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Dr. Bob is Robert Hsiung, MD,
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Posted by Spriggy on March 7, 2005, at 18:39:42
In reply to Klonopin/Bipolar II, posted by fires on March 7, 2005, at 18:24:16
I'm on Klonopin and they mentioned I *might* have bp 2.
It helps me with anxiety but it doesn't help with the mood swings and depression.
So I don't know if that answers your question or not.
I don't think Klonopin would be benefial for depression... some people say it can actually increase it.
Posted by fires on March 7, 2005, at 18:55:45
In reply to Re: Klonopin/Bipolar II, posted by Spriggy on March 7, 2005, at 18:39:42
> I'm on Klonopin and they mentioned I *might* have bp 2.
>
> It helps me with anxiety but it doesn't help with the mood swings and depression.
>
> So I don't know if that answers your question or not.
>
> I don't think Klonopin would be benefial for depression... some people say it can actually increase it.
>
I'm also being told: might have BP 2. One doc says anxiety with my Dep., one said maybe BP 2. Do you know how your doc plans to decide your correct Dx?I've had arrhythmias of late, and I'm not convinced that they are due to anxiety, even though they say they are benign. I'm even thinking: maybe hyperthyroid - even though one blood test was normal -- or some other condition.
Also, can BP 2 cause arrhythmias? I haven't heard of this.
Posted by med_empowered on March 7, 2005, at 19:19:16
In reply to Re: Klonopin/Bipolar II » Spriggy, posted by fires on March 7, 2005, at 18:55:45
hey! Before you do anything else, *please* get checked out for any sort of physical problem/abnormality. Remember that, in general, before any psychiatric diagnosis can be made, physical causes must be *ruled out*. On the psychiatric side of things...BP II is quickly becoming a slippery diagnosis. Some docs are careful with it, some include people who would be dx'd "cyclothymic" in it, some lump people with manic reactions to anti-depressants in there (not a good idea), and some use it for patients with more complex cases of depression and anxiety. So, basically, I wouldn't worry too much about the dx itself; treatment is what matters. Klonopin is popular in bi-polar b/c it is believed to be something of a mood-stabilizer, probably b/c of its anti-epileptic properties (ALL benzos have anti-seizure properties; Klonopin just happens to have been designed primarily for seizures). Anyway, what is absolutely known is that Klonopin can calm down people during mania, and can be very helpful when dealing with psychotic mania/mixed-episodes; in addition to keeping people calm, the Klonopin can reduce side-effects (such as anxiety and akathisia) from anti-psychotics and improve their efficacy, which should help keep the dose low. But, again: this is true of pretty much ALL benzos...Klonopin does last a long time, though, so it is more convenient. (Outpatients with mania are often given Klonopin; inpatient, Ativan is preferred b/c it is available in injection form). In my experience, .5-1mg Klonopin as needed was about as helpful for mood-swings/mania as, say, 2-4mgs Ativan or 10-15mgs valium. Klonopin lasted longer, which is nice, but it also takes longer to kick in than some others, such as Ativan, Xanax, and Librium. As for depression...here, things get interesting. Klonopin and other benzos (particularly high dose, as in epilepsy) are known for their ability to CAUSE depression. Then again...Klonopin and other benzos are commonly used in depression, especially in cases where anxiety and insomnia are prominent, and it seems like the benzos have an ability in these cases to alleviate depression. A number of clinical studies seem to indicate that, used wisely, benzos can help some people more than anti-depressant therapy alone.
Posted by Phillipa on March 7, 2005, at 20:04:05
In reply to Re: Klonopin/Bipolar II, posted by med_empowered on March 7, 2005, at 19:19:16
I think my change to valium [original drug used 30yrs ago to control my panic attacks], is helping me more than any AD. Plus now I'm sleeping, which causes less anxiety and depression. And, I always try to cut back when I'm feeling well. Fondly, Phillipa
Posted by Spriggy on March 7, 2005, at 20:51:45
In reply to Re: Klonopin/Bipolar II » med_empowered, posted by Phillipa on March 7, 2005, at 20:04:05
Wow med empowered, that was interesting information.
I learned a lot.
To answer fires question about a real diagnosis for me; I don't know if I'll ever get one. My primary doctor seems to think I'm BP 2 while the psychiatrists said, " no bi polar just akathasia and anxiety."
