[jeffsimmons]

Hello,

A few years back, I saw a psychiatrist a few times and was diagnosed with SAD and was making a little progress. Unfortunately I ran into insurance problems and would have had to pay $125/visit, twice a month and simply couldn't afford that. Recently I brought up to my general practitioner my anxiety issues and he just promptly wrote me a script for .5mg clonazepam 2 times a day and sent me on my way without explaining a thing.

I've been taking this medicine now for a week or so, and feel absolutely no effects at all. I hear it's supposed to make you a bit drowsy, and help your anxiety somewhat quickly (2 hours after first dose or so.) Is this true or should it take longer? I called my doctor but it appears he's on vacation, yet again, and will be gone for 2 weeks more and is pushing people off on another doctor in his practice who won't change this medication for me and says to wait for him to return.

Long story short, is there any danger in upping it to 2-.5mg pills, 2 times a day? Does anyone here have any other advice?

 

[UltraShy]

Peak effect in about two hours would be about right for clonazepam (Klonopin).

If it's not working the most likely reason is that the dose if too low for your needs.

Long story short, is there any danger in upping it to 2-.5mg pills, 2 times a day? Does anyone here have any other advice?

No, there's no physical danger in taking 1 mg twice a day. This is a danger of your doc having a hissy fit about a patient who ignores instructions and takes more of a controlled substance than Dr. God instructed.

 

[jeffsimmons]

Ok, well I'll have to give it a try then. As for the changing of medications, he's completely used to that by now. I have chronic ulcerative colitis (a big factor in my axiety issues) and have been as high as 43 pills a day, and have slowly found that I need only 11 pills a day to remain in remission. He actually has kept records of what I change and keeps track of my symptoms so as to help other patients as well since he himself has admitted it's all a guessing game to see what works well.
Anyways, I'll have to up it to 1mg twice a day and see how that goes and if it's not any good, I'll go back in two weeks. One other thing though, if it doesn't work, what other medications should I be looking at for SAD? I don't want something that'll make me feel like a zombie, or something that won't allow me to do my job because I'm too out of it, etc. Also, what's the best way to approach asking for a medication change, I don't want to seem like a drug seeker.
Any insight is appreciated.

 

[DontTrustheGov't]

The immediate danger in upping your dose without doctors approval is that you will run out before your supposed to refill. Eventually the doctor will catch on and will think your abusing the meds and wont prescribe it again. The long term danger is of course physical dependence and tolerance but hopefully you already know this.

Your GP should have explained Klonopin better to you. Unfortunately this about the best care you can expect from a GP because they are not very experienced in mental health issues. It really is best to see a psychiatrist if you don't have a good understanding of the pills used to treat it.

If you absolutely cannot afford to see a psychiatrist then it would be best to research all of the drugs used to treat SA before you try them. Some of the medications can be dangerous and you must be able to accept the danger before you start treatment.

I was on 4mg/day Klonopin so I am fairly experienced with the drug. The first benzo I ever tried was .5mg of Klonopin and it didnt do much. The only dose that helped me was 1mg and above. For quite some time I was on 1mg 2x daily. I eventually grew tolerant at the 4mg dose and decided to switch meds/doctors.

If your not satisfied with the Klonopin then I would recommend trying Xanax. I am on .75mg/day and it helps me more than Klonopin ever did because it works so fast. Most doctors prescribe even bigger doses than .75mg/day, this is just the minimum dose that helps me.

Benzo's like Klonopin should take effect within 1 hour and the effect usually lasts for 8 hours and is still noticeable the next day. Dissolving it under the tongue makes it work quicker. At first, they give you an alcohol like buzz but this feeling wears off after several days of regular use. The "buzz" feeling is not intended to be the anti-anxiety effect and I think many people mistake this.

 

[jeffsimmons]

Alright, thanks for the info, I appreciate it. As for running out, that shouldn't be a problem over the next month, I was given a script for 2 .5's a day, filled it once and never used it since i was anxious over taking it. I recently talked witha friend who uses it and said it's really no big deal and to not worry. So I called the doc and asked for a refill just in case I needed it and am finally just getting around to starting it. Again, I appreciate the info and am hoping that the 1mg will have a positive effect on my life.

