Posted by JohnL on January 12, 2001, at 2:59:50
In reply to Klonopin Side-effects?, posted by SoftTones on January 11, 2001, at 10:20:32
Hi,
I thought I would jump in with a few ideas to think about. Just when you thought you were running out of options! :-)
First, anxiety can be caused by a variety of different chemistries, some having to do with the serotonin system, some more related to GABA, some to excess dopamine or excess NE, and some to chemical instability. These are broad generalities of much more complicated stuff, but they allow one to categorize things into a way that is useful in treatment.
Since SSRIs acted negatively with you, and Imipramine doesn't help completely, that could rule out serotonin.
The negative reaction to Ativan and Klonopin is not a good sign for the GABA system, however other drugs from the same class could be tried. It's not unusual for one to work real well while the others don't.
If the chemistry involved is dopamine related, a small dose antipsychotic could work. If the chemistry is noradrenaline related, then an antihypertensive drug could work nicely.
And for chemical instability there is small dose Lithium.
All of these drugs have been helpful in treating anxiety. Some have no clinical justification in anxiety--Lithium for example--yet they still work. One doctor kept records and graphs of which drugs worked in his anxiety patients, and all of the above mentioned drugs worked. It's just a matter of sampling them all to find which one you like. When you stumble onto one you like, then you'll know what chemistry you're dealing with. In the'probing' process to find the superior med and to better identify the underlying chemistry, long trials are not needed. You should know within one week whether one of the above drugs will be helpful or not. Listed below are drugs to try:
Xanax (benzo)
Valium (benzo)
Zyprexa (antipsychotic)
Risperdal (antipsychotic)
Two or three antihypertensive meds
Lithium
And sometimes, but not as often as the above drugs, Depakote or Tegretol.
And this sounds strange, but it's true...sometimes stimulants actually helped. That's usually the opposite of what would be expected, but they sometimes work for anxiety. The others listed though would probably have better odds of working.There are plenty of options. So far the real underlying chemistry of your anxiety has not been targeted. One of the above drugs will target it head-on. Your doctor might at first think you're nuts, but ask him/her to let you try these drugs for one week each. They may not work completely in that short of a time, but that's not the point. You are merely screening for superior meds, and in the process gathering clues to better identify which chemistry to focus on. The superior med you are looking for will make itself known quickly. You'll have no doubt that you are onto something good. If we were talking about chronic depression, these trials might have to be longer. But for anxiety, one week is plenty of time except with the SSRIs.
John
poster:JohnL
thread:51445
URL: http://www.dr-bob.org/babble/20010111/msgs/51500.html