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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 30. This is the beginning of the thread.
Posted by blueberry on April 23, 2006, at 17:59:33
Klonopin is calming me down and giving me some sleep, even in the miniscule dose of .125mg during the day and .25mg at night. But it makes me kind of depressed, more than I already am. I like xanax better for mood, but the peaks and valleys are viscious, plus it just feels way more addicting than klonopin. The extended release version is so expensive.
What is another choice for a long lasting benzo for anxiety and sleep that will not be depressing like klono? I see mention here from Phillipa and sometimes others about valium, and once in a while about ativan. I have a friend on lorazepam and I asked him how it made him feel, and he said "good". So I don't know. Any advice?
Posted by SLS on April 23, 2006, at 19:14:52
In reply to Klono depressing. Need long benzo not depressing., posted by blueberry on April 23, 2006, at 17:59:33
I have never tried Valium. I took Ativan continuously for at least a year. I found it to be a very clean drug. You will probably want to take it twice a day.
- Scott
Posted by bassman on April 23, 2006, at 19:33:04
In reply to Re: Klono depressing. Need long benzo not depressi, posted by SLS on April 23, 2006, at 19:14:52
Since you mentioned benzo withdrawal fear, I found Ativan to be absolutely painless to withdraw from. Of course, I withdrew from it because it wasn't doing any good. :>} Best of luck and be thankful the Xanax XR is too expensive-my experience with it was Not Good, to say the least-although Xanax immediately release works the best of the benzos for me, far and away.
Posted by Phillipa on April 23, 2006, at 22:34:57
In reply to Re: Klono depressing. Need long benzo not depressi, posted by bassman on April 23, 2006, at 19:33:04
Since I have taken them all for over 30years at different times my experiences only. Valium was first at 5mg three times a day at first it was combined with mephrobamate450mg. I stopped the mep when my anxiety was under control panic attacks. Ended up on only 5mg of valium you only take what you need. Next to enter the picture ativan which worked well three times a day. Enter xanax with depression slight additional advantage was wonderful for may years. Then it made me just tired. Tried klonopin make me feel suicidal back immediately to xanax . then valium again. It doesn't work like it used to but it works well. I word try all of them again except klonopin. Ativan really was good. Actually I may ask for it again instead of valium and take it during the day to and split the dosing up. And I was always able to switch from one to the other with no side effects. Hope this helps Love Phillipa
Posted by yxibow on April 24, 2006, at 6:22:09
In reply to Klono depressing. Need long benzo not depressing., posted by blueberry on April 23, 2006, at 17:59:33
> Klonopin is calming me down and giving me some sleep, even in the miniscule dose of .125mg during the day and .25mg at night. But it makes me kind of depressed, more than I already am. I like xanax better for mood, but the peaks and valleys are viscious, plus it just feels way more addicting than klonopin. The extended release version is so expensive.
>
> What is another choice for a long lasting benzo for anxiety and sleep that will not be depressing like klono? I see mention here from Phillipa and sometimes others about valium, and once in a while about ativan. I have a friend on lorazepam and I asked him how it made him feel, and he said "good". So I don't know. Any advice?
Lorazepam, Ativan probably does feel "good"... it has a more immediacy effect than Klonopin which is really subtle and takes longer to take effect. I don't know if Ativan is really the best for non PRN usage since it is used alot that way in hospitals to calm patients but I suppose really any benzodiazepine with the exception of Xanax can be timed and tailored right for the right person.I switched from Klonopin to Valium for more anxiolytic effect -- I can't say whether it is less depressive, but some find it better. It has a better half life anyhow.
Posted by med_empowered on April 24, 2006, at 6:33:59
In reply to Re: Klono depressing. Need long benzo not depressi » blueberry, posted by yxibow on April 24, 2006, at 6:22:09
hey! Valium is an option..if you're in the US, docs tend to either not RX it (cuz its associated with "Mother's Little Helpers"-era practices) or they waaaaay under-prescribed it (20mgs day==1mgs Klonopin..when you do the math, you see patients get screwed). One that isn't RX'd much but I like is Librium..its kind of weak, but it lasts a while and is pleasant without being really intense. Ativan is good, too. Tranxene is an option, but it can be depressing..if it works, though, there's the T-Tab which is once-daily anxiety relief (how convenient).
Serax is also an option, although for some reason it seems to be used mostly for alcohol withdrawals/DTs.
