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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 18 of 18. This is the beginning of the thread.
Posted by blueberry on November 25, 2006, at 14:34:33
Clinically xanax is the best benzo for depression with anxiety. Other benzos can worsen depression. But not always. Mileage varies. So I am interested in your experiences.
Lorazepam (ativan) had my depression getting a lot worse in 4 days. Klonopin in 2 days. Xanax was different. Xanax worked very well for the week I used it in an emergency. I was fine on it. In my notes I wrote, "there was nothing about xanax that I did not like". All of my benzo trials were along with 10mg-20mg prozac and 2.5mg-5mg zyprexa.
I weaned off xanax after a good week on it. Benzo phobia I guess.
Maybe a longer experience with xanax would have turned into depression like the other benzos?
Anyway, your experiences please? I am most interested in benzos that are good for depression and anxiety at the same time.
Current meds:
2.5mg zyprexa (useless after 10 years, significant EPS, weaning off)
300mg Kira SJW (has worked fairly well in the past)
Maybe a 5mg blood level of prozac still leaving my system. Stopped 10mg a week ago. 10 years on it. Useless now. Significant EPS from it. Have tried about any antidepressant you can name except maois.Symptoms:
Depression
Anxiety
A great deal of shaking, nervousness, and jitteriness in the morning after waking.
Posted by Tom Twilight on November 25, 2006, at 15:14:01
In reply to The Best Benzo for Depression? Experiences?, posted by blueberry on November 25, 2006, at 14:34:33
I haven't had a lot of experience with Benzo's but I have to say that my favourite Benzo is without a doubt Bromazepam!
Sadly its not available in the US or the UK :( although its apparently very popular else were and is available in Canada.
I wish I didn't live in the UK the most Benzo Phobic country on earth.
Its the only Benzo I'd consider taking long term, if I could.
Diazepam-Clonazepam=more depressed!
Posted by Quintal on November 25, 2006, at 16:13:36
In reply to Re: The Best Benzo for Depression? Experiences?, posted by Tom Twilight on November 25, 2006, at 15:14:01
Xanax had hardly any effect on my anxiety, which annoyed me because I'd paid specially for a private prescription after reading good reports about it. Clonazepam was always the most effective for my social anxiety and didn't seem to make me any more depressed, but I had a friend who had this experience.
I also 'acquired' some bromazepam here in the UK and it seemed much like the other benzos to me, though I wasn't depressed at the time I took it. Does it have an antidepressant effect on you Tom?
I think I would rate my favourite benzo as estazolam. It got rid of my anxiety and seemed to have give me a euphoric mood boost as well. I think it's only available for certain types of epilepsy in the UK, though I read it is supposed to have less abuse potential than other benzos.
Q
Posted by Phillipa on November 25, 2006, at 19:55:09
In reply to Re: The Best Benzo for Depression? Experiences?, posted by Quintal on November 25, 2006, at 16:13:36
Depends what type of anxiety. Panic attacks xanax and I took about 2mg divided for years. Then I guess it pooped out and made me tired. Now I'm back on my original benzo from my twenties when I really didn't have a choice valium. I don't think its depressing. But xanax is the best for a few years or longer. And I never felt high or the need to increase it. It just took away the horrible anxiety. Love Phillipa
Posted by Declan on November 25, 2006, at 22:16:19
In reply to The Best Benzo for Depression? Experiences?, posted by blueberry on November 25, 2006, at 14:34:33
"A great deal of shaking, nervousness, and jitteriness in the morning after waking."
Blueberry, apart from noting it as part of the depressive symptom cluster, has anyone ever thrown light on to why you feel this particularly on waking? Not that I have any ideas, except to note the slight similarity with how I wake after alcohol and the theory that it in some way relates to carbohydrate metabolism that has been blocked, with stress hormones, cortisol then adrenaline, arising. I did a post on Health about this.
Any thoughts?
I wonder if all benzos are problematic in depression? I prefer Xanax, then bromazepam.
