Hi, I'm brand new to this Forum. Some background on me - About 3 months ago I started having anxiety problems. It was gradual, over a few weeks time, but at the end of that few weeks I was in full blown anxiety - mental anguish through the roof. I could not concentrate at work and had to leave early, and did not return for a week. The week I was at home it kept getting worse and worse, I could not concentrate on ANYTHING, even to get up and get a glass of water seemed difficult. I take a betablocker for borderline/high blood pressure, which I think kept me from going into full blown panic. I saw my doctor asap, and was presribed Klonopin, .50 twice a day as needed. I am also seeing a therapist to see why this all happened. Anyway, things were going Ok pretty much until about 2 weeks ago, when it seemed the Klonopin was helping less and less. My doctor increased my dose to .50 up to 4 times a day if I needed it. I don't like the idea of that amount but he feels its still a pretty low dose and it will be OK when I need to wean off of it. My question is, I also take vicodin - not a large amount, 5 -15 mg a day as needed for an injury I had a while back. I've been taking the vicodin for about a year. My question is, why is this all suddenly starting again with the anxiety rearing its ugly head? Things were going along OK and then all of a sudden I start feeling anxious - not overwhelming when I wasn't taking the medication, but enough to feel uncomfortable. I could even deal with the daytime discomfort, but nighttime before bed is the worst - the medication doesn't help - I sleep for about 3 hours and wake up in a sweat from weird dreams and take another .50 mg to get back to sleep, and in the morning feel like I haven't slept much at all. So sorry for this long post, but again, I guess my main question is, should I stop taking the vicodin and see if the Klonopin works more effectively? I'm really at a loss here and could use some advice. Thanks!
First, it sounds like you've taken all of the important steps to start addressing your anxiety. That's great. Definitely keep up with the therapy, that will be a great help to you.
There could be two reasons why the medication isn't as effective as it could be. Klonopin is a long acting benzo that works best if it is dosed regularly versus on an "as needed" basis. That allows the medicine to build up in your system and get you to a more steady state. Typically, Klonopin is Rx'd 2 or 3 times daily regularly. It can take some time to build up, but once it does, most people notice an improvement. My suggestion to you would be to take the dose twice a day for starters morning and night,. Take it at at the same time each day and then give it a week or two to assess how it is working. Discuss this with your doctor and see if he would be agreeable to you dosing this way instead of PRN or "as needed".
The other issue that may be causing some issues is the Vicodin. The Vicodin isn't contraindicated with the Klonopin, and it shouldn't affect the action of the Klonopin, however, since you have been on it long term, you may be dealing with some tolerance issues and experiencing a mild form of withdrawl, especially if your dose hasn't been increased for a while. Your symptoms are pretty consistent with a withdrawl phenomena, and I feel it is worth looking into. I would discuss that with the doctor who prescribes the Vicodin for you. Also, make sure that both docs are aware of the medications you have been Rx'd by the other doc.
Best of luck, be sure to let us know how you're doing!
Sorry to hear about your struggle there. My situation was somewhat similar in that about 3 months ago I started getting weird stress-related conditions like shingles then got sinusitis and a bad cold and as a result of all that one after the other (never had that before) began having very bad health anxiety - i pretty much thought my immune system had completely shut down!.. Went and had every blood test imaginable and everything came back ok...but in the meantime i developed some classic physical symptoms of anxiety - nervousness, tingling in arms and legs, headiness, etc and so my doctor said it was anxiety and started talking about medication. I'm not clear on what triggered it as well but I suspect (as does my psychologist) that it was a culmination of things building up overtime and then the bout with the successive illnesses triggered it....
Have you spoken to your doctor about SSRI's like Lexapro, for example? My doc gave me Klonopin (very low dose .25) to use on a "as needed only basis" but said that if I needed to take it everyday then it was time to consider something more long term and non-addictive. I tried Lexapro for 3 days and basically spooked myself with the side effects and not wanting to commit to months of medication and got off it. Figured I would just do therapy, breathing and relaxation exercises and that would be good. But realizing now that a combination of effective medication and therapy is often the recipe to beat this thing and therefore am planning to go back on the Lexapro (slow staggered increase of dose cause I don't appear to tolerate meds all that well) and dedicate 4 weeks to seeing what it does cause the SSRI's take a while to clear the side effects and start working.
I guess the moral of the story is everyone is different and it might take a bit of trial and error to get the formula that works best for you.
As far as adjusting your meds... please... only a doctor should give you advice on that. Changing any course of medication too rapidly can produce undesirable results. See your doctor and good luck....keep us posted.
I was wondering with respect to your comment on Klonopin being used on a regular basis. I have read on numerous sites that Klonopon, when used regularly, is more likely to develop a physical addiction scenario than SSRI's? My doctor gave it to me as a "rescue pill" - very low dose first .5mg (but that made me basically fall asleep) and then .25 mg and said to take 1 or 2 in times of high anxiety but said if I started to need it everyday then it was time to consider SSRI's like Lexapro which, if tolerated, offer a more continuous solution to controlling anxiety without the physical addicition developing. That said I see people on this forum who are taking Klonopin everyday. So I am a bit confused...any comments on this?
Some people do take Klonopin on a PRN basis and do well, but typically, it is more effective if dosed regularly, due to it's long half life. Compared to the shorter acting benzos (Ativan, Xanax), Klonopin builds in the plasma and keeps a person at a steadier state if dosed regularly, versus the "up and down" people have with taking a PRN. This is what makes it good for a more long term approach. The short acting benzos are not indicated for regular long term use, as they leave the system too quickly, and re-dosing is necessary to tackle anxiety, and tolerance issues are common.
