would happen if I just tapered off of EVERYTHING.I agree with you about taing meds to counter the untoward effects of other meds. The problem is that they all cycle in the system with different frequencies. I might need Klonopin to take the edge off of Wellbutrin SR, but if I take them at the same time, I'm going to be all over the place emotionally (i.e., at times the K levels will be low while the WB levels will be high; the K levels will be high while the WB levels are low; sometimes they'll both be in that perfect ratio; etc.) What I've been noticing is that I have violent rages with suicidal/homicidal ideation in the morning. These subside into relative normalcy by 10 AM. Then, by early afternoon, all I can do is cry like a baby...over nothing, really...I just weep like a school girl. Then around dinner time I'm back to relative normalcy with a tinge of hypomania. Then to bed to start the cycle over again. I'm almost SURE it is linked to the way the the ratios of the two drugs cycle over a 24 hr period. Plus, I still haven't been able to kick my caffeine habit, which makes this whole thing impossible to figure out.
Plus, I'm so indecisive. Yesterday, I got that horrible AD dulling effect (the one where it feels like someone has drilled a hole in your forehead and filled your cranium with sand). Different than the Klonopin drowseys...I'm talking about that **sub-hallucinogenic-LSD-dose-put-me-on-the-short-bus-and-tie-my-shoes-for-me-what's-that-word-I-can't-remember** feeling. And I said, that's f*cking it, I want this crap out of my system. Then this morning, I think, "well, maybe it's helping a little," so I popped a WB tablet. I can't make up my mind and I'm rambling so I must not be *depressed* depressed, but it all seems so complex and difficult and not worth the effort and I just wish I didn't have go through the meaningless motions.
MB
Posted by Merci on December 13, 2002, at 20:14:32
In reply to Re: Can Klonopin decrease AD efficacy?, posted by MB on December 13, 2002, at 11:47:21
MB,
I'm currently taking Nardil after trying just about everything else. I have absolutely NO side effects. Nardil pulled me out of a dark, dark place and I truly believe it saved my life.
If you're willing to stick to the restricted diet, I think Nardil or another MAOI is worth a try. I personally haven't had any weight gain because the restricted diet has forced me to change my eating habits so much that I've ended up changing to a healthier eating style. I figure that if I'm going to spend so much time trying to find food that I can eat and enjoy, I might as well make it healthy. I'm not sure that's realistic for everyone, and since I've only been on Nardil for 2 months, I can't say for sure that's realistic for me. We'll see.
Whether it's an MAOI or not, I hope you find the right "stuff" soon. It's out there.
Merci
Posted by utopizen on December 13, 2002, at 20:40:02
In reply to Re: Can Klonopin decrease AD efficacy?, posted by MB on December 13, 2002, at 11:47:21
Um, may I ask why you're using a GP? I always thought it was interesting a GP would even bother with meds- I mean, they refer people to neurologists (I mentioned a tic, my GP said to go to a neurologist) so why not a psychiatrist? I would be pretty humble over the thing if I was a GP.
Posted by Bobbiedobbs on December 13, 2002, at 21:48:41
In reply to My 2 cents about Nardil » MB, posted by Merci on December 13, 2002, at 20:14:32
Total agreement here. Nardil rules. It saved my life also, I've gotten the only pleasure I have really gotten out of life while on this medication, plus the food restrictions are 80 percent total scientific voodoo.
Posted by Ritch on December 13, 2002, at 22:32:10
In reply to Re: Can Klonopin decrease AD efficacy?, posted by MB on December 13, 2002, at 11:47:21
> I've been reading that there is an availability issue with Nardil, so I may not go that route either. I can't handle anything that blocks H-1 receptors (which brings on the restless leg syndrome I've had since a kid) so the tricyclics are kinda out (plus, I can't even take Allegra or Zyrtec, the "non-drowsey" antihistamines, without passing out for days on end). The only thing left for me to try is the MAOI thing. I'm doing this through my GP, so anything experimental like taking a stim with memantine (to avoid tolorance and dependence like last time) or trying a foreign drug like moclobemide is out of the question. Looks like it's Parnate or ECT or au natural. You know, now that I think of it, I haven't been chemical free for over 15 years...and what I mean by that is no p-meds, no rec-drugs, no caffeine, no alcohol, no psychotropics of any kind. I wonder what would happen if I just tapered off of EVERYTHING.