Posted by dreamboat_annie on November 25, 2006, at 22:55:03
In reply to The Best Benzo for Depression? Experiences?, posted by blueberry on November 25, 2006, at 14:34:33
I've only ever tried Xanax and Klonopin. Klonopin made me feel very depressed within a few days, even on a very low dose. Xanax is wonderful! I've never had a problem with it, even when I use it daily (although at a very low dose and I try not to use it daily).
With respect to the shakiness, etc., in the morning upon waking, have you had a glucose tolerance test done? Maybe it is a blood sugar problem. I experienced the same thing for years and, after seeing a naturopath who did some regular blood testing, I was told that I have borderline hypoglycemia. I started taking 600mg - 800mg of chromium daily (in three doses) and I now rarely wake up feeling shakey and jittery.
Posted by zmg on November 25, 2006, at 23:45:32
In reply to Re: The Best Benzo for Depression? Experiences? » blueberry, posted by dreamboat_annie on November 25, 2006, at 22:55:03
This one always kind of makes me giggle. Xanax is *very* popular with most doctors I've seen and a lot of people swear by it. It doesn't help my anxiety very much and makes me very, very drowsy, which is a show-stopper. Diazepam on the other hand doesn't make me drowsy at all and not only relieves the anxiety, but also provides a little mood-boost. I've been taking it daily for a little over a year and whats even funnier is that it also seems to help me concentrate much longer (I've built a fairly popular arts site and managed the community around it, gone back to school and started work in a new, (technology) field).
I'm off Valium now and have found myself back to my old lethargic ways. My site languishes and my interviews go unfinished. :)
Of course as with everything, mileage varies. I'm sure the relief from the anxiety was the cause for my increased motivation.
My wife used very small doses of Klonopin sucessfully (for years before we met).
Unfortunately now I measure success in terms of (reasonable) productivity and I'm having a tough time finding a medication that agrees with me in the same way. Currently trying Stablon (Tianeptine), which of course isn't a benzo at all.
Best of luck!
Posted by med_empowered on November 26, 2006, at 1:56:28
In reply to Re: The Best Benzo for Depression? Experiences?, posted by zmg on November 25, 2006, at 23:45:32
xanax might be good, if klonopin and ativan make you depressed. By all means--AVOID TRANXENE. I like Librium myself, buts it kind of weak.
Xanax comes in an XR form, which might be good if you're thinking of taking it long-term and if you have good insurance (its is expen$ive).
I've heard good things about Serax, but I dont think it gets Rx'd all that much, unless you're in rehab or something. Still..its an option.
Have you thought about maybe a benzo plus provigil? That might help counter any drug-induced lethargy/depression.
Posted by blueberry on November 26, 2006, at 5:32:31
In reply to Re: The Best Benzo for Depression? Experiences?, posted by med_empowered on November 26, 2006, at 1:56:28
> xanax might be good, if klonopin and ativan make you depressed. By all means--AVOID TRANXENE. I like Librium myself, buts it kind of weak.
>
> Xanax comes in an XR form, which might be good if you're thinking of taking it long-term and if you have good insurance (its is expen$ive).
>
> I've heard good things about Serax, but I dont think it gets Rx'd all that much, unless you're in rehab or something. Still..its an option.
>
> Have you thought about maybe a benzo plus provigil? That might help counter any drug-induced lethargy/depression.
>I have been pondering taking adrafinil again. I took it years ago with great results. It breaks down primarily to the metabolite provigil. Provigil itself is not an option since at the moment I do not have insurance. My thoughts have been in the direction of low dose SJW+low dose Adrafinil+low dose benzo and try to get ride of the 2.5mg zyprexa.
Posted by lukeds on November 26, 2006, at 7:58:10
In reply to Re: The Best Benzo for Depression? Experiences? » med_empowered, posted by blueberry on November 26, 2006, at 5:32:31
It is a long acting version of the old xanax.
I am taking 6mg. in two doses of 3mg, and it has a secondary effect that is hypomania that is similar to an antidepressant effect.lukeds.
Posted by valene on November 26, 2006, at 8:23:07
In reply to The Best Benzo for Depression? Experiences?, posted by blueberry on November 25, 2006, at 14:34:33
Xanax. Definitely gives me an antidepressant effect especially since I switched to name-brand Xanax.
