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Dr. Bob is Robert Hsiung, MD,
[email protected]Shown: posts 1 to 17 of 17. This is the beginning of the thread.
Posted by LilithLeigh on October 3, 2016, at 21:16:19
My new pdoc first reduced my dose of Effexor from 225mg to 150mg before adding 7.5mg mirtazapine and 0.25mg clonazepam twice a day. I asked for clonazepam because I couldn't leave my house to do any kind of exposure therapy. I had tried clonazepam before this on a temporary basis while going through a bad spell of stress in my life.
But when the mirtazapine was added, I felt like the clonazepam didn't work. Almost like its effects were blocked by being on Effexor and Remeron (mirtazapine). Is this possible?
I have been on effexor for a decade and every time was dose was lowered to 150mg (at doc's suggestion because of the rare serotonin syndrome) my depression came back.
My depression returned this time too when the dose was lowered even though Remeron was added. Then my pdoc upped the Remeron to 15mg and Effexor to my regular dose of 225mg. And the clonazepam was increased too to 0.5mg twice a day. I still feel a bit depressed and like the clonazepam is not working.
My anxiety has not reduced significantly at all. I am wondering if combining these three drugs or being on two AD's could somehow interfere with the efficacy of the benzo?
I have also read somewhere that clonazepam may trigger depression in people who've had depression before. Is this true?
Any suggestions for clonazepam alternatives if it comes to that?
I would like something long lasting like clonazepam.
Posted by rjlockhart37 on October 3, 2016, at 21:39:05
In reply to California Rocket Fuel and Clonazepam, posted by LilithLeigh on October 3, 2016, at 21:16:19
there's lorazepam, which is ativan.....it lasts 6 hours and is good for anxiety
Posted by LilithLeigh on October 4, 2016, at 0:57:30
In reply to Re: California Rocket Fuel and Clonazepam, posted by rjlockhart37 on October 3, 2016, at 21:39:05
I already take that prn. The half life is pretty short. I'm interested to know about valium or xanax for panic and agoraphobia.
Thanks
Posted by SLS on October 4, 2016, at 3:50:47
In reply to Re: California Rocket Fuel and Clonazepam » rjlockhart37, posted by LilithLeigh on October 4, 2016, at 0:57:30
> I already take that prn. The half life is pretty short. I'm interested to know about valium or xanax for panic and agoraphobia.
Xanax is usually considered to be a better drug for agoraphobia and panic attacks. Xanax has a short half life, but there is a long-acting (extended release) version.
An older tricyclic antidepressant (TCA) named imipramine was used quite often for panic disorder with agoraphobia before Prozac became available. I imagine that clomipramine may be even better because of its increased effects on serotonin. I don't know for sure.
- Scott
Posted by Christ_empowered on October 4, 2016, at 8:54:35
In reply to Re: California Rocket Fuel and Clonazepam » LilithLeigh, posted by SLS on October 4, 2016, at 3:50:47
any benzodiazepine can cause depression or make it worse. Having said that...Klonopin is apparently fairly notorious for doing this.
xanax, xanax xr, ativan, valium...those are the more popular ones. There are less popular benzodiazepines (serax, tranxene, librium, etc.) that your doc might consider, too. I think the big issue with benzodiazepines is getting a drug that gets the job done w/o too much sedation or cognitive impairment, while also avoiding too many drug-drug interactions.
I hope things work out well for you. Some people just do not do well on Remeron, despite its reputation for being effective and claming, etc. etc. etc. Everybody's different.
Posted by LilithLeigh on October 4, 2016, at 11:06:39
In reply to Re: California Rocket Fuel and Clonazepam » LilithLeigh, posted by SLS on October 4, 2016, at 3:50:47
I didn't know there was an extended release of xanax. I'll talk to my pdoc about that next time I see him.
Prozac didn't work for me. :(
Thanks.
Posted by rjlockhart37 on October 4, 2016, at 21:30:56
In reply to California Rocket Fuel and Clonazepam, posted by LilithLeigh on October 3, 2016, at 21:16:19
there's the xanax xr which lasts 12+ sometimes 24 hours, but it's because of it's delayed delivery system
there's of course the off label benzo's such as librium, serax, and tranxene but those are not first choice like the popular benzos like xanax and klonopin are
tranxene lasts very long......
california rocket fuel is a strong combination to treat depression, be sure not to go to high on the doses, because that can cause mania, or excess neuerotransmitters that would make you temporarly high or racing.....
maybe add a mood stablizer with california rocket fuel
Posted by LilithLeigh on October 4, 2016, at 21:58:33
In reply to Re: California Rocket Fuel and Clonazepam, posted by rjlockhart37 on October 4, 2016, at 21:30:56
Thanks, rj. I'll keep that in mind. I was just confused as to why I feel more depressed on the california rocket fuel than I did on just effexor.
Posted by rjlockhart37 on October 4, 2016, at 22:04:50
In reply to Re: California Rocket Fuel and Clonazepam, posted by rjlockhart37 on October 4, 2016, at 21:30:56
but what could be is too much serotonin from remeron, but i'm not a nuero mood specialist, i've noticed too much lamictal makes boring and dysphoric, it may just be the doses to work on.....
i think the max for effexor, usally in xr form is 225-300mg, effexor is a good antidepressant....
you could stop remeron, and add provigil but it's expensive......
