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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 babs on June 1, 2003, at 20:02:36
I just started klonopin on Friday and I am a zombie (.5 mg twice a day). All I did was sleep all weekend and I'm dreading tomorrow because I HAVE to get work done for classes. Will this initial sedation wear off? Also I've had no appetite- is this normal? Thanks, babs
Posted by mattdds on June 1, 2003, at 22:02:15
In reply to Will klonopin initial sedation wear off?, posted by babs on June 1, 2003, at 20:02:36
Babs,
Yes, it will. That is the beauty of the benzos. The sedation wears off, but the anti-anxiety effects do *not*. Why not start at 0.5 once a day and titrate up. You can split the pills in half, and even start at 0.25 mg, then 0.5 mg, and so forth until you get to the dose that eliminates anxiety without side effects.
One way I deal with anxiety is to eat more. Perhaps now that your anxiety is controlled, you eat less? That was my experience, but you may be different. Also, for me, Klonopin causes hypersalivation, which makes food taste better, and (likely) protects your teeth.
Best,
Matt
Posted by Viridis on June 2, 2003, at 0:22:44
In reply to Will klonopin initial sedation wear off?, posted by babs on June 1, 2003, at 20:02:36
It took about 1-2 weeks for the K sedation etc. to wear off for me. During that time, I took small, divided doses throughout the day (4X), which helped minimize the problems. After that, I had no side effects whatsoever. As Matt said, the side effects typically wear off quickly, but the anxiety relief remains.
Good luck!
Posted by babs on June 2, 2003, at 7:53:58
In reply to Re: Will klonopin initial sedation wear off?, posted by Viridis on June 2, 2003, at 0:22:44
I feel a little less groggy this morning but very anxious. I took half my usual dose- I can't afford to sleep today. I have too much work to do for school. I'm coming off risperdal which helped my anxiety really well so my pdoc said to take ativan while the klonopin is kicking in. How long does it take for the klonopin to work? So far all I'm noticing is increased sedation.
Posted by Viridis on June 3, 2003, at 0:27:41
In reply to Re: thanks matt and viridis, posted by babs on June 2, 2003, at 7:53:58
Hi Babs,
I noticed a difference with Klonopin almost immediately, but for some people, it seems to take a few days or more to get the benefits. One poster here a while back complained of side effects and anxiety for a couple of weeks, and said his Klonopin wasn't working, then wrote back later to say that after about two weeks he noticed major anxiety relief and disappearance of side effects. Of course, everyone's different, and K may not be right for you. But my impression is that it has a very high positive response rate, so the odds are good that it will work, once you get over the side effects and find the appropriate dose.
I took Xanax as needed while getting used to Klonopin, and it helped a lot too. I still take it when I need it, but only occasionally now. I don't have much experience with Ativan, but of the benzos I've tried, I find Xanax the least sedating. Doctors are wary of it (it supposedly has the highest abuse potential), but if your doctor is willing, you might try it while you're getting used to K. The two mix very well for me, and I haven't found that one potentiates (increases) the effects of the other re: drowsiness etc.
Posted by babs on June 3, 2003, at 15:36:48
In reply to Re: thanks matt and viridis, posted by Viridis on June 3, 2003, at 0:27:41
I started . 5 mg twice a day on Friday. I don't feel quite so anxious but my little tummy is quite upset and I can't eat. I don't have much of an appetite and the last few times I did eat. I got sick. It may be anxiety as anxiety tends to really upset my stomach but my pdoc said it may be the klonopin. It's not very fun! Also, what is the usual dose people take of K, or the dose range? Am I on a pretty small dose?
Posted by KellyD on June 3, 2003, at 15:56:41
In reply to more klonopin questions, posted by babs on June 3, 2003, at 15:36:48
Following thread. Curious on dosing, too.
Posted by SteveB on June 3, 2003, at 17:21:27
In reply to more klonopin questions, posted by babs on June 3, 2003, at 15:36:48
Hi Babs,
Regarding the initial sedation on Klono, yes it does clear .... somewhat. Most folks say they stopped feeling the sedative effect within a few days/weeks of continual use. That's not been my experience though - after 4 months on Klono I still feel a little drowsy after my morning dose.