>
> I agree with you about taing meds to counter the untoward effects of other meds. The problem is that they all cycle in the system with different frequencies. I might need Klonopin to take the edge off of Wellbutrin SR, but if I take them at the same time, I'm going to be all over the place emotionally (i.e., at times the K levels will be low while the WB levels will be high; the K levels will be high while the WB levels are low; sometimes they'll both be in that perfect ratio; etc.) What I've been noticing is that I have violent rages with suicidal/homicidal ideation in the morning. These subside into relative normalcy by 10 AM. Then, by early afternoon, all I can do is cry like a baby...over nothing, really...I just weep like a school girl. Then around dinner time I'm back to relative normalcy with a tinge of hypomania. Then to bed to start the cycle over again. I'm almost SURE it is linked to the way the the ratios of the two drugs cycle over a 24 hr period. Plus, I still haven't been able to kick my caffeine habit, which makes this whole thing impossible to figure out.
>
> Plus, I'm so indecisive. Yesterday, I got that horrible AD dulling effect (the one where it feels like someone has drilled a hole in your forehead and filled your cranium with sand). Different than the Klonopin drowseys...I'm talking about that **sub-hallucinogenic-LSD-dose-put-me-on-the-short-bus-and-tie-my-shoes-for-me-what's-that-word-I-can't-remember** feeling. And I said, that's f*cking it, I want this crap out of my system. Then this morning, I think, "well, maybe it's helping a little," so I popped a WB tablet. I can't make up my mind and I'm rambling so I must not be *depressed* depressed, but it all seems so complex and difficult and not worth the effort and I just wish I didn't have go through the meaningless motions.
>
> MB
Wow!, you are having *ultradian* mood cycles. What sounds especially spooky is the early morning rage thing and then getting very depressed later on. That is not uncommon with folks with intermittent explosive tempers (like me-which at worst follows a rage/panic/depression sequence), but that is also not uncommon with temporal lobe epilepsy either. I think you went and did a bunch of SPECT scan stuff, right? What was the result of all that? You never replied about ever trying any Depakote---have you tried any? Just a hunch, but it sounds like you might benefit a lot from Depakote+T4 or something like it.
Posted by utopizen on December 13, 2002, at 23:53:23
In reply to Re: My 2 cents about Nardil, posted by Bobbiedobbs on December 13, 2002, at 21:48:41
> Total agreement here. Nardil rules. It saved my life also, I've gotten the only pleasure I have really gotten out of life while on this medication, plus the food restrictions are 80 percent total scientific voodoo.
>>>>Did you take it with stims? I'd like to take it w/ 20mg of Adderall/day.
I'd also like to continue eating soy and tofu also
Posted by BrittPark on December 14, 2002, at 2:05:01
In reply to Can Klonopin decrease AD efficacy?, posted by MB on December 12, 2002, at 15:57:56
> I've been on Wellbutrin (again) along with Klonopin to take the *edge* (rage, anxiety, panic, neck cramps, blurry vision) off of the Wellbutrin. Anyway, the depression isn't any better. Could it be that the Klonopin is keeping the Wellbutrin from working? I've heard that benzos can make depression worse (except for Xanax...why *is* that by the way, why is Xanax different?).
>There is certainly a lot of anecdotal evidence that klonopin can be mildly depressogenic. There are also many people who take it who continue to respond well to their ADs.
I don't think anybody knows why xanax is a mild antidepressant. There have been a few studies that showed this. Chemically xanax has one property, along with, triazolam, in that it is tetracyclic instead of tricyclic like all the other benzos.
You might try switching to xanax to test the hypothesis that klonopin is somehow blocking your response to wellbutrin. Xanax requires more frequent dosing but otherwise swaps about 1mg for 1mg with klonopin. At least that's what my psychiatrist and I have found.
Feel better,
Britt
Posted by comftnumb on December 14, 2002, at 2:21:07
In reply to Can Klonopin decrease AD efficacy?, posted by MB on December 12, 2002, at 15:57:56
It's the most effective form of treatment for depression. May cause some memory problems, but they usually clear up after a few months. Highly dramatized by the media. It's actually quite safe and doesn't make you a zombie. I've known people who've been through it and they said it worked wonders for them.
