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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 65. This is the beginning of the thread.
Posted by KevinM on October 6, 2004, at 19:38:41
I have been taking Klonopin for several weeks and it has helped greatly with my anxiety. Unfortunately it started causing a depression that I haven't felt for some time. Does anyone have an opinion of an alternative that might be better in that regard? I get the impression that Klonopin is more "PC" than others although my Pdoc is usually open to suggestions. Thanks for your help.
Posted by utopizen on October 6, 2004, at 20:01:01
In reply to Help with anxiety/benzos, posted by KevinM on October 6, 2004, at 19:38:41
> I have been taking Klonopin for several weeks and it has helped greatly with my anxiety. Unfortunately it started causing a depression that I haven't felt for some time. Does anyone have an opinion of an alternative that might be better in that regard? I get the impression that Klonopin is more "PC" than others although my Pdoc is usually open to suggestions. Thanks for your help.
>It's best to augment Klonopin with an antidepressant, because depression is especially prone to anyone with a mental illness of any kind, and Klonopin can't stop the inevitable.
In other words, since depression happens in 1 out of 5 Americans, and even more than that in patients with a mental illness, guess what? Chances you're going to get depressed at any given time with or WITHOUT Klonopin are already really, really high.
If psychopharmacology was simple, we'd simply refer to the clinical trials sheets and see depression occured in patients taking Klonopin in a dose-dependent relationship. Unfortunately, psychopharmacology isn't that simple--if you read clinical trial statistics that literally, you'll go insane.
Go on an antidepressant, regardless of what the hypothesis of the month is about whether the Klonopin is causing your depression or not. In a sense, a drug can only -agitate- existing problems like depression. Why are some people more prone to getting depression from a certain med while others can take the same med and never get depression? Who knows.
But the fact that a drug might set it off should alarm you for this reason alone: if a med can trigger depression in you, who's to say the next negative life event for you won't just as easily?
Moral of the story: try lowering or substituting the Klonopin, but don't look for this as a solution within itself: if you're like me, join the antidepressant for life club. (Start trying 'em for social anxiety disorder, stay on 'em once you get depression).
I went off antidepressants when I went on Klonopin, and a few months later got depression. Who knows what caused it, but I regret ever going off antidepressants.
Posted by KevinM on October 6, 2004, at 20:24:27
In reply to Re: Help with anxiety/benzos, posted by utopizen on October 6, 2004, at 20:01:01
utopizen, thanks for your reply. I apologize, I should have mentioned that I take 300mg of Wellbutrin XL and 400mg of Lamictal. I agree totally with what you are saying. It's really strange (and scary) of what happened-I felt a few days of being a little down-then bam! It was as if someone flipped a switch. I have decreased the dose which has helped somewhat, but the anxiety has increased. I seem to recall a benzo that actually has antidepressant qualities, but I'm not sure it is available in the US.
Posted by utopizen on October 6, 2004, at 20:49:30
In reply to Re: Help with anxiety/benzos, posted by KevinM on October 6, 2004, at 20:24:27
> I seem to recall a benzo that actually has antidepressant qualities, but I'm not sure it is available in the US.
>Klonopin is the most proven to, when augmented with an antidepressant, have antidepressant properties. You should look to trying a different antidepressant, as Wellbutrin may worsen your anxiety.
Posted by Colleen D. on October 6, 2004, at 21:05:17
In reply to Help with anxiety/benzos, posted by KevinM on October 6, 2004, at 19:38:41
a tricyclic AD that works for depression and anxiety if you can add it to the other meds you are taking.
I take Effexor, Klonopin and Doxepin. Effexor has pretty much wiped out my depression, Klonopin works very well for my anxiety, and Doxepin works on both anxiety and depression but I use it mainly for it's sedative qualities at night. I'm guessing that the small dose of Doxepin helps combat any add'l depression I might get from the Klonopin.
Good luck!
Colleen
PPD, GAD and OCDp.s. - What's your diagnosis?
Posted by Fred23 on October 6, 2004, at 22:58:36
In reply to Re: Help with anxiety/benzos, posted by KevinM on October 6, 2004, at 20:24:27
> I seem to recall a benzo that actually has antidepressant qualities, but I'm not sure it is available in the US.
