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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 20 of 20. This is the beginning of the thread.
Posted by linkadge on November 29, 2010, at 19:49:32
Please mind the language but.....
I can't even think why the f*ck I've spent the past 10 years of my life on a *repeated* SSRI merry-go-round, will such *marginal* anti-anxiety effects? Why in the f*ck wasn't I just prescribed a benzodiazapine? I do not find the clonazepam anywhere NEAR as mind warping as the SSRIs. I am finally coming to the realization that my core issue has been ANXIETY - not depression.
I have been completely preventing the weekly cyclic insomnia (usually 3+ nights a week)
Currently on 2.5mg of amitriptyline and 0.125mg of clonazepam (1/4 of a 0.5). I can taper off this by the end of the week and I have no noticable withdrawl. On the contrary, coming off even 2.5mg of lexapro send me into a spiral of pure maddness.
These medications kill the anxiety and do not produce anhedonia (like the SSRIs did). I'm sleeping better than I have in a decade - through the entire night - not waking up every 15 minutes, 40 times a night like on SSRIs.
I wake up refreshed, with plans, ideas and the capacity to feel pleasure - not a complete zombie, who feels like that past 8 hours has been more torture than rest.
For a lot of people here, I think the core problem is **not being targeted very well**. If you're just being shoved on a high dose of SSRI (for me which just make anxiety and insomnia worse), then stop all the augmentation this/that crap and find a medication that hits the problem better.
I remember first starting on SSRIs (at the tender age of 17) and waiting through months of elevated anxiety, insomnia, akathesia, suicidality, apathy, you name it.
If I had just been prescribed a good ol TCA plus a benzo, I would have been chipper again within a few days.
Linkadge
Posted by Conundrum on November 29, 2010, at 20:22:37
In reply to why didn't they prescribe this 10 years ago?, posted by linkadge on November 29, 2010, at 19:49:32
Sounds like you had poor doctors, how many had you seen in this time period?
I'm glad you are feeling better. It is really encouraging as well, seeing a long time poster finally get the right meds.
...but you still sound like angry old linkage. :P
> Please mind the language but.....
>
> I can't even think why the f*ck I've spent the past 10 years of my life on a *repeated* SSRI merry-go-round, will such *marginal* anti-anxiety effects? Why in the f*ck wasn't I just prescribed a benzodiazapine? I do not find the clonazepam anywhere NEAR as mind warping as the SSRIs. I am finally coming to the realization that my core issue has been ANXIETY - not depression.
>
> I have been completely preventing the weekly cyclic insomnia (usually 3+ nights a week)
>
> Currently on 2.5mg of amitriptyline and 0.125mg of clonazepam (1/4 of a 0.5). I can taper off this by the end of the week and I have no noticable withdrawl. On the contrary, coming off even 2.5mg of lexapro send me into a spiral of pure maddness.
>
> These medications kill the anxiety and do not produce anhedonia (like the SSRIs did). I'm sleeping better than I have in a decade - through the entire night - not waking up every 15 minutes, 40 times a night like on SSRIs.
>
> I wake up refreshed, with plans, ideas and the capacity to feel pleasure - not a complete zombie, who feels like that past 8 hours has been more torture than rest.
>
> For a lot of people here, I think the core problem is **not being targeted very well**. If you're just being shoved on a high dose of SSRI (for me which just make anxiety and insomnia worse), then stop all the augmentation this/that crap and find a medication that hits the problem better.
>
> I remember first starting on SSRIs (at the tender age of 17) and waiting through months of elevated anxiety, insomnia, akathesia, suicidality, apathy, you name it.
>
> If I had just been prescribed a good ol TCA plus a benzo, I would have been chipper again within a few days.
>
> Linkadge
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Posted by merpmerp on November 29, 2010, at 20:31:08
In reply to why didn't they prescribe this 10 years ago?, posted by linkadge on November 29, 2010, at 19:49:32
Link, that's fantastic. I've lurked here a long time and so have some idea of the meds you've suffered through. I am going to keep my fingers crossed for you that it only gets better from here!
