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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 BRC on April 18, 2004, at 18:27:57
I would like to thank everyone for their input and concern about my post concerning Klonopin. I have never been on a meesage board that had people to respond so openly with their info and ideas. THANKS. But I do have some questions that some of you wrote that I was wondering about. 1. I didn't know that Remeron was not a very potent antidepressant (is it is not as effective as the SSRI's) 2. I knew that one of the drawbacks to Klonopin was depression, but I didn't know that other benzo's such as Xanax and Ativan did not cause depression. So should I ask my Psychiatrist to maybe switch. 3. Can you increase Lexapro to more than 20mg ( I thought 20mg was the max dose). 4. Is 4mg daily of Klonopin considered a high daily dose. Thanks in advance for anyone who replies. Your earlier posts were great!!
Posted by judy1 on April 18, 2004, at 19:35:37
In reply to Questions to those who responded to Klonopin post., posted by BRC on April 18, 2004, at 18:27:57
Hi,
I'm no longer 'allowed' ADs since they trigger manic episodes for me, but I have taken remeron in the past and found it fairly effective- it's just in a different class (TCA? vs SSRI)- but I don't see a potency issue. Some classes of ADs simply work better than others for different people. A question- is your depression secondary to your anxiety disorder?- if so then treating the anxiety with a benzo often gets rid of the depression. If it's primary depression then that simply doesn't work.
Honestly, mild depression (in my case) is a side effect of klonopin, but it works much better for me than xanax. You can certainly try xanax and see if it works as well as klonopin- perhaps the XR version would be a good replacement.
Depending on the severity of your anxiety disorder, 4mg of klonopin is not terribly high- I take 6mg (which is considered high).
take care, judy
Posted by Guy on April 18, 2004, at 19:50:46
In reply to Re: Questions to those who responded to Klonopin post. » BRC, posted by judy1 on April 18, 2004, at 19:35:37
Judy, why are you on 6 mg of klonopin?. Did the med lose its effect over time? I would like to try high dose of K, but in the past, it quit working at 1 mg for sleep. I decided to step off because I didn't want to just keep escalating the dose. Now I'm wondering if I should try again because I know it a very safe drug compared to the anti-psychotics, for example. Does the tolerance level off at a higher dose?
Posted by collegeguy on April 18, 2004, at 21:35:16
In reply to Questions to those who responded to Klonopin post., posted by BRC on April 18, 2004, at 18:27:57
1. How "potent" an antidepressant Remeron is is a matter of personal chemistry and the way the drug interacts with you. Just because someone else may find one chemical to be mild does not mean you will expreience the same effect. If you look at Remeron chemically, it is *more* potent than some of the other drugs, since it provides a boost of serotonin via two pathways: first, it blocks the reuptake of serotonin in the synapse like other SSRIs and second it also antagonizes (blocks the action of) the 5HT2A histamine receptor. It is because of this antihistamine effect that people on Remeron tend to experience more fatigue and weight gain. Remeron also blocks the reuptake of norepinephrine (like the SNRI Effexor and NDRI Wellbutrin), so it thus acts dually on the brain chemical systems. Good combo drugs with Remeron are Wellbutrin and Effexor (higher dose) because they help balance out norepinephrine and dopamine to negate some of Remeron's adverse side effects.
2. All benzodiazepines can cause "depression" (or rather, depression-like symptoms) if taken in doses too high because they "depress" activity of the nervous system. Xanax and Ativan are less likely to do this because they stay in the body for a shorter period of time compared to Valium and Klonopin. However, Klonopin is sort of a unique benzo drug in that it seems to have extra benefits aside from the normal anxiolytic action: people with anxiety disorders often find Klonopin is the most therapeutic of the benzo class and that it decreases anxiety without causing too much fatigue, etc--some even find it to be activiating, paridoxically.
3. Lexapro can be increased to more than 20 mg per day if your doctor feels a larger dosage of the medication is necessary. Initially clinical studies showed that a normal population received no significant increase in therapeutic effect with the 20 mg dose over the 10 mg dose, but everyone is different and you may need >> 20 mg per day of the drug. However, you should be especially watchful of side effects, as those are usually dose related, and perhaps even reevaluate the effectiveness of Lexapro as an antidepressant if you require such a high dose.