Posted by ItsHowdyDudyTime on December 14, 2002, at 7:48:34
In reply to Can Klonopin decrease AD efficacy?, posted by MB on December 12, 2002, at 15:57:56
> I've been on Wellbutrin (again) along with Klonopin to take the *edge* (rage, anxiety, panic, neck cramps, blurry vision) off of the Wellbutrin. Anyway, the depression isn't any better. Could it be that the Klonopin is keeping the Wellbutrin from working? I've heard that benzos can make depression worse (except for Xanax...why *is* that by the way, why is Xanax different?).
>
> MB
>
> Oh, anyway, the doc says maybe Nardil next since SSRIs don't do well by me. Exactly how fat should I expect to get if I take Nardil (I gained 40 lbs on Paxil). I don't like the SSRIs because, after the akathisia (RLS), teeth grinding, neck cramps, headache, insomnia, tachycardia, and sweats are behind me I'm left an emotionless, fat, 14-hr-a-day sleeper who can't have an orgasm. Should I expect Nardil to be any better? I've also thought about ECT, shooting myself in the head, or becoming a heroin addict.
>
> Any advice?
>
> MB
>
>The answer is a definite YES as to whether klonopin and other similar benzos can decrease antidepressant effectiveness. Klonopin is a depressant drug, its a downer. Taken over the longterm it can literally make you depressed or more depressed. I find that when I take even low doses of klonopin with an AD, the AD has about half as much effect as off the klonopin. More than a few cases of "TRD" are due to longterm klonopin usage.
sometimes benzos must be taken longterm for management of severe and chronic anxiety. However, benzos are best used for short term acute management of panic and anxiety, insomnia and things like that. To combat anxiety better for the "long haul" youd be better off taking something like a sedating serotonergic antidepressant like Paxil, Luvox or Remeron. Or taking Buspar. Some of the anti-convulsant mood stabilizers like Neurontin are being used for anxiety as well and dont tend to be quite as much of a "downer" when taken longterm.
To sum up, klonopin is a good drug but its best used for the short term in the majority of anxiety cases. It can definitely decrease antidepressant activation and effectiveness, cause mental slowing and sluggishness, etc.
Howdy Doody
Posted by viridis on December 14, 2002, at 21:05:29
In reply to Re: YES!!, posted by ItsHowdyDudyTime on December 14, 2002, at 7:48:34
Most of my depression stems from anxiety, and Klonopin alleviates the anxiety. So, for me, Klonopin has a major antidepressant effect, long-term. Adderall seems to take care of the "residual" depression, but I have no doubt that Klonopin has eliminated the majority of my depression, while a range of "ADs" failed to do so and just made things worse.
Of course, YMMV etc.
Posted by MB on December 15, 2002, at 14:40:02
In reply to Why a GP? » MB, posted by utopizen on December 13, 2002, at 20:40:02
> Um, may I ask why you're using a GP? I always thought it was interesting a GP would even bother with meds- I mean, they refer people to neurologists (I mentioned a tic, my GP said to go to a neurologist) so why not a psychiatrist? I would be pretty humble over the thing if I was a GP.
There are only two psychiatrists in my area. One works for the state and is closing his private practice. The other is an egomaniac who spent 45 of my 50 minute session discussing his trip to Africa and how flies vector the H. pylori bacteria and that I should get tested for it. Then, after I had told him that SSRIs made me worse, he sent me home with samples of Celexa. I never went back. There *is* a nurse practitioner, but he fired me when he found out I had taken unprescribed morphine. Also, he wouldn't let me stay on my Klonopin, which has been a life saver as far as anxiety goes (wanted me on lithium instead, though I've never been manic). There isn't anybody else. I'm not sure a neurologist would be appropriate in treating depression/anxiety/rage issues. Ergo, GP it is.
Posted by MB on December 15, 2002, at 14:49:34
In reply to Re: My 2 cents about Nardil, posted by Bobbiedobbs on December 13, 2002, at 21:48:41
> Total agreement here. Nardil rules. It saved my life also, I've gotten the only pleasure I have really gotten out of life while on this medication, plus the food restrictions are 80 percent total scientific voodoo.
Maybe I'll try it. I've heard a few people on this board swear that it saved their lives. I'm supposed to taper off of the Wellbutrin and then give my doc a call. The anorgasmia and postural hypotension thing has me worried. More nuisances than anything, I guess. I wouldn't put up with the anorgasmia, postural hypotension, and akathisia from the SSRIs, especially since they were worthless for the depression. If a drug really made me feel *better*, though, I might put up with those side effects. Does anybody know if MAOIs exacerbate Restless Leg Syndrome the way SSRIs do?MB
Posted by utopizen on December 15, 2002, at 15:43:05
In reply to Re: Why a GP?, posted by MB on December 15, 2002, at 14:40:02
Your p-doc sounds interesting... incompetent, but interesting, lol
I have this rather sensitive stomach, and I thought I might have H. Pylori, but 2 separate blood tests came up negative for the antibody to it, which indicates I don't-- although it's not 100% accurate, my GP said it's rather close, and not to worry. Some weeks I feel terrible, others I forget I felt anything before.
