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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 25. This is the beginning of the thread.
Posted by Tepiaca on April 3, 2003, at 1:13:11
which are the risks of taking this drug?
which is the highest dose?
thanks
Posted by utopizen on April 3, 2003, at 1:44:38
In reply to Any risks with Klonopin (Clonazepam)??, posted by Tepiaca on April 3, 2003, at 1:13:11
>
> which are the risks of taking this drug?
> which is the highest dose?
> thanksSince it targets anxiety, its biggest side effect is making you no longer care about its side effects...
Posted by SpreadDaALoha on April 3, 2003, at 5:41:21
In reply to Re: Any risks with Klonopin (Clonazepam)??, posted by utopizen on April 3, 2003, at 1:44:38
I personally believe benzos can often worsen depression. I say be careful. I think there are better things for anxiety, but I don't know what. :)
Posted by btnd on April 3, 2003, at 5:57:00
In reply to Re: Any risks with Klonopin (Clonazepam)??, posted by SpreadDaALoha on April 3, 2003, at 5:41:21
> I personally believe benzos can often worsen depression. I say be careful. I think there are better things for anxiety, but I don't know what. :)
There are no better things for anxiety than benzos (especially Klonopin for social-phobia and Valium for GAD). And it all depends on the person whether benzos worsen depression. For me, Klonopin acts as an anti-depressant.
Posted by Dave1 on April 3, 2003, at 10:21:19
In reply to Any risks with Klonopin (Clonazepam)??, posted by Tepiaca on April 3, 2003, at 1:13:11
Just addiction, although since klonopin is longer acting it isn't as addicting as something like ativan. My pdoc actually has switched me to klonopin in the past to get me off ativan.
I think you really need alot of any benzodiazapene to overdose unless you take it with alot of alcohol or something.
Dave
Posted by bretbe on April 3, 2003, at 10:48:23
In reply to Re: Any risks with Klonopin (Clonazepam)??, posted by Dave1 on April 3, 2003, at 10:21:19
The risk is NOT addiction, but dependence which is different. In addiction, one starts to seek it in higher and higher doses due to bulding tolerance and it become a distructive force as one obsesses about the next "fix." Whereas, dependence, as it relates to Klonopin, means you won't want more of it, but it may become extremely difficult to get off of it should you want to quit taking at some time in the future (body/brain has difficulty functioning without presence since it got used to it being in system resulting in withdrawel symptoms, e.g., higher anxiety, dyshporia, etc. trying to get off). This seems more difficult for some, like myself and I have had to accept that I will take it for life...like taking insulin for diabetes. Some people find success in tapering off over 1 to 2 years. But the key here is whether it will help you. If you need it, then by all means don't let it scare you away. Just realize it may be a life-long "friend."
Klonopin and other benzodiazapines are definately the most effective meds for anxiety...no doubts. But since they can cause dependence, some argue to try other meds with anxiolytic properties for SOME individuals. This would include Buspar, and a number of SSRI's like Paxil. Yet many people, like me, find these meds make their anxiety worse. Depending where you are in your trial and how willing you are to suffer longer while you experiment, you may try the others first. But if you want some immediate relief to your anxiety, Klonopin will make a dent in it within a day.
I'm not sure max dosages but I take 1mg and, like someone else said above, it has an anti-depressant effect for me as well perhaps (speculating) because my anxiety is driving my depression. It all depends on the type of anxiety, the type of depression, etc. and as many people can attest to on this board, the words "anxiety" and "depression" are often used to describe a wide range of different kinds of maladies experienced subjectively since we can't put probes into our heads and say, "hey, you're a 9.5 out of 10 on anxiety sub-type II." Besides no probe existing, unfortunately science has not yet broken down anxiety and depression by it's sub-types either. So in the mean time, like all of us here on this board, our brains have become pharmacological play grounds for experimenting psychiatrists purporting to be specialists while having no more knowledge about what will work than the drug rep dropping off a box of samples...that's my experience anyway.
Posted by Tepiaca on April 3, 2003, at 17:28:40
In reply to Re: Any risks with Klonopin (Clonazepam)??, posted by bretbe on April 3, 2003, at 10:48:23
.
