# "Which is better", alprazolam oder clonazepam? What about side-effects?



## nameuser (Jul 29, 2009)

Hello,

I suffer from social anxiety, undiagnosed for decades. 

As for medication, "which is better", i.e. has better scientific study results and has less side-effects, alprazolam (Xanax) or clonazepam (Klonopin)? 

I tried alprazolam a few years ago and remember feeling a bit weird on it. I will try clonazepam as from tomorrow. Recently I have taken lorazepam on occasion, which is okay (doesnt cause cognitive deficits or sedation in me), but I have hairloss as a side-effect. I have read that clonazepam can cause hairloss...

Does anyone have infos on "which is better", also, I would appreciate to hear of experiences of those who have taken both and can compare... and possibly mention side effects too?


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## arthur56 (Jul 31, 2005)

they are all the same except K lasts longer than the others, they all take getting used to , if sedated strongly, reduce the dose for a while

they dont cause hairloss


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## UltraShy (Nov 8, 2003)

arthur56 said:


> they dont cause hairloss


Agree. I've read the whole laundry list of possible side effects and hair loss is not on that list. I've read the anti-benzo propaganda that blames benzos for damn near every problem under the sun and even they failed to find hair loss as a problem. And the anti-benzo folks manage to link benzos to virtually everything. Prof. C. Heather Ashton, the old bag who's the UK queen of benzo bashing was even able to link benzos to a case of blindness. If you're wondering how that's possible, you have to crush a benzo, make it into a solution and then use a dirty needle to inject it into your eye which causes and infection that leads to blindness. Yeah, blame a benzo for one of the world's most stunning cases of stupidity. Isn't this the last place you'd think of to inject anything?


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## UltraShy (Nov 8, 2003)

As for which is better, there isn't an overall better benzo. It's a matter of personal preference and your specific needs. Klonopin is longer lasting, but slower to take effect. Xanax is shorter acting, but takes effect faster. Due to this Xanax is more suited to PRN (as needed) use and Klonopin is more suited to chronic use. Though that is a generalization as I've been using Xanax on a daily basis for years and there are lots of people who use Klonopin PRN.

The answer to which is better is whichever one works best for you.


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## nameuser (Jul 29, 2009)

arthur56 said:


> [...]
> 
> they dont cause hairloss


hmm, apparently clonazepam can cause hairloss, says so in the prescription guide (at least in mine it does, generic version).


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## nameuser (Jul 29, 2009)

thanks for all the replies, I guess it's personal trial and error then. i've got both now and I'll see which I prefer, also with regards to side effects.

when I wrote "which is better" I also meant with regards to (scientific) efficacy (sic). apparently though these two benzos are first choice in SP.


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## RockiNToM (Jun 15, 2009)

Hair loss? Jesus, I would be more concerned if you were using an anti-depressant concerning hair loss than a benzodiazepine. On paxil I like to refer to my hair experience as 'moulting' as my hair line receded quite a bit. When I came off it grew back.


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## jim_morrison (Aug 17, 2008)

RockiNToM said:


> Hair loss? Jesus, I would be more concerned if you were using an anti-depressant concerning hair loss than a benzodiazepine. On paxil I like to refer to my hair experience as 'moulting' as my hair line receded quite a bit. When I came off it grew back.


Jesus, that's pretty concerning, makes you wonder about SSRI's, then again, I always had my doubts over SSRI's.


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## nameuser (Jul 29, 2009)

RockiNToM said:


> Hair loss? Jesus, I would be more concerned if you were using an anti-depressant concerning hair loss than a benzodiazepine. On paxil I like to refer to my hair experience as 'moulting' as my hair line receded quite a bit. When I came off it grew back.


how long after you stopped the paxil did the hair start growing back? and would you say it reaches/reached the level it was before the paxil?


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## MissMay1977 (Oct 25, 2008)

I prefer Klonopin because Xanax makes me angry.


