![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 71. This is the beginning of the thread.
Posted by Squiggles on February 6, 2007, at 17:27:15
Sorry, to deviate the thread on 'Ashton Rocks'.
I thought that my search for the benzo with a
a past may be clearer with a new title.I found something:
"Marketing Assessment: Neurontin in Psychiatric
Disorders" Parke Davis Marketing, Planning (Confidential)xpdf:/tmp/jc
"a) Acute
The benzodiazepines are the only treatment currently approved for the treatment of
panic disorder. In the U.S. alprazolam (UpJohn) is the only compound approve d
while clonazepam (Roche indicated for myoclonic epilepsy) is extensively used
without a formal claim. In Europe, alprazolam and bromazepam (Roche) are used but
not always for panic disorder. Listed below is a summary of the current medical
practice of Panic Disorder."NB "without a formal claim"-- that means without medical experience or research, right?
and on p. 37
"7. The C7onazepam (Roche) Case Study
Clonazepam was initially studied and approved as an anticonvulsant used alone or as an
adjunct in the treatment of Lennox-Gastaut syndrome and akinetic and myoclonic seizures .
In studies, up to 30% of patients showed a loss of anticonvulsant activity often within three
months of administration, therefore offering limited utility in epilepsy.
Several psychiatrist anecdotally reported an antipanic effect in some patients. These
reports led Roche to fund several studies in panic disorder. The publication of favorabl e
results is directly linked to the success of the brand . During 2Q'94 U.S.clonazepam sales
exceed $160 million with a five year average annual growth rate of +37°/e. The majority of
clonazepam sales and growth is attributed to the off label use by psychiatrists in the
treatment of panic disorder.""anecdotally" -- rather sloppy, imho, but as this report says, they have to tackle this panic disorder disease taking over the nation, with
whatever.
This is a pdf file.Squiggles
Posted by med_empowered on February 6, 2007, at 18:18:07
In reply to Benzo Confidential - clonazepam's history, posted by Squiggles on February 6, 2007, at 17:27:15
yeah...whats with klonopin's surge in popularity? I mean, OK, it has some helpful aspects but..does everyone need to on it? Theres also...serax, librium, valium, ativan...lots of choices.
Posted by willyee on February 6, 2007, at 18:32:23
In reply to Re: Benzo Confidential - clonazepam's history, posted by med_empowered on February 6, 2007, at 18:18:07
> yeah...whats with klonopin's surge in popularity? I mean, OK, it has some helpful aspects but..does everyone need to on it? Theres also...serax, librium, valium, ativan...lots of choices.
I had some pharmcology notes on it,sorry i dont have them at the moment,they are on a old pc.
Anyway klonopin was shown to also have "MOOD STABLIZING" effects as well as anti-anxiety effects,which was one of the reasons it was used a lot,kinda kill two birds one stone kinda thing.
Ive used a few benzos,and id have to agree that the build up of klonopin does seem to add a mood stablizing effect,something the other benzos did not.
The others helped,but i dident feel a actual acumaltion and overall back bone like i did on klonopin.This is just my experiance of course,and nothing official.
Posted by bassman on February 6, 2007, at 19:05:47
In reply to Re: Benzo Confidential - clonazepam's history, posted by med_empowered on February 6, 2007, at 18:18:07
I figure it's because Klonopin is the lesser evil in the eyes of physicians (when compared with Xanax); it is believed to be easier to withdraw from then Xanax, and the therapeutic dose for epilepsy is 20 mg/day which make 0.5 mg/day look like a little tiny dose. I'm amazed at biological differences...I can't take over 1 mg/day without feeling on the verge of sleep (and depression). I have a 110 lb female friend that takes 6 mg/day. Amazing.
Posted by Squiggles on February 6, 2007, at 19:40:52
In reply to Re: Benzo Confidential - clonazepam's history, posted by bassman on February 6, 2007, at 19:05:47
> I figure it's because Klonopin is the lesser evil in the eyes of physicians (when compared with Xanax); it is believed to be easier to withdraw from then Xanax, and the therapeutic dose for epilepsy is 20 mg/day which make 0.5 mg/day look like a little tiny dose. I'm amazed at biological differences...I can't take over 1 mg/day without feeling on the verge of sleep (and depression). I have a 110 lb female friend that takes 6 mg/day. Amazing.