Posted by LilithLeigh on October 4, 2016, at 22:22:11
In reply to Re: California Rocket Fuel and Clonazepam, posted by rjlockhart37 on October 4, 2016, at 22:04:50
I'm not exactly sure why he wanted to add the remeron in the first place. Possibly because it has anti anxiety effects? I will need to ask him about that. Especially since my depression was under control at 225mg effexor.
I'm in Canada and on disability so all meds are covered 100% thankfully.
Posted by SLS on October 5, 2016, at 5:36:18
In reply to Re: California Rocket Fuel and Clonazepam, posted by LilithLeigh on October 4, 2016, at 21:58:33
> Thanks, rj. I'll keep that in mind. I was just confused as to why I feel more depressed on the california rocket fuel than I did on just effexor.
>My bipolar depression is exacerbated when I take certain drugs. Remeron is one of them. If I were to guess, I would say that it is its NE alpha-2 antagonist properties that is responsible for this. I had a similar reaction to two other alpha-2 receptor blockers. Effexor has treated me well when I combine it with nortriptyline. Other people do better adding Wellbutrin to it.
- Scott
Posted by LilithLeigh on October 5, 2016, at 18:26:41
In reply to Re: California Rocket Fuel and Clonazepam » LilithLeigh, posted by SLS on October 5, 2016, at 5:36:18
Thanks Scott. I'm thinking of going off remeron just to see how I feel without it.
Posted by Lamdage22 on October 8, 2016, at 7:18:36
In reply to Re: California Rocket Fuel and Clonazepam, posted by LilithLeigh on October 4, 2016, at 11:06:39
its funny. American docs seem to be not too concerned about benzo addiction in comparison to the germans.
Just an observation. Personally i find it much more addicting than alcohol for example.
Posted by Lamdage22 on October 8, 2016, at 8:30:42
In reply to Re: California Rocket Fuel and Clonazepam, posted by Lamdage22 on October 8, 2016, at 7:18:36
i use it mostly for emergencies. And then usually after 3 days i crave more lorazepam and i dont like that.
Posted by Lamdage22 on October 8, 2016, at 8:32:30
In reply to Re: California Rocket Fuel and Clonazepam, posted by Lamdage22 on October 8, 2016, at 7:18:36
i use it mostly for emergencies. And then usually after 3 days i crave more lorazepam and i dont like that.
Posted by Christ_empowered on October 8, 2016, at 9:36:29
In reply to Re: California Rocket Fuel and Clonazepam, posted by Lamdage22 on October 8, 2016, at 8:32:30
it seems that bzd prescribing in America has become more lax over the past 10ish years. Its weird...for a while there, pdocs and family docs were reulctant to prescribe them. Now...its the 70s all over again, lol. Of course, its not just the bzd drugs...its also stimulants and pain killers and the z hypnotics.
My best guess is that there will be shift towards more conservative prescribing after a while. Too many people getting hooked and damaged and burned and...not enough informed consent, either.
BZDs can be good for people, but it does seem that the longer people stay on them, the higher % will experience problems, some of which apparently last well after even the most skilled taper.
I think part of it is that, for whatever reason, docs here generally don't prescribe valium or the other older, low to mid potency bzd drugs, but they're all about some xanax, klonopin, and ativan. Good for PRN use, but the higher potency bzd drugs can be very, very difficult to taper, especially since it seems most docs here (that I've seen...) taper straight off the klonopin or whatever, instead of doing a switch a roo to valium and tapering off that (ashton manual method).
Rambling...I'm glad you can use the lorazepam strictly as needed and can also spot your need/desire for more. I think more people have problems with tapering and even ongoing treatment than the "experts" would have us beleive, although a lot of people can and do take the bzd drugs long term without any serious problems. Mixed bag, I suppose.
Posted by LilithLeigh on October 8, 2016, at 19:15:53
In reply to Re: California Rocket Fuel and Clonazepam, posted by Christ_empowered on October 8, 2016, at 9:36:29
Here in Canada most doctors including my own are reluctant to prescribe benzos. Even when the benefits outweigh the risks. Plus gp's really shouldn't be the ones making decisions about psychiatric meds anyways but it falls on them since our mental health system here in BC is pretty much broken.
I've been on anti benzo forums and don't really believe in extended withdrawals from benzos as they claim. Mostly because there's no evidence and a lot of posters have quit their meds cold turkey or tapered too fast and then they're surprised when their brains rebel. That's just stupid. Plus, they fail to take into account their underlying conditions (anxiety, panic disorder) for which they took the benzos in the first place.
I'm someone who is afraid of dependency and I don't chase the high. I don't even get the high anyway and that's good. I did in the beginning with lorazepam but nit klonopin. It just calms my anxiety and ra ing panicked thoughts so I can function. If I had to taje it for the rest of my life I wouldn't have a problem with that since the alternative is uncontrollable fear deoression and thoughts of suicide.
Recently, I read a great book about the so called War on Drugs and how it's a dismal failure and there is so much misinformation that it boggles the mind.
One thing I found interesting is that some cancer pafients who were given actual heroin for pain and went into remission were successfully weaned off of it. The thinking is that if drugs are taken purely for therapeutic reasons the risk of addiction is rare. Once the cancer patients were no longer in pain they didn't feel the need for heroin anymore.
I question everything now.
This is the end of the thread.
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Dr. Bob is Robert Hsiung, MD,
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