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Question about anxiety

Hello Everybody,
Hope you are all having a decent day. I have a question for you guys. I get really and I mean really bad anxiety/panic attacks. Last month my doctor prescribed clonazepam 1.0 to take one at night for REM sleep behavior disorder and night seizures. I found these to be very helpful. The calming effect was lasting into part of the next day at first and I found I was able to go out in public more easily. Now that I am used to them, they only work for sleep. Do you think my doctor would say no way if I was to ask him if I could take one during the day for anxiety and one at night for the seizure/sleep disorder?
Thanks,
Brain

Quote:

Originally Posted by Brain patch (Post 963756)

Hello Everybody,
The calming effect was lasting into part of the next day at first and I found I was able to go out in public more easily. Now that I am used to them, they only work for sleep.

Hi, Brain,

Yes. Let the doc know that more will work.

Mari

Dear Brain,

you have acquired some tolerance to the clonazepam - this is normal. the thing is tolerance can increase progressively with benzos, so it is desirable to take the lowest effective dose. when therapeutic effect is lost, it is best to make the smallest necessary increase in dosage, so as to avoid unnecessary tolerance. this is particularly relevant if one is likely to stay on the drug long term. benzos cause cognitive impairment in the long term (years of use)... so the lower your levels, the better off you are.

describe to your doc the extent to which the med helped at first, and where you are now. he is likely to increase your script but he may try you on a smaller daytime dose first, to see if that does the trick.

i wish you good luck with relief from these nasty panic attacks. let us know how it goes. :heartthrob:

~ waves ~

Quote:

Originally Posted by Brain patch (Post 963756)

Now that I am used to them, they only work for sleep. Do you think my doctor would say no way if I was to ask him if I could take one during the day for anxiety and one at night for the seizure/sleep disorder?
Thanks,
Brain

Brain,

I take 2.5 mgs of Klonopin at night for anxiety related to sleep.
(Actually, for the past few years I have been taking 0.5 in the am and 2.0 at night).

What if after talking to the doc, you ended up taking half of your dose (or other fraction of it) at night and the other part in the morning.

One thought I have is that you can take something else for sleep and take the Klonopin during the day (unless that makes you too sleepy).

Here is what I found for meds that supposedly help with panic attacks:

http://www.mayoclinic.com/health/pan...ents-and-drugs

Quote:

Medications
Medications can help reduce symptoms associated with panic attacks as well as depression if that's an issue for you. Several types of medication have been shown to be effective in managing symptoms of panic attacks, including:

Selective serotonin reuptake inhibitors (SSRIs). Generally safe with a low risk of serious side effects, SSRI antidepressants are typically recommended as the first choice of medications to treat panic attacks. SSRIs approved by the Food and Drug Administration (FDA) for the treatment of panic disorder include fluoxetine (Prozac), paroxetine (Paxil, Pexeva) and sertraline (Zoloft).

Serotonin and norepinephrine reuptake inhibitors (SNRIs). These medications are another class of antidepressants. The SNRI drug called venlafaxine hydrochloride (Effexor XR) is FDA approved for the treatment of panic disorder.

Benzodiazepines. These mild sedatives belong to a group of medicines called central nervous system depressants. Benzodiazepines may be habit-forming (causing mental or physical dependence), especially when taken for a long time or in high doses. Benzodiazepines approved by the FDA for the treatment of panic disorder include alprazolam (Niravam, Xanax), clonazepam (Klonopin) and lorazepam (Ativan). If you seek care in an emergency room for signs and symptoms of a panic attack, you may be given a benzodiazepine to help stop the attack.

If one medication doesn't work well for you, your doctor may recommend switching to another or combining certain medications to boost effectiveness. Keep in mind that it can take several weeks after first starting a medication to notice an improvement in symptoms. All medications have a risk of side effects, and some may not be recommended in certain situations, such as pregnancy. Talk with your doctor about the possible side effects and risks.

