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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 10 of 10. This is the beginning of the thread.
Posted by porkpiehat on January 3, 2012, at 13:07:51
I'm taking low dose Klonopin to augment my celexa/lamictal combo for social anxiety, concentration, and some hypomanic tendencies that the latter drugs can induce in me. I'm having obsessive thoughts about suicide and apathy.
A friend suggests seroquel for all the above, and I'd love to kick my obsessiveness and fear over people, sex, and medication. This feeling that other people "own" me.
I am a little terrified of an AAP, however. I added risperidone to my serzone a decade or so ago. that feeling of being "owned" and fear about sex disappeared but was replaced by panic, akasthesia, and the strangest, scariest damn feeling of detatchment that I will never be able to describe! That took about two weeks to achieve.
As it is now I'm having trouble not wanting to kill myself every minute of the day. Dr. doesn't return for two weeks.
I'm worried even a low low dose of Seroquel will make me heavy and overtired.
Any suggestions or experiences?
Much appreciated,
PPH
Posted by Christ_empowered on January 3, 2012, at 14:16:27
In reply to replacing benzos with Seroquel?, posted by porkpiehat on January 3, 2012, at 13:07:51
I'd just add in a really low dose of Abilify (I think the tabs come as a low as 2mgs now, maybe lower), work up until you feel a little calmer, and keep the Klonopin. I'd also work on non-medical ways to calm your anxiety and fears and obsessions.
Hopefully, you'll be able to discontinue the neuroleptic after a while. Avoid high doses if you can. I wouldn't switch straight over to Seroquel unless the Klonopin is causing problems.
Posted by Phillipa on January 3, 2012, at 18:38:53
In reply to Re: replacing benzos with Seroquel?, posted by Christ_empowered on January 3, 2012, at 14:16:27
If suicidal thoughts isn't zyprexa the med of choice in neuroleptics? Jan/P
Posted by Phidippus on January 3, 2012, at 20:14:19
In reply to replacing benzos with Seroquel?, posted by porkpiehat on January 3, 2012, at 13:07:51
First of all, I have been battling OCD for 5 years now and there's a particular way to treat it, from a drug standpoint.
1. Start with an antidepressant that will raise seratonin levels in the brain-people with OCD have lowered levels in their brain. What's your Celexa dose?
2. If an antidepressant isn't adequate, augment treatment with an AAP. A key part of the OCD circuit in the brain usually exhibits higher than normal levels of dopamine, so an AAP will help lower them.
3. If symptoms remain, augment treatment with a glutamate antagonist, like Lyrica, Zonegran, Riluzole, Topemax, MEmantine or Tramadol.
I think that adding Seroquel would be a good idea at this point to augment the Celexa, which is your main OCD treatment. You might feel sedated but after taking the drug for a while you will grow accustomed to it. You can even try the XR version, which for me did not cause the same kind of sedation.
Eric
Posted by Tony P on January 4, 2012, at 0:16:05
In reply to replacing benzos with Seroquel?, posted by porkpiehat on January 3, 2012, at 13:07:51
My experience with Seroquel, especially as a substitute for benzos, it not good. It doesn't relieve the anxiety from reducing benzos, or have a similar effect on social anxiety etc., and it has all the bad effects others have described - drowsiness, apathy, akathisia etc.
One of the MDs at the clinic I go to says he has had good experience with several patients with VERY low doses of Trazadone - 6.25 mg 3 x a day. I have tried this but not very consistently; it is MUCH better for me than Seroquel, but still makes me a bit dozy. You would probably have to get this low dose specially compounded into caps as it is next to impossible to split a 50 mg Trazadone tab into eighths!
Surprisingly, I find stimulants (e.g. Modafinil) &/or SNRI's such as Cymbalta are very helpful for social anxiety, agoraphobia, etc. I may feel a little shaky physically, but my mood is so much improved that I can function much better and am more active -- and activity/exercise is definitely good for both anxiety & depression.
