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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 10 of 10. This is the beginning of the thread.
Posted by zuzu80 on May 3, 2004, at 15:22:13
Hello,
I just got Klonopin today 0.5 mg tablets.
I can just give some info about my type of Socail Anxiety:
I don't experience any sort of physical symptoms in social settings. The problem is that I am behaviorally/emotionally inhibited. I am not realxed, it's like I get into a glass bubble.It's not that I am afraid that ppl are going to criticize me or reject me. I just think that there's only one way to do things. It's just that I am not open and "loose" in social setting. My problem is mainly that of non OPENNESS and little seriousness.
I am not used to be open and talkative in social setings.
So, what do you think, what dosage (timing) of Klonopin will help ?
Thanks a lot.
Posted by Franz on May 3, 2004, at 16:46:39
In reply to Klonopin for Social Anxiety -- Dosage ?, posted by zuzu80 on May 3, 2004, at 15:22:13
> Hello,
>
> I just got Klonopin today 0.5 mg tablets.
>
> I can just give some info about my type of Socail Anxiety:
> I don't experience any sort of physical symptoms in social settings. The problem is that I am behaviorally/emotionally inhibited. I am not realxed, it's like I get into a glass bubble.
>
> It's not that I am afraid that ppl are going to criticize me or reject me. I just think that there's only one way to do things. It's just that I am not open and "loose" in social setting. My problem is mainly that of non OPENNESS and little seriousness.
>
> I am not used to be open and talkative in social setings.
>
> So, what do you think, what dosage (timing) of Klonopin will help ?
>
> Thanks a lot.
>I think your "type of Socail Anxiety" is not social anxiety.
Who gave you a diagnose, a doctor?.
Posted by psychodad on May 3, 2004, at 19:07:51
In reply to are you sure? » zuzu80, posted by Franz on May 3, 2004, at 16:46:39
Yeah it sounds as if you're shy. Try exercise and or joining some group activities so you can gain confidence and feel more comfortable in social settings. Some people drink alcohol or use coke to overcome this type of "social anxiety." If you're shy it just takes practice in social settings to get used to them. Maybe try an acting class or get involved in a team sport. Don't wimp out and take drugs if you don't really need them. Be a man.
> > Hello,
> >
> > I just got Klonopin today 0.5 mg tablets.
> >
> > I can just give some info about my type of Socail Anxiety:
> > I don't experience any sort of physical symptoms in social settings. The problem is that I am behaviorally/emotionally inhibited. I am not realxed, it's like I get into a glass bubble.
> >
> > It's not that I am afraid that ppl are going to criticize me or reject me. I just think that there's only one way to do things. It's just that I am not open and "loose" in social setting. My problem is mainly that of non OPENNESS and little seriousness.
> >
> > I am not used to be open and talkative in social setings.
> >
> > So, what do you think, what dosage (timing) of Klonopin will help ?
> >
> > Thanks a lot.
> >
>
> I think your "type of Socail Anxiety" is not social anxiety.
>
> Who gave you a diagnose, a doctor?.
Posted by Anthony Quest on May 3, 2004, at 19:51:31
In reply to Klonopin for Social Anxiety -- Dosage ?, posted by zuzu80 on May 3, 2004, at 15:22:13
I would be very cautious. I have taken Klonopin for 7 years. Most people who start to use just occasionally end up becoming dependent. Not addicted but physically dependent. There is a lot posted on the board about how hard it is to stop using Klonopin, and well, there's nothing wrong with short term use. .5 mg is the starting dose and if helps your anxiety and it probably will that will be great.
Before you consider it as a long term solution, really look hard though at the facts of what percentage of people who take it for more than a few months are ever able to stop. If it's worth it to you then go for it.
Also, one thing to be aware of is that Klonopin lasts 6-8 hours. Xanax for example is 2-3 hours and Ativan is 4-5 hours. If there are just certain discrete situations, maybe you want something shorter acting otherwise you will feel its effects longer than you may want.
Posted by Kon on May 3, 2004, at 21:11:50
In reply to Re: Klonopin for Social Anxiety -- Dosage ? » zuzu80, posted by Anthony Quest on May 3, 2004, at 19:51:31
> Also, one thing to be aware of is that Klonopin lasts 6-8 hours. Xanax for example is 2-3 hours and Ativan is 4-5 hours. If there are just certain discrete situations, maybe you want something shorter acting otherwise you will feel its effects longer than you may want.
