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Dr_Anderson
Dr_Anderson, Doctor
Category: Mental Health
Satisfied Customers: 335
Experience:  Psychiatrist
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Hello Docs, Ive been taking 1mg klonopin just recently

Customer Question

Hello Docs,

I've been taking 1mg klonopin just recently upped the dosage to 1.5 mg per day for anxiety disorder. A recent stressful event happened that makes my anxiety worse. My pyschiatrist recently started on and SSRI. We agreed that this is best long term medicine for my condition. What benefits should I expect when adding the SSRI? thanks.
Submitted: 4 years ago.
Category: Mental Health
Expert:  Dr_Anderson replied 4 years ago.

Dr_Anderson :

Greetings, and thank you for the question! Several benefits come to mind: (1) SSRI's are not potentially habit-forming, as Klonopin is; (2) SSRI's usually do not build up a tolerance, like Klonopin can; (3) SSRI's can provide more even and consistent relief as compared to Klonopin; (4) SSRI's typically do not have the long-term potential side effects of clumsiness, gait problems, and memory problems; (5) Low or no potential respiratory problems which Klonopin can give (slowed respiratory drive in particular)

Customer:

Thanks, XXXXX XXXXX I suspect that either I'm having more anxiety or that the klonopin is not effectively controlling it via tolerance to its effects. Since I'm already symptomatic, a taper off process at this point would be difficult right?

Customer:

I do eventually want off of meds. I was medication free for almost 3 years

Dr_Anderson :

Hello again. Yes, it is likely that the anxiety symptoms are simply overwhelming the ability of the Klonopin to do the job adequately. A taper off would be tough, and likely the anxiety would get worse because what little good the Klonopin is doing, would be gone. The choice there is to either keep going up on the dose (with the subsequent risks noted above also increasing), to switch to a different benzo, or to add something like an SSRI, with longer-term control, and with the option to go off the medicine at a later date.

Customer:

Yes, that is why we decided to go this route. A different benzo would help my condition ?

Dr_Anderson :

Perhaps, but it is robbing Peter to pay Paul - going from one benzo to another, the new one may help or work better than the Klonopin, but you still have the situation of having to come off it, too. Since Klonopin has worked in the past, I'd probably go up just a little bit while waiting for the SSRI to start to work, then come down off it when the SSRI kicks in.

Customer:

Yes that is the goal. Klonopin does work albeit not as well as it did back a few months ago. I hope the SSRI lowers the anxiety. Have your patients with high anxiety felt relief from using an SSRI alone or always with a benzo?

Customer:

The klonopin isn't ineffective, it's just taking a larger amount to do the trick than at the beginning

Customer:

I've heard SSRIs are used mainly for depression but also for anxiety disorders. I'm hoping that with an SSRI and klonopin at least in the beginning after the SSRI kicks in, my anxiety will be under control like it was back when i started treatment

Dr_Anderson :

Most of mine have been able to get great relief from the SSRI alone, although I will commonly use a benzo as a "bridge" to help until it begins to work. you are quite correct, SSRI's are used for both anxiety and depression. In both cases, serotonin is mis-regulated, just in different ways. There is every reason to hope and expect your anxiety to be under control, if not gone, once the SSRI begins to work. Hang in there! :)

Customer:

yes, one thing i read about is that benzos used long term down-regulate the receptors which calm you down, while upregulating the stimulating chemicals. How will the SSRI deal with this issue? Or is it that only by a slow taper off the klonopin even while taking the SSRI will I be stable and functional without going out of my mind (just kidding)lol

Dr_Anderson :

*lol* Great question. The benzo work in a different way than the SSRI's, which is why you can fiddle with one and not necessarily impact the other. Kind of like microwaving vs. grilling. In grilling, it takes longer, more work, but the results are much more satisfying (in my opinion) than microwaving, which does work quickly but not as tasetfully. Microwaving is benzo, grilling is SSRI. In both cases, the food is cooked, and you can do one and still have a cooked meal with the other.

Customer:

great analogy. ok well I just started on the SSRI today so i'll have to wait a few weeks at least to feel its effects. In the meantime I'll continue with the klonopin and hope for the best. 2 major thoughts regarding my condition are on my mind: the positive one is that I was feeling fine just a short time ago, and the negative one is that I'm not feeling as good as back when I first started on the klonopin even though I'm at a higher dose. I'm confident that there's a a solution out there to get me back on track. The one thing I fear is continually escalating a habit forming and tolerance building medication that's meant for short term use

Dr_Anderson :

Precisely why being on an SSRI, which does not carry that risk, is such a great option now. you note that you have not really been at your "baseline" for some time now. I am quite hopeful that, once at the right dose, the SSRI will help you get back to that baseline more effectively.

Customer:

btw, my pyschiatrist recommended paxil for my situation and i agreed until he told me to expect a weight gain of 15-20 lbs. I gave him a discouraged look. I suggested zoloft because of its proven record and he recommended viibryd which he said has worked well for about 15 of his patients with less side effects. I asked him for the one that works best and he thinks viibryd will be effective enough with less side effects. what is your opinion on viibryd?

Dr_Anderson :

For me, the jury is still out on it. It does not work any better or any worse than the other SSRI's in the studies, so why go with the new drug hat is not generic when the old ones that are generic and cheaper will work just as well? I do have some folks on Viibryd, and the clinical experience of my patients mirrors the clinical trials in effectiveness. Zoloft is good but sometimes can be a bit on the activating side. Another I routinely turn to for anxiety treatment is Prozac.

Customer:

My doc never mentioned prozac. He mentioned paxil, zoloft and viibryd. I wonder why? Maybe i should bring this up next time. However, since I've decided to add an SSRI which do you recommend for someone who fits my profile: 33 yr old male, highly anxious, stressful work environment, developing tolerance to benzo, insomnia often, perhaps a bit of depression but mainly anxiety for now? thanks,

Dr_Anderson :

Believe it or not, in your case I would actually recommend Paxil first. Yes, there is a risk of weight gain, but 15-20 pounds is a bit much. Most of my patients who gain weight from it (and not everyone does) gain 5-10 pounds. But, keeping active and watching what one eats usually keeps that to a low roar. Why Paxil? Great for anxiety, panic, and social phobia. Sedating, so if taken at bedtime it can help with sleep. Prozac would be the second option. Lexapro third.

Dr_Anderson :

You are quite welcome! Hope this helps. :)

Dr_Anderson :

Please let me know if I may be of further service!

Dr_Anderson :

Regards, XXXXX XXXXX

Customer:

Thanks, XXXXX XXXXX you and my pysch recommend paxil. Must be something there. Anyway, as always, thanks for the advice Dr. Anderson and have a great night. :)

Dr_Anderson and other Mental Health Specialists are ready to help you
Expert:  Dr_Anderson replied 4 years ago.
And you as well! It is a red-letter day - 2 psychiatrists agreed on something! :)

Best wishes. :)

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