Posted by polarbear206 on November 29, 2010, at 20:57:44
In reply to why didn't they prescribe this 10 years ago?, posted by linkadge on November 29, 2010, at 19:49:32
I've been utilizing it to taper down to a lower dose of Effexor. One good thing about Klonopin, it doesn't give you that hung-over feeling in the morning. Great drug.
Posted by SLS on November 30, 2010, at 0:01:55
In reply to why didn't they prescribe this 10 years ago?, posted by linkadge on November 29, 2010, at 19:49:32
> Please mind the language but.....
>
> I can't even think why the f*ck I've spent the past 10 years of my life on a *repeated* SSRI merry-go-round, will such *marginal* anti-anxiety effects? Why in the f*ck wasn't I just prescribed a benzodiazapine? I do not find the clonazepam anywhere NEAR as mind warping as the SSRIs. I am finally coming to the realization that my core issue has been ANXIETY - not depression.
>
> I have been completely preventing the weekly cyclic insomnia (usually 3+ nights a week)
>
> Currently on 2.5mg of amitriptyline and 0.125mg of clonazepam (1/4 of a 0.5). I can taper off this by the end of the week and I have no noticable withdrawl. On the contrary, coming off even 2.5mg of lexapro send me into a spiral of pure maddness.
>
> These medications kill the anxiety and do not produce anhedonia (like the SSRIs did). I'm sleeping better than I have in a decade - through the entire night - not waking up every 15 minutes, 40 times a night like on SSRIs.
>
> I wake up refreshed, with plans, ideas and the capacity to feel pleasure - not a complete zombie, who feels like that past 8 hours has been more torture than rest.
>
> For a lot of people here, I think the core problem is **not being targeted very well**. If you're just being shoved on a high dose of SSRI (for me which just make anxiety and insomnia worse), then stop all the augmentation this/that crap and find a medication that hits the problem better.
>
> I remember first starting on SSRIs (at the tender age of 17) and waiting through months of elevated anxiety, insomnia, akathesia, suicidality, apathy, you name it.
>
> If I had just been prescribed a good ol TCA plus a benzo, I would have been chipper again within a few days.
I understand the anger and frustration you must be feeling for having languished for so many years when the drugs that ultimately helped you were available before you were born.Anxiety can drive depression. Depression can drive anxiety. Knowing the difference between the two might increase the odds of finding a successful treatment more quickly.
- Scott
Posted by Phillipa on November 30, 2010, at 0:19:55
In reply to Re: why didn't they prescribe this 10 years ago? » linkadge, posted by SLS on November 30, 2010, at 0:01:55
Benzos as I've said repeatedly were all I needed and could cold turkey them and never really needed much to quell anxiety and didn't and don't have depression Gad as my pdoc says. Careful with the klonopin though as some me included find it depressing and personally can't take it. Xanax and valium and ativan years ago were fine. Good luck and glad your're feeling better. Phillipa
Posted by rculater on November 30, 2010, at 4:27:50
In reply to Re: why didn't they prescribe this 10 years ago?, posted by Phillipa on November 30, 2010, at 0:19:55
Good news glad you finally found the core problem and a med to treat it with minimul S/Es
Ive become anti SSRI myself also after years trying various types with different results and dont want to go MAOI route.
Posted by bearfan on November 30, 2010, at 5:31:39
In reply to Re: why didn't they prescribe this 10 years ago? » linkadge, posted by Conundrum on November 29, 2010, at 20:22:37
I agree as well that he must of not had helpful doctors. I thought Benzodiazepines were long known to help anxiety and worked, in many cases, better than SSRIs. Xanax, for instance, has an indication for anxiety associated with depression. There is an issue with tolerance and not working as well if your on them constantly. I lot of doctors are willing to give them to patients until their antidepressants 'kick in'.
Posted by Conundrum on November 30, 2010, at 10:08:40
In reply to Re: why didn't they prescribe this 10 years ago?, posted by bearfan on November 30, 2010, at 5:31:39
Link had you tried either amitriptyline or clonazapam in the past but the dose was too high? or another benzo? The doses you are taking are very low, so maybe it took a while to realize how low you needed to go.