There's always xanax but...that's a pretty tricky med.
Posted by blueberry on April 24, 2006, at 19:59:54
In reply to Klono depressing. Need long benzo not depressing., posted by blueberry on April 23, 2006, at 17:59:33
Good responses and I appreciate it all. Taking it all in, and looking back at my own experiences, I need to think about switching back to xanax. I asked my doc today for a different long lasting benzo like valium and she said no they're all the same. I would normally have debated her on it but I just let it go for now.
Posted by yxibow on April 25, 2006, at 3:03:00
In reply to Re: Klono depressing. Need long benzo not depressi, posted by med_empowered on April 24, 2006, at 6:33:59
> hey! Valium is an option..if you're in the US, docs tend to either not RX it (cuz its associated with "Mother's Little Helpers"-era practices) or they waaaaay under-prescribed it (20mgs day==1mgs Klonopin..when you do the math, you see patients get screwed).
Yep -- fortunately I have a pdoc who trepidatiously allows the high dosage of Valium needed to switch from Klonopin. And Valium as previously said has a 24+ half life due to its main plus three other metabolites (Klonopin is about 16).
One that isn't RX'd much but I like is Librium..its kind of weak, but it lasts a while and is pleasant without being really intense.
Librium shares some of the metabolites of Valium except for Restoril, which probably makes Valium stronger.
Ativan is good, too. Tranxene is an option, but it can be depressing..if it works, though, there's the T-Tab which is once-daily anxiety relief (how convenient).
Ativan in vivo doesn't necessarily exceed Valium or Klonopin's half life. I was on Tranxene years ago and I was on it 3x a day. Didnt know they made an extended version, or whether they still do -- its a fairly old drug. But its half life is also fairly low and I was feeling like I was dependant on it -- I hadn't necessarily habituated but I didn't know as much about benzodiazepines as I know now and I stopped it cold turkey. (And the college health pdoc didn't reinstate my full dosage medication like she should have, nor did anyone give the head "snap" and moving of scalp smooth muscle tissue the credence it should have been in an emergency fashion, which would have immediately stopped this.) I still have scalp muscular spasms irregularly from time to time when my current disorder rears its head, this is after 9-10 years. Not that I dont think properly prescribed benzodiazepines monitored for respiratory depression especially in combination with other medications, aren't about the safest psychiatric drugs out there. I still am on Valium after all.
>
> Serax is also an option, although for some reason it seems to be used mostly for alcohol withdrawals/DTs.
>
> There's always xanax but...that's a pretty tricky med.I would agree -- as I say, Xanax is best left PRN
Posted by valene on April 25, 2006, at 10:32:23
In reply to Klono depressing. Need long benzo not depressing., posted by blueberry on April 23, 2006, at 17:59:33
I prefer xanax as a benzo. For me it seems to have a half-life of about 18 hours. I found valium very depressing and have heard that K is also. Best wishes, Val
Posted by yxibow on April 25, 2006, at 12:48:06
In reply to Re: Klono depressing. Need long benzo not depressi, posted by valene on April 25, 2006, at 10:32:23
> I prefer xanax as a benzo. For me it seems to have a half-life of about 18 hours. I found valium very depressing and have heard that K is also. Best wishes, Val
Interesting -- alprazolam usually has a 4-6 hour half life and requires 3-4 times a day dosing. So our metabolism I guess is a case against XanaxXR :)
Cheers
-- Jay
Posted by valene on April 26, 2006, at 8:19:23
In reply to Re: Klono depressing. Need long benzo not depressi » valene, posted by yxibow on April 25, 2006, at 12:48:06
Jay,
According to the benzo equivalency chart on Dr. Bob's site, xanax has a half-life of 9-20 hours! Here is the link:http://www.dr-bob.org/tips/bzd.html
Best wishes, Val
> > I prefer xanax as a benzo. For me it seems to have a half-life of about 18 hours. I found valium very depressing and have heard that K is also. Best wishes, Val
>
> Interesting -- alprazolam usually has a 4-6 hour half life and requires 3-4 times a day dosing. So our metabolism I guess is a case against XanaxXR :)
>
> Cheers
>
> -- Jay
Posted by yxibow on April 26, 2006, at 19:30:08
In reply to Re: Klono depressing. Need long benzo not depressi » yxibow, posted by valene on April 26, 2006, at 8:19:23
> Jay,
> According to the benzo equivalency chart on Dr. Bob's site, xanax has a half-life of 9-20 hours! Here is the link:
>
> http://www.dr-bob.org/tips/bzd.html
>
> Best wishes, Val
>
> > > I prefer xanax as a benzo. For me it seems to have a half-life of about 18 hours. I found valium very depressing and have heard that K is also. Best wishes, Val
> >
> > Interesting -- alprazolam usually has a 4-6 hour half life and requires 3-4 times a day dosing. So our metabolism I guess is a case against XanaxXR :)
> >
> > Cheers
> >
> > -- Jay
>
>Those take in account all metabolite half lives and are really "in vitro" lab half lives, not "in vivo" (human and post marketing trials).
