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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 9 of 9. This is the beginning of the thread.
Posted by mattye on September 4, 2006, at 20:46:23
OK - this is a long message, but I really want to run this by you guys and get your opinion. I had an earlier post about Help with Anxiety. The following is what I want to read to my pdoc this coming Friday:
---------------------
I want to consult your professional opinion on a treatment option that I believe will greatly improve the quality of my life. Specifically, I am wondering about your opinion on Klonopin.I know what you are thinking - that I am trying to get drugs. But I have been 100% honest with you thus far about my addictions, and I can assure you I am not trying to get high. In fact, Klonopin does not make me euphoric in the least. At a higher dose, it just makes me extremely groggy and sleepy - not a pleasant effect for me. I feel no more compulsion to abuse this medication than I do my Remeron. The reason is that the thereputic dose of this medication acheives exactly the effect that I need. Higher doses are not pleasant to me, and besides, I don't want to bite the hand that feeds me. Furthermore, since I am taking the Naltrexone, I do not feel compelled to abuse substances.
Let me explain how Klonopin helps me. I believe I am genetically wired with a hyper-active limbic system. My flight-or-flight response is better attuned to fighting saber toothed tigers rather than life in a cubicle. This is evident from the extensive psychopathology on both sides of my family tree.
My depression stems from the surges of anxiety and panic that overtake my system on a daily basis. Most of these anxious thoughts stem from my low self esteem. My nervous system is constantly jolted into action by alarming thoughts, and I am constantly being soaked with adreneline and cortisol. Often I will ruminate uncontrollably about various worries. I am working with the Health Realization program to practice changing my thoughts, and thereby my mood, but I am having a difficult time with this. Like a broken record, my mind keeps returning to negative and anxious thoughts. I spiral into a dark, hopeless, anxious mood. My boyfriend once said to me, "You live in fear, don't you?" to which I replied, "Yeah, pretty much."
I am tired of living my life in fear. I want to live like other people.
So... the Klonopin has a subtle, but very welcome effect on me. I am calmer, more serene. My back and neck muscles, which are usually so stiff my boyfriend can't even massage me without me squirming in pain, are now more relaxed. I still get anxious, but I am capable of objectively analyzing the worries and letting them pass instead of them overtaking me. I believe that if I am treated with this med and continue weekly therapy and HR meetings I will be able to learn how to manage my anxiety better. When I am ready, I could slowly taper off the med.
Now, I know your drug manual strongly cautions you to NEVER give this drug to people like me. But it is exactly the people like myself that can benefit the most from this medication. For instance, my friend Mike kicked heroin with methadone and xanax. Many methadone clinics treat addicts with benzos because it controls the overwhelming anxiety that compells them to use. As I've said before, the only times I've craved and used opiates is when my anxiety, panic, and depression overtakes me and becomes unmanageable to the point where I seek any kind of relief I can. When I am happy and serene, I don't want to use at all.
Furthermore, from my cursory Google research, I learned that benzos are a safe, well-researched, and effective treatment for anxiety. Klonopin, in particular, has a mood stabilizing effect that helps even out my rapid and disorienting mood swings.
But ultimately, I trust your informed judgement, speaking from years of clinical experience. If you do not believe this will be an effective treatment for me, I will understand. I am willing to give a low dose of Lexapro another try, and perhaps increase my Wellbutrin to counter the debilitating sexual side effects. Ultimately I want to taper off the Remeron, because I don't think it is doing much for me.
I know you are probably used to addicts lying to you to try to get drugs to make them high, and I want to reiterate that in all sincerety, this is not what I am seeking. I am only looking for a way to improve my life, and I believe this is worth a try.
Posted by Oppycat on September 5, 2006, at 9:59:18
In reply to Klonopin helps me, but I'm an addict, posted by mattye on September 4, 2006, at 20:46:23
> OK - this is a long message, but I really want to run this by you guys and get your opinion. I had an earlier post about Help with Anxiety. The following is what I want to read to my pdoc this coming Friday:
>
> ---------------------
> I want to consult your professional opinion on a treatment option that I believe will greatly improve the quality of my life. Specifically, I am wondering about your opinion on Klonopin.
