Posted by g_g_g_unit on May 24, 2012, at 22:36:09
In reply to Re: update » g_g_g_unit, posted by SLS on May 23, 2012, at 6:03:27
> For some people, Klonopin produces the depressive symptoms and flat affect that you describe. I don't think these things disappear with continued use. I hope I'm wrong.
>
> I like combining short acting and longer acting BZD receptor agonists at bedtime. I recently had some success using a combination of Sonata and Ativan. For myself, I will administer (Sonata or Halcion or Ambien) + (Ativan or Restoril). I do not experience a hangover the next day with these treatments. I would be very surprised if your doctor were to consider such aggressive combination treatment. However, this is what I found necessary in order to treat total insomnia the first time I combined Parnate with a TCA.
>
> Some people consider Gabitril (tiagabine) to be a reasonable choice for insomnia. However, clinical studies do not support this claim. Besides, I feel that the drug is unpredictable. It can actually cause agitation rather than reduce it.
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> I hope you can find an answer for the insomnia.
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>
> - ScottHi Scott,
I met with my psychiatrist today. I told him that I was having difficulty with sleep on-set, but not maintenance, and thus having to continually up my Clonazepam dose. His suggestion was precisely to combine a short-acting agent (in this case, Temazepam) with 0.5mg Clonazepam.
Two further matters were discussed. I said I was having trouble reasoning who determines when I'm 'well'. I understand I suffer from a very severe case of anxiety, but I said that I also pride myself on (what's left of) my cognitive abilities and wouldn't want to take anything that (too severely) compromised them.
He agreed, that it was up to me, a fact I brought up in light of the fact that Clonazepam was producing a lot of cognitive dulling, though I think it's easing up a bit regardless. However, it does interfere with the stimulating effect quite a bit and I'm not satisfied at all with my ability to read on the combination -- something he said I may have to cope with (which I guess is a slight contradiction of his earlier statement, but oh well).
Anyway, he wanted to raise the dose to 60mg -- from my understanding, speaking to Dr. Jenkins from Harvard, who specializes in OCD, this is generally the dose he finds effective for anxiety/panic/OCD. However, the suggestion came at the very end of our appointment and I said can we delay a week, because I was going to bring up the idea of introducing Memantine to hypothetically preserve the stimulation from 60mg of Parnate next time I see him.
However, I'm beginning to think it might be worthwhile seeing what 60mg of Parnate alone does for me (and hopefully weaning off the Clonazepam), before introducing another agent. I'm sure that will be my doctor's reasoning for saying no(?), but in some way it makes sense. Right now I'm feeling quite depressed and emotional on 45mg of Parnate, but it seems like some people experience a turnaround at 60mg.
I think I'd be disappointed if Parnate didn't help my ADD in the long-term (since no one will prescribe a stim with it), but maybe there's more to be gained initially by seeing if it works as an AD and anxiolytic?
poster:g_g_g_unit
thread:1018497
URL: http://www.dr-bob.org/babble/20120522/msgs/1018631.html