My med history + Klonopin tolerance question

[cbanana]

I haven't posted here in about a year and a half (and even then, I only posted twice), so this thread will necessarily entail some back-story.

This back-story is quite long; skip to the end if you merely wish to address my Klonopin question.

(I don't mean to treat you guys like fools, I just want to save time for some people.)

I was diagnosed with ADHD (age 19) and then began seeing my same psyc a year later for social anxiety (though I've never been formally diagnosed with anything of that nature). For ADHD, I've been taking Adderall IR and it has worked perfectly since day one. I've never a single complaint about the medication and it has enhanced my life in countless ways: I can listen to entire CDs, read books, sit through an entire movie, actually talk to and help people with their personal issues, and do many other things that were previously impossible. At the risk of sounding like a tweaker (though I've never exceeded therapeutic levels), I feel like it enhances and strengthens me in nearly every regard.

For my anxiety, Adderall operates in extremes: it makes me more comfortable among close friends and in non-threatening situations but amplifies my anxiety around strangers and in public. Even in situations which would normally make me anxious, Adderall can often sufficiently distract me from it by keeping me engrossed in some particular matter or conversation. When taken with Adderall, my social anxiety vanishes; however, this is not at all an option that I exercise often (two or three times a year, max) and certainly not one that I wish to turn to in the future.

As I mentioned, I sought advice from my doc about a year later about anxiety. Without getting into it the details, my SA is somewhere between moderate and severe; I typically toss back six shots of Jäger before any kind of social event (that's just the prep; I continue drinking during the event as well). I've had two (very superficial) relationships and have delayed many things in life for years at a time simply because of fear.

Because we had a pretty trusting rapport, he went and ahead and gave me a prescription without putting me through any testing. In addition, I'm the sort to exhaustively research these kinds of things before seeing professionals, so that likely affected his decision as well.

I had read reports on SSRIs, MAOIs, benzos, and other options, but I initially decided to go with whatever he suggested. I tried Celexa (which ended disastrously) and then Prozac, to which I didn't have any particularly positive or negative reaction. Though 2 SSRIs is hardly exhaustive or indicative of the efficacy of an entire class of medications, I pushed for Nardil, which I had become intensely interested in during earlier research.

I took Nardil for an entire summer and it was life changing; I went from a near hermit to a moderately extroverted, happier person. I even dated someone for the first time in years (I was 21 at the time). The contraindications were an interesting challenge, but I gradually adapted and even ate most of the foods on the "banned" list (paying close attention to my reactions, the nature and aging of the food itself, and a blood pressure kit), though I never dared any of the contraindicated medications. Aside from severe sexual dysfunction (killed my ability to orgasm), moderate insomnia, moderate fatigue (which may have simply been a result of the insomnia), and mild twiching, Nardil was excellent. That might sound like a lot of side effects, but the benefits were mind-blowing.

At the end of that summer, my psyc moved away and I was assigned to an older, more conservative doc. In his 30+ (or whatever) years of practice, he had prescribed MAOIs to less than ten patients. He was eager to get me off of the Nardil and I needed Adderall for the upcoming fall semester, so I reluctantly tapered off.

After a few weeks of no meds, it was clear that I still needed help. The new doc put me on Paxil, which was hellish and almost as bad as Celexa, and then Zoloft, which was very similar to Prozac (it did very little if anything at all). He was very much against MAOIs. By this time, it was the late spring and I was at the end of my undergrad career. He gave me one last script for Adderall before my eligibility ran out (this was at a university health center).

From this past June through early October, my life tumbled out of control; my social anxiety prevented my from even finishing job applications because my crushingly low self esteem. I was out of contact with my parents for a time, as one was against psychiatry in general and the other was highly stressful to deal with (regardless of the matter). I ran out of money and had to move in with a friend; I'm still living on his couch (he's been really cool about it and I'm thankful for that).

Last month, I finally had a big sit down and gave my family the low-down, and (honestly) stated that I could not move forward with my life until I dealt with the these issues. They're currently paying for a therapist and a psychiatrist, so things are looking up for the first time in a while.

So far, I'm neutral regarding the therapist; I can't tell if I've reaped any benefit from our sessions and I can't see a clear direction that we're going, but I trust his judgment and he was recommended by a family friend.

