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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 4 of 4. This is the beginning of the thread.
Posted by zeugma on November 14, 2003, at 17:19:35
I started Klonopin last week for extreme anxiety (general and social) at 0.25 mg bid, and immediately experienced a return of hypnagogic and hypnapompic hallucinations and cataplexy. My neuropsych and I came to the conclusion that since Klonopin suppresses stage 3 and 4 sleep, it caused a return of my narcolepsy-like symptoms that had gone into remission with the NE reuptake inhibitors I take. Her advice was to increase the nortriptyline dosage (I'm currently at 75 mg) because nortriptyline has a beneficial effect in both reducing REM s;eep (linked to depression and narcolepsy) and increasing slow-wave sleep (probably through 5HT-2A antagonism). My anxiety is unbearable, but the narcoleptic-like symptoms are painful and can completely disrupt my sleep. Does it sound like a reasonable strategy to up the nortriptyline dosage in order to tolerate the clonazepam? Currently I take 0.25 mg klonopin in the am and it helps some with anxiety, but it wears off and I'm left with some unpleasant anxiety rebound. Also, I seem to be developing tolerance to such a low dose.
Posted by zeugma on November 15, 2003, at 19:24:11
In reply to anxiety or cataplexy, posted by zeugma on November 14, 2003, at 17:19:35
I took about .35 mg of clonazepam this morning (the 0.5 mg pill broke into thirds) and felt a little less anxious today. And I woke up VERY anxious. I napped about 4 pm and did not have the hypnagogic hallucinations, just normal dreamlike imagery :) Maybe 0.5 mg in the morning will get me through the day.
Posted by Guy on November 15, 2003, at 19:38:02
In reply to Re: anxiety or cataplexy, posted by zeugma on November 15, 2003, at 19:24:11
Almost every drug disrupts sleep. I think that is why most drugs are such a double edged sword...they may help you cope for a while, but they will never let you feel good. Feeling good requires natural sleep.
Posted by zeugma on November 16, 2003, at 12:36:55
In reply to Re: anxiety or cataplexy, posted by Guy on November 15, 2003, at 19:38:02
Well, I took about 0.35 mg clonazepam yesterday and had good anxiety relief. Then I had disrupted sleep, insomnia, and mild hynagogic hallucinations. This despite the fact that I only took an am dose. It was better than when I took the 0.25 mg does in the pm, so maybe it will be worth it to put up with sleep disruption for some badly needed anxiolysis.
I assume this is part of why i couldn't tolerate SSRI's. The reason I might tolerate this and not an SSRI is that 1) the SSRI messed up my sleep worse and 2) I never got so much as a tiny bit of anxiolysis from one.
This is the end of the thread.
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