You're thinking of Xanax, which is available, but doctors are less likely to prescribe it now due to its bad reputation.
Ativan is another benzo that doesn't worsen depressions, and is less sedating that Klonopin, but doesn't have as long of a duration of action.
Posted by maddog on October 7, 2004, at 2:24:14
In reply to Help with anxiety/benzos, posted by KevinM on October 6, 2004, at 19:38:41
> I have been taking Klonopin for several weeks and it has helped greatly with my anxiety. Unfortunately it started causing a depression that I haven't felt for some time. Does anyone have an opinion of an alternative that might be better in that regard? I get the impression that Klonopin is more "PC" than others although my Pdoc is usually open to suggestions. Thanks for your help.
Klonopin is known to have a depressive effect in some users. For myself, I was on Paxil and Klonopin and during that period suspended the use of Paxil. Both times I eventually had a depressive episode. Perhaps it was related to the Klonopin, perhaps not. However, taking a AD in combination with Klonopin that does not cause anxiety is a good idea.
maddog
Posted by maddog on October 7, 2004, at 2:24:28
In reply to Help with anxiety/benzos, posted by KevinM on October 6, 2004, at 19:38:41
> I have been taking Klonopin for several weeks and it has helped greatly with my anxiety. Unfortunately it started causing a depression that I haven't felt for some time. Does anyone have an opinion of an alternative that might be better in that regard? I get the impression that Klonopin is more "PC" than others although my Pdoc is usually open to suggestions. Thanks for your help.
Klonopin is known to have a depressive effect in some users. For myself, I was on Paxil and Klonopin and during that period suspended the use of Paxil. Both times I eventually had a depressive episode. Perhaps it was related to the Klonopin, perhaps not. However, taking a AD in combination with Klonopin that does not cause anxiety is a good idea.
maddog
Posted by mcp on October 7, 2004, at 2:43:33
In reply to Re: Help with anxiety/benzos, posted by utopizen on October 6, 2004, at 20:01:01
No disrespect, but I think it is reckless and irresponsible for you to casually recommend someone take an AD and join the AD for life club, as you put it.
There are so many things you can try and do before you take the DRASTIC last step of taking a drug. It may work for you, but that doesn't mean it will for others.
> > I have been taking Klonopin for several weeks and it has helped greatly with my anxiety. Unfortunately it started causing a depression that I haven't felt for some time. Does anyone have an opinion of an alternative that might be better in that regard? I get the impression that Klonopin is more "PC" than others although my Pdoc is usually open to suggestions. Thanks for your help.
> >
>
> It's best to augment Klonopin with an antidepressant, because depression is especially prone to anyone with a mental illness of any kind, and Klonopin can't stop the inevitable.
>
> In other words, since depression happens in 1 out of 5 Americans, and even more than that in patients with a mental illness, guess what? Chances you're going to get depressed at any given time with or WITHOUT Klonopin are already really, really high.
>
> If psychopharmacology was simple, we'd simply refer to the clinical trials sheets and see depression occured in patients taking Klonopin in a dose-dependent relationship. Unfortunately, psychopharmacology isn't that simple--if you read clinical trial statistics that literally, you'll go insane.
>
> Go on an antidepressant, regardless of what the hypothesis of the month is about whether the Klonopin is causing your depression or not. In a sense, a drug can only -agitate- existing problems like depression. Why are some people more prone to getting depression from a certain med while others can take the same med and never get depression? Who knows.
>
> But the fact that a drug might set it off should alarm you for this reason alone: if a med can trigger depression in you, who's to say the next negative life event for you won't just as easily?
>
> Moral of the story: try lowering or substituting the Klonopin, but don't look for this as a solution within itself: if you're like me, join the antidepressant for life club. (Start trying 'em for social anxiety disorder, stay on 'em once you get depression).
>
> I went off antidepressants when I went on Klonopin, and a few months later got depression. Who knows what caused it, but I regret ever going off antidepressants.
