Posted by Rick on September 19, 1999, at 11:44:44
In reply to Re: alternatives to Nardil: Rick, posted by Elizabeth on September 19, 1999, at 5:52:21
> > MY current sedation from Klonopin isn't a major problem, but it's still strong enough to be a bit of a bother, and detracts somewhat from the drug's relief of my most troublesome Social Phobia symptom (tremulous voice in certain meetings/presentations/center-of-attention situations/phone or at-the-counter discussions with strangers -- especially one-on-ones "authority figures" (!!) like operators or clerks -- and most especially if there's some contentious situation involved).
>
> It might be helpful to take a small amount of extra pindolol (2.5-5 mg? not sure; it would be 10-20 mg of propranolol if you were using that) before nerve-wracking situations (such as presentations and one-on-ones) to help with tremulousness in your voice.
>
> > How long a "chance" does the sedation need to go away? I've been at 1.5-3.0 mg of Klonoin per day for almost 2 months, ususally 1.5-2.5.
>
> What dosing schedule? Dividing it up more may decrease the side effects, including sedation (i.e., if you're taking it just twice a day, try splitting the same amount in three - for example, if you took 1mg in the AM and 1mg in the PM, you might switch to 0.5mg AM, 0.5mg afternoon, and 1mg at bedtime).
>
> >No other meds except just 5mg Pindolol in the morning. I don't want to take either med after dinner, because they could worsen whatever severe sleep apnea I have remaining afetr losing 40-50 pounds. I know this would only worsen nervous reactions (not to mention being a detriment to my health).
>
> Very wise! Sleep apnea is something serious and not to be messed with, IMHO.---------
Thanks for the ideas, Elizabeth.Interestingly I find the Klonopin least sedating first thing in the morning, so I take 1 mg when I get up, along with my 5 mg daily Pindolol dose. (I don't want to take Pindolol too late either, because non-selective beta blockers can also interfere with sleep and thus worsen apnea.) Since I handle it well early, I might try upping the initial Klonopin to 1.5 to see if I can take less later. I've already tried 2.0 first thing, but that was sedating. After the initial dose, I spread the remainder of my daily 1.5-3.0 dosage over the rest of the WORKING day (usually in .5 increments), with a special eye towards dosing a bit before an anticipated stressful situation.
The problem is that I can relapse a bit in the evenings with this approach. Yesterday I saw my pdoc, and he wants me to try compensating for the no-Klonopin-at-night self-restriction by adding Buspar -- 15 mg, all at dinner. He said that, after awhile, this might help with evening social phobia episodes.
Now, I did a little (oh, just 5 hours) of net research last night, and found that most trials have found Buspar completely ineffective for SP. On the other hand, I might have mild GAD (which is Buspar's official indication), and I KNOW I have mild OCD (Buspar has been said to be a good potentiator for AD's in treating OCD).
Most interestingly, however, I found a 1997 Medline abstract that actually concluded the SSRI potentiators Buspar + Pindolol ALONE (i.e. WITHOUT an AD) acted as a more effective, and much quicker acting, antidepressant than Buspar + Luvox -- 50% significant response to severe depression in one week! (Reply if you'd like me to send or post a copy of the abstract. The authors' explanations of the possible underlying mechanisms is fascinating, once i was able to digest it). So, in an attempt to take advantage of this discovery, I've decided to take half (i.e., 7.5 mg) of the Buspar in the morning along with the usual 1 mg Klonopin, at the same time I take the Pindodol instead of 12 hours later (when I will take the remaining 7.5 Buspar). I'll try this for at least the first week.
Maybe this will turn out to be a bust, or maybe it will be a good move? Who knows? Frankly, my main concern is that I don't want to somehow "screw up" the tremendous (75+%?) relief I've gotten from th Klonopin (+ Pindolol) thus far. For my first dose of Buspar, I *did* take it as described, and felt some of those mild dizziness/lightheadness feelings that I got from Nardil just before it pooped out. So I started worrying (irrationally, no doubt) about un-doing the good that's been done. I'm just now entering a period where I've got a big slew of SP challenges (especially presentations and meetings) coming up, so I was hoping to be nearly past the experimentation stage. Indeed, I almost decided not to even try the Buspar until I saw how te first big challenges went. Hey, maybe that continual worrying means I *do* have some degree of GAD, ergo, Buspar could be helpful!
BTW, does anyone have real-life experience with Buspar+Klonopin, or Buspar+Klonopin+Pindolol (I'm probably #1 on THAT odd cocktail). I'm particularly interested in hearing from anyone with Social Phobia. Be sure to mention all of the mental disorders you deal with, since that would make a big difference in how your situation on these meds could predict possible reactions for me.
poster:Rick
thread:11383
URL: http://www.dr-bob.org/babble/19990914/msgs/11772.html