Klonopin and the other benzos are hard to get off of. Once you are several weeks into them, you have signed up for them.
I took Xanax for a while and loved it because he did not make me sleepy but it was h3ll getting off it. I asked the pdoc to get me off the Xanax. The pdoc increased my Klonopin by what he considered to be the equivalence of the Xanax.
So I was taking 2.0 Klonopin and 1.0 Xanax. He changed the plan to 2.5 Klonopin and 0 .0 Xanax. Even so, I went through a fierce Xanax withdrawal.

M

I take 2 mg. my doctor didn't have a problem giving it to me. i have high anxiety. i take one in morning and one at night although i don't think it helps me to sleep.
i have been on it for ten years. It doesn't make me sleepy
bobby

All benzos have anxiolytic, hypnotic, myorelaxant, antiepileptic and amnestic properties - but each drug has a different profile, exhibiting each of these properties to a different degree.

Klonopin is one with excellent antiepileptic and anxiolytic properties; it is somewhat sedating. (Btw, in some areas of the EU it is used only for seizure control).

It was a good choice for you given you have both szs and anxiety/panic. Its has a mid-range half life so it accumulates in the bloodstream. I believe a daytime dose should boost your levels enough to help the anxiety/panic... especially as it was in fact helping when you had not developed tolerance.

Other hypnotic benzos and the Z-drugs often used for insomnia might not work as well in your case because they are short-acting - you could end up with REM disturbance or szs later in the night. The Z-drugs (zolpidem et al.) are not particularly indicated for the seizures at all.

It occurred to me he might choose a different drug for the daytime anxiety... perhaps a less sedating and shorter-acting drug like Xanax, or possibly Lorazepam (a bit more sedating than Xanax). However shorter-acting drugs are harder to manage in the long term.

IMHO, for the combined problems you have, Klonopin seems like the best all-around solution. I tend to hope that, with a different posology, it can cover all the bases, but your doc will know best of course.

take care - let us know what falls out! ;) :hug:

~ waves ~

Thanks everybody

Yeah, I have to take the clonazepam at night for REM sleep behavior disorder and seizures. It is not prescribed to me for anxiety at all. I just noticed that it helped with the anxiety. The clonazepam is the only medication that keeps that REM sleep disorder under control and it has to be controlled as it is brain damaging me every time it happens. I had another seizure two days ago so he might up the dose anyway. He is not a doctor that likes to prescribe much medication so I am afraid to ask and I have taken one in the day and one at night since that other seizure has happened so he is not going to be happy about that. I don't know what else to do. It has stopped seizures. I have an appointment with him next Thursday so I will let you know how it goes.
Hope you are all having a good day.
Brain

Brain Patch...

good job regaining sz control - that is very important. I think your doc will understand - I hope so anyway. If you have a concern about his response, you could call into his office and leave a message about what you are doing, why, and that it has been working. That way he will feel you are keeping him in the loop at least.

(((hugs)))

~ waves ~

Thanks you guys. I am more worried about being short on my prescription than what my doc will say as I have Medicaid and they will only pay when you are completely out of meds. Now I am going to have to ask my mom to pay for them or just withdrawal. Which will probably give me major seizure problems. I am thinking if I just tell him what I did he will probably change it to twice a day. Do you think if I am like 6 days short on my old prescription that says take one at night and I present a new prescription saying I need to take 2 one in the day and one at night that Medicaid might pay for it? This is the last thing I need to have to worry about. It is so stressful at my house right now. My dad has Parkinson's disease with dementia and he has gotten so much worse lately and my mom is a nervous wreck. It is really affecting me. My anxiety is out the roof and things are only going to get worse. Maybe if I tell him this also he may have mercy on me. ?
Brain

Quote:

Originally Posted by Brain patch (Post 964246)

My anxiety is out the roof and things are only going to get worse. Maybe if I tell him this also he may have mercy on me. ?
Brain

Brian,

Tell him. Call him as soon as you can -- today or Monday.

I found the drug to be a lifesaver but one needs to be careful with Klonopin (and some of our other meds). Stopping it abruptly can cause seizures.
You are right about the hassle and anxiety that we go through to deal with our medications.
Things can get better.

Mari