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Dr. Bob is Robert Hsiung, MD,
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Posted by ed_uk on April 2, 2006, at 13:49:18
In reply to Re: Is Valium more potent than Xanax? » ed_uk, posted by zeugma on April 2, 2006, at 12:28:54
Hi Z
>The often-noted greater prevalence of depression as a result of clonazepam relative to other benzos, would appear to disprove this
I don't know. It seems to be more depressing than Xanax, but is it more depressing than the other benzos? Xanax seems to be somewhat unique.
Regards
Ed
Posted by zeugma on April 2, 2006, at 14:29:01
In reply to Re: Is Valium more potent than Xanax? » zeugma, posted by ed_uk on April 2, 2006, at 13:49:18
hello Ed,
this is something I didn't expect to find:
Eur Neuropsychopharmacol. 2003 Mar;13(2):129-34.
Clonazepam in the long-term treatment of patients with unipolar depression, bipolar and schizoaffective disorder.Winkler D, Willeit M, Wolf R, Stamenkovic M, Tauscher J, Pjrek E, Konstantinidis A, Schindler S, Barnas C, Kasper S.
Department of General Psychiatry, University Hospital for Psychiatry, Wahringer Gurtel 18-20, A-1090, Vienna, Austria. [email protected]
The value of a long-term treatment with clonazepam in the prophylaxis of affective disorder is discussed controversially in the scientific literature. Altogether there are only a few reports on the use of this compound as a mood stabilizer, most of them describing patients suffering from bipolar affective disorder. The aim of this investigation was to evaluate clonazepam as a phase prophylactic medication in affective disorder. We conducted a retrospective chart review in 34 out-patients of our lithium clinic (15 suffering from unipolar depression, 15 from bipolar disorder, four from schizoaffective disorder), who had been treated with clonazepam as a long-term medication. Clonazepam was either given as monotherapy, or as in the case of lithium non-responders, as adjunctive therapy. Patients with unipolar depression had significantly (P=0.026) less depressive episodes after initiation of treatment with clonazepam. Patients with bipolar disorder did not benefit from this therapy. Neither manic/hypomanic phases nor depressive episodes were reduced in this group of patients. Interestingly, clonazepam also reduced affective phases in our four schizoaffective patients on a trend level. Our results indicate that patients with unipolar depression may benefit from a maintenance treatment with clonazepam. Due to methodological limitations our results need to be replicated in controlled double-blind randomized clinical trials.
>>>>>>>>>>>>>>>>>>>>>>>>>>>
nfortunately, there really is very little literature on clonazepam and depression, other than anecdotal reports here, in which I have seen far more frequent attributions of depression to clonazepam than to any of the other benzos. It is difficult to find literature on the possible antidepressant or depressant effects of other benzodiazepines other than alprazolam and adinazolam.
-z
Posted by ed_uk on April 2, 2006, at 15:14:50
In reply to Re: Is Valium more potent than Xanax? » ed_uk, posted by zeugma on April 2, 2006, at 14:29:01
Hi Z
Clonazepam has been looked at to 'augment' antidepressants. I think the research was Japanese.
>reports here, in which I have seen far more frequent attributions of depression to clonazepam than to any of the other benzos
That's true. Most babblers compare it to Xanax though. In many cases they haven't taken any other benzodiazepines.
>Patients with unipolar depression had significantly (P=0.026) less depressive episodes after initiation of treatment with clonazepam. Patients with bipolar disorder did not benefit from this therapy. Neither manic/hypomanic phases nor depressive episodes were reduced in this group of patients. Interestingly, clonazepam also reduced affective phases in our four schizoaffective patients on a trend level. Our results indicate that patients with unipolar depression may benefit from a maintenance treatment with clonazepam.
That's interesting. I would not consider clonazepam to be a 'mood stabiliser'. There seems to be a trend to refer to all antiepileptics as mood stabilisers, even in the absense of evidence.....Topamax being the most obvious example today..........gabapentin a few years ago.........probably Keppra next.