Nah... I think they just picked something in a rush that had side effects which were applicable to the "mal du jour". That's frequently done in pharmacology and they have a train to catch. However, there is the lack of tolerance with K, unless of course, some other explanation can be given. BTW, the dose for epileptics is not 20mg--that's the max; it starts at 1mg TO 20mg per day. I looked it up.Squiggles
Posted by yxibow on February 6, 2007, at 20:12:47
In reply to Re: Benzo Confidential - clonazepam's history, posted by Squiggles on February 6, 2007, at 19:40:52
> > I figure it's because Klonopin is the lesser evil in the eyes of physicians (when compared with Xanax); it is believed to be easier to withdraw from then Xanax, and the therapeutic dose for epilepsy is 20 mg/day which make 0.5 mg/day look like a little tiny dose. I'm amazed at biological differences...I can't take over 1 mg/day without feeling on the verge of sleep (and depression). I have a 110 lb female friend that takes 6 mg/day. Amazing.
>
>
> Nah... I think they just picked something in a rush that had side effects which were applicable to the "mal du jour". That's frequently done in pharmacology and they have a train to catch. However, there is the lack of tolerance with K, unless of course, some other explanation can be given. BTW, the dose for epileptics is not 20mg--that's the max; it starts at 1mg TO 20mg per day. I looked it up.
>
> SquigglesDefinately the max, that's 400mg of Valium per day. And always worked up to over a period of time until the MED (minimum effective dose) can cover seizures.
Seizure disorders though are often covered, especially today with all the AEDs with more than one medication, e.g. clonazepam + Depakote, etc, so the doses of each medication are definately not on the 20mg side. Of course everyone varies.
-- tidings
Posted by madeline on February 6, 2007, at 21:01:26
In reply to Benzo Confidential - clonazepam's history, posted by Squiggles on February 6, 2007, at 17:27:15
I take klonopin for anxiety and panic and it works at 0.5 mgs a day.
That's enough for me to know.
M
Posted by Squiggles on February 6, 2007, at 21:11:45
In reply to Re: Benzo Confidential - clonazepam's history » Squiggles, posted by madeline on February 6, 2007, at 21:01:26
> I take klonopin for anxiety and panic and it works at 0.5 mgs a day.
>
> That's enough for me to know.
>
> MWell, i'm the curious type.
Let's start with the IPCS:
Definitely addictive and definitely productive
of cognitive impairment-- see description:
Posted by Squiggles on February 6, 2007, at 21:31:15
In reply to Re: Benzo Confidential - clonazepam's history, posted by Squiggles on February 6, 2007, at 21:11:45
From a presentation article by Professor Heather Ashton, I see a proposed explanation for the particular difficulty of withdrawing from Clonazepam to be the unappreciated potency of
the drug (along with some others):----------------------------------------------
History of Benz odiazepines: What the Textbooks May Not Tell You
(3rd Annual Benz odiazepine Conference, Bangor, Maine, October 12, 2005)
C.H. Ashton" [SLIDE 10 ] Half-lives and equivalent potencies of benz odiazepine
anxiolytics
Explain slide (elimination half-lives and approximate clinical potency of some
benzodiazepines compared to diazepam). The three most potent in this group of anxiolytics
are alprazolam, clonazepam and lorazepam which are 10-20 times more potent than
diazepam. This difference is often disregarded and the drugs prescribed in excessive dosage.
For example, I have recently seen patients prescribed alprazolam in daily doses of 4-6mg
equivalent to 80-120mg of diazepam. Alprazolam is no longer prescribed under the NHS in
the UK though it can be prescribed privately. I have also recently seen lorazepam prescribed
in 6, 10, and over 12mg daily doses again in equivalence up to 120mg diazepam. Both
these drugs are fairly short-acting and have to be taken 3-4 times a day. Patients often suffer
mini-withdrawal symptoms between doses. Clonazepam is also very potent, 10-20 times the
strength of diazepam. In the UK it is only officially indicated as an anticonvulsant for
epilepsy but it is popular in the US and British doctors are following suit and prescribing it for
anxiety.