Xanax is notoriously known for an actual 4-6 hour half life in individuals requiring up to 4x daily dose were it to be used ongoing, only preceeded by things like Halcion and Rohypnol with true half lives of around 1-2 hours.
Xanax is still best used in most people as PRN or for breakthrough anxiety as its absorption to plasma level is very short and it is one of the benzodiazepines which can develop a greater habituation due to its short half life.
Posted by bassman on April 26, 2006, at 20:40:56
In reply to Re: Klono depressing. Need long benzo not depressi » valene, posted by yxibow on April 26, 2006, at 19:30:08
Looks like there are two major metabolites in vivo and one is inactive and one is at a very low concentration, so it's hard to see how it would contribute to the half-life.
http://www.rxlist.com/cgi/generic/alpraz_cp.htm
but speaking from experience, no matter what the half-life is, you do have to establish a schedule, like twice a day, and stick to it, or you will end up taking it 4 times a day and barely getting through the night. Whatever schedule you put yourself on, the Xanax will "remind" you take it on that schedule. The most used schedule is supposedly 0.25-0.5 mg tid, but once you go above that, I think you'll need a fourth dose a day. It's a great med if you don't mind being reminded several times a day how dependent you are on it. It is a star for periodic periods of panic, however. I agree that PRN is the best way to go for most folks.
Posted by valene on April 27, 2006, at 10:01:48
In reply to Re: Klono depressing. Need long benzo not depressi, posted by bassman on April 26, 2006, at 20:40:56
This is making me nervous then. I take xanax daily for my anxiety and was first put on it to take at bedtime only, 2mg. Now I take 1.50-1.75mg. and split my doses to 3x a day, but I have gone 17 hours without feeling I need my next dose. I've tried valium to no avail and xanax works.
I have an appointment with a renowned psychopharmacologist in Boston next week who has vast knowledge of benzodiazepines. I will ask him about this.
(Some of you would recognize his name if I wrote it. He has been mentioned on this forum before). He has written many papers and textbooks and is known all over the country if not the world.
Best wishes,
Val> Looks like there are two major metabolites in vivo and one is inactive and one is at a very low concentration, so it's hard to see how it would contribute to the half-life.
>
> http://www.rxlist.com/cgi/generic/alpraz_cp.htm
>
> but speaking from experience, no matter what the half-life is, you do have to establish a schedule, like twice a day, and stick to it, or you will end up taking it 4 times a day and barely getting through the night. Whatever schedule you put yourself on, the Xanax will "remind" you take it on that schedule. The most used schedule is supposedly 0.25-0.5 mg tid, but once you go above that, I think you'll need a fourth dose a day. It's a great med if you don't mind being reminded several times a day how dependent you are on it. It is a star for periodic periods of panic, however. I agree that PRN is the best way to go for most folks.
Posted by bassman on April 27, 2006, at 10:29:16
In reply to Re: Klono depressing. Need long benzo not depressi » bassman, posted by valene on April 27, 2006, at 10:01:48
I'm REALLY interested in his opinion, esp. on benzo therapy-I hope you post something about what happens. Hint: I hope he thinks Xanax is as valuable a drug as I do.
bassman
Posted by ed_uk on April 27, 2006, at 16:19:46
In reply to Re: Klono depressing. Need long benzo not depressi » valene, posted by yxibow on April 26, 2006, at 19:30:08
Hi Yxi,
Flunitrazepam (Rohypnol) is a long-acting hypnotic. Its effects tend to persist the following morning. Triazolam (Halcion), as you said, has a short duration of action.