And as for dosage, this has to be the drug with the widest effective range I have ever seen. I'm a 6'5" foot guy, 200 pounds, and anything over 0.25 mg of Klono in one take knocks me to the ground. And then I hear people on the board taking 2, 4 mgs or more per day - inconceivable for me.
My advice is to start on the smallest dose you can and work your way upwards until you find what works for you - i.e. the right compromise between anxiety-relief and sedation.
All the best.
Steve
Posted by McPac on June 3, 2003, at 19:56:33
In reply to Re: Will klonopin initial sedation wear off?, posted by mattdds on June 1, 2003, at 22:02:15
I've heard that Klonopin can cause depression....is this relatively rare?
Thanks!
Posted by Viridis on June 4, 2003, at 0:59:08
In reply to more klonopin questions, posted by babs on June 3, 2003, at 15:36:48
Hi Babs,
Re: dosage: as SteveB pointed out, it's highly variable. I take 1 mg/day (which has worked well for about two years), and my pdoc says this is "very low" for someone with a serious anxiety disorder, especially a 5'11" male who weighs 175 lbs. He's offered to increase the dose (he says many patients need "several times this much"), but since it works as is, I've declined. Studies I've seen suggest that 1-2 mg is a "typical' dose for people with moderate anxiety. Klonopin was originally prescribed for epilepsy (and still is), and epileptics may take 10-20 mg/day!
So, you really just have to find your level. Again, 1-2 mg seems to be a common baseline, with others needing more, some doing well with less. I do suspect the side effects will clear up fairly quickly.
Posted by Viridis on June 4, 2003, at 1:22:44
In reply to Matt/Viridis, Re: Will klonopin initial sedation, posted by McPac on June 3, 2003, at 19:56:33
Some people do report depression from Klonopin; I think it depends on the root cause of the depression. Most of my depression is precipitated by anxiety, so for me, K is a very good antidepressant. Those with the "lethargic" kind of depression may be more prone to benzo-induced depression (I have no hard evidence on this; it's just speculation on my part).
A while back, links to some papers were given here that suggested that K may actually increase brain levels of serotonin, suggesting an AD effect. The bottom line is that, like so many drugs, K works differently for different people, so you really just have to try it and see. However, I strongly suspect that if you suffer from anxiety-induced depression, K could be a big help (as it is for me).
Posted by mattdds on June 4, 2003, at 16:50:57
In reply to Matt/Viridis, Re: Will klonopin initial sedation, posted by McPac on June 3, 2003, at 19:56:33
McPac,
I have the exact same response to Klonopin as Viridis, and the same explanation as to why I think it works.
Just to parrot him, I have a very high degree of certainty that most of *my* depression is secondary to anxiety. All the depressive thoughts and feelings I get are related to relentless, enduring and untreated anxiety. It seems to develop much later in the course of things. I start to feel hopeless, because anxiety really prevents you from enjoying things. For me, relieve the anxiety, and the depression goes with it.
I also agree (totally my speculation) that for atypical depression -- the kind with neurovegetative symptoms like overeating, oversleeping, and *especially* depression without symptoms of anxiety -- Klonopin would not be very helpful, and could possibly exacerbate the depression.
However, depression is so frequently comorbid with anxiety that it is difficult to think of times where Klonopin couldn't be of at least *some* benefit.
For me Klonopin is without a doubt a potent antidepressant!
I just recently browsed a popular book from the 80's by Sheehan, called "The Anxiety Disease". His clinical experience with anxiety disordered people was that they went through a number of phases, starting usually with panic attacks, or severe anxiety and moving on to phobias, hypochondriasis, and depersonalization / derealization. The final endpoint of untreated anxiety, according to him was depression. He recommended high dose alprazolam (Xanax) or phenelzine (Nardil) as the best agents for anxiety. This was, of course, written before Klonopin was used for panic. I am pretty sure that most clinicians feel that Klonopin is a better choice because of the pharmacodynamics, longer half-life providing a more even anxiolysis. But Xanax tends to be even less sedating than Klonopin, and purportedly has some antidepressant properties (but I think most benzos do in the cases I described above). I am tempted to give Xanax XR a try, but my luck with Klonopin has been so good. If it ain't broke, don't fix it, as they say!
Hope this helps.