Kind regards
Ed
Posted by SLS on April 2, 2006, at 15:39:52
In reply to Re: Is Valium more potent than Xanax? » zeugma, posted by ed_uk on April 2, 2006, at 15:14:50
Clonazepam + lithium was more effective than lithium alone in treating my manic reaction to Parnate + desipramine.
- Scott
Posted by zeugma on April 2, 2006, at 16:52:01
In reply to Re: Is Valium more potent than Xanax?, posted by SLS on April 2, 2006, at 15:39:52
> Clonazepam + lithium was more effective than lithium alone in treating my manic reaction to Parnate + desipramine.
>
>
> - Scotthi Scott,
did you only take clonazepam acutely? and if not, what effect did it have?
-z
Posted by Sobriquet Style on April 2, 2006, at 18:09:51
In reply to Re: Is Valium more potent than Xanax?, posted by bassman on April 2, 2006, at 11:13:09
>I hope these will be of help:
I am extreamly grateful, thank you :-)
~
Posted by bassman on April 2, 2006, at 18:31:02
In reply to Re: Is Valium more potent than Xanax? » bassman, posted by Sobriquet Style on April 2, 2006, at 18:09:51
My pleasure. I hope you can get your doc to be reasonable...that's a pet peeve of mine when docs make patients "beg" for medication, because, of course, they know so much better. A month of severe anxiety and depression for them to educate them, I say. :>}
Posted by SLS on April 2, 2006, at 18:45:13
In reply to Re: Is Valium more potent than Xanax? » SLS, posted by zeugma on April 2, 2006, at 16:52:01
> > Clonazepam + lithium was more effective than lithium alone in treating my manic reaction to Parnate + desipramine.
> >
> >
> > - Scott
>
> hi Scott,
>
> did you only take clonazepam acutely? and if not, what effect did it have?
I took clonazepam for 6-12 months. I can't remember exactly. I was also taking Nardil for most of that time. I really don't know what to say other than it helped with sleep and was difficult to discontinue. I wish I had the insight then that I have now regarding the management of withdrawal symptoms. I went through hell.More recently, an attempt at using clonazepam acutely as a sleep aid did make my depression somewhat worse.
The last time I tried using a benzodiazepine (lorazepam) for sleep, I found that it made me more depressed the day after my first dose. However, this depressogenic effect disappeared after a few days.
- Scott
Posted by Phillipa on April 2, 2006, at 19:55:55
In reply to Re: Is Valium more potent than Xanax? » bassman, posted by ed_uk on April 2, 2006, at 13:37:40
Ed that's exactly what a pdoc said. And they have to take regular xanax in between. It doesn't release exactly at the rate it should Love PJ O
Posted by Phillipa on April 2, 2006, at 20:03:18
In reply to Re: Is Valium more potent than Xanax? » ed_uk, posted by Phillipa on April 2, 2006, at 19:55:55
What do you do if you regularly suffer from panic attacks. Did you ever have one you can't even breathe. Love Phillipa
Posted by Meri-Tuuli on April 3, 2006, at 5:51:29
In reply to So If You Live In The UK? » Phillipa, posted by Phillipa on April 2, 2006, at 20:03:18
Its awful. I have no idea what GPs do when they get patients with aniexty problems. I guess try them on BuSpar, but.. then what? And thats not even recommended for panic. I reckon they just put people on an SSRI/TCA and thats it.
My 'mother in law' is on valium, she gets it no problem -- but I think that is because she has been on it for most of her life so the GPs view that completely differently. As for us young 'uns, benzo = forget it.
Sigh. It makes me so mad we can't get the pysch medication we need here in the UK.
Posted by Sobriquet Style on April 3, 2006, at 8:16:49
In reply to Re: Is Valium more potent than Xanax?, posted by bassman on April 2, 2006, at 18:31:02
>that's a pet peeve of mine when docs make patients "beg" for medication, because, of course, they know so much better.
I know exactly what you mean!
:-)
~
Posted by ed_uk on April 3, 2006, at 14:06:15
In reply to Re: So If You Live In The UK? » Phillipa, posted by Meri-Tuuli on April 3, 2006, at 5:51:29
Hi Meri
>Its awful. I have no idea what GPs do when they get patients with aniexty problems. I guess try them on BuSpar, but.. then what? And thats not even recommended for panic. I reckon they just put people on an SSRI/TCA and thats it.
