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Dr. Bob is Robert Hsiung, MD,
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Posted by anodyne on April 6, 2005, at 21:35:52
In reply to Re: Abilify vs. Seroquel » anodyne, posted by ed_uk on April 6, 2005, at 17:33:45
Hey Ed, good to hear from you.
> What side effects do you have from clonazepam? Have you tried any other benzos?
>I have been taking varing doses of Clonazepam from 2mg a day to .5mg a day for about 18 months. I must say it WORKS and tolerance has not been an issue. Howver it has killed my libido, caused some other sexual SE and caused me to be a bit lethargic (probably all symptoms of the same thing). Also, I get this low level of depression when I take it every day for a couple of months.
I have tried ativan (artificial feel), xanax (good night), xanax xr (drowsy & limited effect) so far. Thought about giving diazapam a try but I'm not sure it will be any better than the clonazepam.
Benzos certainly come closest to making me feel "normal" and boost everthing from concentration, motivation, socialability - all at the expense of my physical energy level and sex life.
I thought about augmenting clonazepam with something like Provigil, but anything activating doesn't seem to agree with me. And my Pdoc is hesitant in precibing one med to conteract the SE of another.
Any thoughts on the Provigil?
It seems like a anticonvulsant might be the way to go. Perhaps it will enable me to cut down on the clonazepam. I thought Seroquel might do the same but I hated Abilify.
Sorry for the ramble. -Dan
Posted by anodyne on April 6, 2005, at 21:51:27
In reply to Re: Abilify vs. Seroquel, posted by Spriggy on April 6, 2005, at 20:58:58
Thanks for the link Spriggy. I am still not sure how different they are other than the fact that Seroquel knocks you out, they both seem to hit Dopamine and Seratonin receptors. I might just have to give it a try to see.
Keep me posted on how it is working for you. I also have terible insomnia that I know this will take care of. I only hope that I can still wake up in the AM!
Take care,
Dan
Posted by mworkman on April 6, 2005, at 22:07:43
In reply to Re: Abilify vs. SeroquelSpriggy, posted by anodyne on April 6, 2005, at 21:51:27
I know that abifly increase dopamine acitivity while some lower it. I don't know which seroquel does, but that could make a difference.
Posted by banga on April 7, 2005, at 0:13:56
In reply to Re: Abilify vs. SeroquelSpriggy, posted by mworkman on April 6, 2005, at 22:07:43
From what I have understood on this board, these meds feel very different. Abilify is activating, seroquel sedating...I have not taken more than a day's worth of Seroquel, it knocked me out. However it seems people say if you stay on it for a while the drowsiness wears off.
I am taking a small dose of Abilify, actually for anxiety. It is a bit of a contradiction I believe--almost as though it is physically stimulating, yet stops anxiuous ruminations. (For me that is--we are all different!)
Bottom line: these are two very different drugs, even though they are in the same class and can work on controlling thought disorder/psychosis. It may be worth a try. For me, the atypical antipsychotics kick in within four days, so you would know fairly quickly if it is working.
Also, slight difference in mode of action--oversimplifying it a bit, Seroquel lowers dopamine action, Abilify regulates it.
Posted by Phillipa on April 7, 2005, at 0:36:35
In reply to Re: Abilify vs. SeroquelSpriggy, posted by banga on April 7, 2005, at 0:13:56
All I know is that seroquel knocked me out, left me feeling "drunk" the next day stumbling around, faint. It also didn't let me sleep through the night no matter how high the dose. After the doc saw what it did to me he dc's it. I'm on valium and sleep through the night and don't have to worry about the remote possibility of TD. I don't want an Atypical antipsychotic for anxiety. I know the benzos don't have any longterm side effects they've been around too long. And as long as you take the meds as Rx'd and take more, you will not abuse them. Valium is also used to W/D from other benzos xanax included. It has a long half-life, and it is easy to discontinue. Fondly, Phillipa
Posted by cache-monkey on April 7, 2005, at 0:47:16
In reply to Re: Abilify vs. Seroqueled_uk, posted by anodyne on April 6, 2005, at 21:35:52
Hey Dan,
I would consider giving diazepam a shot. I don't know how you might react to it in terms of your anxiety levels, but it's less likely to truck with your sex life than clonazepam.