 

[UltraShy]

Your GP should have explained Klonopin better to you. Unfortunately this about the best care you can expect from a GP because they are not very experienced in mental health issues. It really is best to see a psychiatrist if you don't have a good understanding of the pills used to treat it.

Any GP should be able to explain benzos reasonably well (if we ignore the typically strong anti-benzo "this stuff is super addictive" nonsense). After all, benzos have been in use since 1960 and have been one of the most widely used drug classes in the history of the world. Valium was the #1 selling prescription drug for an entire decade back in the 1970s, so benzos are hardly some exotic unknown.

If you absolutely cannot afford to see a psychiatrist then it would be best to research all of the drugs used to treat SA before you try them. Some of the medications can be dangerous and you must be able to accept the danger before you start treatment.

Other than MAOIs I can't think of any SA treatment that you have any realistic chance of getting a drug that carries any serious risk. SA drugs tend to be annoying but harmless, not potentially deadly. SSRIs are the standard first-line SA treatment and to use one common SSRI as an example, there has been only one documented case of death by Zoloft in the entire world -- not even suicidal folks who are trying to die can manage to off themselves with SSRIs; I'd call that pretty damn safe.

 

[Medline]

Other than MAOIs I can't think of any SA treatment that you have any realistic chance of getting a drug that carries any serious risk.

And what about benzodiazepines? They can be psychologically and physically addicting. If you would hypothetically stop your Xanax too fast (for whatever reason) this could result in seizures, delirium and potentially death. And if you would like to come off your Xanax this would take you really many unpleasant months (without Phenobarbital). But we both know you will stay on it forever so nevermind.

Here something about MAOIs and their (death) risk in comparison with NSAIDs:

An approximation of the risk to benefit ratio of NSAIDs compared with MAOIs will place things in perspective. This is especially topical and pertinent in view of the recently recognised association between SSRIs and GI bleeding. NSAIDs are mostly used for arthritis which rarely has a fatal outcome. In major depression there is a 10-15% life-time risk of suicide as well as a greatly increased standardised mortality ratio (SMR). Consider the number of deaths from GI bleeds associated with NSAIDs (the figure is 1,200 deaths every year in the United Kingdom (2), not to mention cases of Stevens-Johnson syndrome/toxic epidermal necrolysis (3). Most doctors will have seen quite a few cases. Compare that to the rarity of cerebral bleeds from MAOIs. Most doctors will never ever see, or even hear of, a single case in their entire career. Deaths from MAOI induced hypertension are very rare. It is hard to find many reported in the last 50 years. A search of the whole Pubmed data base returns 67 hits for the keywords 'fatal' + 'monoamine oxidase inhibitor'. Many of these relate to serotonin toxicity, older reports to hepatic toxicity, but not one single report of intra-cranial bleeding. Another possible perspective is to note that fatal cerebral bleeds are documented as a result of the increase in arterial blood pressure secondary to weight lifting (4), which can elevate BP to 480 mm Hg. So, although exact figures for cerebral bleeds are imprecise this comparison puts the matter into perspective. It is abundantly clear that to regard MAOIs as dangerous is not just an over-reaction but also an egregious example of the unscientific and ill informed opinions not uncommon in the psychiatric fraternity.

 

[euphoria]

I've been taking this medicine now for a week or so, and feel absolutely no effects at all. I hear it's supposed to make you a bit drowsy, and help your anxiety somewhat quickly (2 hours after first dose or so.) Is this true or should it take longer? I called my doctor but it appears he's on vacation, yet again, and will be gone for 2 weeks more and is pushing people off on another doctor in his practice who won't change this medication for me and says to wait for him to return.

That's because your dose is tiny. Even when I wasn't tolerant at all to benzos, it took about 2mg for proper anxiety relief. The annoying thing is that these doses affected my mental function significantly, so I had to choose between feeling calm or having intelligence.

Long story short, is there any danger in upping it to 2-.5mg pills, 2 times a day? Does anyone here have any other advice?

