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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 7 of 7. This is the beginning of the thread.
Posted by sheilac on August 6, 2012, at 12:22:21
I have been taking Klonopin for at least 7 years. the dose varies from 1mg to 3mg.
Right now I am taking 1mg in the morning (because of morning irritability) and 1mg at dinner to try and wind down from the Adderall. But, I think I may need more like 2mg to wind down from Adderall. I have trouble going to sleep and then feel groogy and irritable (my biggest issue) in the morning.
I get no antidepressant feel from Klonopin, but years ago when I took xanax I did.
My question is, I can't go up on my 450mg of Lithium (tried, bad results). But my 10mg XR of Adderall is perfect. Still have some morning, daytime irritability.
Does this mean that I have to take an antipsychotic?
Or should I consider replacing or adding xanax to my line-up?
I am wondering if Xanax would be better with my irritability than Klonopin?
Also - if I am taking 2 - 3mg a day of Klonopin, what is that equivalent to in Xanax?
My mother takes both Klonopin and Xanax.
My regular MD suggested Xanax as a way to deal with end of day let down from Adderall, but she (being a regular family doc) didn't want me taking it everyday. She suggested zoloft for the anxiety. But I won't take an antidepressant.
I'm not depressed on 450mg of Lithium and 10mg of Adderall. I'm just still irritable - I think from the Adderall, which I DON'T want to cut out.
Posted by Phillipa on August 6, 2012, at 15:31:33
In reply to Xanax instead?, posted by sheilac on August 6, 2012, at 12:22:21
I googled saw .5 of xanax =.25 of klonopin. But there used to be an equivalency chart here on babble. Will see if can find? Phillipa
Posted by Phillipa on August 6, 2012, at 15:37:28
In reply to Xanax instead?, posted by sheilac on August 6, 2012, at 12:22:21
If you google benzodiazephine equivalency charts on Dr Bob Website the benzos are all there. It's 2-1 2mg xanax = lmg klonopin. From what I saw. Phillipa
Posted by brynb on August 6, 2012, at 17:14:35
In reply to Xanax instead?, posted by sheilac on August 6, 2012, at 12:22:21
Hi Shiela,
Finding the perfect balance/cocktail/dosage is beyond frustrating. It's a never ending process. I've seen your posts and I understand how you feel.
In my opinion (and I used to use & abuse all the benzos), klonopin and Xanax are pretty different. First, they're kind of opposites in terms of half-lives. Xanax is one of the shortest acting benzos. It doesn't stay in your system all that long. That means "rebound anxiety" is more likely. Klonopin is the longest acting benzo and stays in your system for days. Klonopin can definitely be more of a depressant, and I find that Xanax isn't.
Also, klonopin seems to be the favorite amongst pdocs for controlling GAD & long term use, but I find that Xanax works faster and is harder-hitting (so to speak). Consider this too (you're probably not going to like it, though): long term benzo use can cause major irritability :(.I know you don't want to consider going off the Adderall, but it could be doing more harm than good. During my brief stints with stims, they only helped my depression initially, then they made me super angry and irritable.
I know you mentioned you can't take ADs, but (I think) we both mentioned how great Tramadol is for mood. Maybe Tramadol & Lithium (plus a benzo) would work? I'm currently on Lexapro 20mg, Lithium 300mg and Tramadol, and it's doing the trick (for now anyway!).
Good luck.
B
Posted by Sheilac on August 6, 2012, at 18:15:41
In reply to Re: Xanax instead? » sheilac, posted by brynb on August 6, 2012, at 17:14:35
Brynn, you may be right. As awesome as I like the Adderall, I may need to drop it.
Lexapro brand was good back in the day, but the generic causes really bad stomach issues.
I wonder if I could get away with low dose (like 25mg) of Zoloft?
Tramadol is great for mood too.
My pdoc won't condone using Tramadol but would be open to an antidepressant.
I haven't told my family I'm on lithium, but everyone has remarked how much better I seem. So I guess lithium is working.
Posted by brynb on August 6, 2012, at 19:17:01
In reply to Brynn-Re: Xanax instead?, posted by Sheilac on August 6, 2012, at 18:15:41
I say give it a shot. If Lexapro helped back in the day, maybe your doc can write the Rx for the brand. Or the low dose of Zoloft sounds good, too. Maybe do a trial (a week or so) off of Adderall?
My pdoc has issues w/ me using Tramadol too. (He'd actually prefer I use Subutex for pain and depression.) But, in trying to be respectful and compliant, I'm weaning off per his instructions and will see him in a few weeks to regroup. If I feel I can't do without it (and I do think it's an integral part of my current mix), I'll have to get it through another doc or something.
But def try going without the stims and see how you feel. Even at the lowest doses, I couldn't handle them.
Feel better :)
Posted by SLS on August 8, 2012, at 15:58:49
In reply to Brynn-Re: Xanax instead?, posted by Sheilac on August 6, 2012, at 18:15:41
> I say give it a shot. If Lexapro helped back in the day, maybe your doc can write the Rx for the brand. Or the low dose of Zoloft sounds good, too. Maybe do a trial (a week or so) off of Adderall?
Those are good ideas.
How does Adderall help you? Why was it chosen as a treatment in the first place?
Zoloft has been used in the past to treat irritability, anger and aggression. However, it seems that in a minority of people, it can actually cause these things. I have seen it work, though.
I would explore increasing the lithium to 600 mg/day first based upon your partial response to lower dosages. Hopefully, the side effects will subside. I think it makes sense to then try to discontinue the Adderall, but only if your irritability continues - understanding that you might temporarily feel depressed and lethargic as a result. I would leave Zoloft for last since its effects can be unpredictable when treating bipolar disorder.
It's too bad that you don't react well to Trileptal. Most people do not feel more depressed as a side effect. By comparison, some people do feel more depressed while taking Depakote. However, it can be a good drug to treat bipolar II mixed-states.
Lithium seems to be a good drug for you. Try to make it work. Perhaps you could increase the dosage by half a pill for a few days before moving up to 600 mg/day.
- Scott
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