Best of luck,
Matt
Posted by mattdds on June 4, 2003, at 16:55:38
In reply to Matt/Viridis, Re: Will klonopin initial sedation, posted by McPac on June 3, 2003, at 19:56:33
One more thing:
I remember reading the monograph for Klonopin, and there was only like a 1-2% chance of developing depression relative to placebo. So yeah, it's not very common at all.
Matt
Posted by mattdds on June 4, 2003, at 17:05:49
In reply to Re: Matt/Viridis, Re: Will klonopin initial sedation, posted by mattdds on June 4, 2003, at 16:55:38
One more thing, for real this time, :).
Caffeine "augments" my Klonopin. In fact combining the two at the same time puts me into a zen-like trance of tranquility and clarity. Others have reported the same effects with ritalin, amphetamine / dextroamphetamine or ADD drugs.
I used to be sensitive to caffeine, but now I can wash down my Klonopin by slamming a 44-ouncer of black coffee and not feel anything. OK, that's exaggerating a bit.
I don't get sedated from Klonopin anymore, in fact it feels like a sugar pill now because it is so unnoticible (other than the fact that I have almost no anxiety, which is the only effect that lasts for me). But perhaps this could work for people that are bothered by K sedation.
But I don't suggest this for people with caffeine sensitivity.
Posted by KellyD on June 4, 2003, at 17:25:48
In reply to Re: Matt/Viridis, Re: Will klonopin initial sedation » mattdds, posted by mattdds on June 4, 2003, at 17:05:49
What's your dosing and how long have you been on? I know from before you have the AM dose. How do you procede and what total mgs. in 24 hrs? Thanks if you'll share.
Kelly
Posted by mattdds on June 4, 2003, at 21:13:49
In reply to Matt???, posted by KellyD on June 4, 2003, at 17:25:48
I've been taking Klonopin for around 2 years. At first I was really afraid of getting "addicted", but have gotten over that.
The original dose that I started at was prescribed at 0.5 mg b.i.d. - but I would only take 0.25 mg at first. It really never did much at 0.25 for me (this is a miniscule dose and considered subtherapeutic). Since I started taking what I was actually prescribed - a total of 1mg daily in 2 doses, I have virtually no anxiety. Seriously. This effect has lasted well over a year.
Recently however, I told my pdoc that even though my anxiety was totally gone, I still had some residual derealization. He told me to go up to 2mg daily (0.5 mg q.i.d). I tried that for a while but it seemed to be too much, so I have scaled back to two 0.5 mg tablets. One in the morning, one at around 5 pm. I take Ambien for sleep, as I find that Klonopin is an extremely poor sedative (for me). Seriously, I'll take a Klonopin to go to bed and although I feel no anxiety whatsoever, it doesn't sedate me. I just enjoy the insomnia a bit more, because I'm relaxed.
It continues to be just as effective as ever for anxiety as it ever was. As a matter of fact it is even better, because I have no side effects, as my body has adjusted to it (I used to get sedated and slowed). It is a very smooth drug. Even though I keep predicting that it will poop out, it never does.
Best,
Matt
Posted by KellyD on June 4, 2003, at 21:33:26
In reply to Re: Matt??? » KellyD, posted by mattdds on June 4, 2003, at 21:13:49
You were so gracious to answer with such honesty. I had really gotten caught up in the benzo phobic information out there. I do really think it's a good drug for me.... nothing else has been!!!! I am currently beginning (again, for the stupid stoppage) my .25mg twice a day and it does initially make me a little "blah". This does wear off, but as I remember before, it takes awhile for me. I know it takes away a horrible neck ache from tension. Thanks ever so much again, I need the positive info to help me "make peace" with a good drug. You and Viridis help alot with that. Wish me luck!!!
Kelly
Posted by mattdds on June 4, 2003, at 23:48:55
In reply to Thanks Matt, posted by KellyD on June 4, 2003, at 21:33:26
I feel what you're going through. I almost had to drop out of dental school for anxiety. I was fighting the benzo thing so hard! I kept getting worse with every SSRI, TCA or other antidepressant. I had to leave my school healthcare system because they all felt benzos were "addictive". Having read a great deal about benzos and taken a medical pharmacology class in dental school, I feel anyone who tells people benzos are addictive in people with anxiety disorders is just misinformed and not up on the literature.