All these three drugs are highly addictive; dependence develops rapidly and they are
particularly hard to withdraw from. This difficulty is partly due to the relatively excessive
dosage used, partly I suspect from their potency which probably means that they bind
particularly avidly to GABA/BZ receptors, partly because equivalent potencies are not
adhered to when switching patients to other benzodiazepines such as Valium or Librium in
attempts at withdrawal, and partly because they are not available in small enough dosage
strengths to allow for gradual dosage reduction. In the UK Ativan is only available in 2.5mg
or 1mg tablets. The 1mg tablet is equivalent to 10mg diazepam. Even if you halve it you are
withdrawing by decrements of 5mg in diazepam equivalents, which can be a big drop for
some people. Strangely, 0.5mg Ativan tablets are available in the US and Canada, but all
attempts to get the drug company (Wyeth) to supply this in the UK have failed. "pdf file: (xpdf:/tmp/Maine.benzo2.pdf)
-----------------------------------------
However, in my experience, alprazolam (XANAX) was a piece of cake to withdraw from (1.50mg over about 7-10 yrs.) in comparison to clonazepam (1.0mg) over about the same time.
Squiggles
Posted by Squiggles on February 6, 2007, at 21:54:59
In reply to Re: Benzo Confidential - clonazepam's history, posted by Squiggles on February 6, 2007, at 21:31:15
WMD:
Here is an interesting and unique use
of the anticonvulsant benzos:"Medical Aspects of Chemical and Biological
Terrorism" Monov and Dishovsky, Sofia 2005, Publishing House of the Union of Scientists in Bulgaria.Convulsions are among the most severe symptoms of intoxication with high
toxic OPC. The reduction of central convulsive syndrome exerts positive effect
on both the course of OPC intoxication and the delayed consequences. For this,
antidotic formulas are supplemented with anticonvulsants of different chemical
structures (diazepam, clonazepam, phenazepam, etc.). Anticonvulsants facilitate
normalization of metabolism of biogenic amines and CNS uptake of glucose,
whose consumption grows up steeply in poisonings with soman [92]."xpdf:/tmp/chemical_poisoning-1.pdf
Posted by Phillipa on February 6, 2007, at 21:56:11
In reply to Re: Benzo Confidential - clonazepam's history, posted by Squiggles on February 6, 2007, at 21:31:15
I withdrew from xanax over a weekend. No ill effects . Switch to ativan easy too. I hate klonopin it depresses me and I find it much stronger than xanax, ativan, or valium. Boy we're all different. Love Phillipa
Posted by willyee on February 6, 2007, at 22:17:49
In reply to Re: Benzo Confidential - clonazepam's history, posted by Squiggles on February 6, 2007, at 21:54:59
Not sure of your aim,that benzos,klonopin in main are toxic?
Im sure they are,addictive as well.However if youre a person who believes clinical anxiety is chemical,unknown,and uncurable,id be willing to take the health risks.
Not being able to live a life due to anxiety is not much worse than toxcity on the body.There are people who dont use meds,and they literaly cant drive,or even leave the house.So is it in awe they would choose to use these meds,knowing it will be likly a life long medication.
I dont see such concern for having to withdraw,not advocating or defending them,but how many people smoke packs of cigs a day,or drink a beer after work,personaly id rather not know the toxcity of benzos,i just know they arent healthy for me pyshicaly,but god knows they help me live a somewhat normal life.I know old people still smoking cigarettes today,and they have no clue to the horrid toxins entering their brains in seconds,ever see the entire ingredients of a basic cigarette,not good.
Again,might have read your post wrong,but other than that,im curious what your message is with the information your posting,and im not being funny,i truly am,i dont understand the numerous postings,what view or stand are you taking with it?
Thanks
Posted by laima on February 6, 2007, at 22:58:46
In reply to Re: Benzo Confidential - clonazepam's history, posted by willyee on February 6, 2007, at 22:17:49
I'd reckon the message is "klonopin is not a casual drug". Use with thought, care, and caution. Weigh your pros and cons.