The psyc is in the middle of the road compared to my first two; she listens carefully to my opinions but doesn't give me free rein. I immediately asked for Nardil on the first visit, but she wanted to research it and consult some peers before giving me this script. She is the first psyc that has implicated dopamine shortage in my SA; her reasoning came from the success I've had on Adderall (to an extent) and with Nardil. Because four SSRIs have failed to have any impact of my anxiety, we've agreed that serotonin likely has little part to play in my overall situation. I also think (this is just me, not my doc) that GABA is crucial to my relief, as evidenced from my results from Nardil and alcohol.

She denied Nardil for now (though she allows for the possibility in the future) and put me on Seroquel. This struck me as very odd since I had come across no mentions of it in my research and scant evidence for any antipsychotic as being efficacious for SA. I sampled it for three days and it completely knocked me out; even a high dose of Adderall and caffeine could not overcome the tremendously sedating effect.

I rather sternly put my foot down against any other antipsychotics (as well as SSRIs), so she began thinking of other options. To my surprise, she asked if I wanted to try Klonopin. I had been very skeptical of benzos because of their reputation of dependence, rapid development of tolerance, and withdrawal symptoms; the idea of mixing a benzo with amphetamine didn't seem like such a hot idea, either. On the other hand, I was running low on choices.

I've been testing the combo for a week and it's absolutely amazing. It's very close to what I experienced with Nardil; I have slightly more energy and motivation but a little more anxiety as compared to Nardil, but it's overall very nice. My current dose is .75 to 1 mg Klonopin a day combined with 10mg of Adderall taken 2-3 times a day, as needed.

This past week has been the first time in a very long while that I've been able to go out in public and function. I've even applied for a few jobs; it seems too good to be true.

Therein lies the issue. I know that my success with Klonopin will not last forever; in fact, most sources seem to indicate that I have, at most, a month or two before the consequences start catching up to me (tolerance, dependence, and then the subsequent withdrawal).

So, here are my questions for you (extremely patient) readers:

1. Has anyone successfully and sustainably (6+ months) found relief with a combination of a stimulant and a benzo without developing tolerance or severe side effects? If yes, were the doses stable or did you have to escalate one or the other gradually to offset the other med? Also, have you tried and had success on an MAOI?

2. What are the chances that I can continue to benefit from Klonopin beyond these initial weeks/months? Can I take steps to slow or prevent tolerance (like people do with Magnesium and Adderall) aside from drug holidays?

3. Has anyone successfully used Klonopin (or other benzos) for very long periods of time (several years or more) without any measures taken to combat tolerance? I ask this because I've never had any issues with tolerance while taking Adderall (I've taken the same dose for three years), and wonder if some people simply don't develop tolerance to certain substances.

4. If benzos don't turn out to be viable, what would be my next step? SSRIs are out of the question, as are antipsychotics. Returning to Nardil would be nice, but giving up Adderall would be a great sacrifice. I have heard of people successfully combining Nardil with stimulants, but that sounds extremely dangerous.

5. Also, I'd be interested in hearing from anyone else who has ADHD in addition to SA and the steps they've taken to treat it.

6. Kind of unrelated; does anyone else suffer from SA but have no fear of public speaking? Passing someone on the street or ordering at a restaurant is hell, but if a group is larger than, say, 10-15 people I can speak to them with ease. I even won several awards as an attorney in high school mock trial competitions; for some reason, I have absolutely no fear of speaking to large groups and have never suffered from stage fright.

That's all! Thanks a lot to those (if anyone) who read through all of that, and I thank anyone in advance for any advice or relevant experience.

[Vini Vidi Vici]

First of all, im Really glad the K-pin + Aderral is working for you. i can feel your pain, through all the crappy SSRIs, which i also hate. i had to do exactly what you did, going through tons of Docs until i finally got an MAOI. for me, i did develop a tolerance to K-pin after 4 months of excessive 5-10 mg a day use. the anti anxiety effects, i got somewhat tolerant to. but it still helped considerably, and if i took gradual breaks (only taking K -Pin 4 days a week,) my tolerance went way down. But i must mention that i grew completely tolerant to Adderral (taken for depression/ADD) in less than 1 month. but you havent...so maybe you get tolerant 2 stuff slowly..