There's a study fingering clonazepam as the worst benzo in the sex department. I think I posted about it in another thread which you were a part of. (I can repost the abstract again if I'm mistaken...)
Anyway, I was having sexual problems on clonazepam as well. I switched to diazepam and, voila, problem solved. I also found the diazepam a little better in terms of its anxiolysis-to-sedation ratio.
Another thing re: the Seroquel. Granted it's company-sponsored, but there's a recent double-blind placebo controlled study done on it. (Decent sample size, too -- N>500.) They found not only benefits for depression, but also for anxiety and sleep. Both of these are new findings, since it has only been approved for the treatment of mania so far.
Here's a link to a summary of the Seroquel study:
http://www.pslgroup.com/dg/24415a.htmGood luck, and let us know what happens if you decide to try the Seroquel.
Best,
cache-monkey> Hey Ed, good to hear from you.
>
> > What side effects do you have from clonazepam? Have you tried any other benzos?
> >
>
> I have been taking varing doses of Clonazepam from 2mg a day to .5mg a day for about 18 months. I must say it WORKS and tolerance has not been an issue. Howver it has killed my libido, caused some other sexual SE and caused me to be a bit lethargic (probably all symptoms of the same thing). Also, I get this low level of depression when I take it every day for a couple of months.
>
> I have tried ativan (artificial feel), xanax (good night), xanax xr (drowsy & limited effect) so far. Thought about giving diazapam a try but I'm not sure it will be any better than the clonazepam.
>
> Benzos certainly come closest to making me feel "normal" and boost everthing from concentration, motivation, socialability - all at the expense of my physical energy level and sex life.
>
> I thought about augmenting clonazepam with something like Provigil, but anything activating doesn't seem to agree with me. And my Pdoc is hesitant in precibing one med to conteract the SE of another.
>
> Any thoughts on the Provigil?
>
> It seems like a anticonvulsant might be the way to go. Perhaps it will enable me to cut down on the clonazepam. I thought Seroquel might do the same but I hated Abilify.
>
> Sorry for the ramble. -Dan
>
Posted by temoigneur on April 7, 2005, at 5:04:07
In reply to Re: Abilify vs. Seroquel » anodyne, posted by cache-monkey on April 7, 2005, at 0:47:16
Hey, some of you may have caught this in a previous post, seroquel made me extremely obsessive. Ocassionally/sometimes, a-typicals can worsen OCD, on 200mg I 'had' to phone my sweet elderly aunt and enunciating very well, say f*&^ you Aunti _ . It was bad, just to reinforce the point that everyone's chemistry is so different.
>
>
Posted by anodyne on April 7, 2005, at 7:46:08
In reply to Re: Abilify vs. Seroquel » cache-monkey, posted by temoigneur on April 7, 2005, at 5:04:07
Thank you so much everyone. Once again, it sounds like you just have to give these meds a try and see what happens. I think I might give the Seroquel a go to see what happens AND try switching over to diazapam. If the Seroquel is too much to handle i'll stay on with the diazapam solo for a while.
The only reason I don't want to rely solely on a benzo is that I have had several break through attacks on them unless I am so heavily dosed (cases of lack of sleep+public speaking) that I need a 12 hour nap afterwards.
I know there are equivalency charts out there but what has been the experience on what amount of diazapam would be needed to supplant 1mg of clonazepam for anxiety?
I think the classifications of these drugs for marketing purposes does so much more harm than good. One person's anti-psychotic is another's anxiolytic miracle. Now if I could just look the pharmacist in the eye and explain that yes, this is the second anti-psychotic I am taking in two months time.
I'll see the doc next Tuesday and will keep you posted on the outcome.
Thanks again for all the experience! -Dan
Posted by banga on April 7, 2005, at 8:05:45
In reply to Abilify vs. Seroquel, posted by anodyne on April 7, 2005, at 7:46:08
>> Now if I could just look the pharmacist in the eye and explain that yes, this is the second anti-psychotic I am taking in two months time.