BuSpar is hardly ever prescribed. SSRIs are widely used for panic disorder. Older docs often prescribe dothiepin (a tricyclic). Have you ever tried a tricyclic?
>My 'mother in law' is on valium, she gets it no problem -- but I think that is because she has been on it for most of her life so the GPs view that completely differently. As for us young 'uns, benzo = forget it.
That's exactly right. Elderly women who have been on diazepam (Valium) for many years generally have little problem getting prescriptions. Young people (especially men I believe) are treated very differently. I've actually seen prescriptions for ONE 2mg diazepam tablet. Geez, I need at least 10mg per dose.
Regards
Ed
Posted by Meri-Tuuli on April 3, 2006, at 15:07:55
In reply to Re: So If You Live In The UK? » Meri-Tuuli, posted by ed_uk on April 3, 2006, at 14:06:15
Hello Ed!
> BuSpar is hardly ever prescribed. SSRIs are widely used for panic disorder. Older docs often prescribe dothiepin (a tricyclic). Have you ever tried a tricyclic?
No I haven't. I daren't touch them, as I'm sleepy enough on SSRIs let alone a tricyclic -- I could sleep for 16 hours a day on 20mg of celexa. I believe the tricyclics are quite sedating? I need the opposite! : )
A friend of mine is on Dothiepin, and she does very well on it. I think she even got a benzo from her GP for panic, although I don't know which one/how much. I've emailed her to ask. I'm desperate not to have another one!!
I don't know how we're supposed to cope. Why are GPs so incredibly anti-benzo? I know they are addictive etc but to not prescribe them when they are clearly needed? And why are SSRIs the answer?? They're not! They are pretty bad. I haven't taken one thats helped my anxiety!! And anyway, SSRIs aren't exactly an easy ride when coming off them.
Anyway I still can't believe that my GP doesn't think that ADs are suitable 'in my case'. He doesn't even know which ones I've tried!!!!!!!! Well anyway, the whole establishment with GPs is totally pathetic. I know more about pysch meds than they do. It gets me really mad. Like suicide is the second/third cause of death for young people (I can't remember the exact stats) and what does anyone on the NHS do about it? Nothing!! There should be mental health support groups at every GPs surgery, there should be better counselling services, CBT courses etc etc, but there isn't anything. Well I suppose CPNs but I never found mine particulry useful. Yet I bet if that suicide stat was for say, breast cancer, there would be sooooo much more money and resources availble. Yet suicide is still abit taboo, and somehow the person who did its fault. People don't see it as a diease, they see it as a charactor flaw. Grrrrrrrr
Anyway, sorry to rant on! I should put my ranting energy into something useful, although I've already written a letter to my health centre manager to complain about the mental health services. But I don't what to rock the boat too much, I have to go there....LOL!
>Young people (especially men I believe) are treated very differently. I've actually seen prescriptions for ONE 2mg diazepam tablet. Geez, I need at least 10mg per dose.
I wonder why men specifically? Maybe anxiety is still percieved as primarily a womens disorder.
Oh well.
Take care,
Meri
x
Posted by yxibow on April 3, 2006, at 15:08:10
In reply to Re: So If You Live In The UK? » Meri-Tuuli, posted by ed_uk on April 3, 2006, at 14:06:15
> That's exactly right. Elderly women who have been on diazepam (Valium) for many years generally have little problem getting prescriptions. Young people (especially men I believe) are treated very differently. I've actually seen prescriptions for ONE 2mg diazepam tablet. Geez, I need at least 10mg per dose.
I was going to say ___ out of luck, but Ed put it more politely. Seems the same as lists of things in Australia from what I can tell -- including a government of big brother over movies, which we used to have in the US until it was self-regulated.Its really atrocious that life enhancing and saving medications (i.e. getting housebound people out into the public), even the smallest dose of benzodiazepines are disdained upon by the NHS. Of course maybe one could circuitously freeze this by going to a private doctor. But I imagine the costs would be much greater than NHS.