4. 4 mg daily of Klonopin is towards the high end of the normal dosage, but it is not uncommon (6 mg /day is probably the cut off before Klonopin dosing becomes greater than normal [multiply the highest dose Klonopin pills by 3 x per day]). Again, it is up to you and your doctor to determine whether you really need that much Klonopin (as the probability of a more difficult or longer withdrawal increases with dose). You should also be careful on long term benzo treatment to watch for any sort of dose dependence (i.e. the 4 mg/day dose starts to lose its effectiveness for you) that might necessate you going even higher.
Posted by f l y on April 18, 2004, at 21:50:39
In reply to Questions to those who responded to Klonopin post., posted by BRC on April 18, 2004, at 18:27:57
i've taken about 20 different AD's. remeron was by far the most effective anti-depressant for me. the only reason i'm not still taking it is i gained 70 lbs.!
best to ya,
fly
Posted by judy1 on April 19, 2004, at 19:08:17
In reply to Judy - does Klonopin poop out?, posted by Guy on April 18, 2004, at 19:50:46
No, klonopin has never 'pooped out' in my 7 years of taking it. I am on 6mg because a. that is how much I needed to stop my panic attacks and b. my pdoc considers it a secondary mood stabilizer for my bipolar disorder. I have stopped it when pregnant (for a few months) and have also lowered my dose at various times over the years.
hoped this answered your question- judy
Posted by Rick on April 21, 2004, at 2:48:10
In reply to Questions to those who responded to Klonopin post., posted by BRC on April 18, 2004, at 18:27:57
>I knew that one of the drawbacks to Klonopin was depression, but I didn't know that other benzo's such as Xanax and Ativan did not cause depression. So should I ask my Psychiatrist to maybe switch.
Klonopin does seem to cause depression in some people at some point, but that seems to be a minority. Besides, if you're taking an antidepressant, that lowers the risk of such an effect. Ironically, some studies have actually suggested anti-depressant effects for Klonopin (although there are more such reports for Xanax). After five years of daily Klonopin, I have not suffered clinical depression. BTW, I took Xanax before Klonopin and for me the difference was night and day. Xanax basically just zonked me out, and made me feel vaguely uncomfortable and somewhat less anxious. OTOH, Klonopin eradicated most of my anxiety, and I don't feel it physically at all at my current dose. I was so glad I switched. When I was at the higher doses it did cause some sedation.
>Is 4mg daily of Klonopin considered a high daily dose.
Yes, for anxiety treatment that's pretty high, especially when you are also taking the other psychotropics. While that could prove to be the level you need, have you tried cutting back some? After about six months on Klonopin I learned that taking LESS actually worked better for me than a higher dose. I.e., there's a U-shaped theraputic response curve. As I said in the reply I posted to your first thread a few hours ago, I started at 2.5-3 mg, but then tapered down to 1 mg/day, where I've been for four years to sustained excellent effect.
Incidentally, a few studies suggest that people who take benzos for GAD have less risk of withdrawal difficulties than those who use it for other anxiety disorders (especially panic). This was mentioned in the recent Journal of Clinical Psychiatry supplement I cited in my other post.Rick
Posted by BRC on April 21, 2004, at 13:51:33
In reply to Re: Questions to those who responded to Klonopin post. » BRC, posted by Rick on April 21, 2004, at 2:48:10
Thank you for your response to my post. I knew that 4mg of Klonopin was sort of a high dose. Thats why I don't take it like I am supposed to. Even though my p-doc wants me to take 2mg in the morning and 2mg at night. I try to get by on as little as possible. I am not a big fan of medication and not feeling myself ( I have never done drugs and I don't use alcohol). My prescription is for the 2mg pill and I usually only take one at night (as a matter of fact my prescription gets automatically refilled every month and I have tons of the medication left over. I wish I did not have to take any medication, but my symptom severity calls for it. I can definately tell when I am off the meds and on them and I have weighed the consequences and have decided to stick with the medication regimine (even though the meds to not fully control my symptom, something is better than nothing and I thank God for that).