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## RockiNToM (Jun 15, 2009)

nameuser said:


> how long after you stopped the paxil did the hair start growing back? and would you say it reaches/reached the level it was before the paxil?


A lot of it grew back but some it didn't as well. It was strange when it happened because there is no male baldness on either side of my family and when I read that SSRIs can cause hair loss it made sense - plus as well as some of it growing back when I came off it.


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## arthur56 (Jul 31, 2005)

hairloss is often caused by stress or anxiety, also everyone moults but the hair lost grows back soon

at one stage the antibenzo fanatics said all panic attacks were caused by benzos.....


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## RockiNToM (Jun 15, 2009)

True, but this definitely was the Paxil, since my anxiety and depression was very much erradicated at that time while on it.

Shame it stopped working and didn't work when I went back on it.


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## Cast Away (Feb 12, 2009)

Which is better coke or pepsi? There about the same besides half life. Xanax is more suited for panic attacks and clonazepam is more of a subtle long lasting effect.


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## nameuser (Jul 29, 2009)

Cast Away said:


> Which is better coke or pepsi? There about the same besides half life.


really? which has the longer half life, coke or pepsi?  just kidding, thanks for info.


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## gillettecavalcad3 (Jul 9, 2009)

*Hairloss*

Years ago I suffered hairloss on ssri's (mixture) Stopped taking them and My hair grew back almost thicker. I have been on Clonazepam for 5- 6 years and experienced no hairloss whatsoever. In fact, ....people actually comment on the thickness of my hair.

Benzophobes will lead you to believe that benzo's were put on this earth by the devil. I would just love for these people to become crippled and house bound due to anxiety.

Let them see how it feels to be scared to leave your house.


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## euphoria (Jan 21, 2009)

gillettecavalcad3 said:


> Years ago I suffered hairloss on ssri's (mixture) Stopped taking them and My hair grew back almost thicker. I have been on Clonazepam for 5- 6 years and experienced no hairloss whatsoever. In fact, ....people actually comment on the thickness of my hair.
> 
> Benzophobes will lead you to believe that benzo's were put on this earth by the devil. I would just love for these people to become crippled and house bound due to anxiety.
> 
> Let them see how it feels to be scared to leave your house.


Yes, they make a good short-term treatment, but is your life as organised as it once was? Memory still going strong? Concentration? Sex drive? Ability to feel emotion and pleasure? How about your career (if you have one), has that advanced at all?

Agreed benzophobes are stupid, but so are benzophiles. There are far better ways to treat depression/anxiety than benzos.


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## DMBfan (Aug 29, 2008)

euphoria said:


> Agreed benzophobes are stupid, but so are benzophiles. There are far better ways to treat depression/anxiety than benzos.


For anxiety what works better than benzos?


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## Ash09 (Apr 27, 2009)

DMBfan said:


> For anxiety what works better than benzos?


Opioids, they also have a better side effect profile, they don't cause the sedation and impairment that benzos do.


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## euphoria (Jan 21, 2009)

DMBfan said:


> For anxiety what works better than benzos?


SSRI + mirtazapine or SSRI + bupropion are both extremely effective for both anxiety and depression without many side-effects. There are many possibilities outside legal prescriptions, and opioids as mentioned are pretty miraculous if you stop tolerance.


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## BradPit (Apr 8, 2008)

gillettecavalcad3 said:


> Years ago I suffered hairloss on ssri's (mixture) Stopped taking them and My hair grew back almost thicker. I have been on Clonazepam for 5- 6 years and experienced no hairloss whatsoever. In fact, ....people actually comment on the thickness of my hair.
> 
> Benzophobes will lead you to believe that benzo's were put on this earth by the devil. I would just love for these people to become crippled and house bound due to anxiety.
> 
> Let them see how it feels to be scared to leave your house.


I don't think you have never gone trough a benzo withdrawal believe me the symptoms are so bizarre and long drown you don't want to get addicted to this stuff ... 
take them only when you really need them not more that once a week that way you wont get physically dependent on them believe me the withdrawals are no fun!