>
> I know what you are thinking - that I am trying to get drugs. But I have been 100% honest with you thus far about my addictions, and I can assure you I am not trying to get high. In fact, Klonopin does not make me euphoric in the least. At a higher dose, it just makes me extremely groggy and sleepy - not a pleasant effect for me. I feel no more compulsion to abuse this medication than I do my Remeron. The reason is that the thereputic dose of this medication acheives exactly the effect that I need. Higher doses are not pleasant to me, and besides, I don't want to bite the hand that feeds me. Furthermore, since I am taking the Naltrexone, I do not feel compelled to abuse substances.
>
> Let me explain how Klonopin helps me. I believe I am genetically wired with a hyper-active limbic system. My flight-or-flight response is better attuned to fighting saber toothed tigers rather than life in a cubicle. This is evident from the extensive psychopathology on both sides of my family tree.
>
> My depression stems from the surges of anxiety and panic that overtake my system on a daily basis. Most of these anxious thoughts stem from my low self esteem. My nervous system is constantly jolted into action by alarming thoughts, and I am constantly being soaked with adreneline and cortisol. Often I will ruminate uncontrollably about various worries. I am working with the Health Realization program to practice changing my thoughts, and thereby my mood, but I am having a difficult time with this. Like a broken record, my mind keeps returning to negative and anxious thoughts. I spiral into a dark, hopeless, anxious mood. My boyfriend once said to me, "You live in fear, don't you?" to which I replied, "Yeah, pretty much."
>
> I am tired of living my life in fear. I want to live like other people.
>
> So... the Klonopin has a subtle, but very welcome effect on me. I am calmer, more serene. My back and neck muscles, which are usually so stiff my boyfriend can't even massage me without me squirming in pain, are now more relaxed. I still get anxious, but I am capable of objectively analyzing the worries and letting them pass instead of them overtaking me. I believe that if I am treated with this med and continue weekly therapy and HR meetings I will be able to learn how to manage my anxiety better. When I am ready, I could slowly taper off the med.
>
> Now, I know your drug manual strongly cautions you to NEVER give this drug to people like me. But it is exactly the people like myself that can benefit the most from this medication. For instance, my friend Mike kicked heroin with methadone and xanax. Many methadone clinics treat addicts with benzos because it controls the overwhelming anxiety that compells them to use. As I've said before, the only times I've craved and used opiates is when my anxiety, panic, and depression overtakes me and becomes unmanageable to the point where I seek any kind of relief I can. When I am happy and serene, I don't want to use at all.
>
> Furthermore, from my cursory Google research, I learned that benzos are a safe, well-researched, and effective treatment for anxiety. Klonopin, in particular, has a mood stabilizing effect that helps even out my rapid and disorienting mood swings.
>
> But ultimately, I trust your informed judgement, speaking from years of clinical experience. If you do not believe this will be an effective treatment for me, I will understand. I am willing to give a low dose of Lexapro another try, and perhaps increase my Wellbutrin to counter the debilitating sexual side effects. Ultimately I want to taper off the Remeron, because I don't think it is doing much for me.
>
> I know you are probably used to addicts lying to you to try to get drugs to make them high, and I want to reiterate that in all sincerety, this is not what I am seeking. I am only looking for a way to improve my life, and I believe this is worth a try.I'm not sure whether your letter will sway your p-doc, but it should. It's an extremely well written note that makes sense and should address his concerns.
There is a substantial body of evidence that supports prolonged use of Klonopin for extreme anxiety and social phobia. Further, most doctors prefer Klonopin over other benzos because it apparently doesn't provide that quick calming effect so prevalent in other benzos.
I am sympathetic to your plight because I'm used to pdocs trying to get me of various medications because I have many vices. I control them quite well, I believe, but that doesn't carry much weight. I have had some success, however, when I've brought them evidence e.g. test results, doctors' articles, to support my ideas.
If your letter doesn't convice your pdoc, nothing will. Good luck.