I weaned down from 3mg. to 2mg or less using valium and was very depressed on the valium, but that could have been from the withdrawal. I've been on xanax for 20+ years.
Val
Posted by Quintal on November 26, 2006, at 8:41:04
In reply to Re: The Best Benzo for Depression? Experiences?, posted by zmg on November 25, 2006, at 23:45:32
>I'm off Valium now and have found myself back to my old lethargic ways. My site languishes and my interviews go unfinished. :)Of course as with everything, mileage varies. I'm sure the relief from the anxiety was the cause for my increased motivation.
I am in a similar situation myself with Klonopin. Since stopping it I've been so lethargic and tired my life has ground to a standstill. I think you may be right, much of the energy and motivation we get from benzos is probably from the relief and not wasting so much energy on worrying.
Q
Posted by blueberry on November 26, 2006, at 10:26:02
In reply to Re: The Best Benzo for Depression? Experiences? » blueberry, posted by valene on November 26, 2006, at 8:23:07
> Xanax. Definitely gives me an antidepressant effect especially since I switched to name-brand Xanax.
>
> I weaned down from 3mg. to 2mg or less using valium and was very depressed on the valium, but that could have been from the withdrawal. I've been on xanax for 20+ years.
>
> ValHi Val,
20 years. Wow. Ya know, over the years watching psychobabble it seems to me that a good proportion of users find a dose they can stick with for a long time, after going through early treatment tolerance buildup that eventually plateaus. And many of them actually decrease dose. Too bad antidepressants don't work like that. I mean, 20 years at 3mg. If tolerance was an ongoing phenomenon with no end in sight, you would be at 30mg by now. :-)
Mileage varies, and I'm happy to see you get outstanding mileage.
What do you use xanax to treat? Do you take other meds?
Posted by valene on November 26, 2006, at 11:00:46
In reply to Re: The Best Benzo for Depression? Experiences? » valene, posted by blueberry on November 26, 2006, at 10:26:02
>
> Hi Val,
>
> 20 years. Wow. Ya know, over the years watching psychobabble it seems to me that a good proportion of users find a dose they can stick with for a long time, after going through early treatment tolerance buildup that eventually plateaus. And many of them actually decrease dose. Too bad antidepressants don't work like that. I mean, 20 years at 3mg. If tolerance was an ongoing phenomenon with no end in sight, you would be at 30mg by now. :-)
>
> Mileage varies, and I'm happy to see you get outstanding mileage.
>
> What do you use xanax to treat? Do you take other meds?Blueberry, I take xanax as monotherapy. Used to take prozac 20mg but quit 2 years ago. I have never been in tolerance but now that I tapered to 2mg or less from 3mg. I feel sort of like tolerance withdrawal sometimes.
Best wishes,
Val
>
Posted by valene on November 26, 2006, at 11:03:07
In reply to Re: The Best Benzo for Depression? Experiences? » blueberry, posted by valene on November 26, 2006, at 11:00:46
Sorry - forgot - my diagnosis is GAD with Social Anxiety Disorder also. My doc keeps trying to push a/d's and have a few in my cupboard but have not given in yet...
Posted by zmg on November 26, 2006, at 12:39:05
In reply to Re: The Best Benzo for Depression? Experiences? » med_empowered, posted by blueberry on November 26, 2006, at 5:32:31
> I have been pondering taking adrafinil again. I took it years ago with great results. It breaks down primarily to the metabolite provigil. Provigil itself is not an option since at the moment I do not have insurance. My thoughts have been in the direction of low dose SJW+low dose Adrafinil+low dose benzo and try to get ride of the 2.5mg zyprexa.
>
>
Provigil? Sorry this is obviously off the benzo topic but I'm curious hearing it mentioned in line with the current topic. Its currently on my "consider" list (along with Wellbutrin) but I'm a little worried it might increase my anxiety in addition to decreasing my lethragy.