It's VERY powerful, and for me was VERY excruciating to withdraw from. Even when it appeared to be doing zero for my anxiety, and even when it appeared to no longer be detectable in my body or mind. Ie, even after I eventually appeared to be utterly immune to it. I couldn't tell I was taking it. I didn't even know it had ANY effect left in my body whatsoever until the withdrawal began...and then it looked that it had actually an astonishingly strong grip after all.
It was indeed very helpful for myoclunus, for awhile, btw. But I never had severe myoclonus before I tried atypical antipsychotics...
Posted by Squiggles on February 7, 2007, at 6:36:43
In reply to Re: Benzo Confidential - clonazepam's history, posted by willyee on February 6, 2007, at 22:17:49
> Not sure of your aim,that benzos,klonopin in main are toxic?
>
> Im sure they are,addictive as well.However if youre a person who believes clinical anxiety is chemical,unknown,and uncurable,id be willing to take the health risks.
>..........Not at all; I am not against the rational use
of benzos, and infact I made a grievous mistake in trying to get off clonazepam (but not Xanax).
I am very curious about the nature of clonazepam because it seems to be very different from the other benzos. I hope I am not being intrusive in the search for clues on this.Squiggles
Posted by Squiggles on February 7, 2007, at 6:39:11
In reply to Re: Benzo Confidential - clonazepam's history, posted by laima on February 6, 2007, at 22:58:46
> I'd reckon the message is "klonopin is not a casual drug". Use with thought, care, and caution. Weigh your pros and cons.
>
> It's VERY powerful, and for me was VERY excruciating to withdraw from. Even when it appeared to be doing zero for my anxiety, and even when it appeared to no longer be detectable in my body or mind. Ie, even after I eventually appeared to be utterly immune to it. I couldn't tell I was taking it. I didn't even know it had ANY effect left in my body whatsoever until the withdrawal began...and then it looked that it had actually an astonishingly strong grip after all.
>
> It was indeed very helpful for myoclunus, for awhile, btw. But I never had severe myoclonus before I tried atypical antipsychotics...That's exactly what happened to me, though i never did withdraw. You can't say that about the other benzos.
Squiggles
Posted by laima on February 7, 2007, at 7:22:53
In reply to Re: Benzo Confidential - clonazepam's history, posted by Squiggles on February 7, 2007, at 6:39:11
Lucky you Squiggles, not going through a withdrawal. My doctor wasn't willing to raise my official dose over a mere 2 mg, because to sum up a longer story, he said tolerance would continue to go on indefinately, and then to withdraw from a higher dose would be even worse and more dramatic. And that unwanted side effects, such as cognitive /sensory difficulty, would really manifest and then just go up with the dosing. I'm sure doctors would argue this, how to handle this, but mine believed it was best to just get the withdrawal over with asap, with a brief couple week taper, and said that "taking less" wasn't going to solve the anxiety it was contributing to. Being "off" would bring the relief, drawing out the taper would only draw out my misery, he felt. I actually think my taper was too rapid, but that's my opinion. I suspect my taper was designed to prevent seizures, as I was immediately given 2.5-5mg zyprexa for anxiety during that period. So that's how I ended up having to withdraw. But off both the klonopin and zyprexa, I do indeed feel much less anxious, so much so that people have actually commented on it, that I seem relaxed, glad I'm not as stressed out as I used to be, looking good, that kind of thing.
One way klonopin/clonazepam differs from other benzos, of course, is that it is also an anti-convulsant. The .5, then finally 2mg which I was prescribed was supposed to be doing double-duty for anxiety as well as for restless legs/active sleeping and the myoclunus. And it worked very well for all of these purposes at these doses for a couple years.
The anticonvulsant part- I wonder if that could have anything to do with the depression many report it seems to bring on for them? Could it be literally "depressing" something if it is "anti-convulsing"? Is the benzo component the only way it differs from other anticonvulsants used in psychiatry, such as lamictal?
But people take lamictal for "mood stabilization" and for help with depression- though when I used it, my suspicion and impression was that it kept my mood stuck in "flat". My mood lifted when my lamictal trial was over.So why aren't other benzos not considered depressing- or are they? The only one I personally am certain I got markedly depressed from was restoril, but that has sedative/hypnotic properties to it. Though the sedative/hypnotic I've tried, the extended release version of ambien, didn't make me depressed at all. If anything, it gave me a groovy, really nice dreamy feeling- which led me to stay awake on it to enjoy it, and all sorts of ridiculous and very embarressing behavior resulted.