I definitely tend to be more anxious than depressed, and then the longer I am anxious.. the more depressed I begin to feel.
Here lately, I notice if I can go a day or so wihtout the anxiety being too bad, the depression seems to be on the back burner.. it seems to always be "there" but not hanging directly over my head. Does that make sense?
The Klonopin helps calm me down and then I take Restoril to sleep at night.
I've tried to not use it for sleep and ended up realizing I needed it!
Posted by fires on March 7, 2005, at 21:28:39
In reply to Re: Klonopin/Bipolar II, posted by med_empowered on March 7, 2005, at 19:19:16
> hey! Before you do anything else, *please* get checked out for any sort of physical problem/abnormality. Remember that, in general, before any psychiatric diagnosis can be made, physical causes must be *ruled out*.
I know that all too well. B 12 deficiency and Postural Orthostatic Tachycardia Syndrome, both dxed by me and then docs.
They both require continuous treatment.
>> On the psychiatric side of things...BP II is quickly becoming a slippery diagnosis. Some docs are careful with it, some include people who would be dx'd "cyclothymic" in it, some lump people with manic reactions to anti-depressants in there (not a good idea), and some use it for patients with more complex cases of depression and anxiety. So, basically, I wouldn't worry too much about the dx itself; treatment is what matters.<<
I was under the impression that the treatments for the 2 conditions were quite different (most of the time). Then again the more I read about BP II, the more confusing/complicated it gets.
>> Klonopin is popular in bi-polar b/c it is believed to be something of a mood-stabilizer, probably b/c of its anti-epileptic properties (ALL benzos have anti-seizure properties; Klonopin just happens to have been designed primarily for seizures). Anyway, what is absolutely known is that Klonopin can calm down people during mania, and can be very helpful when dealing with psychotic mania/mixed-episodes; in addition to keeping people calm, the Klonopin can reduce side-effects (such as anxiety and akathisia) from anti-psychotics and improve their efficacy, which should help keep the dose low. But, again: this is true of pretty much ALL benzos...Klonopin does last a long time, though, so it is more convenient. (Outpatients with mania are often given Klonopin; inpatient, Ativan is preferred b/c it is available in injection form). In my experience, .5-1mg Klonopin as needed was about as helpful for mood-swings/mania as, say, 2-4mgs Ativan or 10-15mgs valium. Klonopin lasted longer, which is nice, but it also takes longer to kick in than some others, such as Ativan, Xanax, and Librium. As for depression...here, things get interesting. Klonopin and other benzos (particularly high dose, as in epilepsy) are known for their ability to CAUSE depression. Then again...Klonopin and other benzos are commonly used in depression, especially in cases where anxiety and insomnia are prominent, and it seems like the benzos have an ability in these cases to alleviate depression. A number of clinical studies seem to indicate that, used wisely, benzos can help some people more than anti-depressant therapy alone. <<I've had good luck with Klonopin in the past, and still take 1 mg at bedtime. I've always thought that it worked for me due to its anti-seizure properties. Prior to Klon., I was on Parnate and Tegretol -- then Klon. replaced my Tegretol.
Did you get some of your info. from biopsychiatry.com ? That's the only place I've seen info. similar to yours.
Also, I hope I don't end up with a BP II dx because lamictal and seroquel make me to sedate/tired and zyprexa didn't seem to do anything.
Thanks for all the info.
Posted by Spriggy on March 7, 2005, at 21:41:08
In reply to Re: Klonopin/Bipolar II » med_empowered, posted by fires on March 7, 2005, at 21:28:39
What was your Lamictal dosage (and Seroquel) if you don't mind me asking??
Posted by fires on March 7, 2005, at 22:12:56
In reply to hey fires, posted by Spriggy on March 7, 2005, at 21:41:08
> What was your Lamictal dosage (and Seroquel) if you don't mind me asking??
Lamictal was only 25 mg, then 50mg. Had "severe tiredness" and "daytime sleepiness".
Seroquel 25 mg: took one pm dose and woke up the next am too sedate. I looked back at my old diaries and found that my old doc had given me Seroquel 25-50 mg for sleep back in 1996 for sleep. I only lasted 2 weeks on it. Called my pdoc for an alternative to Seroquel.