Posted by partlycloudy on October 7, 2004, at 6:58:16
In reply to Re: Help with anxiety/benzos---utopizen, posted by mcp on October 7, 2004, at 2:43:33
So what would be your advice to Kevin if ADs are the last resort?
pc
Posted by Squiggles on October 7, 2004, at 7:27:38
In reply to Help with anxiety/benzos, posted by KevinM on October 6, 2004, at 19:38:41
It's possible that K causes
depression in some - it may
explain a puzzle with my friend;
are you already taking an AD?
In this case an AD was present,
but another had to be added after
K was prescribed.I just don't get it -- why would
K cause depression, unless it is
an interaction with the AD?If it is any help, an AD is what
the dr. prescribed on top of the other
one, consequent to K prescription.Squiggles
Posted by utopizen on October 7, 2004, at 8:54:52
In reply to Re: Help with anxiety/benzos---utopizen, posted by mcp on October 7, 2004, at 2:43:33
> No disrespect, but I think it is reckless and irresponsible for you to casually recommend someone take an AD and join the AD for life club, as you put it.
>Saying that I "casually" recommend this peson to do this is wrong. It's disrespectful and insulting to characterize my language in such a way, and I don't think it's appropriate. I never casually said anything-- I simply said it. Ultimately, someone has to go to a doctor, and that suggests they need to SERIOUSLY consider these things.
There's nothing "casual" about a prescription medicine. Please be more polite in the future. thanks! =)
Posted by utopizen on October 7, 2004, at 8:58:26
In reply to Re: Help with anxiety/benzos---utopizen, posted by mcp on October 7, 2004, at 2:43:33
> No disrespect, but I think it is reckless and irresponsible for you to casually recommend someone take an AD and join the AD for life club, as you put it.
>sorry, but I rather like how users on this board tend to refrain from characterizing other users' language in such a way. It's why I use this and avoid the curmudgeons on Usenet!
I hope you enjoy this board, and avoid trying to make such judgement calls as this. I think you should realize I'm a pretty serious kid, and I don't lightly advise people things-- I think these are serious matters, and that's inferred by the fact that you must see a doctor over them. Have an enjoyable day!
Posted by cache-monkey on October 7, 2004, at 13:47:35
In reply to Re: Help with anxiety/benzos, posted by Fred23 on October 6, 2004, at 22:58:36
<<
> I seem to recall a benzo that actually has antidepressant qualities, but I'm not sure it is available in the US.You're thinking of Xanax, which is available, but doctors are less likely to prescribe it now due to its bad reputation.
Ativan is another benzo that doesn't worsen depressions, and is less sedating that Klonopin, but doesn't have as long of a duration of action.
>>So, my pdoc has been giving me a prescription for Xanax to help with my bouts of anxiety and near-panic-attacks. Low dose; 0.25mg tablets, which I take maybe 5 of a week. Thing about it is that I can sometimes feel a little "hung over" the next day when I take one in the evening. Is this common to all benzos, or is it some reaction I'm having to Xanax?
I'm thinking about asking for a different benzo and had been thinking about Klonopin because of its long half-life. (In the back of my mind I'm worried about getting dependent. I've been fine so far with the Xanax, as indicated above, but I'm pretty thoroughly addicted to cigarettes, so...) But I'm concerned about Klonopin's potential for depression because I tend to have dysthymia.
So I'm wondering about Ativan. Anyone have experiences with it? Efficacy? Any sort of "hang over" effect?
Thanks for your feedback,
cache-monkey
Posted by KevinM on October 7, 2004, at 20:05:56
In reply to Re: Help with anxiety/benzos: Xanax/Ativan?, posted by cache-monkey on October 7, 2004, at 13:47:35
> <<
> > I seem to recall a benzo that actually has antidepressant qualities, but I'm not sure it is available in the US.
>
> You're thinking of Xanax, which is available, but doctors are less likely to prescribe it now due to its bad reputation.
>
>
> Ativan is another benzo that doesn't worsen depressions, and is less sedating that Klonopin, but doesn't have as long of a duration of action.