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## jim_morrison (Aug 17, 2008)

euphoria said:


> SSRI + mirtazapine or SSRI + bupropion are both extremely effective for both anxiety and depression without many side-effects. There are many possibilities outside legal prescriptions, and opioids as mentioned are pretty miraculous if you stop tolerance.


Hey euphoria, do you find that adding mirtazapine to your SSRI, actually reverses the sexual side effects, nausea and insomnia of the SSRI, as it's sometimes suggested?


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## gillettecavalcad3 (Jul 9, 2009)

*withdrawel*

I take Clonazepam as needed along with propranolol. I can not take them for over a week and no withdrawals or side effects, nada, nothing. Bearing in mind I have been on this drug for over 5 years at the same dosage and they have never lost there efficacy.

SSRI withdrawel is terrible for me. In fact SSRI's in general are a living nightmare for me. I'm not trying to give them a bad name as they have helped many people, ....but we are all different and they just don't agree with me at all. My anxiety becomes 10 fold.

euphoria, as for my life and career, .....benzo's have pretty much saved my career. I own my own studio and make a great living from that and I've also just started up another business that is starting to turn profit. . When I take Clonazepam I am sharper and more witty than when not on them. They don't make me sleepy and I don't suffer any memory issues.

My pdoc wants to put me on Nardil, because we both agree that it is the Gamma aminobutyric acid (gaba) properties of the Clonazepam that help me so well. So Nardil and Clonazepam/propranalol as needed. I start it in 2 weeks.

Will keep you posted.


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## DMBfan (Aug 29, 2008)

euphoria said:


> SSRI + mirtazapine or SSRI + bupropion are both extremely effective for both anxiety and depression without many side-effects. There are many possibilities outside legal prescriptions, and opioids as mentioned are pretty miraculous if you stop tolerance.


You must not read the forums, other than Nardil/Parnate, antidepressants have a poor reputation for treating anxiety (especially SSRI's.) I'm not talking about co-morbid depression, just anxiety disorders. Benzos (and stimulants) have by far the best reputation. Opiods may work but you're not going to be a prescription for anxiety and the efficacy hasn't been studied.


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## Cast Away (Feb 12, 2009)

"My pdoc wants to put me on Nardil, because we both agree that it is the Gamma aminobutyric acid (gaba) properties of the Clonazepam that help me so well. So Nardil and Clonazepam/propranalol as needed. I start it in 2 weeks." 

Thats about the most potent combination you can get.


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## jim_morrison (Aug 17, 2008)

gillettecavalcad3 said:


> My pdoc wants to put me on Nardil, because we both agree that it is the Gamma aminobutyric acid (gaba) properties of the Clonazepam that help me so well. So Nardil and Clonazepam/propranalol as needed. I start it in 2 weeks.
> 
> Will keep you posted.


sounds like a heroic combo for SA, will be interesting to hear how it goes. 
I agree that Gamma aminobutyric acid (GABA) plays a large role in SA, I'm curious did your doc ever mention Lyrica? that also has an affect on GABA.


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## RockiNToM (Jun 15, 2009)

I think you're right Jim, GABA I believe possibly plays just as an important role as dopamine on its own. Look at the effects of alcohol and how it works on GABA, thus being the reason why people who turn to it to calm themselves down or relax. 

It's just a shame that most things that work on GABA cause addiction of some kind or if they don't, they tend to be ones that don't work as well.

In conclusion you could perhaps say, people who have some kind of anxiety disorder have an addictive personality as well - some but not all.

:blank


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## euphoria (Jan 21, 2009)

jim_morrison said:


> Hey euphoria, do you find that adding mirtazapine to your SSRI, actually reverses the sexual side effects, nausea and insomnia of the SSRI, as it's sometimes suggested?