I think that the fact that these 2 meds were so sedating, may point to a different direction for my next med. to try.
Posted by Maxime on March 8, 2005, at 0:12:51
In reply to Re: Klonopin/Bipolar II, posted by Spriggy on March 7, 2005, at 18:39:42
it's a mood stabiliser and i use it as such. it's an anticonvulsant like many mood stabilisers ... but it is also a benzo.
i don't suffer from anxiety. I'm BP type 2. i've been taking 4 mg for years now.
Maxime
Posted by SLS on March 8, 2005, at 7:16:06
In reply to Klonopin/Bipolar II, posted by fires on March 7, 2005, at 18:24:16
> Has anyone been given Klonopin for BP II? If it helps, does that tend to indicate that one probably doesn't really have BP II, but rather severe anxiety with depression?
>
> Any help appreciated?
Klonopin sure is an interesting choice. What are your doctor's reasons for choosing it? What other drugs are you taking? To what degree has anxiety been a problem relative to depression?Klonopin is sometimes used to help stabilize moods, especially for severe mania. It does seem to have mood stabilizing properties that are unique to the benzodiazepines. Maybe you have a unique doctor.
- Scott
Posted by TamaraJ on March 8, 2005, at 20:09:40
In reply to Re: Klonopin/Bipolar II, posted by med_empowered on March 7, 2005, at 19:19:16
If you don't mind, could I ask a couple of questions. I have not been diagnosed as BP (my gp thought I was, the pdoc determined otherwise). Anyway, I think I may have finally found an AD - nortriptyline) that will work for me (although it has only been 5 days, my mood is better than it has been in quite some time). I am feeling a little trippy and agitated at times, but I figure that is just some start-up side effects (and the extra coffee I have been drinking the past few days). Anyway, I use Xanax as needed, but I was wondering if Klonopin might be a more effective, longer-term solution for the sometimes paralyzing anxiety, "what if" thoughts and inner turmoil I experience (even if it was just for a month or two until I can get a better handle on these emotions/feelings).
Thanks.
Tamara
Posted by med_empowered on March 9, 2005, at 17:55:49
In reply to Re: Klonopin/Bipolar II » med_empowered, posted by TamaraJ on March 8, 2005, at 20:09:40
Personally, I think Xanax and other short-acting benzos (Ativan, etc.) are best used for people who are usually just fine, but are sometimes seized by paralyzing anxiety. Used to manage chronic anxiety, I think the patient would be better off with something else...like Klonopin. There is a Xanax XR now, but my personal opinion is that its more of a marketing ploy than anything else...Klonopin, Valium, and Librium are my personal faves. for managing chronic, long-term anxiety problems. Switching over from Xanax to Klonopin can be tricky, espcially if you're dosing "as needed," as opposed to having a fixed-dose. That said, it can be done; one way would be to convert your xanax dose into Klonopin, spread the dose over 2-3 intervals, and provide a little bit of Xanax to be taken while switching over if you feel the need. There are some important differences between Xanax and Klonopin to keep in mind here: 1)Klonopin takes 20minutes or so to work, but 4hours or so to reach peak blood levels...so most people seem to find that fixed-dosing works MUCH better than as-needed dosing 2) Klonopin lasts FOREVER. The half-life is incredibly long, so when and if you withdraw, be prepared for a protracted withdrawal period. Sucks, I know, but its usually not that bad. 3) Klonopin makes a very bad sedative. It works well for a few nites, but then wears off in terms of hynpotic ability. IF a doc RX's Klonopin for sleep, ask about back-up. Good luck!
Posted by Phillipa on March 9, 2005, at 19:14:14
In reply to Switch from Xanax to Klonopin, posted by med_empowered on March 9, 2005, at 17:55:49
I agree l00%. I love the difference valium has made. It's long-acting and just seems to let me fall asleep. I'm not tired during the day either. Klonopin made me feel dull. Xanax just was making me tired. Fondly, Phillipa
Posted by TamaraJ on March 9, 2005, at 21:15:50
In reply to Switch from Xanax to Klonopin, posted by med_empowered on March 9, 2005, at 17:55:49
Thanks so much. I agree with you on the use of Xanax and other short-acting benzos. Right now, I have really been avoiding using Xanax unless I was in a really bad anxious state. And, even then, I have found that once I have two or three anxiety free days, I can usually (if I am lucky) go weeks without experiencing severe anxiety (if that makes sense). Just another question or two - sorry. Does the Klonopin initially cause fatigue, drowsiness and spaciness? Do these side effects go away after the body adjusts to the med (like after about a week)?
