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Author Topic: Long-term use of clonazepam vs. SSRI's and side effects vs. Therapy  (Read 504 times)

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Offline Whistle

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I'm wondering if you guys think I should keep trying SSRI's or not. I'll post my symptoms at the bottom.

My doctor prescribed me 50mg Zoloft and I took that for a month and dealt with only two side effects: extreme fatigue and absolutely no motivation to get things done.
He switched me to 20mg Celexa and I'm dealing with two side effects: extreme fatigue and absolutely no motivation to get things done.
I started taking it in the morning with food, and I'd ruin my entire day with my laziness. I then started to take it around 5pm to allow myself to function in the morning and get moving, but found that the effects carried through overnight and I found it harder to get out of bed.

Anyway, I've been dealing with anxiety and panic attacks associated with things out of my control: the future, disease, death, someone else driving, being in a place I know I can't just get up and go (funerals), I feel like I need to use the bathroom during long car rides like every 2 minutes, sitting in class, etc. As well as mild social anxiety, it can become high depending on how uncomfortable I feel in the situation.

The doctor gave me .5mg Klonopin for the short term to deal with these things and it pretty much keeps the anxiety under control for most of the day and seems to prevent those random panic attacks I used to get. The only thing it doesn't stop is a panic attack in a situation where I've already classified that sort of situation as panic zone. If I know I'm going to be in one of those situations I'd take 2 or 3 of the .5mg and I'm usually okay but still get extremely nervous and feel like I could have an attack.

So my question is, should I keep trying new SSRI's til I find one that doesn't make me feel fatigued? Should I stick with a daily dose of Klonopin? Should I try therapy?
I'm also wondering if Klonopin is the right benzo for me. I like that it is long-lasting, but it doesn't help me sleep, doesn't work in an emergency situation since it takes like an hour to kick in, and it doesn't really prevent panic attacks in my predetermined situations too well.


I'm open to all opinions, thank you so much for reading this!


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Offline insights

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Re: Long-term use of clonazepam vs. SSRI's and side effects vs. Therapy
« Reply #1 on: January 15, 2014, 06:14:10 AM »
So my question is, should I keep trying new SSRI's til I find one that doesn't make me feel fatigued?

I'm unclear how long you've now been on Zoloft and Celexa, but I'm assuming 6-8 weeks in total. If so, it may be that the SSRIs aren't the right med for you, but it could still be worth trying Prozac (fluoxetine) which is usually the most stimulating SSRI.

Another alternative would be to supplement the Celexa with small dose of Wellbutrin (bupropion) which is the most stimulating antidepressant, but care is needed because it could trigger anxiety too. However, on the principle that one good med is better than two so-so ones, I think the better long term bet would be to switch to either a SNRI or tricyclic antidepressant.

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Should I stick with a daily dose of Klonopin?

The benzodiazepines (BZDs) are very effective anti anxiety meds, but doctors are becoming increasingly wary of prescribing them because of the perceived dependency issue which makes them risky primary, taken daily meds. IMHO, they are best reserved for occasional use to control breakthrough anxiety, or to ease the transition onto antidepressants.

Quote
I'm also wondering if Klonopin is the right benzo for me. I like that it is long-lasting, but it doesn't help me sleep, doesn't work in an emergency situation since it takes like an hour to kick in,

BZDs are not good sleeping pills and shouldn't be used as such because tolerance to the sedation builds up within a few weeks. Small doses of trazodone (Desyrel) would be a better bet, however, it could add to your daytime fatigue problems, as would the alternatives (I suspect the Klonopin is also part of this problem). Doses to 50mg should be okay, but 75mg plus is likely to be problematic.

All the BZDs take about an hour or two to become fully effective. It takes 20-30 minutes for the tablets to dissolve and the active chemical to penetrate the stomach wall and enter the bloodstream, plus another 30-90 minutes to reach peak levels. So taking a shorter acting BZD like Ativan (lorazepam) or Xanax (alprazolam) won't help much.

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Should I try therapy?

The cognitive and/or behavioural and/or mindfulness therapies are about as effective as antidepressants so are a good alternative if your health insurance will pay for it.

Ian
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NOTE: I'm not a doctor, and particularly not yours, so there may be factors I'm unaware of. Therefore all advice is of a general nature and you should consult your doctor before following any of it, especially before changing med doses.

Offline Whistle

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Re: Long-term use of clonazepam vs. SSRI's and side effects vs. Therapy
« Reply #2 on: January 15, 2014, 07:35:07 AM »
I'm unclear how long you've now been on Zoloft and Celexa, but I'm assuming 6-8 weeks in total. If so, it may be that the SSRIs aren't the right med for you, but it could still be worth trying Prozac (fluoxetine) which is usually the most stimulating SSRI.