The annoying thing is I haven't properly tried it yet, but at 5mg paroxetine and 30mg mirtazapine I'm not aware of a single side-effect on my body or brain. Oh, I do get a tiny bit of yawning, but it's hardly the end of the world. While on mirtazapine it's easy to see how it works in the opposite direction to a number of SSRI sides, most importantly nausea, insomnia and sexual dysfunction. It greatly increases libido on its own...

I need to get my 20mg going (very soon), then if 30mg mirtazapine isn't enough to control the sides, I can easily ask to up it.



gillettecavalcad3 said:


> I take Clonazepam as needed along with propranolol. I can not take them for over a week and no withdrawals or side effects, nada, nothing. Bearing in mind I have been on this drug for over 5 years at the same dosage and they have never lost there efficacy.
> 
> SSRI withdrawel is terrible for me. In fact SSRI's in general are a living nightmare for me. I'm not trying to give them a bad name as they have helped many people, ....but we are all different and they just don't agree with me at all. My anxiety becomes 10 fold.
> 
> ...


Yes used "prn" benzos are great, but not as a continuous thing (which a lot of anxiety sufferers need).



DMBfan said:


> You must not read the forums, other than Nardil/Parnate, antidepressants have a poor reputation for treating anxiety (especially SSRI's.) I'm not talking about co-morbid depression, just anxiety disorders. Benzos (and stimulants) have by far the best reputation. Opiods may work but you're not going to be a prescription for anxiety and the efficacy hasn't been studied.


See my above comments re: SSRIs with mirtazapine.



RockiNToM said:


> I think you're right Jim, GABA I believe possibly plays just as an important role as dopamine on its own. Look at the effects of alcohol and how it works on GABA, thus being the reason why people who turn to it to calm themselves down or relax.
> 
> It's just a shame that most things that work on GABA cause addiction of some kind or if they don't, they tend to be ones that don't work as well.
> 
> In conclusion you could perhaps say, people who have some kind of anxiety disorder have an addictive personality as well - some but not all.


I used to believe all the hype about GABA, but anxiety can always be controlled in better ways than slowing the central nervous system.


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## DMBfan (Aug 29, 2008)

euphoria said:


> See my above comments re: SSRIs with mirtazapine.


If there was a magic SSRI/AD combo that worked for a large percentage of people I think we'd be aware of it at this point. If it works for you than great but don't make the mistake of thinking your individual experience applies to everybody. All that is going to do is give people unrealistic expectations. Some of us take only benzos, do just fine, and don't suffer tolerance or addiction so respectfully I disagree that benzos are only safe taken PRN.

BTW, why are there so many wikipedia educated pharmacologists around here offering advice?


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## jim_morrison (Aug 17, 2008)

DMBfan said:


> BTW, why are there so many wikipedia educated pharmacologists around here offering advice?


At the end of the day, I would strongly suggest that anybody looking to try a medication, first consult a doctor, any discussion about mechanisms of action etc on here is just discussion, and I don't think that it in any way should replace a doctors opinion.


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## jim_morrison (Aug 17, 2008)

RockiNToM said:


> I think you're right Jim, GABA I believe possibly plays just as an important role as dopamine on its own. Look at the effects of alcohol and how it works on GABA, thus being the reason why people who turn to it to calm themselves down or relax.
> 
> It's just a shame that most things that work on GABA cause addiction of some kind or if they don't, they tend to be ones that don't work as well.
> 
> ...


Thats true, although alcohol is a clumsy drug, and also interacts with the dopamine, opioid and glutamate systems, in addition to GABA.


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## euphoria (Jan 21, 2009)

DMBfan said:


> If there was a magic SSRI/AD combo that worked for a large percentage of people I think we'd be aware of it at this point. If it works for you than great but don't make the mistake of thinking your individual experience applies to everybody. All that is going to do is give people unrealistic expectations. Some of us take only benzos, do just fine, and don't suffer tolerance or addiction so respectfully I disagree that benzos are only safe taken PRN.


