Posted by viridis on October 26, 2002, at 1:25:11
In reply to Re: Is anyone on Neurontin these days? » viridis, posted by Rick on October 24, 2002, at 23:22:01
Hi Rick,
My "official" diagnoses are panic disorder, major depression, and ADD. There's probably some social anxiety mixed in there; like the panic attacks, that's sporadic, but without meds I have a high level of general anxiety much of the time. The pattern before meds was a regular buildup of worry, ruminating thoughts, and insomnia, sometimes precipitating periods of panic attacks and often causing a crash into severe depression. I've experienced this for as long as I can remember (30+ years), even as a child.
I've had various rounds of treatment with SSRIs (sometimes for months at a time) and respond very badly to this class of meds -- increased anxiety, insomnia, bizarre mood swings, and various other side effects that don't subside over time. I refuse to take SSRIs now, and my current pdoc agrees that they're not appropriate for me.
When I started Klonopin, my overall anxiety level dropped drastically. I also took a fair bit of Xanax at first, but rarely use it any more. I have plenty of Xanax, but reserve it for occasional, very stressful situations.
I started with 1 mg/day of Klonopin; my pdoc offered to increase the dose if necessary, but 1 mg works very well and has continued to do so after over well over a year. I tried various dosing schedules early on. I did have some initial drowsiness/ clumsiness/ forgetfulness, but that subsided after a couple of weeks. Initially I tried 1 mg before bed, but found that the anti-anxiety effect wore off by mid-morning. Then I tried 0.25 mg 4X/day, then 0.50 mg 2X/day, but quickly settled on the whole 1 mg in the morning once the initial side effects disappeared.
Klonopin alone (plus occasional Xanax) greatly reduced my anxiety and eliminated the severe depression that results from anxiety. However, I still had some depression on and off, and continued to have problems with focus. I'd been tentatively diagnosed with ADD twice before, and my pdoc picked up on this too. After a lot of questioning, he concluded that I fit the criteria for ADD and suggested addition of a psychostimulant. I tried 50-100 mg Provigil/day for a while. It was OK -- stimulating without causing anxiety -- but didn't really help with the focus problems. I also experimented with addition of various (low) doses of Wellbutrin. I'd taken this before without benzos and found it very anxiogenic, but thought that maybe with the benzos it would be alright. It provided stimulation but was just irritating and didn't help, so I abandoned that.
Then my pdoc prescribed Adderall (about 10 months ago). It's been very helpful, and seems to work synergistically with the Klonopin. Although some stimulants (such as caffeine) can make me feel "wired", amphetamines have a calming, focusing effect at low doses for me. Adderall also relieved most of the depression that remained (although Klonopin had already reduced the severity of my depression greatly). I take 5 mg of Adderall every morning, along with 1 mg Klonopin, and often take another 2.5-5 mg Adderall a few hours later. So far I haven't needed to increase the dose of either, and they continue to provide the same benefits as they did initially.
Then there's Neurontin. I suggested it early on, and my pdoc agreed that it might help with mood stability (although he considers it a very "mild" mood stabilizer). I take 1200 mg/day in three 400 mg doses, and it has no side effects. Maybe it's helping, but I'm quite sure that Klonopin and Adderall are the key meds. However, my pdoc suggests I stay with Neurontin for now, as he suspects it adds "background" stability. Since things are going well, I'm sticking with this combo for the time being, although I may try dropping the Neurontin at some point.
So my dosing regimen is 1 mg K in the AM along with 5 mg Adderall and 400 mg Neurontin, then often 2.5-5 mg Adderall in the afternoon and two more 400 mg doses of Neurontin at about 5-6 hour intervals. As I mentioned, I occasionally take 0.25-0.50 mg Xanax (maybe once every week or two on average).
I hope this is helpful,
Viridis
poster:viridis
thread:124369
URL: http://www.dr-bob.org/babble/20021025/msgs/125279.html