That's a good point from one perspective but note that the potential for dependency and/or tolerance may be greater with short-acting benzos particularly xanax. If one's goal is to maintain the as-needed basis and not risk going to full-time drug usage, I think a good argument can be made to stick with klonopin. Again, I'm not certain...but I think a good argument can be given that klonopin will be less likely to lead to escalating dosage and/or dependency. There's no "high' associated with klonopin and most of the stuff I've read suggests that dependency and severity of withdrawl may be less likely with longer-acting benzos like klonopin. That's how I'm justifying it to myself. Been taking Klonopin as-needed for about 2 years.
Posted by Anthony Quest on May 3, 2004, at 21:43:51
In reply to Re: Klonopin for Social Anxiety -- Dosage ? » Anthony Quest, posted by Kon on May 3, 2004, at 21:11:50
I agree that addiction potential is much higher with Xanax, but whenever we speak of addiction potentials or abuse potential - this is by definition meaningful only in the context of a large population.
I think practitioners use Klonopin for precisely the reason that in the aggregate they will have less patients who will develop problems. Even if the majority of patiens would never develop a problem.
Klonopin just doesn't give the high that Xanax nor does it have a "street value" so diversion is not an issue. Of that, there is no dispute. Neither does Klonopin have the stigma with some doctors.
But how important is this for an individual clinical decision. Assuming for the sake of argument, patient X doesn't get a high from Xanax or simply doesn't have any propensity to abuse or sell drugs, why does abuse in the general population matter? I would argue it shouldn't.
The benefit of Klonopin in the situation I describe does not go to the patient- it's to society or the physician or some nebulous interest. I think one could argue the patient, absent a history suggesting abuse or addiction potential, should be able to make this choice for himself.(Of course, ask for Xanax and see where that gets you).
I think most people would agree that Klonopin is the best way to go, but I am not convinced for the following reasons:
1. After a few months, one gets a tolerance to any high fron any benzodiazepine. At that point, abuse will depend on something other than the "euphoric" factor and rather the common trait of all benzos. So this is a short term worry. Diversion would always be a concern. Also, for sleep purposes, if you just have trouble falling asleep but not staying asleep, Klonopin is going to leave a hangover effect that Xanax wll not.
2. Withdrawal is probably worse with Klonopin. I think someone who knows more about pharmacology could comment but I know that if you are comparing opioids, it's easier to withdrawlfrom say Oxycodone than it is from methodone. The longer half life means the drug stays in one's body longer and the withdrawal is prolonged. The shorter half-life means the withdrawal happens quicker but it's over more quickly too. I have no idea whether this is a fair comparison between opioids and benzos.
I know some people consider Klonopin a still short acting benzodiazepine. When you look at the half-life of Valium, or Librium, Klonopin is not that long acting. The gung-ho benzo haters say Klonopin is just as evil as all the rest and its just America's way of denying reality. (Ashton et al)
But you know what, I am just arguing for the sake of arguing. Unless there is reason Klonopin is not satisfactory, I would agree that Xanax is not the first choice. Except for maybe truly PRN use- like fear of flying when some flies a few times a year.
Posted by Kon on May 4, 2004, at 0:33:28
In reply to Re: Klonopin for Social Anxiety -- Dosage ?, posted by Anthony Quest on May 3, 2004, at 21:43:51
>2. Withdrawal is probably worse with Klonopin...The longer half life means the drug stays in one's body longer and the withdrawal is prolonged. The shorter half-life means the withdrawal happens quicker but it's over more quickly too.
From my understanding withdrawal may be longer with klonopin but severity of withdrawal will be greater with xanax. Here's an interesting article on this point from Ashton's site (see below). Interesting though, that according to this author, over 50% of individuals will not experience much in the way of benzo withdrawal symptoms, even after long-term use.