I didn't say it's unsafe to take benzos, just that they're a very poor solution. Saying people won't develop tolerance or become addicted to benzos seems much more likely to give them unrealistic expectations.


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## gillettecavalcad3 (Jul 9, 2009)

*Benzos*

"I didn't say it's unsafe to take benzos, just that they're a very poor solution."

That is a generalization. They weren't a poor solution for me and I have been on Clonazepam for 6 years.

I makes me more sharp, witty, prevents depression, .....and last but not least, ....helps my anxiety. I literally couldn't leave the house, thought I was losing my mind.

SSRI's made me suicidal and increased my anxiety.

Clonazepam is by far the only drug that has helped my social phobia and I have tried nearly all the SSRI's SNRI's and Tricyclics.

I wouldn't call that a poor solution.


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## Medline (Sep 23, 2008)

I also don't think that benzos are a poor solution for anxiety, sometimes potent GABAergic drugs like Clonazepam are the only thing that helps. Benzos have very low toxicity and in general few side effects and drug interactions.


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## euphoria (Jan 21, 2009)

gillettecavalcad3 said:


> SSRI's made me suicidal and increased my anxiety.


As they do for many people initially. Did you wait 4-8 weeks on a fixed dose?


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## jim_morrison (Aug 17, 2008)

euphoria said:


> As they do for many people initially. Did you wait 4-8 weeks on a fixed dose?


I don't tolerate SSRI's very well either, they seem to amplify my anxiety and put me on edge, and I was on them for 1 year (paxil) and 2 months (lexapro) respectively.

Mirtazapine on the other hand, for me, works well, especially in combination with clonazepam.


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## gillettecavalcad3 (Jul 9, 2009)

*SSRI's*

I spent years on SSRI's to no avail.

Everytime I moved on to a new one I always give it a couple of months. They did nothing for me but make my symptoms worse.


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## RockiNToM (Jun 15, 2009)

Although I found some very good success for my depression and anxiety with Paxil, most of the SSRIs I've taken don't do enough or give me enough positive effects to justify staying on them. I've been through 5 anti-depressants and only 1 of them I was on for 2 years (Paxil). So in conclusion, for me SSRIs offer very little benefit unless your lucky and find one that works well for you, but even then they can stop working like Paxil did for me.

I wish there was such a thing as an anti-depressant that had benzopdiazepine qualities to it, where instead of working on just the serotonin or norepinephrine, we have the GABA affected too, maybe even dopamine as well. 

So my point is, there is no easy solution. It seems SA on its own or with depression is a very complex and non-specific treatment. There seems to be too many factors contributing to the cause.


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## Medline (Sep 23, 2008)

RockiNToM said:


> I wish there was such a thing as an anti-depressant that had benzopdiazepine qualities to it, where instead of working on just the serotonin or norepinephrine, we have the GABA affected too, maybe even dopamine as well.


Nardil does that.


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## RockiNToM (Jun 15, 2009)

But most doctors are numpties and don't use it much anymore - well my doctor doesn't.


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## DMBfan (Aug 29, 2008)

euphoria said:


> Saying people won't develop tolerance or become addicted to benzos seems much more likely to give them unrealistic expectations.


The medical research does not support that assertion. And you have to support your assertion that benzos are a "poor solution" in comparison to the AD cocktail you are recommending.


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## jim_morrison (Aug 17, 2008)

Medline said:


> I also don't think that benzos are a poor solution for anxiety, sometimes potent GABAergic drugs like Clonazepam are the only thing that helps. Benzos have very low toxicity and in general few side effects and drug interactions.


I agree, Clonazepam sometimes feels like its the only thing that gives me a better qaulity of life, compared to that, the idea of being dependent on something, doesnt really bother me half as much as the idea of feeling so utterly depressed/anxious every day.


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## euphoria (Jan 21, 2009)

DMBfan said:


> The medical research does not support that assertion. And you have to support your assertion that benzos are a "poor solution" in comparison to the AD cocktail you are recommending.