Posted by MelD on April 3, 2003, at 17:36:24
In reply to Any risks with Klonopin (Clonazepam)??, posted by Tepiaca on April 3, 2003, at 1:13:11
I have taken Klonopin for over 10 years, for sleep and the highest dose i generally take for it is .5mg. Since i dont take it for anxiety, i cant advise you there, but i can attest to the fact that it makes you drowsy. Rather or not this puts you at risk for something depends on your circumstances. Medically, i view it as safe.
Posted by Tepiaca on April 3, 2003, at 17:41:26
In reply to Re: Any risks with Klonopin (Clonazepam)??, posted by bretbe on April 3, 2003, at 10:48:23
Hi
Im scared about taking this drug for the rest
of my life .
I tried first some SSRIS but they help me
just a little bit.
Now on Klonopin I feel better , but my anxyety is not completely gone. Im on 3mg/day and I want
to increase the dose to see If I have good
improvements . Anyway Im also taking effexor XR
together with klonopin.
What do you suggest me to do ?
Im not tried yet any MAOI , what do you think
is best?
how many years you have been taking this drug?
Another question , Im very worried about what doctor bob say about benzodeazepines , that they
are dangerous because inhibition may lead you
to hurt other people . What do you think about this?
Thankyou
Posted by bretbe on April 4, 2003, at 12:38:05
In reply to Re: Any risks with Klonopin (Clonazepam)??bretbe, posted by Tepiaca on April 3, 2003, at 17:41:26
It's understandable to be worried about taking a medication for the rest of your life, especially since it is "worry" (anxiety) that you are taking the medication for. For me, I have sometimes tried to go off of it more because it seems an inconvenience to have to always have some of it on hand, take at night, etc., if it isn't helping. However, since I am now convinced it is helping tremendously, I think of it like taking insulin for diabetes or heart medication; if my body needs it, why worry about taking it. Lots of people take medication every day who would otherwise be dead...that's the beauty of modern medicine.
I've never heard of the "hurting other people" effect of Klonopin. I've certainly never had that problem or any other problems, on Klonopin and I've taken it now for 10 years (1mg/night-time). Well, I should say that I have not been able to get off of Klonopin even when trying to slowly taper down over the course of 2 years, but that could also be because it is helping me. It's literally a life saver for me. If you have anger/irritability problems, you may want to consider Depakote, Tegrital, or Trileptal usually very good for agitation and/or aggression. Both Tegrital and Depakote were great at reducing irritability for me.
MAOI's are often very powerful anti-depressants and for many people they are life-savers. If your depression is the low energy kind, these can be very activating. I have a good friend who has been on Nardil for over ten years and he had originally been very suicidal. The down side is you have to watch what kinds of food you eat and over-the-counter medications you take. I personally did not have good results from Nardil but most anti-depressant meds (SSRI's, TCA's) and especially Welbutrine make my anxiety sky rocket! Parnate and Seligiline are other MAOI's. As you can see from all the advice from people on this message board, our bodies all respond differently to medications so you have to find the one that works for you.
I'm not an expert so this is just my opinion but if 3mg Klonopin is not working, you may want another combination. Have you tried buspar? If SSRI's work a little, you may want to experiment with different doses (e.g., higher) and combinations with other anti-depressants. Also, some people have good results with anti-epileptic meds like Neurontin or Topamax with SSRI's. I'm not sure what stage you are in trying medications and what you've tried in the past. When did your anxiety/depression start? Did you have anxiety over specific things or just all the time? Is your "pain" more anxiety or depression...or both equally? Is your depression cause low energy or do you have too much energy? (or just enough?). It's hard to say exactly what you need but keep working with a good psychiatrist who knows ALL the available medications. If you've never had counseling, you may want to try that too.
Best of luck to you!