LOL I too feel rather self-conscious...if they looked at my meds for the past year, there would be four antipsychotics, 5 antidepressants, one mood stabilizer, one Parkinsons medication, one stimulant....I look them in the eye and say "yes, I this week need my mood stabilizer, it was *last* week that I needed the antipsychotic.. and no I dont feel addicted to the Adderall, I am not desperate to get the bottle from you and take my next dose..yes I know I look dissheveled, but that is NOT because I am in a med stupor and dont take care of myself..etc."
Posted by ed_uk on April 7, 2005, at 9:47:41
In reply to Re: Abilify vs. Seroqueled_uk, posted by anodyne on April 6, 2005, at 21:35:52
Hi Dan!
>Thought about giving diazapam a try but I'm not sure it will be any better than the clonazepam.
In terms of sexual side effects, diazepam may be better. Whether diazepam is more or less sedating than clonazepam seems to be very individual. Chlordiazepoxide (Librium) is another benzo which you could try, it has much in common with diazepam. Diazepam is *possibly* a more powerful muscle relaxant than chlordiazepoxide. I have a theory that you might find chlordiazepoxide less physically tiring than diazepam- just a guess.
>Any thoughts on the Provigil?
I think it might improve your energy but probably not your sex life. Before going down the Provigil route, I think it would be best to try diazepam or chlordiazepoxide.
>It seems like a anticonvulsant might be the way to go.
Gabapentin (Neurontin) can be useful for anxiety.
>I thought Seroquel might do the same but I hated Abilify.
In practice, Seroquel and Abilify are more different than you might expect. Seroquel does occasionally cause restlessness but not often.
>1mg clonazepam = how much diazepam........
It various from person to person, probably 10-20mg/day for most people- the majority of charts say 20mg. Occasionally, as little as 5mg might be adequate. You will have to try a range of doses to get the best effect.
>1mg clonazepam = how much chlordiazepoxide........
This is a very difficult question to answer, accurate data is not available. Most charts say 60mg. In reality, you could end up taking anywhere from 15 to 100mg a day!
Remember that with diazepam and chlordiazepoxide, the maximum anti-anxiety effects can take a couple of weeks to develop at any given dose. Both drugs have long-acting active metabolites, it can take a long time to reach steady state.
It might be useful for you to do a cross taper from clonazepam to your 'new' benzo ie. instead of taking 1mg clonazepam you could take 0.5mg clonazepam and x mg of the 'new' benzo. A few weeks later you could stop the clonazepam completely and increase the dose of your 'new' benzo. You might need to do quite a bit of 'trial and error' in order to find the best dose of diazepam or chlordiazepoxide. Because the maximum effect of any given dose of diazepam or chlordiazepoxide can take a week or two to develop, finding a suitable 'maintenance' dose can be a rather time consuming process- it shouldn't be difficult though :-)
Kind regards,
Ed.
Posted by anodyne on April 7, 2005, at 13:12:28
In reply to Benzodiazepines » anodyne, posted by ed_uk on April 7, 2005, at 9:47:41
Thanks Ed, sound advice as usual. I am starting to wonder if maybe I should just give Librium or Valium a mono trial before adding Seroquel. I am usually a believer in the one change at a time philosophy but I am up against some time constraints in getting my anxiety under control (new job).
I am considering making two changes (dropping the clonazepam and adding Seroquel + diazapam or Librium)as I have heard that if Seroquel works, it does so quickly. Any thoughts on this?
I will have to run it by my pdoc to see what he thinks but like to be prepared for my appointments. There is nothing worse than remembering something you wanted to bring up on the drive home.
Best Regards,
Dan
Posted by chess on April 7, 2005, at 13:29:52
In reply to Benzodiazepines » anodyne, posted by ed_uk on April 7, 2005, at 9:47:41
Hi Ed,
my understanding is that benzo half-lives don't correlate to the duration of action of a single dose, and that valium is very lipophilic which means alot of it gets stuck in your fat cells and doesn't reach your brain, which is why a person needs to take valium 3 times a day in order to get a therapeutic effect for the whole day. the benzo with the longest duration of action from a single dose is XanaxXR (10-15 hours) and klonopin (8-12 hours), which is why XanaxXR and klonopin only need to be taken 2 times a day to cover the whole day. is my understanding correct? thanks> Hi Dan!