I've already posted the study showing mirtazapine + venlafaxine produced more remission than Parnate for depression, with a great deal less side-effects. Depression and anxiety are not the same, but often are closely linked and one could safely assume potent antidepressant effect is likely to transfer over into anxiolysis when dealing with drugs used extensively on their own for anxiety disorders.

http://www.ncbi.nlm.nih.gov/pubmed/16946177

It definitely needs more research.

I've heard others saying benzos don't produce dependence, withdrawals or dose-escalation when taken over a long period of time, but never seen any proof...

Don't get me wrong, if that's the only thing that works for you then by all means go for it. I just can't take benzos & similar drugs myself because they invariably have a negative impact on my memory, cognition, etc. These side-effects are why I consider them a poor solution in comparison to mirtazapine + SSRI, where the worst you get is transient sedation/weight gain.


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## gillettecavalcad3 (Jul 9, 2009)

*horrible drug for me*

Mirtazipine was a horrible drug for me. My head felt like a tonne weight and I couldn'd find any energy to get out of bed.


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## RockiNToM (Jun 15, 2009)

It sucked for me too, but I have to say despite my very bad reaction, I wasn't as emotionally numb as I felt as other anti-depressants. Just a shame I couldn't tolerate the other effects.


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## DMBfan (Aug 29, 2008)

euphoria said:


> It definitely needs more research.
> 
> I've heard others saying benzos don't produce dependence, withdrawals or dose-escalation when taken over a long period of time, but never seen any proof...
> 
> Don't get me wrong, if that's the only thing that works for you then by all means go for it. I just can't take benzos & similar drugs myself because they invariably have a negative impact on my memory, cognition, etc. These side-effects are why I consider them a poor solution in comparison to mirtazapine + SSRI, where the worst you get is transient sedation/weight gain.


I can dig up the research on long term benzos not causing tolerance or addiction when taken for anxiety disorders if you'd like. My therapist tested me for depression and I don't suffer from it, good old fashion GAD and moderate SA is my diagnosis. The one thing we can agree on is to use what works for you. I completely agree that we need more research, new anxiety medications and better psychotherapy treatment options (2 1/2 years of CBT didn't help me.)


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## jim_morrison (Aug 17, 2008)

gillettecavalcad3 said:


> Mirtazipine was a horrible drug for me. My head felt like a tonne weight and I couldn'd find any energy to get out of bed.


Alot of people seem to not be able to tolerate staying on mirtazapine long enough to see the benefits, and it seems that alot of the mirtazapine reviews on here and other sites seem to reflect that. But for me, after a few weeks, most of these side effects faded away and the benefits kicked in.


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## RockiNToM (Jun 15, 2009)

I envy that, I really do. I hoped mirtazapine would be the wonder drug for me, considering how different it was in the way it worked from SSRIs. I was very hopeful and optimistic about using it, however those damn suicidal feelings and thoughts screwed me over and it affected my own safety. But, next time I might try and use it while already being on an SSRI, then the suicidal problems should go away. Until I find a suitable SSRI to work with it, I can't use it.


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## jim_morrison (Aug 17, 2008)

I had been having suicidal feelings for years, so at the start I just thought, oh yeah more of these feelings, whatever and waited it out, glad I did. After awhile Mirtazapine stopped those feelings. Another thing I find with mirt though is that I dont get lonely when I'm alone anymore, it kills the feeling of isolation without even having to leave the house. Maybe thats not such a great thing for those who are all about exposure exercises and getting out there, but I like it.


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## jim_morrison (Aug 17, 2008)

RockiNToM said:


> I envy that, I really do. I hoped mirtazapine would be the wonder drug for me, considering how different it was in the way it worked from SSRIs. I was very hopeful and optimistic about using it, however those damn suicidal feelings and thoughts screwed me over and it affected my own safety. But, next time I might try and use it while already being on an SSRI, then the suicidal problems should go away. Until I find a suitable SSRI to work with it, I can't use it.