Of course I speak as a user of (prescribed) high dose benzodiazpines (for a specific disorder that is quite atrocious), but I used to take lower doses frequently in the past of things like Klonopin to augment antidepressants, etc here in the US. Yes, we have the looming DEA, but if you present a good case to a doctor you're likely to get some response for necessary medications. And then we pay more here too, since we don't have the NHS or Canada to regulate drug prices. Argh...
My 2c
-- Jay
Posted by ed_uk on April 3, 2006, at 15:48:07
In reply to Re: So If You Live In The UK? » ed_uk, posted by yxibow on April 3, 2006, at 15:08:10
Hi Yxi
At one point, benzodiazepine prescribing was used as one of several factors which were used to compare 'good prescribing' between primary care trusts in England. Areas in which benzo prescribing was high were assigned the lowest 'marks'.
GPs may try to force patients off benzos in order to meet NHS targets and improve their ratings.
Benzophobia is extreme in the UK. One GPs I saw sneered 'I never prescribe drugs like THAT'. He even had the cheek to tell me than my pdoc should never have prescribed me a benzo.
Most English doctors believe that the long term use of benzos is never valuable and that patients must be withdrawn ASAP. Withdrawing from benzos is (rather nauseatingly) seen as a great necessity, even in people who are apparantly doing well on benzos. Having taken a benzo seems to be viewed as something to keep quite about. Almost as if it was shameful.
Ed
Posted by Meri-Tuuli on April 3, 2006, at 15:49:25
In reply to Re: So If You Live In The UK? » ed_uk, posted by yxibow on April 3, 2006, at 15:08:10
Hi Jay!!
> Its really atrocious that life enhancing and saving medications (i.e. getting housebound people out into the public), even the smallest dose of benzodiazepines are disdained upon by the NHS. Of course maybe one could circuitously freeze this by going to a private doctor. But I imagine the costs would be much greater than NHS.
Well, the NHS costs nothing. We pay a set fee for all drugs, which is about $9 per script, no matter whats being prescribed! But, obviously, we pay more tax, the NHS is funded through tax, but it is free to everybody and generally nobody really has private operations. Unless its for cosmetic reasons... As much as I moan about the NHS, I do generally think it is a good thing. I would hate to have to pay for my healthcare directly and I even think it morally wrong in a way. I mean, I couldn't believe that people in the US actually beg for money to have an operation - I saw this on a trip there. But then, if you have the money, you get the healthcare that you need as opposed to here where they are pretty bad for mental healthcare... But that said, I think the NHS is pretty good for everything other than mental health.... I mean what do you do in America if you have cancer and can't afford to pay for treatment? Do you just have to accept it? I don't know, I honesty can't imagine having to worry about paying directly for my healthcare or having health insurance.... it somehow seems wrong to me.
But then I'm not entirely sure I would like to have it like in the US where people are on a cocktail of 5 pysch meds. That just seems plain scary to me. I don't know. I sometimes think that the med companies push their drugs abit too hard onto GPs and patients. American doctors (and patients?) seem abit too pill happy for me.
Maybe a middle ground between the US and the UK would be good.
Take care
Meri
>
> Of course I speak as a user of (prescribed) high dose benzodiazpines (for a specific disorder that is quite atrocious), but I used to take lower doses frequently in the past of things like Klonopin to augment antidepressants, etc here in the US. Yes, we have the looming DEA, but if you present a good case to a doctor you're likely to get some response for necessary medications. And then we pay more here too, since we don't have the NHS or Canada to regulate drug prices. Argh...
>
>
> My 2c
>
>
> -- Jay
Posted by Meri-Tuuli on April 3, 2006, at 15:53:49
In reply to Re: So If You Live In The UK? » yxibow, posted by ed_uk on April 3, 2006, at 15:48:07
Ed.
Wow, I didn't know that! Sigh. But aren't benzos 'safer' than SSRIs?? I mean, they have been around a very long time. Certainly, SSRIs haven't been around that long.
I wonder if it is the same in other European countries??
M
> Hi Yxi
>
> At one point, benzodiazepine prescribing was used as one of several factors which were used to compare 'good prescribing' between primary care trusts in England. Areas in which benzo prescribing was high were assigned the lowest 'marks'.