I did some research RE the metabolism of diazepam (Valium). It turns out that temazepam (a metabolite of diazepam) does not contribute significantly to the clinical effects of diazepam, since it is excreted at approximately the same rate as it is generated, and is therefore almost undetectable in the blood. Desmethyldiazepam is the only metabolite of diazepam which is clinically important.
Kind regards
Ed
Posted by yxibow on April 28, 2006, at 1:41:36
In reply to Re: Klono depressing. Need long benzo not depressi » yxibow, posted by ed_uk on April 27, 2006, at 16:19:46
> Hi Yxi,
>
> Flunitrazepam (Rohypnol) is a long-acting hypnotic. Its effects tend to persist the following morning. Triazolam (Halcion), as you said, has a short duration of action.Yes... I inadvertently included Rohypnol in that group... you're right. But Halcion is very short. It got bad press for people supposedly doing wierd and violent things on it at one point but the half life is so short that the likelihood of causality is hard to prove. It is still sold here.
>
> I did some research RE the metabolism of diazepam (Valium). It turns out that temazepam (a metabolite of diazepam) does not contribute significantly to the clinical effects of diazepam, since it is excreted at approximately the same rate as it is generated, and is therefore almost undetectable in the blood.That would make sense, yes
>Desmethyldiazepam is the only metabolite of diazepam which is clinically important.Interesting... I was about to say why didn't they patent extend Valium but they did... in some obscure countries, not here anyhow... Nordazepam
http://en.wikipedia.org/wiki/Nordazepam
-- tidings
Jay
Posted by ed_uk on April 28, 2006, at 14:12:10
In reply to Re: Klono depressing. Need long benzo not depressi » ed_uk, posted by yxibow on April 28, 2006, at 1:41:36
Hi J
>Interesting... I was about to say why didn't they patent extend Valium but they did... in some obscure countries, not here anyhow... Nordazepam
Clorazepate (Tranxene) is a pro-drug of desmethyldiazepam ie. it works because it's converted to desmethyldiazepam in the body. Clorazepate itself does not appear in the blood. Desmethyldiazepam has a very long half-life, hence Tranxene's long duration of action. As is the case with diazepam (Valium), single isolated doses of clorazepate (Tranxene) tend to be quite short-acting, but repeated doses are cumulative, leading to a long duration of action. After the first week or two, clorazepate and diazepam can generally be given as a single daily dose.
Regards
Ed
Posted by yxibow on April 29, 2006, at 0:17:13
In reply to Re: Klono depressing. Need long benzo not depressi » yxibow, posted by ed_uk on April 28, 2006, at 14:12:10
> Hi J
>
> >Interesting... I was about to say why didn't they patent extend Valium but they did... in some obscure countries, not here anyhow... Nordazepam
>
> Clorazepate (Tranxene) is a pro-drug of desmethyldiazepam ie. it works because it's converted to desmethyldiazepam in the body. Clorazepate itself does not appear in the blood. Desmethyldiazepam has a very long half-life, hence Tranxene's long duration of action. As is the case with diazepam (Valium), single isolated doses of clorazepate (Tranxene) tend to be quite short-acting, but repeated doses are cumulative, leading to a long duration of action. After the first week or two, clorazepate and diazepam can generally be given as a single daily dose.
>
> Regards
>
> Ed
Oh don't get me started on Tranxene.... it had to be rx'd 3x a day, definately not a single daily dose. I don't know why the doctor I started with chose a more obscure benzodiazepine. At the time I knew not a lot about them and I went cold turkey eventualy because it became apparent to me and others at the time that I was perhaps losing short term memory. And then the ** of a doctor (different -- they consolidated and eliminated my off campus doctor so all my mental health could be watched in the same place -- the psychologist I liked, the psychiatrist was a pardon the expression feminist b* who didn't particularly seem to like her male patients, especially those who read PDRs) didnt do the immediate thing of giving me back all the Tranxene that I had prescribed. I have permanent muscle spasms in my scalp that arise every now and then. If they took things seriously at the student health place they would have taken muscular movements on my scalp that could be felt by both a doctor and a significant other as something NOT good. And put back the full dose. Until such time as I could slowly taper off. But I'm not anti benzodiazepine. Just anti-past events, things that can't be changed. Or maybe eventually not 9 years later but a couple of decades it will vanish.