Hard to untangle this, isn't it?
> That's exactly what happened to me, though i never did withdraw. You can't say that about the other benzos.
>
> Squiggles
>
Posted by madeline on February 7, 2007, at 7:47:58
In reply to Re: Benzo Confidential - clonazepam's history, posted by Squiggles on February 6, 2007, at 21:11:45
You know, I don't know if you ever experienced generalized anxiety and panic, but I'll do my best to try to describe it:
Imagine feeling like someone has a gun to your head and is about to pull the trigger.
Imagine feeling as though you have been buried alive and are waiting to suffocate.
Imagine watching someone you love is on fire and you can't do anything about it.
Now imagine feeling that way for days at a time for absolutely no reason.
The illness itself is incapacitating and just try to think or even live under those conditions. You can't - you just can't. There is no cure.
Klonopin offers symptom relief for me and a whole lot of other people as well.
I don't care if I become dependent on it (and I think you need to look up the difference between dependence and addiction). And without it, it's not like I can think anyway.
So, while I appreciate you cynicism, on the whole, I'll take the klonopin and live my life.
Maddie
Posted by Squiggles on February 7, 2007, at 7:53:48
In reply to Re: Benzo Confidential - clonazepam's history » Squiggles, posted by laima on February 7, 2007, at 7:22:53
> Lucky you Squiggles, not going through a withdrawal.
-It's a default kind of luck.
My doctor wasn't willing to raise my official dose over a mere 2 mg, because to sum up a longer story, he said tolerance would continue to go on indefinately, and then to withdraw from a higher dose would be even worse and more dramatic.
-But then your doctor must have anticipated the possibility of wanting to withdraw.
And that unwanted side effects, such as cognitive /sensory difficulty, would really manifest and then just go up with the dosing. I'm sure doctors would argue this, how to handle this, but mine believed it was best to just get the withdrawal over with asap, with a brief couple week taper, and said that "taking less" wasn't going to solve the anxiety it was contributing to.
-How long were you on it? And if you took it
for anxiety, why would you want to stop?Being "off" would bring the relief, drawing out the taper would only draw out my misery, he felt. I actually think my taper was too rapid, but that's my opinion. I suspect my taper was designed to prevent seizures, as I was immediately given 2.5-5mg zyprexa for anxiety during that period.
-Do you meant that Zyprexa would prevent seizures?
That seems unlikely. Dr. Ashton recommends Valium or at least another benzo.
So that's how I ended up having to withdraw. But off both the klonopin and zyprexa, I do indeed feel much less anxious, so much so that people have actually commented on it, that I seem relaxed, glad I'm not as stressed out as I used to be, looking good, that kind of thing.-That's odd... is it because you had been in a state of withdrawal while on clonazepam? I don't understand why you feel better having withdrawn.
>
> One way klonopin/clonazepam differs from other benzos, of course, is that it is also an anti-convulsant. The .5, then finally 2mg which I was prescribed was supposed to be doing double-duty for anxiety as well as for restless legs/active sleeping and the myoclunus. And it worked very well for all of these purposes at these doses for a couple years.-But then you needed more, and your dr. thought that would be too high (2mg)? I have heard of people here taking much higher dosages, even on initial prescription.
>
> The anticonvulsant part- I wonder if that could have anything to do with the depression many report it seems to bring on for them?-I doubt it. It may have something to do with anxiety though.
Could it be literally "depressing" something if it is "anti-convulsing"? Is the benzo component the only way it differs from other anticonvulsants used in psychiatry, such as lamictal?-There is some initial depression when taking all benzos I think; but nothing close to clinical depression.
> But people take lamictal for "mood stabilization" and for help with depression- though when I used it, my suspicion and impression was that it kept my mood stuck in "flat". My mood lifted when my lamictal trial was over.-They are certainly not stimulants. And sometimes I have wondered why they do not give stimulant drugs for general anxiety based on fear, rather than adrenal-type hyperactivity.