>
> GPs may try to force patients off benzos in order to meet NHS targets and improve their ratings.
>
> Benzophobia is extreme in the UK. One GPs I saw sneered 'I never prescribe drugs like THAT'. He even had the cheek to tell me than my pdoc should never have prescribed me a benzo.
>
> Most English doctors believe that the long term use of benzos is never valuable and that patients must be withdrawn ASAP. Withdrawing from benzos is (rather nauseatingly) seen as a great necessity, even in people who are apparantly doing well on benzos. Having taken a benzo seems to be viewed as something to keep quite about. Almost as if it was shameful.
>
> Ed
>
>
>
Posted by ed_uk on April 3, 2006, at 16:00:32
In reply to Re: So If You Live In The UK? » ed_uk, posted by Meri-Tuuli on April 3, 2006, at 15:53:49
Hi
>I wonder if it is the same in other European countries??
Maybe some, but I think it's worse here. Benzos are apparantly readily available in some European countries. Italy, Spain, Greece.... I think.
Ed x
Posted by Meri-Tuuli on April 3, 2006, at 16:08:54
In reply to Re: So If You Live In The UK?, posted by Meri-Tuuli on April 3, 2006, at 15:49:25
Hi Jay,
Sorry if that post came across as being abit too strong! I'm not having a go at anything (except the benzo-phobic GPs here in the UK!). I'm just abit frustrated by it all to be honest. In theory, I love the NHS and I'm glad we have it. But then again, it hasn't exactly been helpful to me and my mental health problems.
Kind regards
Meri
Posted by ed_uk on April 3, 2006, at 16:16:50
In reply to Re: So If You Live In The UK? » ed_uk, posted by Meri-Tuuli on April 3, 2006, at 15:07:55
Hi Meri
>I daren't touch them, as I'm sleepy enough on SSRIs let alone a tricyclic
Not all TCAs are sedating. Lofepramine (Gamanil) might be worth a try.
>I think she even got a benzo from her GP for panic, although I don't know which one/how much. I've emailed her to ask.
Probably diazepam 2mg. I always felt like my pdoc was taking the p*ss when he gave me the 2mg tablets. I told him I needed at least 10mg per dose. Many docs seem obsessed with only using the 2mg tablets. Probably the result of some guidelines aimed at withdrawing people from diazepam.
>I know more about pysch meds than they do.
I know more about psych meds that any doc I've ever seen. That's not saying much. It really isn't. I'm not being arrogant - just realistic. Most of the docs were completely useless. The others were just useless. Psychiatry in the UK is extremely unadventurous. In contrast, psychiatry in the US is virtually owned by the pharmaceutical companies.........and doctors just love the newest, most advertised, most expensive, shiny new drugs......and start prescribing them for all sorts of reasons eg. prescribing some new anticonvulsant for anxiety instead of an established treament. It's disturbing at times. You'll here of people starting on Topamax for bipolar disorder without first trying any of the established meds.
Ed x
Posted by ed_uk on April 3, 2006, at 16:36:46
In reply to Re: So If You Live In The UK? - Jay, posted by Meri-Tuuli on April 3, 2006, at 16:08:54
I might come across too strong as well. It's just so frustrating. Arghhhhhhhhhh!
Ed
Posted by bassman on April 3, 2006, at 16:53:50
In reply to Re: So If You Live In The UK? - Jay » Meri-Tuuli, posted by ed_uk on April 3, 2006, at 16:36:46
The GP's here in the US seem to be alright with prescribing SSRI's, tricyclics, and benzos-if there a mental health problem-or much smaller amounts for fear of flying, etc. It's the pdocs with the 5-drug cocktails-the GP's generally stay with pretty established or less-adventuresome meds. And you know the funny thing? I think the GP's do a better job than the pdocs, because they have no agenda other than to make the patient feel better. 2 mg of Valium? Do you know that they prescribe than that here for cats? Benzos are such safe drugs (in terms of toxicity)-unless you do something stupid; but what about acetaminophen, where you can shut down your liver? Why not restrict it?
It must be frustrating for those of you in the UK to know that benzos would make life better and yet be "paternalized". Best of luck…I wonder if you have Ms. Ashton to thank.