Posted by Tony P on January 4, 2012, at 0:41:58
In reply to Re: replacing benzos with Seroquel? » porkpiehat, posted by Tony P on January 4, 2012, at 0:16:05
Another thought is Robaxin (methocarbamol). It's usually prescribed for back & neck pain, but it is a gentle sedative with anxiolytic properties and it greatly reduces the "shakes' from anxiety, which I find can lead to a vicious circle -- I'm shaking, so I feel MORE anxious, so I shake more, etc.
Depending on where you live, methocarbamol will probably be available in combination with various analgesics off-the-shelf. Pure Robaxin is better if you are not experiencing pain; where I live (BC Canada) it's OTC (you have to ask the pharmacist) but I believe it's Rx in other jurisdictions.
If you find it helpful, use it in moderation (.5-1.5 gm 3-4x a day, up to 4 gm/day, and never more than 6 gm/day). At those doses I find it is safe, but higher doses can be addictive, as I've found to my cost. Up to 1.5 gm in a single dose in my experience is relaxing without much drowsiness, but higher doses definitely make me sleepy. Even small doses do affect concentration however, so as they say use caution driving & operating heavy machinery!
One thing that is both an advantage and a disadvantage is it has a very short half-life (about 1.5 hr), so if you find it too strong it will wear off quickly; however, you may need to take small doses more frequently. Take with a little food or a hot drink, as it is poorly absorbed on both an empty stomach and a full one.
Posted by Raisinb on January 4, 2012, at 19:40:40
In reply to replacing benzos with Seroquel?, posted by porkpiehat on January 3, 2012, at 13:07:51
I was on 75-100 mg seroquel for a few months. I didn't notice any severe side effects except this weird thing where my nose would close up after I took it and I had to breathe through my mouth. Like having a bad head cold. Not sure what the mechanism of that is but according to the interwebs it happens to others. I did not experience extreme tiredness or fog (well, I did, but it was from lithium).
I took it to sleep and for BP 2. It didn't help with either, but it might be helpful for the symptoms you describe.
Posted by Phillipa on January 4, 2012, at 19:54:25
In reply to Re: replacing benzos with Seroquel?, posted by Raisinb on January 4, 2012, at 19:40:40
Never heard of the nose? Strange? Phillipa
Posted by porkpiehat on January 5, 2012, at 7:53:51
In reply to Re: replacing benzos with Seroquel?, posted by Raisinb on January 4, 2012, at 19:40:40
Every now and then, I would take maybe 50 mgs of Seroquel to get to sleep, and the next day I would not so much feel less anxious, but definitely a lack of intrinsic fear that comes with human interactions. This has plagued me most of my life, especially since college. That and obsessing over something always being wrong with me, my relationships, and the medication which is supposed to be helping me.
Something similar happened with Risperidone before it made me totally batty. Isn't this ability to curb paranoia what makes an anti-psychotic?
My friend said it also helped him with manic urges like drinking?
I guess my big question would be is can I expect this if taken on a regular basis or does that all change? Klonopin was awesome at first before the sedation of thoughts and emotions, followed by depression, started to overshadow.
Is is general consensus that Abilify is a better drug that Seroquel?
Posted by Christ_empowered on January 6, 2012, at 12:04:44
In reply to Re: replacing benzos with Seroquel?, posted by porkpiehat on January 5, 2012, at 7:53:51
I'd just recommend Abilify because low doses are non-sedating and sometimes a bit "activating." This can be a concern if you're revved up already, but since you're already on a benzo the Klonopin should prevent/reduce drug-induced agitation/stimulation while you adjust to it.
Also, I personally take Abilify and find it much more tolerable than Seroquel, so there's a personal bias. Dosing is easier (although the new XR seroquel is available) and Abilify is much higher potency, so you get more mood-stabilizing and/or tranquilizing bang per milligram. It can and does cause weight gain, but not as much as most of the other atypicals (seroquel included). Also, I personally found Seroquel to be so densely sedating that I felt like some 1950s state mental hospital patient. Abilify isn't a wonder drug, but I think lower doses might be good for you w/o as much of a side effect burden.
This is the end of the thread.
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