Posted by Mr.Scott on December 17, 2002, at 0:02:27
In reply to Can Klonopin decrease AD efficacy?, posted by MB on December 12, 2002, at 15:57:56
In my experience the answer is maybe. Perhaps though it was actually just curtailing a bit of hypomania. It's hard to say.
What i will say about Nardil is that I lost 25 pounds on it when I switched from Zoloft which made my cholesterol and weight skyrocket. Finally though I gave up on on conventional doses of any antidepressant and since gone from 190lbs to 155-160lbs. These SSRI's just aren't for everyone despite all the media and marketing...
Posted by MB on December 17, 2002, at 11:41:31
In reply to Re: Can Klonopin decrease AD efficacy? » MB, posted by Ritch on December 13, 2002, at 22:32:10
> Wow!, you are having *ultradian* mood cycles. What sounds especially spooky is the early morning rage thing and then getting very depressed later on. That is not uncommon with folks with intermittent explosive tempers (like me-which at worst follows a rage/panic/depression sequence), but that is also not uncommon with temporal lobe epilepsy either. I think you went and did a bunch of SPECT scan stuff, right? What was the result of all that? You never replied about ever trying any Depakote---have you tried any? Just a hunch, but it sounds like you might benefit a lot from Depakote+T4 or something like it.
>Yeah, I did do the SPECT thing, and the evaluation was that I needed an anticonvulsant (there was way too much activity in my left temporal lobe). Also, hyperactivity in the limbic region (I thought that would indicate euphoria, but I was wrong, the doc said it was indicative of depression). He wanted to add an SSRI to the AE, stating that the AE would counter the rage and agitation I get from the SSRIs. Then he wanted me on Adderall since activity in my frontal lobes dropped drastically when I took a concentration test. It sounded nice in theory, but things didn't go as planned. There were all sorts of intolorance issues, and I wasn't able to get on the meds in the order the doc wanted me to. I was so sensitive to side effects that he was actually starting to get a little mad and flustered. I know a girl on Depakote for Bipolar One who swears by it, but she's pretty med tolorant. She takes Depakote, Wellbutrin, and an SSRI...and she's pretty much taking the maximum sugested doses of each one. I don't know how she can even complete a sentence, but she's pretty sharp, finished school, and has maintained a pretty sexy bod (she runs daily). Where she gets the energy on those meds, I don't know!! I'm scared of the depakote/weight thing. I'm once bitten, twice shy from 40 lb gain on Paxil. I'm already on thyroxine. Is that T-3 or T-4, I get confused. Anyway, the guy evaluating the spect scan did a battery of thyroid tests (went way beyond the normal TSH test) and said to keep my thyroid meds the way they are. What has your experience with Depakote been? I was hospitalized with a woman who said that her Depakote doses felt like being hit in the head with a sledgehammer when they "kicked in." For some reason that always stuck with me. Also, the son of a therapist I knew almost died from Depakote induced liver failure. I've had such bad luck with drugs (sensitivity, intolorance, etc), that when I hear bad stories like those it scares me to death.
MB
Posted by MB on December 17, 2002, at 11:50:25
In reply to Re: Can Klonopin decrease AD efficacy? » MB, posted by BrittPark on December 14, 2002, at 2:05:01
> There is certainly a lot of anecdotal evidence that klonopin can be mildly depressogenic. There are also many people who take it who continue to respond well to their ADs.
>
> I don't think anybody knows why xanax is a mild antidepressant. There have been a few studies that showed this. Chemically xanax has one property, along with, triazolam, in that it is tetracyclic instead of tricyclic like all the other benzos.
>
> You might try switching to xanax to test the hypothesis that klonopin is somehow blocking your response to wellbutrin. Xanax requires more frequent dosing but otherwise swaps about 1mg for 1mg with klonopin. At least that's what my psychiatrist and I have found.