Not in the short-term, no. Of course a higher dose means more severe withdrawal.

 

[Medline]

It's individual between 3 or 4 weeks and then 10 days off. And the dose shouldn't be too high, so no benzo abuse to get "high" or let's better say "down". 4mg (2mg twice daily seems ok), make a fast taper before the end of week 3 or 4 for some days to be on the safe side.

 

[Cast Away]

Your dose is to small. .5 dosnt faze me or hardly anybody else. 1mg + helps prevents panic attacks and may calm you down slightly, but for me and other people by their posts, to really put a dent or eliminate your SA it takes a big dose. 3-4 mg is what i need to really be somewhat comfortable and worry free around people. I take my klonopin prn because i find it more effective that way.

 

[euphoria]

I much prefer Xanax to Klonopin and Valium. I consider pure GABA agonism to be quite a depressive experience, and Xanax's more "fun" attributes are probably from its other actions in the brain:

http://www.biopsychiatry.com/alprazolam.htm

Anyone else find Xanax to be the most recreational benzo? I only took it at the start of my year-long interlude with benzos, but that was by far the most fun part. Klon just made me dull. Now Xanax + Nardil, that was a different story...

 

[euphoria]

It was very effective, but had too many annoying side-effects like orthostatic hypotension, constipation, sedation, insomnia and sexual dysfunction. I've read that moclobemide is free from most of those, so hopefully I'll have some luck with that in 11 days.

 

[Medline]

I've tried Moclobemide and consider it a sugar pill on it's own even @ 900-1200mg (at least for me it was). But 900mg combined with low dose Selegiline (2.5-5mg) was ok and I could eat what I wanted. Kind of imitating a real MAOI without dietary restrictions. Moclobemide has really few side effects.

 

[euphoria]

I do smoke though, so my MAO levels are already gonna be pretty low. What other drugs were you on at the time? You felt nothing?

 

[Medline]

1200mg Moclobemide felt like nothing, maybe a little bit of a dry mouth, not more. You should know that I am pretty resistant to drugs, so you might have a good response. But don't think it will feel anything like Parnate or Nardil, because it won't.

 

[UltraShy]

Here something about MAOIs and their (death) risk in comparison with NSAIDs:

It could be argued that the risk of NSAIDs is generally ignored. Stats I've seen put the US death rate from NSAIDs at I think around 16,000 a year with 100,000 hospital admissions resulting from the GI bleeding they cause.

There are other drugs that can be used for arthritis pain instead of these gut-rotters. My mother had to stop NSAIDs years ago due to their gut-rotting effect. Tramadol (Ultram) has been working just fine for her for the last 9 years on a daily basis without any side effects at all. Before her knee replacement back 5 years ago she also used OxyContin and later methadone (same effect, but dirt cheap) and, despite the BS spread by the media they failed to turn her into an addict.

 

[UltraShy]

And what about benzodiazepines? They can be psychologically and physically addicting. If you would hypothetically stop your Xanax too fast (for whatever reason) this could result in seizures, delirium and potentially death. And if you would like to come off your Xanax this would take you really many unpleasant months (without Phenobarbital). But we both know you will stay on it forever so nevermind.

Have any stats on how many people die each year from benzo withdrawal? It would be interesting to see any you might be able to find as this is one thing I've never yet seen data on. I know it can kill, but never see any numbers on how often it actually does.

 

[euphoria]

I think denying chronic pain sufferers opioids is more than immoral; it's pure evil. Someone should administer naltrexone to the guys making drug laws and see how quickly they beg for pain meds.

 

[Medline]

I think denying chronic pain sufferers opioids is more than immoral; it's pure evil. Someone should administer naltrexone to the guys making drug laws and see how quickly they beg for pain meds.

Administering the "bad guys" naltrexone won't cause them any pain, not even anhedonia or depression in most cases, the drug is approved by the FDA for alcoholism and considered safe. But you are right, denying chronic pain patients adequate medication is evil and can result in severe suffering and suicide.

 

[euphoria]

Really? I thought it'd block endorphins, causing dysphoria.