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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 16 of 16. This is the beginning of the thread.
Posted by Hanks on September 15, 2003, at 2:51:56
So,, I have these 2 options. I have recurrent depression and staying alive without medicating my brain is almost impossible. Life has left me with 2 options. Take either prozac or a benzo -preferably klonopin or xanax- for the rest of my life. My humble question is what will be a fairtrade ? Taking prozac 20 mg daily makes me apathetic and sexually inactive,whereas taking 1 mg klonopin or xanax makes more social and energetic without sexual side effects. In this refractory period of my depression, door is wide open for me. You experienced guys, can you please advise me !! Thanks.
Peter Hanks.
Posted by HenryO on September 15, 2003, at 3:09:27
In reply to Prozac or a Benzo(Klonopin or Xanax) Please advise, posted by Hanks on September 15, 2003, at 2:51:56
Why are these the only two meds you can take?
You didn't mention a downside to your taking a Benzo.
I personally think Prozac is not a good longterm solution just for the reasons you mentioned. But there are many more options than Xanax or Klonopin.
Posted by rianny on September 15, 2003, at 4:09:48
In reply to Prozac or a Benzo(Klonopin or Xanax) Please advise, posted by Hanks on September 15, 2003, at 2:51:56
Yeah, you should consider other meds too.
I didn't know about drugs before I started to find out myself.The thing is there are lots and lots of antidepressants available.
There must be one that works for you!
Posted by Viridis on September 15, 2003, at 4:32:11
In reply to Prozac or a Benzo(Klonopin or Xanax) Please advise, posted by Hanks on September 15, 2003, at 2:51:56
As others have pointed out, there are many other options that you may not have explored.
However, given the choice between Prozac and Klonopin or Xanax (all of which I've taken for extended periods) and your reactions to these particular meds, the benzos win hands down because:
A) Benzos have a long history of safety and effectiveness and have been used by some people for decades; long-term effects of SSRIs aren't yet known, although Prozac has been around the longest.
B) Benzos usually have many fewer side effects than SSRIs.
C) SSRIs generally are more difficult to discontinue than benzos, although Prozac isn't the worst, given its long half-life.
I think you know the answer. Personally, I'd go with Klonopin (and have).
Posted by mattdds on September 15, 2003, at 12:03:18
In reply to Prozac or a Benzo(Klonopin or Xanax) Please advise, posted by Hanks on September 15, 2003, at 2:51:56
I think your post answered your own question, judging by the reaction you had to it (more social, energetic). If Klonopin is making you more social and energetic, and Prozac is worsening your situation, in my mind your question is answered.
Are you suffering from only depression? Or what is your diagnosis or symptoms? I ask this because I was misdiagnosed and mistreated with SSRI's and other antidepressants for far too long. I realized it was the severe anxiety inducing the depression, and if I got rid of the anxiety, the depression mysteriously vanished.
If you are experiencing panic, generalized anxiety or social anxiety, the benzos (particularly Klonopin) win hands down. For most, the antidepressants cannot even hold a candle to the anxiety-reducing properties of benzos.
For depression *alone* benzos are not very effective, and could possibly worsen your situation. But if anxiety is a significant symptom, then benzos *will* help, period.
I am coming up on 2 years of Klonopin usage, and it continues to work and is my mainstay. All the fears I had of benzos ("addiction", side effects, etc.) are completely gone as I realized how absolutely benign these drugs are. Every day I am more and more convinced that these are tremendous drugs.
Matt
Posted by Hanks on September 15, 2003, at 23:10:56
In reply to Re: Prozac or a Benzo(Klonopin or Xanax) Please ad, posted by HenryO on September 15, 2003, at 3:09:27
Thanks,I think I didn't make my case clear, that may be why I am being asked rather than answered. The question I see is of the peculiarity of my 2options. Indeed there are more than 2 dozens of antidepressants out there and an equal amount of benzos as well. But why should I experiment with all those while I am having a perfect fit in my hand?
For me both (Prozac and Klonopin) works well and the good effects are almost equal though there is a substantial difference in the amount of unwanted effects. 20mg prozac alone can make me well so do klonopin at 1 mg. Difference lies in the department of side effects. Prozac dampens my sexual desire but klonopin doesn't even touch it. That is the prime thing which prompted me to ask the basic question. Which should be preferred for the long-term use if both works well for a patient? This is the refractory period of my depression and currently I am not taking any medications. But time is too short and from my own experience I can say this state will not last for more than a couple of months. I should take a decision, before it is too late. So once again here is my plea for help. Please....
Peter Hanks.