--------------------------------------------------
http://www.benzo.org.uk/tyrer1.htm"Benzodiazepines with shorter duration of action, such as triazolam and lorazepam, may carry a greater risk of dependence than their longer acting relatives: certainly their withdrawal symptoms occur earlier and are more severe than those of long acting compounds.[12,21,22] The explanation may be that withdrawal symptoms are more likely when blood concentrations of benzodiazepines fall rapidly after stopping the drug.[12] Indeed, the paradox may be that the attempt to make the prescription of benzodiazepines more acceptable by shortening their duration of action has led to a greater incidence of pharmacological dependence."
Posted by zuzu80 on May 4, 2004, at 0:53:54
In reply to Re: are you sure?, posted by psychodad on May 3, 2004, at 19:07:51
Thanks,
It's not just that I'm shy, I'm PAINFULLY shy. I can say that the social world is somewhat new realm for me! I been this way since adolescence (Iam noe 21). I lived for some years in serious isolation, and I never fully got to know the "social" part of me.
I am not going to use Klonopin long term. I might take it for 2 weeks then have a break. And on the summer holiday (I have now exams) I will combine little Klonopin with CBT. Maybe group CBT, or by self exposures/cognitive reconstruction, have some good self help books on the subject. I am psychologically oriented and taking Psychology major.
I tried exposures and new things, but it's REALLY too difficult. Little Klonopin can get the change process moving.
> Yeah it sounds as if you're shy. Try exercise and or joining some group activities so you can gain confidence and feel more comfortable in social settings. Some people drink alcohol or use coke to overcome this type of "social anxiety." If you're shy it just takes practice in social settings to get used to them. Maybe try an acting class or get involved in a team sport. Don't wimp out and take drugs if you don't really need them. Be a man.
>
> > > Hello,
> > >
> > > I just got Klonopin today 0.5 mg tablets.
> > >
> > > I can just give some info about my type of Socail Anxiety:
> > > I don't experience any sort of physical symptoms in social settings. The problem is that I am behaviorally/emotionally inhibited. I am not realxed, it's like I get into a glass bubble.
> > >
> > > It's not that I am afraid that ppl are going to criticize me or reject me. I just think that there's only one way to do things. It's just that I am not open and "loose" in social setting. My problem is mainly that of non OPENNESS and little seriousness.
> > >
> > > I am not used to be open and talkative in social setings.
> > >
> > > So, what do you think, what dosage (timing) of Klonopin will help ?
> > >
> > > Thanks a lot.
> > >
> >
> > I think your "type of Socail Anxiety" is not social anxiety.
> >
> > Who gave you a diagnose, a doctor?.
>
>
Posted by Viridis on May 4, 2004, at 2:46:06
In reply to Klonopin for Social Anxiety -- Dosage ?, posted by zuzu80 on May 3, 2004, at 15:22:13
I've taken Klonopin (1 mg/day) for about three years and haven't had to change the dosage. My pdoc says this is standard for many of his patients. I also take Xanax, but develop tolerance fast so limit its use to a few times a month. My pdoc also says tolerance is common with Xanax, so is very cautious with it and will only prescribe it for occasional use for most patients. I haven't tried to withdraw from Klonopin (which I expect would be difficult) but also have absolutely no side effects from it, so why quit? It's extremely effective for anxiety relief and has been used for decades without any indications of long-term harm, even used daily.
Posted by Anthony Quest on May 4, 2004, at 4:02:03
In reply to Re: Klonopin for Social Anxiety -- Dosage ? » zuzu80, posted by Viridis on May 4, 2004, at 2:46:06
If the medication works, then I see no reason to ever quit. I think the only point those make who talk about the dependence and protracted withdrawal is that a lot of people began using the drug without knowing they would be on it for life. They feel upset that they didn't explicitly consent going into it, and now they find themselves having to take something for life which is a very major decision - even if it is just a tiny pill.
I would guess most of the people would still have chosen to use Klonopin - I would have. It took 7 years for me to find out why I couldn't sleep at night and I couldn't have been functional that 7 years while I was trying to get an accurate diagnosis. Eventually I got an accurate diagnosis but only after all the symptoms of the disorder showed up so, what was I to do in the interim?
I say it is great you know what you do about yourself and Klonopin and freely have chosen to improve your life by taking it. It's a mature decision a lot of people for one reason or another because of other people'e negligence or their own inability to reason, don't ever make. So, you have thought about everything you need to think about can be very confident that you are fully informed in how you live your life.
This is the end of the thread.
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