> I agree as well that he must of not had helpful doctors. I thought Benzodiazepines were long known to help anxiety and worked, in many cases, better than SSRIs. Xanax, for instance, has an indication for anxiety associated with depression. There is an issue with tolerance and not working as well if your on them constantly. I lot of doctors are willing to give them to patients until their antidepressants 'kick in'.
Posted by Joe Schmoe on November 30, 2010, at 13:07:37
In reply to why didn't they prescribe this 10 years ago?, posted by linkadge on November 29, 2010, at 19:49:32
Glad you are finding relief. I have been on clonazepam for years and it really helps me with social anxiety.
Unfortunately I get depressed eventually if I don't also add an ssri, and a few months after I go off one (has happened several times) so I have to go back on, but everyone is different.
Interesting you have success at such low doses and also with a TCA. Only TCA I have taken was imipramine and it was at 300 mg/day, with bad side effects.
Posted by sigismund on November 30, 2010, at 13:21:07
In reply to why didn't they prescribe this 10 years ago?, posted by linkadge on November 29, 2010, at 19:49:32
I understand what the clonazepam is doing.
What is the amitrip doing at that dose?
Posted by ed_uk2010 on November 30, 2010, at 14:09:11
In reply to why didn't they prescribe this 10 years ago?, posted by linkadge on November 29, 2010, at 19:49:32
>Why in the f*ck wasn't I just prescribed a benzodiazapine? I do not find the clonazepam anywhere NEAR as mind warping as the SSRIs.
I don't know, but YMMV. I find benzos a lot more mind warping than SSRIs.
Posted by ed_uk2010 on November 30, 2010, at 14:13:53
In reply to Re: why didn't they prescribe this 10 years ago?, posted by Phillipa on November 30, 2010, at 0:19:55
>could cold turkey them
But can you? Regular use does induce dependence.
Posted by bleauberry on November 30, 2010, at 19:15:46
In reply to why didn't they prescribe this 10 years ago?, posted by linkadge on November 29, 2010, at 19:49:32
Link I think you are absolutely correct in everything you said and I am cheering at your wisdom. Wisdom I wish I had, but I'm at least glad to know someone who does!
I think at some point in the future they will look back at the 30-40 year era of SSRIs and conclude the whole thing was a cruel misguided joke. A result of the collision of politics, science, economics, arrogance, and ignorance.
In your case, you are getting a slight boost in serotonin, slight boost in norepinephrine, indirect slight boost in dopamine, and a slight boost in gaba, and control of any possible overexcitatory glutamate. I mean, you have all the bases covered.
Once in a while we see someone do extremely well on a pure ssri monotherapy. Maybe, what, 1 in 10? I can't explain those, nobody can, it just goes to show that the magic of the brain is far greater than mere humans can comprehend. But in general, those rare cases aside, my pure logic says that artificially increasing someone's serotonin alone without any attention to anything else is destined for trouble one way or the other...side effects, inefficacy, apathy, post-ssri syndrome, on and on. Pure logic tells me that if one neurotransmitter is low, they probably all are. There is so much interplay between them, and they share many of the same genetic and enzymatic processes along the way.
The tca's and benzos went generic a long time ago so there is no profit motive in them. They get shoved aside, with profit makers taking the lead.
Benzo tolerance and addiction are sometimes issues. But then, anyone who has done these drugs knows that SSRI tolerance (poopout) happens all the time, and SSRI withdrawals are a journey through hell.
Anyone who knows me knows that I am not in favor of large doses. Normal doses are too high in my opinion. If it takes that much, then it's the wrong med. Pure and simple.
Nice job. I like it.
Posted by Phillipa on November 30, 2010, at 20:03:20
In reply to Re: why didn't they prescribe this 10 years ago? » Phillipa, posted by ed_uk2010 on November 30, 2010, at 14:13:53
I did many times in the past and continue to cut down as just make me tired. PJxx
Posted by orbital on December 2, 2010, at 2:04:19
In reply to why didn't they prescribe this 10 years ago?, posted by linkadge on November 29, 2010, at 19:49:32
Your frustration is so well grounded, Link. I'm surprised and shocked, having assumed that you'd tried benzos in the past.