>
> So why aren't other benzos not considered depressing- or are they?-I think they are.
The only one I personally am certain I got markedly depressed from was restoril, but that has sedative/hypnotic properties to it. Though the sedative/hypnotic I've tried, the extended release version of ambien, didn't make me depressed at all. If anything, it gave me a groovy, really nice dreamy feeling- which led me to stay awake on it to enjoy it, and all sorts of ridiculous and very embarressing behavior resulted.
-Ambien sounds good.
>
> Hard to untangle this, isn't it?-Yes, because i don't know diddly squat about biochemistry and psychopharmacology. I wonder if drs. prescribe one benzo rather than another because they *do* know. It seems to me that there is great variability in choice among them.
Squiggles
Posted by Squiggles on February 7, 2007, at 8:00:06
In reply to Re: Benzo Confidential - trigger maybe » Squiggles, posted by madeline on February 7, 2007, at 7:47:58
>
> So, while I appreciate you cynicism, on the whole, I'll take the klonopin and live my life.
>
> MaddieI know what it is. I would rather take an anaesthetic than go through panic attacks again for so long. You must have completely misunderstood my curiousity... it is not aimed against benzos AT ALL. I am curious about the nature of clonazepam-- why all the other benzos build tolerance, but clonazepam does not. However, its withdrawal, at even a low constant (15yr. approx.) dose is one of the worst.
So, it's basically an academic question, not a stance against benzodiazepines, which I personally think are necessary for states of anxiety, rage, panic, etc.
Squiggles
Posted by laima on February 7, 2007, at 8:06:44
In reply to Re: Benzo Confidential - trigger maybe » Squiggles, posted by madeline on February 7, 2007, at 7:47:58
What happens when it one day no longer works though- that's the double edged sword. It can indeed konk out. I sure didn't believe it for years, until it happened to me. Your dose can go up and up as it becomes less effective, as anxiety seems to worsen, (dose raised by Dr.), with the beneficial effect becoming less and less, while anxiety gets worse and worse and worse. Whether you call that addiction or dependency, it is indeed something that can happen, and is not uncommon to happen after time. But the catch is, though the benefit goes away, that doesn't mean you don't get a withdrawal syndrome. That's not cynicism, that's reality to reckon with. That's why, as I'm sure you know, non-medication therapies and other measures are also important to examine at the same time as using klonopin. I thank god I only had to come off 2mg- not 4, 6....more.
> You know, I don't know if you ever experienced generalized anxiety and panic, but I'll do my best to try to describe it:
>
> Imagine feeling like someone has a gun to your head and is about to pull the trigger.
>
> Imagine feeling as though you have been buried alive and are waiting to suffocate.
>
> Imagine watching someone you love is on fire and you can't do anything about it.
>
> Now imagine feeling that way for days at a time for absolutely no reason.
>
> The illness itself is incapacitating and just try to think or even live under those conditions. You can't - you just can't. There is no cure.
>
> Klonopin offers symptom relief for me and a whole lot of other people as well.
>
> I don't care if I become dependent on it (and I think you need to look up the difference between dependence and addiction). And without it, it's not like I can think anyway.
>
> So, while I appreciate you cynicism, on the whole, I'll take the klonopin and live my life.
>
> Maddie
Posted by laima on February 7, 2007, at 8:26:52
In reply to Re: Benzo Confidential - trigger maybe, posted by Squiggles on February 7, 2007, at 8:00:06
I'm not at all anti-benzo, either. They are extremely important meds. I just think they are not casual, and need to be used with caution and care-maybe better used on an as-needed basis to minimize chance that they won't work when one needs them most? Not sure. Clonazepam is great, but comes with a few potential glitches.I beg to differ about clonazepam not building tolerance. It happened to me, and my doctor didn't act surprised at all. He commented just, "Yes, I'm sure you have- you've been on it a few years. Since it's not helping, we should get you off now, this cycle will go on indefinately, setting you up for a far worse withdrawal later from a much higher dose." I developed impervience to any anxiety benefit, and it ceased to be very effective for the myoclunus and restless sleeping, too. Even ceased to be much of an antidolt to hyperventilation/suffocation. What REALLY sucked- was not being able to alleviate panic attacks!
