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DiscussionAnxiety adrenaline waves every AM waking me from sleep.
Depression & Anxiety | Last Active: 3 days ago | Replies (110)Comment receiving replies
Replies to "I was given Clonazapam and Paxil for depression and anxiety disorder. Mornings are bad but I’m..."
Are you sure you were on 2-4 mg of clonazepam (Klonopin)? That is a huge dose! The usual starting dose for clonazepam is 0.25 mg. twice a day.
Clonazepam is in a drug category called “benzodiazepines,” which includes Valium, Ativan, Xanax and many others. These drugs can be very helpful in the treatment of anxiety. Anxious people, IMHO, tend to be “control freaks” which is not necessarily a bad thing. Yes, benzodiazepines can be mildly addictive, but from what I’ve observed, anxious people find the dose that works for them (usually a low dose) and stay on that dose that helps them. Oddly, from a chemical standpoint, anxious people don’t seem to reach tolerance on benzos. Tolerance is where a person takes a given dose, but in a short time, the drug is no longer effective and the dosage must be increased in order to get the same effect. Tolerance develops quickly with narcotics (=opiates).
An anxious person might need to be on a “their” dose of a benzo for years. If it is a reasonable and effective dose, I don’t see that as a problem.
With the help of a psychiatrist, find the dose that completely relieves the anxiety. Stay on that dose for 3-4 months (or forever if you like). Then start to taper slowly w/ the help of your psychiatrist. With say, Ativan, an anti-anxiety dose might be 1 mg three times a day. Once you’ve taken that for 3-4 months, begin a slow taper (about 0.25 mg a month) until you reach the dose at which the anxiety recurs. Increase the dose by 0.25 mg. That is “your” dose and you can stay on it indefinitely. A great deal of paranoia has developed about benzodiazepines. It is true that IN COMBINATION with other drugs, respiratory depression can occur. Even death might occur but chances are that it is caused by an opiate that was prescribed with a benzo.
On their own, benzos are among the safest of drugs. It is extremely hard to overdose on them and most cause virtually no side effects.
If you have had cancer (or some other major traumatic event) and believe that you are anxious about a recurrence, find a dr. that will work with you on this. During crises, you may find yourself needing to go back up a milligram or two, but when the crisis abates, taper (w/ a dr.) yourself back down to the minimal dose that works for you.
Gabapentin and Lyrica are drugs that can also be used for some types of anxiety.
But some of the substitutions for benzos that I’ve seen cause more trouble than they are worth—far more trouble than sticking with a low dose benzo might.
Some have been prescribing atypical anti-psychotics for anxiety and sleep. These drugs can help, but they can also cause EPS (extrapyramidal symptoms) which are disconcerting muscle movements that can be treated with Cogentin quickly and easily. Less pleasant side effects are tardive dyskinesia, which are involuntary muscle movements—like tapping a finger, twisting a hand, facial grimaces and tongue protrusion. Akathisia, which is involuntary foot tapping, may also occur. These can be helped somewhat with propranolol. Tardive dyskinesia is permanent though. I think few patients are told about the risks of using these drugs for any length of time, even as they are being excessively cautioned about benzos.
If you are anxious and/or depressed, individual psychotherapy can help. Group therapy and support can also be very helpful especially if you are taking the appropriate medication.