I don't know what approach is generally used wherever you are, but in most places benzos are the first-line treatment for anxiety.
In my book, a doctor's willingness to prescribe benzos is pretty much the deciding factor on whether I'll continue to see him-her or not; it's absolutely non-negotiable. I've been on a benzo for several years, and intend to stay on it for as long as necessary. Why? Because, at one point, my anxiety and multiple daily panic attacks were so severe, I was suicidal.
I'm glad you've finally found relief.
> Please mind the language but.....
>
> I can't even think why the f*ck I've spent the past 10 years of my life on a *repeated* SSRI merry-go-round, will such *marginal* anti-anxiety effects? Why in the f*ck wasn't I just prescribed a benzodiazapine? I do not find the clonazepam anywhere NEAR as mind warping as the SSRIs. I am finally coming to the realization that my core issue has been ANXIETY - not depression.
>
> I have been completely preventing the weekly cyclic insomnia (usually 3+ nights a week)
>
> Currently on 2.5mg of amitriptyline and 0.125mg of clonazepam (1/4 of a 0.5). I can taper off this by the end of the week and I have no noticable withdrawl. On the contrary, coming off even 2.5mg of lexapro send me into a spiral of pure maddness.
>
> These medications kill the anxiety and do not produce anhedonia (like the SSRIs did). I'm sleeping better than I have in a decade - through the entire night - not waking up every 15 minutes, 40 times a night like on SSRIs.
>
> I wake up refreshed, with plans, ideas and the capacity to feel pleasure - not a complete zombie, who feels like that past 8 hours has been more torture than rest.
>
> For a lot of people here, I think the core problem is **not being targeted very well**. If you're just being shoved on a high dose of SSRI (for me which just make anxiety and insomnia worse), then stop all the augmentation this/that crap and find a medication that hits the problem better.
>
> I remember first starting on SSRIs (at the tender age of 17) and waiting through months of elevated anxiety, insomnia, akathesia, suicidality, apathy, you name it.
>
> If I had just been prescribed a good ol TCA plus a benzo, I would have been chipper again within a few days.
>
> Linkadge
>
Posted by linkadge on December 2, 2010, at 18:48:35
In reply to Re: why didn't they prescribe this 10 years ago? » linkadge, posted by orbital on December 2, 2010, at 2:04:19
>I don't know what approach is generally used >wherever you are, but in most places benzos are >the first-line treatment for anxiety.
In my neck of the woods (ontario, canada) benzodiazapines are certainly not first line treatments.
While they are sometimes used acutely, conventional wisdom says to taper off and replace with an SSRI.
Linkadge
Posted by orbital on December 2, 2010, at 19:54:57
In reply to Re: why didn't they prescribe this 10 years ago?, posted by linkadge on December 2, 2010, at 18:48:35
> >I don't know what approach is generally used >wherever you are, but in most places benzos are >the first-line treatment for anxiety.
>
> In my neck of the woods (ontario, canada) benzodiazapines are certainly not first line treatments.
>
> While they are sometimes used acutely, conventional wisdom says to taper off and replace with an SSRI.
>
> LinkadgeDo you think you'd benefit from SSRI+benzo treatment? I can't imagine taking an SSRI without a benzo onboard.
I'm not trying to stir the pot of course, why fix what's not broken :)
Posted by linkadge on December 4, 2010, at 20:33:54
In reply to Re: why didn't they prescribe this 10 years ago? » linkadge, posted by orbital on December 2, 2010, at 19:54:57
>Do you think you'd benefit from SSRI+benzo >treatment? I can't imagine taking an SSRI >without a benzo onboard.
Well, I would if the SSRI did anything predictable.
Linkadge
Posted by orbital on December 5, 2010, at 17:59:59
In reply to Re: why didn't they prescribe this 10 years ago? » orbital, posted by linkadge on December 4, 2010, at 20:33:54
> >Do you think you'd benefit from SSRI+benzo >treatment? I can't imagine taking an SSRI >without a benzo onboard.
>
> Well, I would if the SSRI did anything predictable.
>
> LinkadgeDiminished sex drive and, quite likely, some sort of GI problem. Everything else is a coin toss.
This is the end of the thread.
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