> >>
>
> So, my pdoc has been giving me a prescription for Xanax to help with my bouts of anxiety and near-panic-attacks. Low dose; 0.25mg tablets, which I take maybe 5 of a week. Thing about it is that I can sometimes feel a little "hung over" the next day when I take one in the evening. Is this common to all benzos, or is it some reaction I'm having to Xanax?
>
> I'm thinking about asking for a different benzo and had been thinking about Klonopin because of its long half-life. (In the back of my mind I'm worried about getting dependent. I've been fine so far with the Xanax, as indicated above, but I'm pretty thoroughly addicted to cigarettes, so...) But I'm concerned about Klonopin's potential for depression because I tend to have dysthymia.
>
> So I'm wondering about Ativan. Anyone have experiences with it? Efficacy? Any sort of "hang over" effect?
>
> Thanks for your feedback,
> cache-monkey
>
>I found the name of the drug I was thinking about-adinazolam. Unfortunately not available in the US. http://www.dr-bob.org/babble/20030723/msgs/245823.html
Posted by Michael Bell on October 7, 2004, at 20:32:27
In reply to Help with anxiety/benzos, posted by KevinM on October 6, 2004, at 19:38:41
Kevin, for those doctors that specialize in continuous anxiety disorders (such as GAD or SP), klonopin is the first line of defense. Period. However, it can lead to low grade depression, anhedonia, or dysthymia, call it what you want. I myself have experienced this problem. For some people, augmenting with an antidepressant helps. For many others, however, SSRIs do nothing or only worsen the apathetic feelings.
I would recommend trying to augment with one of the following: Amisulpride, very low dose Selegiline (note: selegiline by itself is not good for anxiety), Adrafinil or low dose Adderall/Dexedrine. Regarding Adderall and Dexedrine, this may be very difficult for you to get, and you need to understand the risks involved in taking amphetamines.
Also, I found Reboxetine to be better for apathy than SSRIs. However, it cause some sexual side effects and sleep problems that eventually led to discontinuation.
Good luck.
> I have been taking Klonopin for several weeks and it has helped greatly with my anxiety. Unfortunately it started causing a depression that I haven't felt for some time. Does anyone have an opinion of an alternative that might be better in that regard? I get the impression that Klonopin is more "PC" than others although my Pdoc is usually open to suggestions. Thanks for your help.
Posted by utopizen on October 7, 2004, at 21:59:55
In reply to Re: Help with anxiety/benzos » KevinM, posted by Michael Bell on October 7, 2004, at 20:32:27
Taking a benzo other than Klonopin because of depression as a side-effect really needs to be re-thought. Stop and examine what's REALLY agitating things. Sure, Klonopin can lead to depression, but let's not kid ourselves: there's people who never get depressed while on Klonopin for years, and no one knows why.
You may simply be more prone to experiencing depression, especially given that you already have a mental illness. The Klonopin may simply be agitating existing factors in your life. Maybe your support system or life events are stressing you out, maybe you lack a mate at the time, I have no clue. But it's very important to consider all these things, and take them seriously. CBT is very important too. There's no guarantee simply removing Klonopin will remove your depression, and trying to focus all of your energy on benzo alternatives might be interfering with your other options.
Talk to your doc/therapist, and take one thing at a time. But most importantly, chill- you're smart, and are sure to get to the matter at some point.
Posted by mcp on October 8, 2004, at 4:23:37
In reply to Re: Help with anxiety/benzos---utopizen » mcp, posted by partlycloudy on October 7, 2004, at 6:58:16
> So what would be your advice to Kevin if ADs are the last resort?
> pc
>WIthout getting into my personal feelings about how liberally these drugs are prescribed and often as a first resort, let me just point out some obvious things. Therapy. Nutrition. Exercise. Natural Alternatives. If all three are given a genuine effort then a synthetic drug may not be needed. If it is, then so be it, but never as a first resort. Just my opinion
Posted by mcp on October 8, 2004, at 4:33:58
In reply to Re: Help with anxiety/benzos---utopizen, posted by utopizen on October 7, 2004, at 8:54:52
Perhaps casually was a poor choice of words. I apologize for offending you. Nevertheless, it doesn't take away from my point.