If the Adderrall + K Pin doesn't keep working....i am not sure of other viable alternative medications. your current combo is one of the best possible, many people would die to get it.

I think one of the best things to do would be to Prevent tolerance to your meds in any way possible. Tolerance to K-Pin and Addy are largely mediated by an NMDA-related mechanism. If you block NMDA activity by using a drug, you will prevent/ slow down tolerance to K-pin and Addy. But getting an NMDA antagonist can be hard, especially when you doc is already superconservative.....and i really havn't been able to find any Reliable natural NMDA antagonists, other than Magnesium. Magnesium might help... i hope more people reply to this post....i think this combo is really popular for SA, and well, every mental disorder except schizophrenia/OCD. --- i might be able to think of some better ideas/suggestions for you, but i will have to do that thinking tomorrow. right now, nearly all of my thinking processes are slowed down to a speed of like 8 miles an hour, cuz i took my Sleeping Pill (zopiclone), which works super strong for me.

[cbanana]

Is a basic magnesium supplement suitable for tolerance prevention?

[Vini Vidi Vici]

it has a good chance of preventing some tolerance. however, its is not very powerful or effective. some types of magnesium are more bioavailiable than others...im not sure which...but i know there are tons of references to magnesium and preventing tolerance on this forum .....you could type it into the search...and im sure you will find tons of information/threads on preventing tolerance with it and other compounds.

[Vini Vidi Vici]

magnesium glycinate or magnesium citrate seems to be the most recommended by people... i dont have experience with either used long term. magnesium seems to make me nauseous sometimes, i dont know why really...could be the placebo effect.

[crayzyMed]

I dont think magnesium would be powerfull enough, memantine would definatly block tolerance to amphetamines and there is some research of it blocking benzo tolerance. DXM would also work (didnt read your whole text due to my ADD mind) if your only on klonopin and adderall you can take DXM to block tolerance.

For more info, check out my own thread with a list of research and anecdotal reports.
NMDA Antagonists and tolerance.

[Vini Vidi Vici]

Originally Posted by crayzyMed

I dont think magnesium would be powerfull enough, memantine would definatly block tolerance to amphetamines and there is some research of it blocking benzo tolerance. DXM would also work (didnt read your whole text due to my ADD mind) if your only on klonopin and adderall you can take DXM to block tolerance.

For more info, check out my own thread with a list of research and anecdotal reports.
NMDA Antagonists and tolerance.

yes..DXM. i knew i had forgotten something last night. Taken in low doses once to 3 times a day, it greatly helped prevent, and even somewhat reversed my incredible tolerance to Addy. but make sure you get DXM cough syrup with ONLY DXM, if you choose to try this potentially risky route. There are conflicting reports on how much DXM is needed to cause neurotoxicity.....but i think it is alot, more than 100mg used consistently. I used only about 25-50 mg DXM Hbr 2-3 times a day...but if you use Delsym (DXM polisterex) you only have 2 use it 1-2 times a day, in much lower amounts.

[crayzyMed]

Originally Posted by Vini Vidi Vici

yes..DXM. i knew i had forgotten something last night. Taken in low doses once to 3 times a day, it greatly helped prevent, and even somewhat reversed my incredible tolerance to Addy. but make sure you get DXM cough syrup with ONLY DXM, if you choose to try this potentially risky route. There are conflicting reports on how much DXM is needed to cause neurotoxicity.....but i think it is alot, more than 100mg used consistently. I used only about 25-50 mg DXM Hbr 2-3 times a day...but if you use Delsym (DXM polisterex) you only have 2 use it 1-2 times a day, in much lower amounts.

Doses used for tolerance prevention are far from being neurotoxic

[Vini Vidi Vici]

Originally Posted by crayzyMed

Doses used for tolerance prevention are far from being neurotoxic

awesome... and also, DXM had for me pro-social/anti-anxiety/antidepressant properties all by itself. when combined with Adderrall, it was actually quite strong, i was really happy, and wanted 2 talk to people and stuff was fun to do. i dunno some people react differently to DXM though.... memantine would probably be easier to dose, you'd only have 2 take it once every 2-3 days