Posted by Tepiaca on April 4, 2003, at 23:56:30
In reply to Re: Any risks with Klonopin (Clonazepam)??bretbe, posted by bretbe on April 4, 2003, at 12:38:05
Actually everything started in 1997 . I had
severe depression an pyschotics symptomps.So
I started with zypreza then seroquel and altruline . I increased the dose of Zolof(Altruline in mexico) until 100mg I didnt feel any difference. My doctor never told me about Social Phobia . I start reading some people with
this thing , and I realized that I had that thing
for sure.My doctor dont use MAOI , so I told him to buy klonopin. Im depressed also , lack of energy . I dont like my life . Life means nothing for me . Maybe Nardil is the perfect medicine for me , dont you think? . Anyway Im going to stay on my combo Effexor-Klonopin-Shintroid and wait for a while to see If I see
any change . Ive never tried neurontin , and all the medicines that you told me. I think that I have a lot of options out there still . Time is my only friend . I hope get beter soon.
Thank you
Posted by bretbe on April 5, 2003, at 14:34:25
In reply to Re: Any risks with Klonopin (Clonazepam)??bretbe » bretbe, posted by Tepiaca on April 4, 2003, at 23:56:30
Yeah, I would encourage you to stay on your combo for a while to see if it works. I understand your feelings about not liking life and not feeling it is worth anything...I think most people writing here can understand. I hope you start feeling better soon. Like you said, there are still a lot of meds out there for you to try so the statistics are in your favor. Paxil (paroxetine) is another SSRI used for social phobias and depression...have you tried it before? How does your social phobia manifest itself, e.g, do you feel anxious in public? do you get panic attacks? Can you leave the house and drive a car? Do you function normally (other people can't see a different) but with a lot of duress/pain and anxiety? What kinds of psychotic experiences did you have?
Yes, Nardil may be worth a try and I hear Parnate (MAOI) is very helpful too. Hopefully your current combo will work! Have you tried Welbutrin or Buspar? By the way, what is Shintroid?
Good luck and hang in there!
Posted by Krissy P on April 5, 2003, at 23:45:21
In reply to Re: Any risks with Klonopin (Clonazepam)??, posted by utopizen on April 3, 2003, at 1:44:38
Posted by Krissy P on April 5, 2003, at 23:47:57
In reply to Re: Any risks with Klonopin (Clonazepam)??, posted by btnd on April 3, 2003, at 5:57:00
Hi btnd,
That's trippy-Klonopin works as and AD for me too. If I am sad, and take 1 mg of Klonopin, lie down and take a nap, I wake up and I am feeling great- and nothing has changed-except my mood:0)
This is really interesting.--------------------------------------------------------------------------------------------------
> > I personally believe benzos can often worsen depression. I say be careful. I think there are better things for anxiety, but I don't know what. :)
>
>
> There are no better things for anxiety than benzos (especially Klonopin for social-phobia and Valium for GAD). And it all depends on the person whether benzos worsen depression. For me, Klonopin acts as an anti-depressant.
Posted by Krissy P on April 5, 2003, at 23:52:46
In reply to Re: Any risks with Klonopin (Clonazepam)??, posted by bretbe on April 3, 2003, at 10:48:23
Doesn't addiction involve the use of a mind-altering substance to feel fully functioning, and if cannot function-they may be "addicted"??
Tolerance=the need to take more and more of a med to get a once achieved desired affect at a lower dose.
Am I making sense? lol
just some thoughts,
GREAT TOPIC!!
kristen> The risk is NOT addiction, but dependence which is different. In addiction, one starts to seek it in higher and higher doses due to bulding tolerance and it become a distructive force as one obsesses about the next "fix." Whereas, dependence, as it relates to Klonopin, means you won't want more of it, but it may become extremely difficult to get off of it should you want to quit taking at some time in the future (body/brain has difficulty functioning without presence since it got used to it being in system resulting in withdrawel symptoms, e.g., higher anxiety, dyshporia, etc. trying to get off). This seems more difficult for some, like myself and I have had to accept that I will take it for life...like taking insulin for diabetes. Some people find success in tapering off over 1 to 2 years. But the key here is whether it will help you. If you need it, then by all means don't let it scare you away. Just realize it may be a life-long "friend."
>
> Klonopin and other benzodiazapines are definately the most effective meds for anxiety...no doubts. But since they can cause dependence, some argue to try other meds with anxiolytic properties for SOME individuals. This would include Buspar, and a number of SSRI's like Paxil. Yet many people, like me, find these meds make their anxiety worse. Depending where you are in your trial and how willing you are to suffer longer while you experiment, you may try the others first. But if you want some immediate relief to your anxiety, Klonopin will make a dent in it within a day.