It's always a person's personal choice when deciding if they want to take something long term, like Klonopin. None of these meds (even the SSRI's) are peachy to discontinue for some, it's a matter of weighing the options.
ALL benzos come with a risk of tolerance and dependency, however, Klonopin is less likely to be problematic in that regard than the shorter acting benzos. Compared to Xanax or Ativan, Klonopin users normally don't require as frequent of a dose increase due to tolerance issues.
My personal opinion is that the best approach, if it works (and everyone is different) is the utilization of a short term course of a shorter acting benzo (ie Xanax) during the adjustment phase of SSRI treatment. After that, optimally, the SSRI should suffice, with an occasional "as needed" dose of a shorter acting benzo. That worked very very well for me. I never had to worry about withdrawling from a benzo, and once the SSRI started working, my need for the prn anxiolytic decreased quite rapidly.
A lot of people have found relief from Klonopin after finding no success with other regimens. Again, it varies greatly from person to person. They are all good meds if taken properly, considering each person's special needs/goals.
Hi, Thanks for the quick response. I think you may be right regarding the regular dosing of the Klonopin vs "as needed", at least for the next month or 2. When I spoke with my doctor about it, he prescribed it as needed, but explained it would be OK to take it on a regular schedule, and if I started feeling alot better and felt I only needed it in the morning or in the evening that he would leave it up to me. Regarding the vicodin, I haven't asked the doctor to change the dose because the lower dose is still effective. At this point, I'm ready to be done with it. I know you cannot advise about tapering schedules on this site, but my concern is, if I drop to the lowest dosage or just quit altogether, do you have any idea how long it would be before the withdrawals (if that's what they are) would end? I ask because I'm leaving for vacation in 5 days and I really don't want to be having major w/d issues while away from home; I'm not even sure what to expect. I won't have a chance to talk to my doctor before I leave, so I feel a bit stuck in this area, because if I continue on as I have been, I still have problems at night. Any advice you could give regarding this issue would be great.
To CanuckGuy: Hi, Thanks for your post. I've discussed anti depressants w/my doctor, and he prescribed Lexapro initially as well, but after 3 days I stopped it because it increased my anxiety as well. He has since prescribed a different one which I have yet to take. I don't plan on trying it until I get this other medication issue straightened out. As you say, its a trial and error process, but I just don't think it's the type of medication for me. If I could, I would rather not take any of the meds at all, and I want to be off of the Klonopin as soon as I feel I am ready. I get the impression that with antidepressants that one is committing to a long term medication, and that is mainly why I shy away from them. I may be wrong about that, but I guess it's another question for my doctor when I see him. I understand the risks of Klonopin and dependency, which is why I would rather take it as needed than on a regular schedule, but if the scheduled dose works in the short run, then I'll do it. I don't want it to be a long term fix; I'm already looking ahead to weaning off of it, and don't want to go through a difficult withdrawl, but first things first.
Hi again. You're right, we can't advise about specific taper instructions. My advice to you is....don't mess with the Vicodin until after your vacation when you can sit down with your doc and come up with an appropriate taper. You're on a fairly low dose, but since you've been on it for an extended period of time, it's pretty likely you'll experience some level of withdrawal, and I don't think you want that for your vacation.
I would also tell you to go ahead and start taking the Klonopin twice a day, morning and night (about 8-12 hours apart) and stick to that regimen for a few weeks to see the difference. I think you'll be pleasantly surprised that once the Klonopin has had a chance to build up, your anxiety will be much better. As for your night's sleep, I wish I had a fix for that for you. Hopefully the steady dosing of the Klonopin will help with that. You can try some exercise (even walking) in the evening, soothing music, baths, etc in the meantime. Hopefully, just being on vacation in a more relaxing environment will help with that!
Hang in there...have fun on your vacation, and update us when you can! :0)
Hi, Thanks for all the good information. You seem knowledgeable about anti-depressants, so maybe you could shed some light on a few things. I talk to my doctor about them, but he tends to go of into long, detailed medical terminology when explaining and he loses me sometimes. (Not all of the time, but sometimes I think he forgets that I don't have an advanced degree in Psychiatry or Pharmacology) :) My question is this: Most SSRI's work by increasing seratonin levels in the brain; I don't feel that I have low levels of seratonin - I feel this way because when I try an anti depressant, I get jittery and anxious and my adrenalin increases; all of these things appear to be symptomatic of high levels of seratonin. So, why would one want to take medication that increases what is already at normal levels? When I asked my doctor this, he gave me an answer that was in doctor-speak so I really didn't get the jist of what he was saying. My 2nd question is this: Is it usually the case that once someone begins to take anti-depressants, that it's for the long term? Years rather than months? As I said in my previous post, I'm not knocking SSRI's, I think they're a great medication for the right patient. I just don't think it's me, but my doctor really thinks I should give it a try, so he prescribed Remeron to me. (when the Lexapro didn't work) He advised that it is quite sedating, but that it does act on the seratonin levels as well, so this again leaves me confused. How can a drug be sedating yet increase seratonin levels? Am I wrong about how all of this works? What do you think? Sorry again about the long post - but you seem well versed to answer my questions and I truly appreciate the time you take to do so. Thank you and I look forward to hearing from you!
Hi, One other question in addition to the above questions re SSRI's; Does anyone know of any drinks/supplements that really do have a calming effect? I'm not really looking for herbal pills since I already take presribed medication, just something that has a natural calming effect. Thanks!
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