Thanks again.
Tamara
> Personally, I think Xanax and other short-acting benzos (Ativan, etc.) are best used for people who are usually just fine, but are sometimes seized by paralyzing anxiety. Used to manage chronic anxiety, I think the patient would be better off with something else...like Klonopin. There is a Xanax XR now, but my personal opinion is that its more of a marketing ploy than anything else...Klonopin, Valium, and Librium are my personal faves. for managing chronic, long-term anxiety problems. Switching over from Xanax to Klonopin can be tricky, espcially if you're dosing "as needed," as opposed to having a fixed-dose. That said, it can be done; one way would be to convert your xanax dose into Klonopin, spread the dose over 2-3 intervals, and provide a little bit of Xanax to be taken while switching over if you feel the need. There are some important differences between Xanax and Klonopin to keep in mind here: 1)Klonopin takes 20minutes or so to work, but 4hours or so to reach peak blood levels...so most people seem to find that fixed-dosing works MUCH better than as-needed dosing 2) Klonopin lasts FOREVER. The half-life is incredibly long, so when and if you withdraw, be prepared for a protracted withdrawal period. Sucks, I know, but its usually not that bad. 3) Klonopin makes a very bad sedative. It works well for a few nites, but then wears off in terms of hynpotic ability. IF a doc RX's Klonopin for sleep, ask about back-up. Good luck!
Posted by med_empowered on March 9, 2005, at 22:54:38
In reply to Re: Switch from Xanax to Klonopin » med_empowered, posted by TamaraJ on March 9, 2005, at 21:15:50
Hi! Problems with klonopin in the beginning are normal and usually go away after a week or less (my experience and people I know), though you may have some problems re-emerge if your dose is increased. There are a couple of ways to deal with this. One, obviously, is to introduce Klonopin very slowly and build up to only a very small beginning dose--say, 1mg daily. Another way, which worked for me, is to introduce Klonopin at first as a sleeping pill (lots of people with anxiety have insomnia and vice versa). So, in my situation, I started out taking 1mg before bedtime for about a week, then an additional .5mgs in the day as needed...when Klonopin was no longer working as a sedative, I took the whole 1.5mgs during the day and my doc RX'd Ambien for occasional sleep problems. It's a less-than-honest way of initiating benzo treatment (my doc, for instance, never told me I would be taking Klonopin during the day--I only knew that was the plan b/c a friend told me that was her doc had initiated Klonopin treatment.), but it seems to work pretty well and pretty quickly, since you can start out with a higher dose (the point is, afterall, to cause sleep at first) and kind of do a two-birds with one stone thing. Good luck!
Posted by reefer on March 10, 2005, at 7:48:43
In reply to Switch from Xanax to Klonopin, posted by med_empowered on March 9, 2005, at 17:55:49
I switched over from Xanax XR 2mg/day to Klonopin 2mg/day right away. Didn't feel any withdrawal symptoms from the Xanax. I was a bit more sedated from the Klonopin the first days but that went away in less then a week.
Posted by TamaraJ on March 10, 2005, at 10:07:13
In reply to Initial problems with Klonopin, posted by med_empowered on March 9, 2005, at 22:54:38
Posted by FredPotter on March 10, 2005, at 13:47:50
In reply to Re: Switch from Xanax to Klonopin, posted by reefer on March 10, 2005, at 7:48:43
I've taken Xanax for years. I think it's good for panic but I feel "nameless dread" every evening. Is it possible Klonopin would be more effective that Xanax for this? Xanax doesn't seem to help
Posted by ed_uk on March 10, 2005, at 14:41:57
In reply to Re: Switch from Xanax to Klonopin, posted by FredPotter on March 10, 2005, at 13:47:50
Hi,
>nameless dread
Perhaps this is a withdrawal symptom as your last dose wears off. You could try taking smaller doses of Xanax but more frequently, this would avoid large fluctuations in the Xanax concentration in your body. Alternatively, you might get a better effect from Klonopin or another long-acting benzo such as Librium.