The withdrawal, if too rapid, has been compared to coming off heroin. Even on a taper, it's not fun. Having once used up my supply early, in a desperate effort to alleviate panic attack out of hell- the amount which used to work did zero- I ended up starting a cold withdrawal- and oh.my.god. I wouldn't wish that on anyone. Without the steady stream of clonazepam which apeared to no longer be helping or even doing anything, it was shocking how dramatic my body's shock was: wavy floors, paranoia, every noise like a clock ticking shattering through my brain- those sorts of withdrawal effects are plenty written about elsewhere. But what I'm getting at is, how curious that the sudden withdrawal can be so dramatic, after the drug ceased to be therapeutically effective or even experiencially detectable? Why? How can this be?
Perhaps then, Squiggles, the tolerance issue, the threshold even, varies person to person? Or, perhaps the tolerance is slow to develop compared to other benzos?
> I know what it is. I would rather take an anaesthetic than go through panic attacks again for so long. You must have completely misunderstood my curiousity... it is not aimed against benzos AT ALL. I am curious about the nature of clonazepam-- why all the other benzos build tolerance, but clonazepam does not. However, its withdrawal, at even a low constant (15yr. approx.) dose is one of the worst.
>
> So, it's basically an academic question, not a stance against benzodiazepines, which I personally think are necessary for states of anxiety, rage, panic, etc.
>
> Squiggles
Posted by Squiggles on February 7, 2007, at 8:40:18
In reply to Re: Benzo Confidential - trigger maybe » Squiggles, posted by laima on February 7, 2007, at 8:26:52
I don't know laima. I appreciate your post
which shows a personal understanding of the
nature of withdrawal-- a disturbing thing if
the only drug you have ever taken was a benzo
and you get misdiagnosed for example.I tend to shy away from the "each person is different" theory, because it is only used for the unexplained cases, but when a drug goes on the market, esp. OTC, such a question is never seriously considered.
What I will do, is look for the most informative site on this question, and stop flooding the board with little chunks of information.
If anyone knows about the unique nature of anticonvulsant type benzo withdrawal, it would be nice to see.
Posting later... much later :-)
Squiggles
Posted by laima on February 7, 2007, at 9:03:19
In reply to Re: Benzo Confidential - clonazepam's history, posted by Squiggles on February 7, 2007, at 7:53:48
> -It's a default kind of luck.
Seriously- You Lucky! Especially if tolerance hasn't been an issue.
I started the clonazepam after ativan proved insufficient, and I am a very restless sleeper, prone to periods of myclonus. Clonazepam seemed like a better choice. I was experiencing severe general anxiety, as well as physical manifestations of anxiety, and panic attacks. Lots of agitation, day and night. I was on it to aleviate these symptoms. He warned me it might not work forever, and urged me to get into therapy and rexamine my lifestyle, etc. but I didn't believe it, because it was working out great. I started with .5, some 4-5 years later was at 2mg- which I would take and not even be able to detect I took anything. And feeling worse than before. Why not raise higher? For one thing, he said most doctors don't like to go over 4mg, and I've actually seen that in print- I wish I could remember where. But it was a mainstream source- maybe medline or something like that. Again, I know all good doctors won't agree for their own reasons. Well so it was a decision I couldn't argue with- why keep raising indefinately, until reaching unsafe levels? I could see plain as day I was getting worse- and then I'd have to eventually come down from a very, very high dose? That would be worse, and I would have gained nothing. And it was already making me cognitively "fuzzy"- that I only see now in retrospect. I didn't really WANT to stop- it just wasn't working anymore, I was worse off than before, and I could see how this would continue. More than anything, I just wished it still worked like it used to. I was very, very disapointed and disillusioned.
No, zyprexa wouldn't touch seizures. Tapering the clonazepam prevented seizures, the zyprexa was to help out with the rebound anxiety associated with withdrawal, and to help sleep. Very hard to sleep through withdrawal- body is on high alert.
Yes, I am aware Drt. Ashton recommends valium or other benzos to aid withdrawal- I guess this guy's philosophy was different. Just wanted the benzos out, asap. Figured that would be in my best interest. He's no dummy, either- I'm sure he had his reasons for his choices.