Posted by Hanks on September 15, 2003, at 23:23:09
In reply to Re: Prozac or a Benzo(Klonopin or Xanax) Please ad » Hanks, posted by Viridis on September 15, 2003, at 4:32:11
Thanks Viridis,
"SSRIs generally are more difficult to discontinue than benzos, although Prozac isn't the worst, given its long half-life"
This is a statement which gives me enough courage to go on with the benzo (klonopin) alone. But is this a well documented fact? Acccording to my doc:He would prefer SSRIs if coming off medications is necessary. Still he says if long-term or life-long treatment is necessary, therapy with antidepressants doesnt make any sense if a benzo will do the job. Yet my doubts arent cleared. According to Dr. Stuart Shipko "benzos can be a part of problem in long-term therapy" Neverthless, he indicates the superiority of benzos over SSRis because of the lack of serious side effects.
Something is missing somewhere. Isn't?
What do you think?Thanks for your input
Peter Hanks.
Posted by HenryO on September 15, 2003, at 23:36:30
In reply to Re: Prozac or a Benzo(Klonopin or Xanax) Please ad » HenryO, posted by Hanks on September 15, 2003, at 23:10:56
This may be one source of our misunderstanding.
refractory:
1. Obstinate in disobedience; contumacious; stubborn; unmanageable; as, a refractory child; a refractory beast.
2. Resisting ordinary treatment; difficult of fusion, reduction, or the like; -- said especially of metals and the like, which do not readily yield to heat, or to the hammer; as, a refractory ore.
adj 1: resistant to authority or control; "as refractory as a mule" 2: (med) not responding to treatment; "a stubborn infection"; "a refractory case of acne" [syn: stubborn] 3: marked by stubborn resistance to and defiant of authority or guidance; "a recalcitrant teenager"
Syn: Perverse; contumacious; unruly; stubborn; obstinate; unyielding; ungovernable; unmanageable.
Posted by HenryO on September 15, 2003, at 23:40:41
In reply to Re: Prozac or a Benzo(Klonopin or Xanax) Please ad » HenryO, posted by Hanks on September 15, 2003, at 23:10:56
The fit doesn't sound all that perfect. Other meds may have fewer side effects than either Prozac or Klonopin and some might work better.
Posted by Hanks on September 16, 2003, at 0:29:42
In reply to Re: Prozac or a Benzo(Klonopin or Xanax) Please advise » Hanks, posted by mattdds on September 15, 2003, at 12:03:18
Thanks Mattdds,
Anxiety and depression. I have both these. But according to my treating physician anxiety makes me depressed. So it makes sense if I can dispel anxiety, depression will not strike. But many old fashioned docs doesn't agree with this. They treat depression and subsequently the contributory factor is also being checked. But at the cost of my sexuality, I don't want to treat depression, rather I prefer to be vigilant in dissipating the contributory factor(anxiety) to keep depression out of fence. But I need to make myself sure I am doing the right thing, since I have read Dr. Stuart Shipko "However, benzos can become a part of problem in long-term treatment"
Your input was helpful. What do you think of the points I made ? Please answer
Thanks
Peter Hanks.
Posted by Hanks on September 16, 2003, at 0:41:57
In reply to Re: Prozac or a Benzo(Klonopin or Xanax) Please ad, posted by HenryO on September 15, 2003, at 23:36:30
Thanks Henry,
The term "refractory depression" was an error. Actually I am in transit period of depression and anxiety. That was what I meant.
Meanwhile, I have taken a lot of meds to ease the agony of anxiety and depression. So far prozac and klonopin are the ones that work for me with fewer side effects. I know there are many ADs and Benzos around so do some mood stabilizers. But what works for me with fewer side effects should be my choice of meds regardless of what others find effective. Now I want to make a choice between prozac and klonopin. That's all I need.
Thanks
Peter Hanks.
Posted by HenryO on September 16, 2003, at 2:59:17
In reply to Re: Prozac or a Benzo(Klonopin or Xanax) Please ad » HenryO, posted by Hanks on September 16, 2003, at 0:41:57
I get it. Sorry to push it. Guess I just needed to be nosy. Thanks for being so tolerant. Meds are a personal choice, you're right. I'd go with the Klonipin, if you feel confident in your ability not to abuse it. Sexual disfunction by itself is depressing. I think long term Prozac knocks out all desire as well. Good luck.
Posted by Viridis on September 16, 2003, at 5:09:25
In reply to Re: Prozac or a Benzo(Klonopin or Xanax) Please ad » Viridis, posted by Hanks on September 15, 2003, at 23:23:09
My statement about difficulty of withdrawal from benzos (especially Klonopin) vs. SSRIs is based in part on what my pdoc has told me and in part on a study that was released a year or so ago (by the World Health Organization, I think, although I'd have to look it up). This is largely confirmed by anecdotal reports that I've seen here and on other boards (although this is the main one I read).