>
> >Thought about giving diazapam a try but I'm not sure it will be any better than the clonazepam.
>
> In terms of sexual side effects, diazepam may be better. Whether diazepam is more or less sedating than clonazepam seems to be very individual. Chlordiazepoxide (Librium) is another benzo which you could try, it has much in common with diazepam. Diazepam is *possibly* a more powerful muscle relaxant than chlordiazepoxide. I have a theory that you might find chlordiazepoxide less physically tiring than diazepam- just a guess.
>
> >Any thoughts on the Provigil?
>
> I think it might improve your energy but probably not your sex life. Before going down the Provigil route, I think it would be best to try diazepam or chlordiazepoxide.
>
> >It seems like a anticonvulsant might be the way to go.
>
> Gabapentin (Neurontin) can be useful for anxiety.
>
> >I thought Seroquel might do the same but I hated Abilify.
>
> In practice, Seroquel and Abilify are more different than you might expect. Seroquel does occasionally cause restlessness but not often.
>
> >1mg clonazepam = how much diazepam........
>
> It various from person to person, probably 10-20mg/day for most people- the majority of charts say 20mg. Occasionally, as little as 5mg might be adequate. You will have to try a range of doses to get the best effect.
>
> >1mg clonazepam = how much chlordiazepoxide........
>
> This is a very difficult question to answer, accurate data is not available. Most charts say 60mg. In reality, you could end up taking anywhere from 15 to 100mg a day!
>
> Remember that with diazepam and chlordiazepoxide, the maximum anti-anxiety effects can take a couple of weeks to develop at any given dose. Both drugs have long-acting active metabolites, it can take a long time to reach steady state.
>
> It might be useful for you to do a cross taper from clonazepam to your 'new' benzo ie. instead of taking 1mg clonazepam you could take 0.5mg clonazepam and x mg of the 'new' benzo. A few weeks later you could stop the clonazepam completely and increase the dose of your 'new' benzo. You might need to do quite a bit of 'trial and error' in order to find the best dose of diazepam or chlordiazepoxide. Because the maximum effect of any given dose of diazepam or chlordiazepoxide can take a week or two to develop, finding a suitable 'maintenance' dose can be a rather time consuming process- it shouldn't be difficult though :-)
>
> Kind regards,
> Ed.
>
Posted by ed_uk on April 7, 2005, at 13:31:17
In reply to Re:Anxiety Medsed_uk, posted by anodyne on April 7, 2005, at 13:12:28
Hi Dan,
>I am starting to wonder if maybe I should just give Librium or Valium a mono trial before adding Seroquel.
Yes, I think that's a good idea. Despite the side effects, is your anxiety well controlled on clonazepam monotherapy?
Regards,
Ed.
Posted by anodyne on April 7, 2005, at 13:47:19
In reply to Re:Anxiety Meds » anodyne, posted by ed_uk on April 7, 2005, at 13:31:17
Ed,
> Is your anxiety well controlled on clonazepam monotherapy?
>For the most part but I have had a few panic attacks centered around public speaking when I am low on sleep.
Sleep does seem to play a major part in my anxiety woes which is why I thought Seroquel might be a good addition. I know it helps you sleep and could have additional anxiolytic properites. I hate to take a benzo for sleep as the sleep benefit usually wears off after a couple of weeks and it is just another way to build up a tolerance.
Another thought is the newly approved (in the US) Lunesta, but I thought if Seroquel can help my anxiety in other ways I might as well try it first.
Ambien doesn't keep me asleep and desyryl (Trazadone) leaves me with a hangover.
-Dan
Posted by ed_uk on April 7, 2005, at 14:05:38
In reply to Re:Anxiety Meds ed_uk, posted by anodyne on April 7, 2005, at 13:47:19
Hi Dan,
>Sleep does seem to play a major part in my anxiety woes which is why I thought Seroquel might be a good addition.
OK, perhaps you could take 25mg Seroquel in the evening for sleep and start cross-tapering on to chlordiazepoxide. Seroquel might leave you with a hangover though!
Regards,
Ed.
Posted by Spriggy on April 7, 2005, at 16:27:36
In reply to Re:Anxiety Meds » anodyne, posted by ed_uk on April 7, 2005, at 14:05:38
Seroquel left me with a slight hangover but nothing any worse than a Benzo the night before.