"Moral of the story: try lowering or substituting the Klonopin, but don't look for this as a solution within itself: if you're like me, join the antidepressant for life club. (Start trying 'em for social anxiety disorder, stay on 'em once you get depression)."
I just find it bothersome that you suggest he goes on the AD for life club. Also, "start trying 'em for social anxiety disorder, stay on 'em once you get depression." No, don't start trying 'em. That is where I got the casual reference. There are a myriad of things people should take a strong look at and try before they start trying 'em. My impression is that you are of the medicate it first crowd. If am wrong, then you can correct me. I think this crowd, which is pervasive on this board, have not fully examined all the things you can do before resorting to the drastic step of taking a dangerous drug. Hope I didn't offend you here either. Just my opinion. All the best
> > No disrespect, but I think it is reckless and irresponsible for you to casually recommend someone take an AD and join the AD for life club, as you put it.
> >
>
> Saying that I "casually" recommend this peson to do this is wrong. It's disrespectful and insulting to characterize my language in such a way, and I don't think it's appropriate. I never casually said anything-- I simply said it. Ultimately, someone has to go to a doctor, and that suggests they need to SERIOUSLY consider these things.
>
> There's nothing "casual" about a prescription medicine. Please be more polite in the future. thanks! =)
Posted by KevinM on October 8, 2004, at 8:00:04
In reply to Re: Help with anxiety/benzos, posted by utopizen on October 7, 2004, at 21:59:55
> Taking a benzo other than Klonopin because of depression as a side-effect really needs to be re-thought. Stop and examine what's REALLY agitating things. Sure, Klonopin can lead to depression, but let's not kid ourselves: there's people who never get depressed while on Klonopin for years, and no one knows why.
>
> You may simply be more prone to experiencing depression, especially given that you already have a mental illness. The Klonopin may simply be agitating existing factors in your life. Maybe your support system or life events are stressing you out, maybe you lack a mate at the time, I have no clue. But it's very important to consider all these things, and take them seriously. CBT is very important too. There's no guarantee simply removing Klonopin will remove your depression, and trying to focus all of your energy on benzo alternatives might be interfering with your other options.
>
> Talk to your doc/therapist, and take one thing at a time. But most importantly, chill- you're smart, and are sure to get to the matter at some point.Yes, I'm prone to depression. Everything I have read regarding Klonopin as it relates to making one more depressed indicates this may be a factor. I know there is no magic bullet. I have taken many medications (including Nardil) as well as CBT. I have SP- Klonopin has been something I have taken situationally before. Recently, I thought taking Klonopin on a regular basis would be worth a trial. It worked *very* well until the depression started. I'm not sure in the long term it would have made as much of a difference. Experience has told me the effect any medication can make may only be temporary. But even if this is the case, hopefully I can gain something- even if it is just insight during that period of time.
While I gather any benzo can cause depression, I'm just seeing if anyone has an opinion or experience as to if there may be a better alternative to Klonopin. Perhaps there no clear cut answer.
I understand what your saying :) Thanks for writing.
Posted by Squiggles on October 8, 2004, at 8:16:41
In reply to Re: Help with anxiety/benzos, posted by KevinM on October 8, 2004, at 8:00:04
I would be interested to know if people
discussing K here, are taking it WITH
ADs or without; i have no depression
with it at all and take Lithium; however,
my friend may have started getting depression
when taking it with Imipramine. Perhaps
the drug interactions are different.BTW, I just saw an interesting article on
BMJ on fetal anti-convulsant syndrome with
epileptic drugs (of which I *think* K is one).Its virtue seems to be the low tolerance
build-up over years, but its disadvantage
is the impossibility of getting off it after
years.Squiggles
Posted by Dr. Bob on October 8, 2004, at 18:32:11
In reply to Re: Help with anxiety/benzos---utopizen, posted by mcp on October 8, 2004, at 4:33:58
> I think it is reckless and irresponsible...
>
> mcp> It's disrespectful and insulting...
>
> utopizen> I just find it bothersome...
> I think this crowd, which is pervasive on this board, have not fully examined all the things you can do before resorting to the drastic step of taking a dangerous drug.