>
> I'm not sure max dosages but I take 1mg and, like someone else said above, it has an anti-depressant effect for me as well perhaps (speculating) because my anxiety is driving my depression. It all depends on the type of anxiety, the type of depression, etc. and as many people can attest to on this board, the words "anxiety" and "depression" are often used to describe a wide range of different kinds of maladies experienced subjectively since we can't put probes into our heads and say, "hey, you're a 9.5 out of 10 on anxiety sub-type II." Besides no probe existing, unfortunately science has not yet broken down anxiety and depression by it's sub-types either. So in the mean time, like all of us here on this board, our brains have become pharmacological play grounds for experimenting psychiatrists purporting to be specialists while having no more knowledge about what will work than the drug rep dropping off a box of samples...that's my experience anyway.
Posted by Viridis on April 6, 2003, at 0:27:34
In reply to Addiction VS Dependence???? » bretbe, posted by Krissy P on April 5, 2003, at 23:52:46
Klonopin is definitely an antidepressant for me, because the worst of my anxiety is anxiety-driven. It seems to have this effect for many others too. Xanax is also very helpful in this respect (for me).
Re: the addiction issue, I post this every couple of weeks, but will do so again:
The American Society of Addiction Medicine (ASAM), the American Academy of Pain Medicine (AAPM), and the American Pain Society (APS) recognize the following definitions and recommend their use:
Addiction: Addiction is a primary, chronic, neurobiological disease, with genetic, psychosocial, and environmental factors influencing its development and manifestations. It is characterized by behaviors that include one or more of the following: impaired control over drug use, compulsive use, continued use despite harm, and craving.
Physical Dependence: Physical dependence is a state of adaptation that often includes tolerance and is manifested by a drug class specific withdrawal syndrome that can be produced by abrupt cessation, rapid dose reduction, decreasing blood level of the drug, and/or administration of an antagonist.
Tolerance: Tolerance is a state of adaptation in which exposure to a drug induces changes that result in a diminution of one or more of the drug's effects over time.
Benzos like Klonopin have a high potential for inducing dependence, so have to be discontinued gradually. This is standard for all sorts of meds. Tolerance to the sedating effects seems to be pretty standard (so they're not great as sleeping pills long-term), but interestingly, once the correct dose is identified, anxiety patients don't seem very likely to develop tolerance to the anxiolytic effects. As far as true "addiction" goes, benzos don't seem to be much of a problem for those who need them (i.e., anxiety patients and sometimes epileptics), so why they're considered "addictive" by many seems to be mainly a PR issue, perhaps due to the fact that most are off-patent, so inexpensive. When people have trouble getting off an antidepressant that's still under patent, the drug companies prefer to call it "discontinuation syndrome". Some popular ADs (e.g., Paxil, Effexor) rank much higher than benzos in terms of difficulty of discontinuation, but since they're still under patent, it's not advantageous re: marketing to label them "addictive"..
Posted by Tepiaca on April 6, 2003, at 0:28:36
In reply to Tepiaca from bretbe, posted by bretbe on April 5, 2003, at 14:34:25
hi bretbe
Actually I tried all kinds of antidepressants
but that was before the antypsichotic treatment.
My doctors thougth I only had suffering a strong
depression , so they gave me all this stuff for 2 years (in that time in Mexico we only had AP convencionals).Then in 1999 I started taking zyprexa for 1 year and seroquel for 2 years more
My psychotics simptomp were very mild , kind of
paranoia . I not taking AP anymore . But now
the antidepressants and the other medicines do
something that in the past they couldnt I dont know why?? my doctor dont know either . Its rare
Im sure that I have SP ,thats why I bought Klonopin without asking my doctor. The results
indicate that my teory is not wrong , there is
something wrong with my GABA ,Serotonin and
Dopamine sistem.