Posted by Caedmon on April 29, 2006, at 7:04:50
In reply to Re: Klono depressing. Need long benzo not depressi » yxibow, posted by ed_uk on April 27, 2006, at 16:19:46
>> I did some research RE the metabolism of diazepam (Valium). It turns out that temazepam (a metabolite of diazepam) does not contribute significantly to the clinical effects of diazepam, since it is excreted at approximately the same rate as it is generated, and is therefore almost undetectable in the blood. Desmethyldiazepam is the only metabolite of diazepam which is clinically important. >>
That is interesting! Good to know, thanks. :-)
- C
Posted by ed_uk on April 29, 2006, at 12:16:53
In reply to Re: Klono depressing. Need long benzo not depressi » ed_uk, posted by yxibow on April 29, 2006, at 0:17:13
Hi Yxi
>it had to be rx'd 3x a day, definately not a single daily dose
Did you try taking it as a single dose?
Ed
Posted by ed_uk on April 29, 2006, at 12:17:17
In reply to Re: Klono depressing. Need long benzo not depressi » ed_uk, posted by Caedmon on April 29, 2006, at 7:04:50
You're welcome C :)
Ed
Posted by yxibow on April 29, 2006, at 17:44:33
In reply to Re: Klono depressing. Need long benzo not depressi » yxibow, posted by ed_uk on April 29, 2006, at 12:16:53
> Hi Yxi
>
> >it had to be rx'd 3x a day, definately not a single daily dose
>
> Did you try taking it as a single dose?
>
> EdWas taking as prescribed.. pretty much needed or was habituated to the use of it around the clock at the time.
Posted by patrickhh on May 2, 2006, at 1:47:30
In reply to Klono depressing. Need long benzo not depressing., posted by blueberry on April 23, 2006, at 17:59:33
> Klonopin is calming me down and giving me some sleep, even in the miniscule dose of .125mg during the day and .25mg at night. But it makes me kind of depressed, more than I already am. I like xanax better for mood, but the peaks and valleys are viscious, plus it just feels way more addicting than klonopin. The extended release version is so expensive.
>
> What is another choice for a long lasting benzo for anxiety and sleep that will not be depressing like klono? I see mention here from Phillipa and sometimes others about valium, and once in a while about ativan. I have a friend on lorazepam and I asked him how it made him feel, and he said "good". So I don't know. Any advice?Klonopin is known to be depressing for a lot of people. It made me depressed.
IMO, ativan is pretty short acting as well....have to dose 3 or 4 times a day.
valium just isn't as potent as the others and it tends to build up in the system.
I've actually added a small dose of risperdal and it seems to make a huge difference. I wouldn't be afraid to try a low dose atypical. They are expensive though.
Posted by yxibow on May 2, 2006, at 1:56:45
In reply to Re: Klono depressing. Need long benzo not depressing., posted by patrickhh on May 2, 2006, at 1:47:30
> > Klonopin is calming me down and giving me some sleep, even in the miniscule dose of .125mg during the day and .25mg at night. But it makes me kind of depressed, more than I already am. I like xanax better for mood, but the peaks and valleys are viscious, plus it just feels way more addicting than klonopin. The extended release version is so expensive.
> >
> > What is another choice for a long lasting benzo for anxiety and sleep that will not be depressing like klono? I see mention here from Phillipa and sometimes others about valium, and once in a while about ativan. I have a friend on lorazepam and I asked him how it made him feel, and he said "good". So I don't know. Any advice?
>
> Klonopin is known to be depressing for a lot of people. It made me depressed.
>
> IMO, ativan is pretty short acting as well....have to dose 3 or 4 times a day.Ativan has a half life of about 10-15 hours, but may be shorter for others, at least 2x a day, you're right, it is shorter acting. Not as short as Xanax which can be as short as 4 hours.
> valium just isn't as potent as the others and it tends to build up in the system.
They all build up in the system eventually. Its just a matter of whether you're genetically disposed to be habituated to benzodiazepines and which kind. Valium is not as potent in terms of mg but its just as good for anxiety as Klonopin if not better in my opinion. A vast majority of people can stay on a particular dose of Valium for years, in fact since it came out in 1962.
> I've actually added a small dose of risperdal and it seems to make a huge difference. I wouldn't be afraid to try a low dose atypical. They are expensive though.That they are... in order of when they came out, Seroquel being the most. Risperdal is a molecular transformation of Haldol and does carry the most risk of TD. A small dose though probably has a low risk, but high doses of Risperdal are nearly as potent as Haldol itself.
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