Another alternative would be to supplement the Celexa with small dose of Wellbutrin (bupropion) which is the most stimulating antidepressant, but care is needed because it could trigger anxiety too. However, on the principle that one good med is better than two so-so ones, I think the better long term bet would be to switch to either a SNRI or tricyclic antidepressant.
I started taking Zoloft at the end of October at 50mg. I went back after 4 weeks without improvement and he decided to take me off of Zoloft and switch me to 150mg Effexor XR, which he forgot to sign the prescription for. It took me a week to get the Effexor XR and at this point it was finals week was coming up and I wasn't willing to put myself in the drowsy state I was in with Zoloft. Saw the doctor again and he decided to forget the Effexor XR and put me on Celexa which I started taking on 12/26 at 20mg.

So I've really only been on an SSRI for 3 weeks now, but the fatigue really messes up my day and I dread putting the pill in my mouth. Initially when I went to the doctor I told him I wanted to get tested for ADHD because of my pre-existing lack of focus and motivation, but he wanted to take care of the anxiety first. I wonder if a stimulant would combat drowsy side effects of an antidepressant?

Quote
The benzodiazepines (BZDs) are very effective anti anxiety meds, but doctors are becoming increasingly wary of prescribing them because of the perceived dependency issue which makes them risky primary, taken daily meds. IMHO, they are best reserved for occasional use to control breakthrough anxiety, or to ease the transition onto antidepressants.
If I were taking an SSRI for long-term wouldn't I become dependent on that and have to taper off eventually? Maybe tolerance plays a role with the long term use of benzos, but I've read posts from people who have taken .5mg Klonopin for years and never needed to increase their dosage.


Quote
The cognitive and/or behavioural and/or mindfulness therapies are about as effective as antidepressants so are a good alternative if your health insurance will pay for it.
I should look into this! Sounds like the better route.


Thank you so much for your help Ian!
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Offline hikingchik63

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Re: Long-term use of clonazepam vs. SSRI's and side effects vs. Therapy
« Reply #3 on: January 15, 2014, 08:29:53 AM »
My suggestion would be to go very low dose with zoloft at first. 12.5mg(1/2 of a 25mg). Its alot smoother and u may find that it works! After 2 weeks, if no improvement, go up to 25mg. Also, klonopin, taken daily will build up in ur system so that u r not experiencing panic attacks, if its the right med. U wont have to keep increasing it once u get to the correct dose for u. Klonopin(i take only .5mg at night) and zoloft together is imho, a very good combo for panic and gad. Good luck!
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"Frame your mind to mirth and merriment which bars a thousand harms and lengthens life."--Shakespeare

Offline insights

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Re: Long-term use of clonazepam vs. SSRI's and side effects vs. Therapy
« Reply #4 on: January 15, 2014, 04:15:00 PM »
So I've really only been on an SSRI for 3 weeks now, but the fatigue really messes up my day and I dread putting the pill in my mouth.

Okay, this changes the picture. Fatigue can be a short term starting side-effect so I suggest you continue with the Celexa for at least another few weeks to see whether it goes away.

Quote
I wanted to get tested for ADHD because of my pre-existing lack of focus and motivation, but he wanted to take care of the anxiety first. I wonder if a stimulant would combat drowsy side effects of an antidepressant?

It may do, but at the risk of increasing the anxiety, which is why your doctor wanted this under control first.

Quote
If I were taking an SSRI for long-term wouldn't I become dependent on that and have to taper off eventually? Maybe tolerance plays a role with the long term use of benzos, but I've read posts from people who have taken .5mg Klonopin for years and never needed to increase their dosage.

Tolerance isn't the concern, it is that at some point your doctor/s may succumb to benzophobia and decide you need to come off. Worse you might be expected to discontinue it within only a few weeks. Unfortunately, this does happen all to often resulting in much misery. It is all nonsense because as you point out, dependency is also an issue with antidepressants. Some are at least as difficult to discontinue, but it is the BZDs that are the focus of attention at the moment. And it is not just the meds themselves, but also that they're being used for a mere 'mental' disorder. If you were taking them for epilepsy, a 'physical' disorder, there would probably be no issue. Such prejudices run deep even in the medical profession which really should know better!

Ian

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NOTE: I'm not a doctor, and particularly not yours, so there may be factors I'm unaware of. Therefore all advice is of a general nature and you should consult your doctor before following any of it, especially before changing med doses.

 

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