doug d

To the Group,

I have a question for those of you who use benzodiazepines to reduce
or help control your anxiety, and to eliminate situational panic
attacks (if you have them - not everyone does with sp). A prelude
first: I recently read a private sp site where the author (a layman)
stated that Klonopin is the preferred benzo treatment for sp (assuming
you're not taking an MAOI as your primary med). Personally, I've
never felt that Klonopin has worked as well for me as Xanax, but I
realize everyone differs. Anyhow, I did a search on the Pubmed site
and sure enough Klonopin was cited more than once as a preferred benzo
for sp - again barring other medication treatment options. Do any of
you who use benzos have a preference and, if so, why? Thank you in
advance.

Doug D.

none

I think socialfears.com isn't worth much if you're referring to that page.

Personally, I my shrink won't prescribe me Xanax (higher risk of
interaction with Effexor than Ativan, which, realistically, doesn't even
interact with alcohol which I've proven again last night, was feeling
tense even after the third beer and then decided to take 1mg no matter
what they say and got relief soon thereafter and actually ended up quite
chatty with my boss' son and possible even scored a date with THE crush
in my life) or Klonopin (because of its very long half life, it's harder to quit).


I think Jessie has had some success with Paxil + Klonopin (she seems in
much better state than some weeks ago at least).

Personally, I'm doing quite well with Effexor and Ativan but I'm
specific (women). These days I can at least go on a date or ask a girl
out which is a long way from where I was without medication. But ok, I
was severely depressed, too.

davidw

From what I've read Klonopin would be preferred, because it doesnt cause
dependence as much as others. It also has a slower onset of action, not
causing the "high" like Xanax can. I took Klonopin for one month 0.5mg twice
a day and never had any withdrawal symptoms. It did help a little. If it's
for use once and a while as needed, I'd prefer something that was strong and
worked quickly such as Xanax.

rgberg_2

Hi. I use Xanax for performance or high-anxiety situations. I tried
Klonopin a couple of times, but found it pretty useless. It had a
calming effect overall, but didn't do much of anything for alleviating
anticipatory and performance anxiety/panic. Based on its
pharmacokinetics, I wouldn't really expect it to. One thing I thought
I noticed was that generic clonazepam didn't seem to work as well for
me as brand-name Klonopin. Coulda been my imagination though. Also,
I think MDs are more willing to prescribe Klonopin because it's
supposed to be less likely than Xanax to cause dependence.

Actually, there have been studies on both Xanax and Klonopin for SP.
Surprisingly, Xanax did very poorly, barely above placebo. In
contrast, Klonopin seemed to help a lot. These studies, like most
others, were testing for effects on generalized SP; there's apparently
no good paradigm for testing drugs for situational SP.

There's a recent review of pharmacotherapy for SP. I don't know if
the full text can be downloaded without having access to the journal,
but the abstract can be found in PubMed at:
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12950437&dopt=Abstract

doug d

Hi David,

I've been taking Xanax since about 1985 and have never experienced a
"high" or euphoric feeling. I have gotten tired on occasion if I've
taken a larger than normal dose for say a meeting. When the meeting
ends, I'm literally exhausted. Nonetheless, I'd rather be exhausted
than have high anxiety or a situational panic attack in an event like
that. I don't think I mentioned it, but I take 2 mg of Klonopin, 3
mg of Xanax and 100 mg of Trazodone daily. Of that total, 1 mg of
Xanax and the Trazodone are taken in the middle of the night for
insomnia. My sp was diagnosed by my psychiatrist as chronic and
severe.

I've been experimenting a little, taking my two 1 mg Klonopin pills at
one time to see if I feel closer to normal or can get a longer useful
effect from them. Result so far is that I feel ok, not tired nor
anxious. It's been nearly 8 hours since I took the pills and I don't
feel any need for a Xanax yet. That said, I also know from prior
experience that 1 mg of Klonopin taken an hour or two before a
difficult social event doesn't stop the high anxiety for me.
Everyone's different with respect to meds so others may react
differently in a similar situation.

Doug D.

doug d

RG,

I believe you've hit the nail squarely on the head. One of the most
difficult things with generalized sp for me, you and I suspect
millions of others is that the anxiety doesn't stay at a steady state.
You can have very good days, say a weekend, when you're not in any
social situations that might aggravate your anxiety; Even a sugar
pill might work just fine.

But in the real world, not the clinical world, "trigger" type social
events pop up all the time that can send anxiety through the roof.
Depending on what the event is and how far away it is time-wise, there
may be days, even weeks of anticipatory anxiety that gets stronger as
the event nears, then very high anxiety or even a panic attack during
the event itself. Plus, if the event catches you completely off
guard, you might (well I might anyway) go straight to panic.

Take a job interview for example. Maybe you've submitted an
application/resume, been contacted and asked to come in to interview
for whatever. You screw up your courage, call someone, the time and
date are set, and perhaps you're informed there'll be 4 or 5 separate
interviews while you're there. Just for arguments sake, let's assume
the interviews are going to occur two weeks in the future. So you're
both elated while simultaneously beginning to become a little anxious.
As the event draws closer the anxiety climbs. The day arrives and you
play it safe by taking some extra Xanax or whatever. You meet the
first interviewer, the talk begins with light chit chat, and you're
not feeling too badly anxiety wise. Then he/she drops a bomb like the
3rd interview will be with a group of 4 managers; all the others will
be one on one. You nor I nor anyone would be prepared for this
eventuality most likely, and the anxiety begins to race because of the
dreaded group interview. Somehow you get thru the first interview,
but all you're thinking about is that 3rd interview and it's eating at
your brain making it difficult to concentrate and present yourself
well. I could go on, but I believe you get the picture.

I don't know this for a fact, of course, but I'd bet a dollar to a
donut that clinical testing never even comes close to evaluating for
extreme, heightened trigger situations like that. So sure, Klonopin
maybe works fine when things are smooth, but it sucks when you're
running for your life, so to speak.

Best I stop. I could write pages of things just like this that have
happened to me, but it wouldn't serve any purpose except to show that
routine doses of whatever med often are completely inadequate in
difficult situations. Others could do the same.

Doug D.

doug d

None,

The web site you mentioned is the one I was referring to.
http://www.socialfear.com/

In any event, I've already decided I'm going to try to get off
Klonopin and substitute Xanax XR for it if my shrink's willing.
Otherwise, I'll just ask for more regular Xanax.

Doug D.

rgberg_2

Doug -

Hi. I know exactly what you're talking about. I've taken meds that
help with the overall dread, but do little if anything for the panic
(Klonopin was like that for me). And, as you note, the drugs that do
work for those situations (eg, Xanax) are not so useful unless events
are predictable. I'm not complaining; I'm very grateful for anything
that helps at all.

I think you're also correct about the problems in doing experiments to
measure the effectiveness of these drugs. Typically what's done to
measure levels of SP (at least in the papers I've read) is to give the
Liebowitz or some other test for SP. If there's a greater change in
the score with the drug than with a placebo, then the drug is assumed
to be helpful. Unfortunately, as you note, taking a test in the
relative calm of an office is not the same as facing a panic-inducing
situation. I've never been able to simulate the panic-inducing
situation or feelings artificially, so, until I faced an actual
situation, I wouldn't know whether the drug was working or not.

The meds clearly are beneficial for some people (including me), but I
think this is part of the reason why so many SPers have so many
different experiences with them. (Of course, it probably also
reflects how complicated neurochemistry and behavior are).