>
> Feel better,
>
> Britt
>I recently spent a fewdays at a friend's house, and didn't have my Klonopin. I took some of his diazapam instead (I think I substituted 20mg diazapam for every 1mg Klonopin, or something like that, and I found the experience very enlightening. It totally squeltched my anxiety *without* knocking me on my ass with drowsyness. I.e., it had far fewer side effects, it seemed.
My question is this: why is Valium so seldomly mentioned on this board? Klonopin seems to be the benzo of choice amongst the members of this group (and sometimes Xanax), but I never read *anything* about Valium/diazapam. It seems like it is a very good medication.
MB
Posted by MB on December 17, 2002, at 11:56:55
In reply to Re: YES!! » ItsHowdyDudyTime, posted by viridis on December 14, 2002, at 21:05:29
> Most of my depression stems from anxiety, and Klonopin alleviates the anxiety. So, for me, Klonopin has a major antidepressant effect, long-term. Adderall seems to take care of the "residual" depression, but I have no doubt that Klonopin has eliminated the majority of my depression, while a range of "ADs" failed to do so and just made things worse.
>
> Of course, YMMV etc.
I've decided that almost all antidepressants make me worse. I've quit my Wellbutrin, stayed on the Klonopin, and already feel better. I almost always feel my depression lift a bit when I quit an AD. I think some of this might be due to the fact that my body is just so happy with not feeling physically ill (from the horrid AD).Of course the depression returns in time, but the point is that ADs have *never* helped, and there is actually a decrease in depression whenever I've quit *any* of them! I might give Nardil a fair chance, but after that I'm giving up on ADs. They just plain make me sick and do nothing for my depression.
MB
Posted by MB on December 17, 2002, at 12:03:25
In reply to Re: Can Klonopin decrease AD efficacy?, posted by Mr.Scott on December 17, 2002, at 0:02:27
> In my experience the answer is maybe. Perhaps though it was actually just curtailing a bit of hypomania. It's hard to say.
>
> What i will say about Nardil is that I lost 25 pounds on it when I switched from Zoloft which made my cholesterol and weight skyrocket. Finally though I gave up on on conventional doses of any antidepressant and since gone from 190lbs to 155-160lbs. These SSRI's just aren't for everyone despite all the media and marketing...I've known probably over twenty people who have been on SSRIs (crazy friends, being in hospitals, etc), and I think that only about two were actually helped by them. I think the perception of their effectiveness *is* basically marketing and media.
I've always wondered why the MAOIs caused weight gain, especially when everything that tastes good is on the "don't eat" list. I think if I went on Nardil, I'd be too scared to eat anything.
MB
Posted by Ritch on December 17, 2002, at 12:37:13
In reply to Re: Can Klonopin decrease AD efficacy? » Ritch, posted by MB on December 17, 2002, at 11:41:31
> > Wow!, you are having *ultradian* mood cycles. What sounds especially spooky is the early morning rage thing and then getting very depressed later on. That is not uncommon with folks with intermittent explosive tempers (like me-which at worst follows a rage/panic/depression sequence), but that is also not uncommon with temporal lobe epilepsy either. I think you went and did a bunch of SPECT scan stuff, right? What was the result of all that? You never replied about ever trying any Depakote---have you tried any? Just a hunch, but it sounds like you might benefit a lot from Depakote+T4 or something like it.
> >
>
> Yeah, I did do the SPECT thing, and the evaluation was that I needed an anticonvulsant (there was way too much activity in my left temporal lobe). Also, hyperactivity in the limbic region (I thought that would indicate euphoria, but I was wrong, the doc said it was indicative of depression). He wanted to add an SSRI to the AE, stating that the AE would counter the rage and agitation I get from the SSRIs. Then he wanted me on Adderall since activity in my frontal lobes dropped drastically when I took a concentration test. It sounded nice in theory, but things didn't go as planned. There were all sorts of intolorance issues, and I wasn't able to get on the meds in the order the doc wanted me to. I was so sensitive to side effects that he was actually starting to get a little mad and flustered. I know a girl on Depakote for Bipolar One who swears by it, but she's pretty med tolorant. She takes Depakote, Wellbutrin, and an SSRI...and she's pretty much taking the maximum sugested doses of each one. I don't know how she can even complete a sentence, but she's pretty sharp, finished school, and has maintained a pretty sexy bod (she runs daily). Where she gets the energy on those meds, I don't know!! I'm scared of the depakote/weight thing. I'm once bitten, twice shy from 40 lb gain on Paxil. I'm already on thyroxine. Is that T-3 or T-4, I get confused. Anyway, the guy evaluating the spect scan did a battery of thyroid tests (went way beyond the normal TSH test) and said to keep my thyroid meds the way they are. What has your experience with Depakote been? I was hospitalized with a woman who said that her Depakote doses felt like being hit in the head with a sledgehammer when they "kicked in." For some reason that always stuck with me. Also, the son of a therapist I knew almost died from Depakote induced liver failure. I've had such bad luck with drugs (sensitivity, intolorance, etc), that when I hear bad stories like those it scares me to death.