Shintroyd is a medicine to treat disfunctions
in the thiroid glandul(wrong spelling sorry)
Levotiroxin of sodium . I have Hypothiroidism that why I take Shyntroid
I hope yo can understand me , i dont speak english very well
Tepiaca
Posted by Krissy P on April 6, 2003, at 1:09:45
In reply to Re: Addiction VS Dependence????, posted by Viridis on April 6, 2003, at 0:27:34
Posted by Viridis on April 6, 2003, at 3:06:26
In reply to Re: Addiction VS Dependence????, posted by Viridis on April 6, 2003, at 0:27:34
Just to clarify: the worst depression I experience is anxiety-based, so benzos are great ADs for this. Stimulants help me for more "standard" depresssion. Regular ADs are awful for me.
BTW -- Hi Krissy -- great to see you back!
Posted by bretbe on April 7, 2003, at 17:04:29
In reply to Addiction VS Dependence???? » bretbe, posted by Krissy P on April 5, 2003, at 23:52:46
I think that's right. See the info Viridis gave above. Basically, like you said, building tolerance means you have to take increasingly higher doses to get same effect and addiction is needing is more an obsessive drug seeking desire often related to getting the "high;" inevitably it ruins one's life as one does all kinds of stupid things just to get the next hit. Tolerance isn't desireable either since eventually you can't take any more without it hurting you physically.
With dependance, like can happen with Klonopin, so long as you keep taking the med, you're fine...it's just if you try to go off too fast. Keep in mind, lots of people are dependent on all kinds of meds like insulin for diabetics, heart medication, etc. Requiring something to help keep the brain more balanced should be thought of the same way in regards to treating mental illnesses.
Posted by bretbe on April 7, 2003, at 17:06:05
In reply to Re: Tepiaca from bretbe, posted by Tepiaca on April 6, 2003, at 0:28:36
Thanks for the info...your English is just fine. Keep up your research and helping your doctor help you. Good luck with your latest combination!
Posted by bretbe on April 7, 2003, at 17:11:29
In reply to Correction: my worst DEPRESSION is anxiety-driven » Viridis, posted by Viridis on April 6, 2003, at 3:06:26
Yeah, I caught that correction issue. I have finally determined that anxiety is the root of my problem with depression rather than the other way around. I too have not responded well to the usually ADs and I just tested a theory on myself after decreasing my Klonopin in half (from 1mg to .5mg.) for a year and nothing helping the desperate mental anguish I felt except when I went back on my full dose of Klonopin...the depression (suicidality, hopelessness, dysphoria) greatly diminished. I think I might try upping my dose of Klonipin since it is the only thing I can say for sure has helped my TRD/anxiety.
Interesting to hear that other people see the depression as driven by anxiety too...and that they haven't responded to the usually ADs. I think researchers need to start breaking down depression into its sub-types for better study since it seems like the 80% who-get-better on AD groupd just keeps getting more option for meds (every pharmaceutical company wants a piece of the Prozac pie) but the 5%-20% group isn't getting studied as well with specific meds. The anxiety driven sub-type (MY classification, not a current one I don't think) definitately needs to be studied more!
Posted by Krissy P on April 7, 2003, at 18:14:03
In reply to Re: Addiction VS Dependence????, posted by bretbe on April 7, 2003, at 17:04:29
Thanks for this>>>"Keep in mind, lots of people are dependent on all kinds of meds like insulin for diabetics, heart medication, etc. Requiring something to help keep the brain more balanced should be thought of the same way in regards to treating mental illnesses".
Makes sense to me why should psych meds be any different?Thanks for reminding me :o)
kristen
--------------------------------------------------------------------------------------------------
> I think that's right. See the info Viridis gave above. Basically, like you said, building tolerance means you have to take increasingly higher doses to get same effect and addiction is needing is more an obsessive drug seeking desire often related to getting the "high;" inevitably it ruins one's life as one does all kinds of stupid things just to get the next hit. Tolerance isn't desireable either since eventually you can't take any more without it hurting you physically.
>
> With dependance, like can happen with Klonopin, so long as you keep taking the med, you're fine...it's just if you try to go off too fast. Keep in mind, lots of people are dependent on all kinds of meds like insulin for diabetics, heart medication, etc. Requiring something to help keep the brain more balanced should be thought of the same way in regards to treating mental illnesses.
