Posted by Rick on July 1, 2001, at 17:41:28
In reply to Re: Giving up, posted by Joe Schmoe on July 1, 2001, at 12:48:53
Yeah, I can definitely see why you'd want to stay away from a daily benzo at this point. With its longer half-life Klonopin is less prone to causing addiction than Xanax, but there's still potential that the same thing will happen to you.
But Klonopin can definitely be taken on an as-needed basis as well. It may not be as good as Xanax where you need super-fast spur-of-the-moment help, but if you take it WITHOUT food 45 minutes to an hour before a challenging event like a presentation, it can be extremely effective. In my case as-needed Xanax made me somewhat more able to cope simply because it numbed me, made me feel kinda drunk...doped up and slow. I didn't like that.
The first Klonopin I took, on the other hand felt so much smoother. It made me a tad "mellow" rather than hitting me over the head with a hammer. To me, Xanax feels like great sleeping pill, not an optimal tool for fighting social anxiety. As always, dosage and timing is important for either one, whether as-needed or taken regularly.
BTW, regarding my own Klonopin experience: The first year I took it I got a promotion, won several awards for creative work, and suddenly started getting calls from clients who wanted me to participate in higher-level meetings. Not to mention injecting good ideas into meetings instead of sitting there with a pounding heart, afraid to speak.
If THAT's sleepiness and cognitive impairment (!), then hit me with a hammer and call me dumbstruck! Of course, YMMV, YMMV, YMMV! Klonopin didn't *directly* enhance my cognitive function of course. It just peeled away the social phobia that had my innate ability and desire to think, act, and participate restrained in a unyielding headlock (pun intended). I might add (OK, I WILL add) that there have actually been a few studies on rodents showing certain kinds of *cognitive improvement* from Klonopin.
Benzos aside, I agree that Effexor might be worth a try.
As for the Serzone skepticism, I had the luxury of (A) having a med that was already helping my SP alot and (B) concurrently taking a med that staved off any sedation (low-dose Provigil). So I just slowly ramped up to to a range that proved to be very typical in the main study for Serzone in SP. A month ago I wanted to see if Serzone was really adding anything to the treatment, so I ramped down pretty quickly -- all the way to zero at one point. I was still doing well, but definitely saw some nervousness creeping back in, even at 300. It's quite possible that Serzone helps me more by prolonging and smoothing out the biovailability and elimination of the other meds.
I, too, find it unusual that the hypotensive effects of Serzone are understated in the medical literature. It defintely lowers my BP, and I have a friend taking it who sees the same effect. (Works very well for her GAD, by the way, and it has never mades her sleepy at 400 mg, believe it or not. Her doc started her on 100mg week one, then 200mg wk 2 and then 400 mg wk 3-4. She saw no benefit at 100, mild at 200 and great benefit at 400).
You should be happy you have good BP. That's great for your health. If you want to see a med with REALLY strong hypotensive effects, its Nardil. I was hypertensive when I started Nardil, but within weeks I had sustained hypotension! Through weight loss and anxiety reduction, my BP had become low normal even before I started Serzone. Klonopin lowers my BP a bit, too.
> > Before settling on Xanax, did you try Klonopin/Rivitrol?
>
> No. I don't take Xanax very often. I often go months without taking any, or only taking it once a month or so when things get bad. I am pretty functional in most situations, just not very happy. Klonopin sounded like more of a daily thing. I don't want to be tired or suffer cognitive impairment on a daily basis nor do I want to get addicted. Xanax seems better for crunch times like presentations and interviews. I would be tempted to try daily Klonopin if it weren't addictive, but I was addicted to Xanax once when I was first taking imipramine/Trofranil a decade ago, and detoxing from that was not fun.
>
> > BTW, how long did you take Serzone, and how much did you take?
>
> I slowly ramped up to 550 mg/day over the course of two months. All it did was make me a zombie and made my blood pressure so low I could hardly stay awake so I slowly ramped back down, so I was on it a total of three months at various dosages both coming and going. Extremely disappointing. It did not work at any dosage.
>
> >it took a full twelve weeks before the Serzone started kicking in. With Serzone I think a lot of Social Phobics and their docs end up rejecting what could have been a big help just because they don't realize it can take quite awhile -- and a minimum 400 mg -- to kick in for this disorder.
>
> You'll forgive me if I am skeptical about this. How on earth do you know what dosage to take if it takes that long for an effect to manifest itself? Trial and error with a three month gap between each change seems totally impractical. Doesn't this medication supposedly have a very narrow therapeutic window? How could you possibly find it if it takes that long? Anyway this drug made me very dopey and the dopiness did not wear off with time, nor did it help with the social anxiety at all. If anything it made it worse because people began to notice how dopey I was acting. My doctor was so startled by how low my blood pressure had become that she would not even tell me what it was for fear of scaring me.
>
> > In the larger of the two open studies of nefazodone (Serzone) for social phobia, treatment benefit took by far its biggest leap between weeks 8 and 12!
>
> I have read a number of Serzone studies but none of them were conducted over six weeks, at least none of the double blind ones. I am curious if you can give me a reference for this study. All the other drugs which work by serotonin reuptake effect and whatever that does to the brain seem to work in a couple of weeks. I don't understand why Serzone would take so much longer. Anyway I was on it for three months with no benefit.
>
> > I know the meds merry-go-round can be damn discouraging, but don't give up!
>
> Thanks, but I am pretty discouraged and don't feel like continuing to be a guinea pig for the pharmaceutical companies. Experimenting with drugs sounds like research, not treatment. My experiences so far have been so unpleasant that I have no motivation to continue with them.
poster:Rick
thread:68599
URL: http://www.dr-bob.org/babble/20010701/msgs/68636.html