Regards,
Ed.
Posted by FredPotter on March 10, 2005, at 16:56:14
In reply to Re: Switch from Xanax to Klonopin » FredPotter, posted by ed_uk on March 10, 2005, at 14:41:57
Ed I get the nameless dread whether I take Xanax or not. I think it's good for panic but not for dread. Make sense? Fred
Posted by ed_uk on March 10, 2005, at 17:14:44
In reply to Re: Switch from Xanax to Klonopin, posted by FredPotter on March 10, 2005, at 16:56:14
Hi Fred,
>Ed I get the nameless dread whether I take Xanax or not. I think it's good for panic but not for dread. Make sense?
Oh I see, perhaps you need a different type a drug as well as the Xanax. What do you dread?
Ed.
Posted by FredPotter on March 10, 2005, at 21:23:58
In reply to Re: Switch from Xanax to Klonopin » FredPotter, posted by ed_uk on March 10, 2005, at 17:14:44
Hi Ed Like I say it's nameless. Fear that comes of itself. CBTists won't believe this. When I had my first anxiety attack in 1964, a nocturnal panic attack that became a nightmarish generalised anxiety, I looked it up in the books of the time and it was clear I had "anxiety neurosis" as it was typified by "nameless dread". I've never seen a better description. The fear is free-floating. If there are cognitive reasons for the fear then they are below conscious awareness or laid down before I had memory. In my case, benzos don't do anything for this
Fred
Posted by ed_uk on March 11, 2005, at 8:15:35
In reply to Re: Switch from Xanax to Klonopin » ed_uk, posted by FredPotter on March 10, 2005, at 21:23:58
Hi Fred!
>CBTists won't believe this.
I believe you :-) Some types of anxiety are very difficult to explain.
My anxiety has always been supported by a logical framework of unpleasant thoughts, too logical in fact- CBT couldn't shift them. Paroxetine 40-60mg helped though.
>In my case, benzos don't do anything for this
Have you tried anything else? Paxil, Celexa, Nardil, a tricyclic antidepressant, BuSpar, a low-dose antipsychotic?
Ed.
Posted by upsndowns on March 11, 2005, at 12:05:17
In reply to Re: Switch from Xanax to Klonopin » FredPotter, posted by ed_uk on March 11, 2005, at 8:15:35
Fred, I have nameless dread as the day wears on as well, especially once it gets dark outside. I am terrified of the dark; this is a symptom that is only about a year old for me. I find that klonopin makes me depressed, xanax is too short acting but is great for panic, tranxene calms me but not for extended periods of time, ativan makes me irritable,valium allergies run in my family, not sure what if anything there is anymore! I just turn on every light in the house, including the ones outside and wait it out until it is time for the ambien. I have tried Buspar but it doesn't seem to do much of anything for me, but then I am limited to a dose no larger than 20mg per day due to side effects, maybe you could have better luck.
Posted by TamaraJ on March 13, 2005, at 18:24:23
In reply to Re: Switch from Xanax to Klonopin » ed_uk, posted by FredPotter on March 10, 2005, at 21:23:58
Hi Fred,
I understand what you are talking about :-( It's like a feeling of dread that kind of stops a person in his/her tracks. I was experiencing that a lot recently. It seems to have subsided somewhat since I switched to nortriptyline (it's still early, but I am hoping that nort will be a good AD for me). So, you might want to consider switching ADs. I think I read somewhere that TCAs are generally effective for panic disorder. So, perhaps a TCA would help quell the dread and nameless fear some people experience. Just a thought FWIW.
All the best to you,
Tamara
> Hi Ed Like I say it's nameless. Fear that comes of itself. CBTists won't believe this. When I had my first anxiety attack in 1964, a nocturnal panic attack that became a nightmarish generalised anxiety, I looked it up in the books of the time and it was clear I had "anxiety neurosis" as it was typified by "nameless dread". I've never seen a better description. The fear is free-floating. If there are cognitive reasons for the fear then they are below conscious awareness or laid down before I had memory. In my case, benzos don't do anything for this
>
> Fred
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