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> MBHey, thanks for responding. OH, thyroxine is T4. There are all sorts of meds that "work" for me, but I can't seem to tolerate many meds and can't tolerate standard doses of practically ANYTHING. I suppose I am one of those "brittle" bipolar types. I know what you mean by everything looking great on paper. I can't believe the dosages people take, either. When I saw that neurologist, he was talking about boosting Depakote up to 1500-2000mg ("where it will really work well"), and I just about freaked. We DID try Neurontin up to 1800mg/day for a while, but I just blanked totally out at work (at 1200mg/day or higher). I tried Gabatril up to 24mg/day and had near total amnesia, it sucked. I was on Depakote at 500mg/day for a year or so, but I had some serious sleepiness/concentration/aggravated depressive issues with it even at that dosage. I was trying to train someone at work and she just turned right around (because I was hem-hawing, restarting, forgetting where I was, etc.), and just said "Do you have Attention Deficit Disorder or something-what the hell!". I have been on 250mg at bedtime for quite a while, but in the last few weeks I started having trouble getting up in the morning, and I would just sleepandsleepandsleep. So, I dropped it back to 125mg which helped, and added a little bit of Trileptal. The Trileptal is activating, so that helps too, but I think it is making me paranoid so I have cut it back to just 75mg midday. Before that we tried some Ritalin (which worked sort of ok), and Wellbutrin (caused agitation). A combo of Depakote 250mg, Adderall 5mg, Effexor 12.5mg (and less) with Klonopin .5mg, was pretty close to "just right", but the freaking Adderall made me too uptight. Dexedrine was calming OTOH, but didn't help me concentrate like Adderall did. I am hoping I can go back up to 250mg of Depakote (from 125mg), and MAYBE a little Straterra with a little Effexor will do the trick (on the sleepiness/concentration issues). The 250mg of Depakote is the "right spot" for me. Lower and I am less stable, higher and I can't think. But I have to take something else even at 250mg to prevent me from sleeping more than 8hrs a day (and napping). I'm not worried about the liver stuff. Maybe if I was 20 I would be more concerned, but the "liver thing" is less of a risk the older you get (with Depakote anyhow).
Posted by Mr.Scott on December 18, 2002, at 8:26:11
In reply to What about Valium?? (was Can Klonopin...) » BrittPark, posted by MB on December 17, 2002, at 11:50:25
Here's my thoughts on why Valium is less commonly thought of or used as compared to Klonopin.
Klonopin has been in a number of well designed studies for panic disorder that seem to indicate that few people develop tolerance to it as was at least the rumor for many years with Valium and regular anxiety. It also appears very effective at what appear to be lower doses unlike 60 or 80 mg of valium that might be needed to stop panic.
Klonopin also has mood stabilizing qualities and is often mentioned as an add on by bi-polar specialists in place of antipsychotics. And bipolar I and II are also the hot diagnoses right now.
Valium just has a bad name because of the 70's and 80's. And it has been de-legitamized beacause of this I think.
Valium does give people a mild euphoria when they begin taking it. Klonopin does not.
Drug addicts and (caged rats alike) prefer valium to klonopin. They prefer Xanax over Klonopin too!
So I think all taken together, that a lot of docs think well if you have to use a benzo, Klonopin is the way to go.
I don't know many doctors at all who would start patients on Xanax unless it's for a few days only. Most doctors I've seen get a look of disgust and cringe in there faces when you even mention it.
I don't know why it's mentioned here so much unless these folks here have been taking it with success since the time period when it was en vogue. (if it aint broke don't fix it)
Finally my own personal note...
Klonopin actually feels more like a depakote or trileptal in my body than a valium or tranxene does. I'm not sure what that means, but it feels like a heavy duty anticonvulsant (complete with more side effects) compared to the older weaker benzos that are just more soothing.just thinking out loud here..
Scott
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