And I'm on 50 mg's and a small female.
I think seroquel sounds like what would work well for you since your main problem is anxiety and insomnia. It should help with both.
I can't remember if I gave you this link already but you can read a lot about Seroquel over at:
crazymeds.org
He explains just about everything about it.
Posted by Phillipa on April 7, 2005, at 16:42:45
In reply to Re:Anxiety Meds, posted by Spriggy on April 7, 2005, at 16:27:36
I also looked at the conversion charts and was shocked when it said lmg of klonopin was equal to about 20mg of valium. What I found was that taking 5mg in the am and l0mg at night gave me loss of anxiety and the ability to sleep. I never needed the high doses I thought I would. Fondly, Phillipa
Posted by ed_uk on April 7, 2005, at 16:44:34
In reply to Re:Anxiety Meds ed_uk, posted by anodyne on April 7, 2005, at 13:47:19
Hi again Dan!
>Another thought is the newly approved (in the US) Lunesta.....
Yes, Lunesta could be helpful. We've had a very similar med in the UK since the 1980s, it's generally better for putting people to sleep than keeping them asleep, it's quite short-acting but not as short-acting as Ambien.
Kind regards,
Ed.
Posted by anodyne on April 7, 2005, at 17:36:29
In reply to Benzodiazepines » anodyne, posted by ed_uk on April 7, 2005, at 9:47:41
I know Ed has ventured an educated guess comparing Chlordiazepoxide (Librium)to Diazepam (Valium) with respect to the anxiety relief vs. physical tiredness. Any other experience comparing the two?
Just trying to save myself yet another month of trial and error. Isn't this game fun.
You all are the best. Thanks for any input you might have.
-Dan
Posted by Phillipa on April 7, 2005, at 18:07:58
In reply to Re:Anxiety Meds ed_uk » anodyne, posted by ed_uk on April 7, 2005, at 16:44:34
Valium doesn't make me tired during the day. But it helps me sleep at night. Fondly,Phillipa
Posted by ed_uk on April 7, 2005, at 18:09:30
In reply to Re: Benzodiazepines, posted by anodyne on April 7, 2005, at 17:36:29
Hi!
It was just a guess- I honestly think you would find them very similar.
Ed.
Posted by cache-monkey on April 10, 2005, at 2:28:07
In reply to Re: Benzodiazepines » ed_uk, posted by chess on April 7, 2005, at 13:29:52
I just stumbled across this post from chess regarding diazepam. I've also read elsewhere that there's an "acute" half-live of diazepam that is pretty short (6-8 hrs), and the decline in levels thereafter is somewhat slower. Does this have to do with its absorption into tissue? If that's the case, though, eventually the tissue would have to get saturated, no? Which would extend the acute half life after chronic dosing?
What's your take on this, Ed?
cache-monkey
> Hi Ed,
> my understanding is that benzo half-lives don't correlate to the duration of action of a single dose, and that valium is very lipophilic which means alot of it gets stuck in your fat cells and doesn't reach your brain, which is why a person needs to take valium 3 times a day in order to get a therapeutic effect for the whole day. the benzo with the longest duration of action from a single dose is XanaxXR (10-15 hours) and klonopin (8-12 hours), which is why XanaxXR and klonopin only need to be taken 2 times a day to cover the whole day. is my understanding correct? thanks
>
> > Hi Dan!
> >
> > >Thought about giving diazapam a try but I'm not sure it will be any better than the clonazepam.
> >
> > In terms of sexual side effects, diazepam may be better. Whether diazepam is more or less sedating than clonazepam seems to be very individual. Chlordiazepoxide (Librium) is another benzo which you could try, it has much in common with diazepam. Diazepam is *possibly* a more powerful muscle relaxant than chlordiazepoxide. I have a theory that you might find chlordiazepoxide less physically tiring than diazepam- just a guess.
> >
> > >Any thoughts on the Provigil?
> >
> > I think it might improve your energy but probably not your sex life. Before going down the Provigil route, I think it would be best to try diazepam or chlordiazepoxide.
> >
> > >It seems like a anticonvulsant might be the way to go.