>
> mcpPlease don't post anything that could lead others to feel accused or put down or jump to conclusions about them.
Sharing something about your own issues and their possible role in your reaction might be an interesting exercise -- and might help others respond to you supportively.
If you or others have questions about this or about posting policies in general, or are interested in alternative ways of expressing yourself, please see the FAQ:
http://www.dr-bob.org/babble/faq.html#civil
Follow-ups regarding these issues should be redirected to Psycho-Babble Administration. They, as well as replies to the above posts, should of course themselves be civil.
Thanks,
Bob
Posted by Fred23 on October 8, 2004, at 19:33:47
In reply to Re: Help with anxiety/benzos: Xanax/Ativan?, posted by cache-monkey on October 7, 2004, at 13:47:35
> So I'm wondering about Ativan. Anyone have experiences with it? Efficacy? Any sort of "hang over" effect?
After spending a few months working with it, and getting my GP to up the dose once, so far, it seems that it may be the trickiest one to take effectively.
Therefore it is likely that it is not being prescribed in an effective way, leading patients to think that it "doesn't work." Which then means they have to "choose" between Xanax or Klonopin.
What I've learned so far:
1. I takes at least as four time as much Ativan to be as effective as Xanax.
2. Its duration of action is much shorter than its rated half-life, so a dose is needed every 6 hours or so.
3. Real Ativan is needed; the generic is useless.
4. It takes longer to find the "right" daily dose, so more upping of the dosage may be needed along the way.
5. Ativan has a more human "feel" to it than Xanax, which is somewhat distancing.
Posted by utopizen on October 8, 2004, at 22:23:39
In reply to Re: Help with anxiety/benzos, posted by KevinM on October 8, 2004, at 8:00:04
> I understand what your saying :) Thanks for writing.
I think you're following the advice, certainly, just trying to keep you encouraged. But maybe lowering the dose, switching to prn use only, with maybe a two week wash out even (of course-- after a CAREFUL tapering off the stuff with your doctor!!!) MIGHT let you have a chance to see what you're like without Klonopin.
I got depressed on Klonopin, too, but it was likely the combination of being off an antidepressant and being with the roommate from hell all at once that my roommates clearly recgonized caused it. I went from being the happiest (albeit socially anxious+akward until I went on Klonopin) to being the most depressed kid on Earth! It's trying, I know.
Maybe an antipsychotic? I dunno, I'm just talking to myself here-- but sometimes combining the antidepressant with the antipsychotic can help bring some relief. I forget if you've said you've tried an AP or not.
I do remember, after being depressed, the Klonopin seemed to have the effect of making me have this really sleepy depression. I'm still depressed now, and again not blaming just the Klonopin-- we don't take these meds in a vacuum, of course- but off the Klonopin, I don't feel tired.
I'm going back on it tomorrow, Yay!, and hopefully I'll not feel tired, just like I felt when I first went on the stuff two years ago. Crossing fingers!
Posted by utopizen on October 8, 2004, at 22:27:40
In reply to Re: Help with anxiety/benzos---partlycloudy, posted by mcp on October 8, 2004, at 4:23:37
> WIthout getting into my personal feelings about how liberally these drugs are prescribed and often as a first resort, let me just point out some obvious things. Therapy. Nutrition. Exercise. Natural Alternatives. If all three are given a genuine effort then a synthetic drug may not be needed. If it is, then so be it, but never as a first resort. Just my opinion
>you said it! these are all great things that we all should explore. And meds often allow us to make these things work for us. You might say meds HELP us to these things, follow these regimens.
I've read that minor depression can effectively be controlled through exercising 3x/day. Great! If I had minor depression, I'd be encouraged! =) I exercise daily, on my bike, and it helps. But it's just a few hours. The meds help somewhat too. I wish more so than they did, but of course, that's why I exercise as well...
No one wants to take meds. We'd all prefer to use exercise, good nutrition, etc. over meds. The side effects just aren't that cool, and I think the fact that we resort to using this board says that loud and clear. These meds sometimes lead us to suffer. But we take them because we know we suffer more without them, in many cases. I encourage you to explore all your options, just as I routinely have said similiar advice to so many on this board. =)
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