I know that Klonopin works on the chemical GABA in the brain and that chemical is what becomes over-active in people with anxiety disorders. Consequently my p-doc suggested a medication that is not intended for anxiety disorders, but works on the GABA system in the brain. The med is Gabitril and it is used to treat seizures (as does Klonopin). It selectively targets the re-uptake of GABA. There have been some research done on the drug to treat anxiety disorders, but it is usally used as adjunct therapy. The drug is not addictive, but like antidepressants it takes several weeks to months to reach the desired effect. I have tried the med., but did not stay on it long enouhg to reach its effectiveness. THANKS for your response. Your info was well appreciated
Posted by Rick on April 21, 2004, at 15:52:20
In reply to Re: To Rick this is BRC, posted by BRC on April 21, 2004, at 13:51:33
You're welcome.
I notice that you said that when you take a lower daily dose you take it at night. Have you tried taking it in the morning instead? Then it would be at its strongest levels during the day when you would (presumably) want the greatest benefit. As for sleep, I take my 1 mg in the morning, but it has still eliminated 90% of the bedtime mental agitation and insomnia I used to have very frequently.
Just curious...how long did you try Gabatril? I hear it's showing good potential as an anxiolytic, but that it can sometimes casue a bit of cognitive slowing like benzos (and ADs, for that matter).
Rick
> Thank you for your response to my post. I knew that 4mg of Klonopin was sort of a high dose. Thats why I don't take it like I am supposed to. Even though my p-doc wants me to take 2mg in the morning and 2mg at night. I try to get by on as little as possible. I am not a big fan of medication and not feeling myself ( I have never done drugs and I don't use alcohol). My prescription is for the 2mg pill and I usually only take one at night (as a matter of fact my prescription gets automatically refilled every month and I have tons of the medication left over. I wish I did not have to take any medication, but my symptom severity calls for it. I can definately tell when I am off the meds and on them and I have weighed the consequences and have decided to stick with the medication regimine (even though the meds to not fully control my symptom, something is better than nothing and I thank God for that).
> I know that Klonopin works on the chemical GABA in the brain and that chemical is what becomes over-active in people with anxiety disorders. Consequently my p-doc suggested a medication that is not intended for anxiety disorders, but works on the GABA system in the brain. The med is Gabitril and it is used to treat seizures (as does Klonopin). It selectively targets the re-uptake of GABA. There have been some research done on the drug to treat anxiety disorders, but it is usally used as adjunct therapy. The drug is not addictive, but like antidepressants it takes several weeks to months to reach the desired effect. I have tried the med., but did not stay on it long enouhg to reach its effectiveness. THANKS for your response. Your info was well appreciated
Posted by BRC on April 21, 2004, at 20:20:51
In reply to Re: To Rick this is BRC » BRC, posted by Rick on April 21, 2004, at 15:52:20
Rick, I tried taking the Klonopin in the mornings, but I usually exercise in the morning. I jog/run and when I take the Klonopin it sort of slows me down to where I don't want to exercise. The reason for running is to help with my anxiety disorder (plus the added health benefit). The running and jogging helps with the stress plus the repetion of the activity calms the mind and releases endorphines ( and gives me something to concentrate on). But when I can't exercise or I have to go some where, attend an event or function, or I know I will be doing something that is likely to cause me anxiety on a particular day I will definately take a morning dose.
Your question about Gabitril. It has been a while since I took it. But I think I was on it about two months. I took 4mg at bedtime and 2mg in the morning. I do remember that you have to eat something with each dose because it tends to make you sick on your stomach. To me I didn't suffer any more cognative defects as opposed to the benzos. Some very good research articles on Gabitril and its treatment in anxiety disorders is at http://www.personalconsult.com/gabitrileffectiveness.html There is also a better series of articles but I do not have the web address for those (sorry). My doctor was going to try to gradually make a switch from the Klonopin to the Gabitril (since Gabitril does not cause addiction). But at the time I was in my senior year in college and with the anxiety the Klonopin was the best med for me at the time (and still remains) . Hope this helps. Lots of luck BRC.
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