The study I mentioned rated several SSRIs and other ADs as THE most difficult-to-discontinue prescription meds, with Paxil and Effexor at the top (I can't remember where Prozac placed; it was less problematic than these). Benzos placed in the teens -- not trivial, but much less problematic than newer, very widely-prescribed ADs. I'm sure I could track down the details; this study has been quoted here quite a few times.
My pdoc has many patients on Klonopin who have stayed at the same dose for years. He considers it an excellent drug for those who need it, although he's certainly not cavalier about prescribing it. His main caution is that it must be discontinued gradually, which he says is generally straightforward (in his experience) as long as you don't rush it. This is no different from many ADs.
Again, benzos have been used for many years, no major problems have emerged except for the small proportion of people who do abuse them (inconceivable to me, especially with Klonopin), the side effects are generally minor and diminish quickly for most people, tolerance to the anxiolytic effects is rare, and they're cheap. What more could you ask for -- especially when you already know that they work for you?
Posted by Jasmine Neroli on September 18, 2003, at 0:55:24
In reply to Re: Prozac or a Benzo(Klonopin or Xanax) Please ad » Hanks, posted by Viridis on September 16, 2003, at 5:09:25
Hello: It is certainly a very personal decision to make, but I would add my vote to the Klonopin side. I've been treated for depression for 2 years even tho' my doc's acknowledge that my initial symptoms were anxieties. But the fear was that unresolved anxieties lead to depression or are co-morbid with it. And depression can be more dangerous to the individual (suicide etc.) and harder to treat in many cases. So, I too had SSRI/SARI treatments. They helped the anxiety, but after sustained use, left me flat, lethargic, worsened my insomnia, sexual dysfunction and caused some very despairing lows, that I didn't have BEFORE! Now I have been re-diagnosed with GAD, with no apparent depression! Klonopin has made me relaxed, calm, free of continual worry, social, and given me sleep again. I have no sign of depression! At first, it was sedating and energy zapping, but a month later, that has gone. So I agree with the previous posters, the sedating effect does wear off (which is why it can be "addictive" as a sleep medication, cuz tolerance builds to it), but the anxiolytic effect is still the same at the same dose I started. I believe that discontinuing AD's to be far more unpleasant than benzo's.
When you have to decide between two things that work for you, consider which has the least side-effects, which is the cheapest, which has the least discontinuation problems, which have been around the longest ( so more is known about them).
And is depression an issue at all, if so, is it secondary to anxiety????
Good luck with your decision.
Jas
p.s. I have recently been put on a trial of Buspar, with the idea of tapering off Klonopin in a few weeks, if it works. That might be another option for you ( however, I'm not optimistic about it for myself).
Posted by Hanks on September 18, 2003, at 3:19:49
In reply to Re: Prozac or a Benzo(Klonopin or Xanax) Please ad, posted by Jasmine Neroli on September 18, 2003, at 0:55:24
Thanks Jasmine for Your wonderful post.
"And depression can be more dangerous to the individual (suicide etc.) and harder to treat in many cases."
I hope this may not be true in any case as this is what annoys me most. I remember an article I read in Reader's Digest long ago stating "depression is surprisingly easy to treat" Depression may be difficult to treat at the initial stages, but once either the drug or psychotherapy starts to kick in, it is fairly easy to manage. According to Dr. Stuart Shipko (Who indeed is not a die-hard fan of psychotherapy)The theories of chemical imbalance in the brain are only theories. Depression resolves naturally within six to nine months in most cases. This is the basic theory of depression. Drugs will shorten this period, but at the cost of dependence especially in the case of newer antidepressants.
I now know what makes sense and what to chose. Either Klonopin or Xanax. Yes, I do.
ThaksPeter Hanks.
Posted by Jasmine Neroli on September 19, 2003, at 15:30:32
In reply to Re: Prozac or a Benzo(Klonopin or Xanax) Please ad » Jasmine Neroli, posted by Hanks on September 18, 2003, at 3:19:49
Hey:
Yeah, I think depression is SOOOOOOO complex! It does seem to have an average 9 month course, from what I've read too. I'm hoping that u r one of those in which it resolves itself!What complicates the issue is brain chemistry alterations from all sorts of other causes, such as endocrine problems (hormonal inbalance, some hormones are present in the brain AND body), nutrition and upsets to the sleep-wake cycle, & the HPA axis, from continual exposure to (even low-level) stress. I believe that depression can become a brain chemistry problem. It can also become a biochem. problem due to repeated or long term psychological problems too.
The important thing to remember is that the brain is very "maleable". It's never static and all neurotransmitters, neuro-hormones etc. are constantly re-adjusting and "re-wiring" our physical brains. And WE JUST DON'T KNOW ENOUGH ABOUT IT!
I've never heard of Dr. Shipko, but you've piqued my interest and I'm gonna try to read his stuff!
Good luck with your benzo trial!!!
Jas
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