Posted by Phillipa on November 26, 2006, at 17:54:54
In reply to Re: The Best Benzo for Depression? Experiences? » valene, posted by valene on November 26, 2006, at 11:03:07
And you won't right!!!!!!!Love Phillipa
Posted by sdb on November 28, 2006, at 10:09:06
In reply to The Best Benzo for Depression? Experiences?, posted by blueberry on November 25, 2006, at 14:34:33
There are two good benzo's available in some countries (Prazepam, Ketazolam). Prazepam has antidepressive actions proven in some studies (clomipramine-prazepam). Ketazolam is probably one of the smoothest benzo pharmacodynamically. Ketazolam->n-desmethyl-metabolites and to some extend Ketazolam->diazepam->n-desmethyl-metabolites
Ketazolam is compared in studies to be more favorable mainly because of its pharmacodynamics.When I took prazepam I thought it had antidepressive actions. Actually a benzo would be indicated for my peripheral spasticity problem of the under extremity but
nevertheless I avoid to take that longer because of some reasons.Its very likely that these benzo's aren't available for most people here.
sdb
Compared efficacy of prazepam and clomipramine in major depression with anxiety: a multicenter controlled study.
* Lemoine P,
* Boulenger JP,
* Caillard V,
* Tanne N,
* Bonnet D.Unite Clinique de Psychiatrie Biologique, C.H.S. Le Vinatier, Lyon Bron, France.
The efficacy of antidepressants is well established in major depressions, especially those with melancholic features. However, some anxiolytics also appear to have antidepressant properties at least for outpatients. 118 outpatients (25 males, 93 females, age: 18-60) with major depression according to DSM-III criteria, neither melancholic nor suicidal, reaching at least 27 on Montgomery and Asberg depression rating scale (MADRS) and 19 on Hamilton anxiety rating scale (HARS) accepted to participate this double blind study carried out by 15 G.P.s coordinated by 3 psychiatrists. After a one week placebo wash-out-single-blind period, they were randomly, double blind, assigned to one of the two following groups: PR treated with prazepam (30-60 mg), a benzodiazepine anxiolytic or CL treated clomipramine, an imipramine antidepressant (75-150 mg). Patients were evaluated at days 0, 7, 14, and 28, using MADRS, HARS, Clinical Global Impression and Hopkins symptoms check list 58. In addition, G.P.s had to meet monthly for a case discussion group. Results: groups were comparable at day 0. A highly significant improvement of MADRS and HARS scores (p less than 0.001) was observed in the total population. For the completer population evolution was also significantly positive in all the parameters studied but, considering MADRS and HSCL scores, a difference in favor of CL is observed.(ABSTRACT TRUNCATED AT 250 WORDS)
PMID: 1775523 [PubMed - indexed for MEDLINE]
Comparison of the therapeutic effect, tolerance and safety of ketazolam and diazepam administered for six months to out-patients with chronic anxiety neurosis.
* Fabre LF,
* McLendon DM,
* Stephens AG.Recently, it has been argued that benzodiazepines may not be safe or efficacious beyond 3 months continuous dosage. This study was designed to provide data regarding efficacy, safety, possible tolerance development, and possible withdrawal effects of administering ketazolam and diazepam for a 6-month period. Chronic anxiety patients were screened for participation according to specific inclusion and exclusion criteria. Of 139 patients, forty-four terminated prematurely for non-drug related reasons and are not included in the analysis. Of the ninety-five patients remaining, sixty-three were on ketazolam, and thirty-two on diazepam. Efficacy parameters included the Hamilton Anxiety Rating Scale, Physician's Global Impressions, Target Symptoms, Self-Rating Symptom Scale, and Patient's Global Impressions. Patients were evaluated weekly for the first month except for Week 3, and then seen bi-weekly and rated monthly. The results of the study showed that ketazolam was as efficacious as diazepam in treating anxiety and resulted in fewer side-effects. No adverse effects were noted in either group. Both benzodiazepines were safe and well-tolerated. No tolerance or withdrawal effects were noted. The average doses were ketazolam Week 4 (50.0 mg), Week 24 (66.14 mg) and diazepam Week 4 (26.33 mg) and Week 24 (33.0 mg). An increase in anxiety occurred in a significant number of patients after termination of either drug. By 2 weeks after the last dose many patients were free of anxiety and did not require further treatment. These results demonstrate that benzodiazepines are safe and efficacious for at least 6 months of continuous dosage.
PMID: 6113174 [PubMed - indexed for MEDLINE]
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