> >
> > Gabapentin (Neurontin) can be useful for anxiety.
> >
> > >I thought Seroquel might do the same but I hated Abilify.
> >
> > In practice, Seroquel and Abilify are more different than you might expect. Seroquel does occasionally cause restlessness but not often.
> >
> > >1mg clonazepam = how much diazepam........
> >
> > It various from person to person, probably 10-20mg/day for most people- the majority of charts say 20mg. Occasionally, as little as 5mg might be adequate. You will have to try a range of doses to get the best effect.
> >
> > >1mg clonazepam = how much chlordiazepoxide........
> >
> > This is a very difficult question to answer, accurate data is not available. Most charts say 60mg. In reality, you could end up taking anywhere from 15 to 100mg a day!
> >
> > Remember that with diazepam and chlordiazepoxide, the maximum anti-anxiety effects can take a couple of weeks to develop at any given dose. Both drugs have long-acting active metabolites, it can take a long time to reach steady state.
> >
> > It might be useful for you to do a cross taper from clonazepam to your 'new' benzo ie. instead of taking 1mg clonazepam you could take 0.5mg clonazepam and x mg of the 'new' benzo. A few weeks later you could stop the clonazepam completely and increase the dose of your 'new' benzo. You might need to do quite a bit of 'trial and error' in order to find the best dose of diazepam or chlordiazepoxide. Because the maximum effect of any given dose of diazepam or chlordiazepoxide can take a week or two to develop, finding a suitable 'maintenance' dose can be a rather time consuming process- it shouldn't be difficult though :-)
> >
> > Kind regards,
> > Ed.
> >
>
>
Posted by ed_uk on April 10, 2005, at 8:05:05
In reply to Re: Benzodizepines ... Ed?, posted by cache-monkey on April 10, 2005, at 2:28:07
Hi!
After a single dose, diazepam has a short duration of action because it is rapidly redistributed into fat, removing it from the blood. After repeated doses, diazepam has a long duration of action, it's long-acting active metabolites accumulate and an equilibrium is achived between fat deposits and the blood.
Ed.
Posted by chess on April 10, 2005, at 9:34:13
In reply to Re: Benzodizepines ... Ed? » cache-monkey, posted by ed_uk on April 10, 2005, at 8:05:05
Hi Ed,
thanks for the reply, one more question if you don't mind,
my doc gave me the choice between XanaxXR and Klonopin and Valium, i tried klonopin first but it was too sedating, then i tried XanaxXR and i'm still using it, but i'm wondering now if i made the right choice in terms of eventually wanting to taper off a benzo ... in other words, why and which benzo would be easier to taper off of and would have less withdrawal propensities during the tapering process, Klonopin or XanaxXR or Valium? Thanks again! chess>
> After a single dose, diazepam has a short duration of action because it is rapidly redistributed into fat, removing it from the blood. After repeated doses, diazepam has a long duration of action, it's long-acting active metabolites accumulate and an equilibrium is achived between fat deposits and the blood.
>
> Ed.
Posted by ed_uk on April 10, 2005, at 10:47:02
In reply to Re: Benzodizepines ... Ed? » ed_uk, posted by chess on April 10, 2005, at 9:34:13
Hi Chess,
>why and which benzo would be easier to taper off of and would have less withdrawal propensities during the tapering process, Klonopin or XanaxXR or Valium?
Valium is usually the best benzo for tapering because it comes in very low dose tablets eg. 2mg. 2mg Valium is a very low dose, the tablets can be split into quarters if you need to taper very gradually. Also, Valium's major active metabolite has a much longer half-life than Klonopin- this may facilitate the tapering process.
It's difficult to say how sedating you'd find Valium, you'll have to try it- I can't predict whether you'd like it! Some people seem to find it more sedating than Klonopin, other people say that they find it less sedating.
If you do eventually want to taper off Xanax XR, you could substitute Valium. Some people have problems when they try to substitute Valium for Xanax but other people have no problem. It can be helpful to cross-taper ie. to substitute part of your Xanax dose with Valium and gradually decrease your Xanax while increasing the Valium. Eventually, you'll be taking all Valium and no Xanax- at this point you can start to taper the Valium.
Regards,
Ed.
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