To Ryan: Klonopin;Depression

[Shannon Wyatt]

Ryan, you have mentioned before that Benzo's (especially Klonopin) can worsen clinical depression.  When I asked my doctor about this, he told me he did not know this.  He told me there should be no problem with using Klonopin for anxiety/sleeping problems -- and an SSRI for my depression.  I'm curious then....if I can't use a Benzo to help with my anxiety from time-to-time, what can I use that will not interfere with my depression?  Thanks!

[heartfluttersflyawayplz]

benz are for anxiety thats why i take them . did he give you klonopin, is so let me know how it works for you .

[RCA7591]

Hi Shannon,

Benzodiazepines are contraindicated in *clinical* depression (that is, where an actual diagnosis of depression, or major depressive disorder was made by a psychiatrist). All Benzodiazepines produce varying degrees of CNS depression, which has been documented to worsen clinical depression. This information is available in the prescribing literature.

The only exception may be Xanax, but there is little evidence to support that  Xanax is useful for depression. Plus, Xanax is not a viable long term option, and should be used "as needed" only.

Klonopin is the strongest Benzodiazepine,and therefore, produces the greatest degree of CNS depression. It is known to worsen depression. It has powerful anxiolytic and anticonvulsant properties.

There are alternatives to Benzodiazepines when anxiety/depression co-exist. The more modern drugs used are the SSRI's (although they are largely ineffective, and carry a plethora of adverse side effects).

Perhaps the best choice is an older family of antidepressants known as Tricyclics. Sinequan or Elavil are the best choices for combined anxiety/depression. Sinequan has the lowest incidence of side effects. The usual dose is 25 mg, tid (three times daily), and the antidepressant effect takes effect in about one month. The anxiolytic effect usually is apparent within a few days. Tricyclics should never be combined with Benzodiazepines, as the CNS depressive effects are additive.

Lastly, Klonopin should *never* be used as a hypnotic, largely because the drug has weak sedative/hypnotic properties (and what little sedative properties it does possess will wear off rapidly with continued use). Klonopin is not intended for PRN use.

I would ask about implementing Sinequan at a dosage of 25 mg, tid. I would try the drug for a month or two. Chances are, you will respond favorably.

-Ryan

[Raine9]

Shannon, you had a question.  I was wondering about this too.  I am not ready for meds right now but I have mentioned Tricyclics to my psychiatrist as well.  However, he just looked dumb founded.  For some reason drs prefer to prescribe
SSRIs.  Why is this?  Tricyclics don't seem to be popular in the medical community.

[RCA7591]

" For some reason drs prefer to prescribe
SSRIs.  Why is this?  Tricyclics don't seem to be popular in the medical community. "

Next time you visit him, take a look around his office. Notice all of the drug rep pens, notepads, clocks, coffee mugs, etc for Lexapro, Effexor, Paxil-CR, etc. Most of the SSRI's are on patent, which means major sales for the drug manufacturers. No generic is available, the consumer is forced to buy the expensive brand name product.

Tricyclic's have been off patent for years, and generic formulations are available. Therefore, you won't find drug reps pushing Tricyclic drugs such as Sinequan, as the generic counterpart (Doxepin) is available cheaply.

That is the only reason why doctors are pushing the SSRI's, more money for the large pharmaceutical companies.

An older psychiatrist who has been in practice for 20 years or more would be better versed on the efficacy of the Tricyclics. Prior to the late 1980's (when Prozac was introduced), Tricyclics were the only antidepressants available.

-Ryan

[Shannon Wyatt]

Ryan, I asked my doctor specifically about the Tricyclic family of drugs.  He told me they were old fashionable, had many more side effects than SSRI's -- and that there have been cardiovacular problems.

I'm completely at a loss now -- should I use the SSRI's or the Tricyclic's...ughhh!

[RCA7591]

Technically, all of the Tricyclics *can* cause cardiovascular side effects, with the more reported one being tachycardia.

However, these effects are much greater with Tofranil (the first and strongest Tricyclic), than with either Elavil or Sinequan. Sinequan is the mildest of the Tricyclics.

In reality, the SSRI's have more side effects, largely because they are non-selective in their actions. Like the Tricyclic's, SSRI's may also cause cardiovascular side effects. The newer SNRI drugs have a high risk of cardiovascular side effects (ie: Effexor), and in particular, hypertension.

Apparently, he failed to inform you that SSRI's also carry the risk of cardiovascular side effects. You can visit the manufacturers website for your particular SSRI, and download the prescribing information. This will provide you with all of the facts.

While SSRI's are indicated for both depression and anxiety, the efficacy of the latter indication (anxiety) falls short in my opinion.

If you have a good relationship/communication with your doctor, you should follow his advice (or at the least, give the drug a fair trial). If the drug fails, you could then mention Sinequan.

-Ryan

[RCA7591]

Shannon,

Actually, Celexa is only indicated for the treatment of depression, according to the manufacturer:

See this link:

http://www.celexa.com/Celexa/faq.aspx

They are promoting Lexapro in place of Celexa, which according to the manufacturer, is more selective with less side effects, and also targets anxiety.

-Ryan

[Shannon Wyatt]

Yeah, I saw that Celexa is for Depression only when I visited their site.  The patent on Celexa is out -- but Lexapro is in.  It seems to me that the mfg. are trying to push Lexapro as much as possible because of the higher price.  But I'm concerened here for my mental state -- I'm anxious all the time; can't sleep; can't eat; I worry endlessly about these crying spells that I have (depression).  I'm just totally at a loss here; I want and need to get better.  i'm going downhill big time here.

[heartfluttersflyawayplz]

shannon you goinghave to pick yourself up ,no one elsa can we can be here to support you but you have to do it, your not going down hill i know it feels that way belive me ive been there in last 6 weeks, i was weak, sick stomack not eating staying in the house laying around doing much of nothing, i have a great family telling me they was there for me and they did all they could do but i had to do it, i had to make myself get up and try , dont give up and the longer you give into it the worse your body will get i know. yes today i woke up sick stomack and little stress it seems to be a morning thing for me, but am going to push foward , eat a little something and get out the house today with hubby to just be out.you need to get your dr to give you something that your happy with so you can start on it and start living again. it will happen you can do it. you can go back to a normal life but you have to do it . keep head up push foward. best of luck barbara

[Raine9]

Shannon, you need to just do whatever your doctor tells you to do at this point and don't worry so much whether the drug is right for you.  If it isn't, you can always try another one.  Right now, you need to concentrate on getting better. If your doctor is a competent doctor, he/she knows what he is doing.  If you trust him, then rely on him and don't read too much about it on the Net.  That's the same as Googleing your symptoms, it'll drive you crazy.   I tried Celexa a long time ago.  I was only on it for a little more than a month but the only side effect that I felt was insomnia during the first week.  Once I got past that, I was okay.  I heard that Celexa is probably one of the safest anti-depressants you can take.  

Try other things too.  Try excercise and getting out with your friends and family, if you're not already doing those things.  When I took Celexa, I was in a rut.  I took up golf lessons and I kept myself busy.  Eventually, I got out of that "rut" and I felt better.  

Take care and keep us posted.