I found a good psychiatrist in NYC with a lot of experience with anxiety disorders. He says he has a number of patients who've been on Klonopin for years with great success.
Do you have panic disorder? Or a similar anxiety disorder? If so, benzos have been shown in the literature to work over decades! They're really remarkable drugs, ya know.
If they have worked for you, then honestly, don't worry about addiction. You might become dependent, but they keep on working for you as long as you take them. The only tolerance is to the bad side effects. The good effects hang around indefinitely! That's the beauty of benzos. You'll know if and when it is time to come off them (perhaps never, but that's ok!), and when you do, just taper over a 3-4 month period and you'll be fine!
Best of luck!
Matt
P.s. Though I consider Klonopin a miraculous drug, I owe much of my success (perhaps 80%?) to CBT. It greatly improved my response to benzos, as well. I know CBT isn't very fashionable on this board, but it helps me and many others! We're having a pretty lively discussion on CBT at psychological babble, if you want to check it out. In particular, Larry Hoover is a genius when it comes to CBT matters. I'm sure you'll find his comments interesting.
Posted by KellyD on June 5, 2003, at 7:27:49
In reply to Re: Thanks Matt, posted by mattdds on June 4, 2003, at 23:48:55
Thanks so much. I may be a "benzo head" (meant in the nicest way) at least for a while. The lethergy is fading day by day. I have done some CBT and should practice its concepts more. I'm playing it as it goes. My doc is very good and listens to me. He even warned me I should stick with the K. He said I had a "gotta not use THAT" complex which was not healthy. I should look at the good benefits I receive.(VERY true) I have had panic, it's not as much of a factor as previous. Main problem is GAD, excessive worry, small amount of agoraphobia (I think I'll feel like sh** while out is the fear there). All of these are lessened when I use K...... instead of worrying about getting off of it. I thought it was to be a short term treatment.. I have to change the mindset. Today is better and it's day 5 on the .5mgs total.... says something. Thanks for your support. I am glad you are doing well... it's what we all deserve.
Kelly
Posted by babs on June 5, 2003, at 8:07:02
In reply to Matt, appreciate the support, posted by KellyD on June 5, 2003, at 7:27:49
I'm having kind of a rough time switching to klonopin. I'm coming off risperdal which helped with mood too so I feel a little depressed. I can't eat much due to the anxiety I'm feeling. I'm on .5 mg twice a day and I can feel it beginning to work but I'm not all the way there yet. At least I'm sleeping well. My pdoc gave me ativan to take as needed and that has helped. I'm also finding meditation and yoga are helping a bit too (especially with stimulating my appetite a little). I'm trying to hang in there- it's been 7 days. How long do you give it before you decide you need a higher dose? I have a feeling I'm going to need more than 1 mg per day as my anxiety is usually pretty severe. Thanks for all you support, babs
Posted by KellyD on June 5, 2003, at 8:30:24
In reply to Thanks for all your posts, posted by babs on June 5, 2003, at 8:07:02
Hang in there, I know it's rough. As I stated before, I'm a restarter with Klonopin. My experience is that it did take time and "tweaking the dosing" right for you - may take a bit. When I initially went on, my doc did have me check back at a week. At that time, I did experience relief but not GONE... which is what we all want. I did not increase at that time and after a second week the relief was really noticable and the "lethergy" had lessened as well. I never had any GI problems with it, as I think you said you did. Only you and your doc can decided the right thing for you to do and how to proceed. I wish you the best. It's rough stuff and just seems to take over and overwhelm. You will feel better and there is a right drug (could be the K), dose, and such to help you.
Kelly
Posted by McPac on June 5, 2003, at 15:46:08
In reply to Re: Matt??? » KellyD, posted by mattdds on June 4, 2003, at 21:13:49
(nm)
Posted by Sassafrass on June 26, 2003, at 17:05:00
In reply to Re: Matt??? » KellyD, posted by mattdds on June 4, 2003, at 21:13:49
I take Klonopin just for sleep only. I don't get a drugged out feeling at all in the morning. It's the only thing that lets me get a good restful sleep. I'm on .75 right now. Does anyone else use it just for sleep? I just worry that I can't stay on it long term b/c I'll start needing more and more. But I'm just going to use it while I can and appreciate the great sleep I'm getting.
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