Funny you mentioned stims- adderall (the brand version in particular) seems to have given me an awesome grip on my anxiety- I guess I feel both more outgoing and capable. Capable in my abilities, capable to face people, situations. No more bodily manifestations of anxiety, panic, any of that. It's weird. No jitteriness or anything like that. Agitation not a problem. Far less worrying, though I still worry too much. I started it about 6 weeks ago. My doctor says tolerance is unlikely if I stick to the low dose I use, and never take it late in the day. It's a short acting drug, short half life, and so the theory is that the brain gets some recovery time overnight. He said drugs which bathe the brain for 24 hours a day (ie, klonopin, many antidepressents) are far more likely to cause tolerance. (Note-didn't say "never" or "always" or use any other words like that.)
Feeling less anxiety off clonazepam-
> -That's odd... is it because you had been in a state of withdrawal while on clonazepam? I don't understand why you feel better having withdrawn.It is very surprising, isn't it? I feel amazed, still. I saw Dr. Ashton wrote about the possibility of having daily or constant "mini-withdrawals" while still on the drug, as its effectivess wanes. Larry Hoover wrote about a similar experience just yesterday, about his experience with oxycodone, and did a little research on the phenomena. While I gather Ashton's asssertation is controversial, I still speculate breaking that cycle most likely explains my experience. I can't come up with a better explanation for why my anxiety got worse as clonazepam went up, then near vaporized after it flushed out of my body- and the real weird thing- after starting an amphetamine! Well, the one other theory I have is this: benzos disrupt sleep architecture, snipping out stages 3 and 4- which are crucial for solid mental health. After a period of deprivation, mental health can become strained. So maybe I'm getting more of these stages of sleep, and that's helping, too. I had a couple of sleep studies while using clonazepam at night, and sure enough, VERY short on these stages. Dr. is interested in me getting another study to see how sleep architecture looks now, but I can't bear to go through that again for an intellectual curiosity.
The one bummer- I am a VERY restless sleeper again, though thankfully no myoclunus. But, I think I'll choose to live with this rather than mess with chronic use of another complicated substance.
Psychopharmacology: weird and complicated.
Posted by laima on February 7, 2007, at 9:07:08
In reply to Re: Benzo Confidential - trigger maybe, posted by Squiggles on February 7, 2007, at 8:40:18
Many of us are on different cocktails of drugs which interact, for one thing. And if we were all the same, all we'd need is one antidepressent, which would work for everyone, one benzo, one antipsychotic. End of story. And we all know that's not true. Case studies are very valuable, you take a lot of case studies, you can look for patterns, build theories, design studies. I think biology and our personal "other factors" are too complex to come up with blanket answers.
> I don't know laima. I appreciate your post
> which shows a personal understanding of the
> nature of withdrawal-- a disturbing thing if
> the only drug you have ever taken was a benzo
> and you get misdiagnosed for example.
>
> I tend to shy away from the "each person is different" theory, because it is only used for the unexplained cases, but when a drug goes on the market, esp. OTC, such a question is never seriously considered.
>
> What I will do, is look for the most informative site on this question, and stop flooding the board with little chunks of information.
>
> If anyone knows about the unique nature of anticonvulsant type benzo withdrawal, it would be nice to see.
>
> Posting later... much later :-)
>
>
> Squiggles
Posted by laima on February 7, 2007, at 9:24:13
In reply to Re: Benzo Confidential - trigger maybe » Squiggles, posted by laima on February 7, 2007, at 9:07:08
Bottom line, Squiggles, I think you are incorrect in your belief that clonazepam can't produce tolerance. I am living proof, and didn't stun any doctors. I brought up withdrawal in context of discussing tolerance- primarily interesting the mini-withdrawals which can apparently start as the aforementioned tolerance developes. And regular withdrawal, for I find it curious that even after total tolerance to the therapeutic benefits of clonazapam develops, real withdrawal still occurs. And sudden withdrawal from clonazapam, a benzo/anticonvulsant, brings on danger of seizures, even in people who have never had a seizure before. It's then particularly important to taper off, not quit cold.
> > If anyone knows about the unique nature of anticonvulsant type benzo withdrawal, it would be nice to see.
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