Michael
Posted by fca on September 5, 2006, at 11:49:25
In reply to Re: Klonopin helps me, but I'm an addict » mattye, posted by Oppycat on September 5, 2006, at 9:59:18
I have a colleague and friend who is a psychiatrist and also board certified in addiction medicine--he does on occassion prescribe long acting benzo's if the patient has been refractory to other interventions--we were recently talking about a patient in his fifties who has been on a low dose benzo for over 10 years. During this time the patient maintained sobriety,his anxiety was well managed and he was able to work and maintain all appropriate roles. There was no dose escalation. Before the benzos the person had experienced multiple relapses, severe medical complications from alcoholism and would probaly soon die. My friend said it was a no brainer. He now sees him twice a year.
Posted by mattye on September 5, 2006, at 12:43:39
In reply to Re: Klonopin helps me, but I'm an addict, posted by fca on September 5, 2006, at 11:49:25
Thanks for the feedback, guys.
I've been clean from heroin for over 6 years, though I can't say the same about pain pills. The only reason I started using opiates again is for relief from my anxiety/panic/depression.I want my dr to know that I am doing everything in my power to get well. I am going to therapy, meetings once a week and I am journaling. Its just that some days real tough and expend all my resources just to make it through. The mood swings are bad and the Klonopin evens me out, and makes me less mood reactive. Its these days that I feel real close to giving up and turning back to drugs.
If he would just trust me that this is not something I would abuse!! I was on Adderall for a couple years and I rarely rarely took more than my dose.
Posted by fca on September 5, 2006, at 13:55:21
In reply to Klonopin helps me, but I'm an addict, posted by mattye on September 4, 2006, at 20:46:23
decide that a benzo is not in your best interest have you considered low dose Seroquel, Neurontin (or Lyrica, a refined derivative of Neurontin) for anxiety--they are dirtier and not as efficacious as a benzo for anxiety but many people find them very useful--and there is no dependence or tolerance. Lyrica is approved for the management of GAD by the EU. My daugter is an addict (and in recovery) and I know only to well the struggle to manage anxiety and recovery at the same time. She was put on Seroquel (low dose) at a residential TX center. My Best fca
Posted by mattye on September 5, 2006, at 14:18:30
In reply to mattye: If he is unwilling or the two of, posted by fca on September 5, 2006, at 13:55:21
Thanks for the advice
While I was in treatment, I was on serzone and neurontin. The serzone seemed to work, but I wasn't sure about the neurontin. Also, I was in an environment where anxiety wasn't a huge problem... not out in the real world. Too bad serzone is discontinued. Maybe I'll try Lyrica.
But Seroquel? AHHHHHHH!!! One pill made me a zombie. I guess it helps with anxiety because it pretty much prevents you from feeling anything at all. Except hungry and tired. I know I never gave my body a chance to get used to it, but everyone told me it was the worst med they ever took and it made them fat.
Posted by fca on September 5, 2006, at 14:46:16
In reply to mattye: If he is unwilling or the two of, posted by fca on September 5, 2006, at 13:55:21
As I said, they are dirtier. There seems to be a hump with Seroquel--once you get past it the flatness and lethargy seems to lift. Weight gain--possibly but remember, we are talking a very low dose. Best of luck in getting what works for you fca
Posted by Phillipa on September 5, 2006, at 17:51:04
In reply to Re: mattye: If he is unwilling or the two of, posted by fca on September 5, 2006, at 14:46:16
Maybe 25mg? Love Phillipa
Posted by Greif on September 11, 2006, at 11:34:28
In reply to Re: mattye: If he is unwilling or the two of, posted by Phillipa on September 5, 2006, at 17:51:04
I used to use alchohol to treat my anxiety. Worked well for years but began to create problems. I havent had a drink in 11 years. I take 2mg of K every evening before bed. I take an SSRI in the AM. I have no anxiety or side effects. You are right. Once you find the correct dose there is no benefit to sneaking an extra K pill. I was on Zanax for years and always was refilling my script every 25 days. Xanax Ativan and valium are more dangerous for addicts. K has improved my life in many ways. I take 15 mg of Lexapro. I recently had oral surgery and needed to take percocet for a few days. For whatever reason there was no narcotic high...just pain relief and a bit sick.
This is the end of the thread.
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