Posted by Phillipa on April 3, 2006, at 20:48:08
In reply to Re: So If You Live In The UK? - Jay » Meri-Tuuli, posted by ed_uk on April 3, 2006, at 16:36:46
Here in the USA it is even scarier. Meds being used off label for everything and if one doesn't work don't change add something else then something else til you're taking so many meds you don't even know where side effects could be coming from. And a lot of so called accidents happen when pts fill precriptions at more than one pharmacy. There is not a pharmacist to make sure all the meds are safe to take together. And somethimes the reason is people price shop cause the meds cost less at one store then then other store. I think it's smart to not prescribe a lot of meds to take together. So does that mean a pt in the UK is not as sick as a pt in the USA? I don't know do you? Love Phillipa
Posted by yxibow on April 4, 2006, at 1:57:11
In reply to Meds In General, posted by Phillipa on April 3, 2006, at 20:48:08
> Here in the USA it is even scarier. Meds being used off label for everything and if one doesn't work don't change add something else then something else til you're taking so many meds you don't even know where side effects could be coming from.
Well as a user of polypharmacy I take the full trust of a psychopharmacologist who has had extensive years of knowledge at a well known institution here that I won't reveal because it isn't necessary. But I would gauge at least 15 years. And our sessions, which are frequent, are give and take -- he may be steering the bus, and thinking about the impact on my body but I also play a part in suggestions and make ample comments when things are not going correctly.
Its not an easy thing to have to be on polypharmacy -- I have a fairly nebulous and complex visual somatiform / OC spectrum disorder that has been going on for more than 4 years. Its not easy having to juggle medications, refills, and taking sheer amounts of pills. But its not nearly as scary as even thinking of wanting to take my own life if I weren't held in as well as 2006 can give me. I'd rather have the uncomplicated dysthymia I had in college over this 110%, but body chemistry changes over life, and I could spend a long time discussing why fluorescent lights irritate me now. (No, I'm not psychotic, just thought I'd add that, but I do suffer from a lifetime of biologically, genetically induced psychiatric illnesses as probably do a majority of people here.)
Yes, I agree that only trained psychopharmacologists should be juggling 6 medications at the same time, because they're trained extensively to know the P450 system, they attend conferences throughout the year, they have journal clubs between fellow peers, and presumably take extensive CE credits.
Medications sometimes have more uses than one, and sometimes this is discovered by accident. I'm sure more than one person here has taken Viagra. That was an accidental discovery. Amantadine, though increasingly having resistance, was also a Parkinsons drug, that was used for flu.One of the most prescribed off-label (now on label) drugs in psychiatry/neurology is Depakote, for Bipolar and Migraine, an AED first used for epilepsy.
As for the other topic, I fully wish we had universal health care here in the US, although at 298 million people, this becomes unwieldy compared to Canada's 33 million and the UK's 60 million.
However, some countries with even larger populations, such as India have made attempts at providing targeted health care at certain illnesses, and a rather large birth control plan at one point, though universal care in a country that large and impoverished remains a dream at the moment. The former Soviet Union had some form of universal care, which has presumably degraded as Russia wields the remains of a former potemkin village.
Of course there are cracks in the seams of universal healthcare, which are happening in Canada, influenced partially by skyrocketing costs in the US migrating across the border, and by triages causing Canadians who need urgent procedures to bypass waiting lists and buy US health insurance (or pay out of pocket) and have procedures done here. The same can probably said about inefficencies in NHS and long waiting periods that would be unheard of in some of the premier health institutions here. Unfortunately the cost is born on the individual as we have governments that collect far less taxes than do European countries, which of course go to social services. I'm sure there will be arguments from all ends of the political spectrum here about that, but it is the plain truth. Nay, though things cost more in Europe, at least in parts of western Europe.
I'm afraid I'm not an economist, I can't change how we conduct business here, but I know that some form of partial capitalism and partial governmental contribution may work better in this country. Who knows. Its not these "discount cards" for sure. My 2c though.
Tidings-- Jay
This is the end of the thread.
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Dr. Bob is Robert Hsiung, MD,
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