Diazepam vs Clonazepam vs Alprazolam

Hello all,

I realize there are other threads on this subject and I have read through them, but I wanted to get information/opinions on my specific situation.

I've been on fluoxetine for almost 5 years to treat my clinical depression, panic attacks, and general anxiety.  I started out at 20mg per day, then after about 3 years I noticed some symptoms starting to return.  After trying a number of other SSRIs, my Dr. and I settled on increasing the fluoxetine to 40mg per day and it's been working great ever since.

At times, I have stressful circumstances that are beyond my control which can flare up my anxiety and sometimes even panic attacks.  I've had friends and family let me sample some of their benzo's (yes, I know, sharing Rxes is bad), among which I've tried diazepam, clonazepam, and alprazolam.  The most recent events to trigger my anxiety sent me to an urgent care center where the Dr. prescribed for me diazepam 10mg tid.  I quickly found out that this seemed like way too much for my system in a day, and have found a happy medium at 5mg bid or pm.

There are two side effects I'm noticing, however, that I'm not too crazy about.  The first is because diazepam has such a long half life, once I go to bed I don't want to get up for at least 12 hours.  The extra rest is great, but I have to be up for work and then school.  The other symptom, which isn't quite as severe, is a slight increase in my depression.  I love taking this medication to help with my jittery nerves, but I don't need to be down in the dumps as a result.

I've never been prescribed alprazolam or clonazepam, but have tried both (never long term).  As has been stated in other threads, the alprazolam has a shorter half life, hits you harder, but doesn't last as long.  1.  While I haven't had this problem, I realize that this can lead to a dangerous increase in self-dosing.  2.  My panic & anxiety can take quite some time to subside, so the longer acting benzos really seem to help the best with this, not to mention not giving me a woozy high.

So far, out of these 3 benzos, the clonazepam has been my favorite.  It lasts long enough to keep me calm and/or keep me from waking up in the middle of the night in a panic.  It also doesn't make me groggy and not wanting to get up in the morning.  Lastly, I never noticed the slight increase in depression with clonazepam that I've experienced with diazepam.  Thus, IMHO, It'd be better for my Dr. to switch me from diazepam to conazepam.

I realize that my best course of action is to talk to my PCP, but as I said before, before I make an appointment I'd really like to get some feedback and information from a forum of people who are knowledgable on the subject.

Thanks for any responses.

[greenlydia]

Actually, you don't really need our input as you've already concluded what would work best for you. (And since you've already berated yourself for taking other peoples meds, I'll spare you that lecture)

We are all very different in how we react to psychotropic meds, so in essence, all the various opinions you'd get here will really not aid you in making a decision. Our usual advice in these situations is to make your choice by trial and error.

You ruled out diazepam due to the side effects of being tired and an increase in your depression. Both very legit reasons to put this one back on the shelf. The one caveat that I'm sure you're aware of is that most, if not all, side effects do abate over time, so it's possible you just didn't give the diazepam a long enough trial. (?)

Your pro and con reasoning for the alprazolam v clonazepam is also well thought out and you've reached a decision you feel would work the best for you. If I told you I thought clonazepam was worthless or had terrible side effects, would that really affect your decision? You'll find as many opinions, for and against, as there are meds. Which brings us back to the trial and error method.

Talk with your doctor and give it a try. IMHO, that is the ONLY way to know which med is right for you.
Be sure and discuss if you'll to taper the diazepam or if you can do a straight across switch without problems.
Peace
Greenlydia    

[nursegirl6572]

My personal opinion is, if the SSRI seems to work for you a majority of the time, I definitely would not consider Klonopin, because, for that to work optimally, it would really have to be taken on a regular basis, to allow the med to build up in the plasma, and since you have found sopme level of success with the Prozac, I wouldn't go down that road.  Againm, that is just my opinion.

A short acting benzo (like Xanax, Ativan) is really the best option for what you're seeking, which is an occasional here and there need when your anxiety is a little worse.  You also won't have as many concerns with tolerance and dependency if you are taking something PRN, versus regularly.  Valium really isn't indicated in the treatment of panic and anxiety, in comparison to the other benzos out there.  

Like lydia said, you've already seemed to make up your mind, but there ARE a lot more things to consider than just your little experiment ( I also will save you a lecture about sharing, with the exception of telling you that both you and your friends could find yourselves in a world of legal trouble, so as you know...BAD idea!)....which is why, thankfully, most of us don't have access to prescription pads, lol!

I always tell people to go into the doctor with an open mind.  Don't go in with tunnel vision.  Cetainly you can discuss the options with your doc, but don't be disappointed if your doctor recommends something completely different.  You also have the option of going higher on your Prozac too.  That seems to have been effective for you in the past, therefore if you are noticing an increase in overall anxiety, you can approach that subject with your doctor too.

Good luck, let us know what you and your doctor decided!