>
>
Posted by Viridis on April 7, 2003, at 23:22:09
In reply to Re: Correction: my worst DEPRESSION is anxiety-driven, posted by bretbe on April 7, 2003, at 17:11:29
It sort of becomes a "chicken-and-egg" issue. My GP (who seems fairly dense) asserted that there's no such thing as an anxiety disorder -- according to him, all anxiety is the result of depression, so antidepressants will almost invariably prevent anxiety. Period. When I responded badly to the ADs he prescribed (as I have in the past), he told me that since modern ADs don't have side effects, I must have a "psychological" problem and would be better off with counseling. But, the counselors I've seen generally wind up telling me that I seem quite "centered" and clearly need medication.
My psychiatrist is much more open-minded. He quickly diagnosed me with a primary anxiety disorder, and started with benzos. This helped tremendously, and continues to. When I brought up the issue of anxiety causing depression, he said that anxiety and depression are "inextricably intertwined", and it's often hard to sort out which comes first. In my case, he thinks I have both an anxiety disorder that can induce depression, and a general vulnerability to depression.
He did try very low-dose SSRIs at first but (as before) I reacted very negatively, even with benzos on board. When I told him what was happening, he said that I should stop the SSRIs immediately, and that they're apparently not appropriate for my brain chemistry. He does find them very effective for many patients, and told me that he's used them himself quite successfully for depression, although he did experience substantial side effects.
I have the added complication of (relatively mild) ADD, so we moved to stimulants. Adderall helped a lot with focus, in conjunction with Klonopin and occasional Xanax. When I told him that in addition to helping with ADD, the Adderall had a significant antidepressant effect, he said yes, that's no surprise, stimulants can be very effective ADs. But, apparently it's risky (legally) for doctors to prescribe them primarily for this purpose. So, in a strange way, I guess I'm lucky to have ADD.
Anyway, my pdoc at least recognizes that anxiety can be a cause of depression, although the relationship between the two conditions is not well understood since the two so often co-occur. I, too, wish that more attention would be paid to the anxiety population. Since we constitute a pretty large group (= market), I predict that this will happen, especially as many of the big-gun SSRIs etc. go off-patent.
Posted by bretbe on April 10, 2003, at 13:24:29
In reply to Re: Correction: my worst DEPRESSION is anxiety-dri » bretbe, posted by Viridis on April 7, 2003, at 23:22:09
Thanks for the info. Yeah, your GP is at least very ignorant. Intersting that said it's "psychological"...well, yeah, duh, it's all psychological in the sense that it has do do with how one thinks and feels but there is a corresponsing physiological functioning that occurs in the brain during different psychological states. Kind of like commments...it's all in your head. Well yes, all human experiences is "in the head!". I know the reference was made more towards how to treat it (i.e., counseling versus meds) but it seems idiotic to think that any mental state, anxiety in this case, could not occur from a malfunctining organ, just as any other mental or phyisical illness. It just infuriates me when even people in the medical community have such ignorant beliefs.
Of course, counseling is effective for some people and some problems which, I suppose, is what makes prescribing difficult, e.g., is this the kind of problem that goes away with talk therapy or requires meds. Like you said..."chicken and egg"... subjective human experience can't be measured with the brain probe so no one can say which causes the other at any given time. Both CAN be the cause. Okay, I know you know this...just venting.
Anyway, interesting stuff about the Adderall. I know other narcotics have AD effects too, even morphine, but of course lots of legal issues and issues of abuse potential. Still, when someone is really suffering, why not throw everything we have, at least temporarily. Health care docs are usually is so into pain management but they seem to approach mental pain as not as "painful" as "real" pain. Ironic that all pain is just a fabrication of the brain anyway...it just depends where the stimulus is coming from (e.g., receptor sites in leg sending signal to brain to create pain, or emotional centers of brain malfunctioning and causing pain. Okay, get off soap-box again.
Anyway, interesting to hear others have similar symptoms. Typical AD's have been horrible for me so anti-anxiety meds have been best
This is the end of the thread.
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Dr. Bob is Robert Hsiung, MD,
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