Btw, if you do try mirtazapine again, and you know don't react well to SSRI's, your probly better off augamenting it with a benzo until the suicidal stuff fades. SSRI's would probly just compound it anyway, as their known to do that at the start of treatment. I find the benzo-mirtazapine combo much better.


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## euphoria (Jan 21, 2009)

DMBfan said:


> I can dig up the research on long term benzos not causing tolerance or addiction when taken for anxiety disorders if you'd like. My therapist tested me for depression and I don't suffer from it, good old fashion GAD and moderate SA is my diagnosis. The one thing we can agree on is to use what works for you. I completely agree that we need more research, new anxiety medications and better psychotherapy treatment options (2 1/2 years of CBT didn't help me.)


I'd like to see that research...


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## DMBfan (Aug 29, 2008)

euphoria said:


> I'd like to see that research...


I already posted it for you before but here it is again.

http://www.biopsychiatry.com/benzoabdos.htm

_RESULTS: A total of 2,440 patients were identified, comprising 460 new and 1,980 continuing recipients...Among all groups of continuing recipients, the median daily dosage remained constant at 10 DMEs [diazepam milligram equivalents] during two years of continuous use. No clinically or statistically significant changes in dosage were observed over time. The incidence of escalation to a high dosage was 1.6 percent...CONCLUSION: The results of this study did not support the hypothesis that long-term use of benzodiazepines frequently results in notable dose escalation._


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## euphoria (Jan 21, 2009)

DMBfan said:


> I already posted it for you before but here it is again.
> 
> http://www.biopsychiatry.com/benzoabdos.htm


Oh sorry, my memory is bad.



> _RESULTS: A total of 2,440 patients were identified, comprising 460 new and 1,980 continuing recipients...Among all groups of continuing recipients, the median daily dosage remained constant at 10 DMEs [diazepam milligram equivalents] during two years of continuous use. No clinically or statistically significant changes in dosage were observed over time. The incidence of escalation to a high dosage was 1.6 percent...CONCLUSION: The results of this study did not support the hypothesis that long-term use of benzodiazepines frequently results in notable dose escalation._


By "long-term use" I meant a study spanning a lot longer than 2 years. Benzo tolerance is usually pretty slow, and some people take them for decades.


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## DMBfan (Aug 29, 2008)

euphoria said:


> Oh sorry, my memory is bad.By "long-term use" I meant a study spanning a lot longer than 2 years. Benzo tolerance is usually pretty slow, and some people take them for decades.


LOL, you said that before to which I supplied this study where the average treatment length had been 3 years on Xanax and 8 years on Ativan. If it takes decades for tolerance to appear (also not supported by the research) I'd say it's not something one needs to worry about.:

CONCLUSIONS: Long-term users of alprazolam/lorazepam seeking treatment for discontinuation had clinically important past and current psychiatric histories. They used a constant or decreasing dose of medication and made attempts to stop their use. Persistent use of alprazolam/lorazepam for therapeutic purposes did not represent abuse or addiction as the terms are usually understood. A substantial proportion of these patients may be receiving appropriate maintenance therapy for a chronic psychiatric condition.

http://ajp.psychiatryonline.org/cgi/content/abstract/152/8/1161


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## No Limit (Dec 6, 2005)

I can feel the calming effects of Xanax much quicker than Klonopin at the same doseage.


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## euphoria (Jan 21, 2009)

DMBfan said:


> If it takes decades for tolerance to appear (also not supported by the research)


I didn't say that. I said benzo tolerance is usually slow, and some people take them for decades.



> CONCLUSIONS: Long-term users of alprazolam/lorazepam seeking treatment for discontinuation had clinically important past and current psychiatric histories. They used a constant or decreasing dose of medication and made attempts to stop their use. Persistent use of alprazolam/lorazepam for therapeutic purposes did not represent abuse or addiction as the terms are usually understood. A substantial proportion of these patients may be receiving appropriate maintenance therapy for a chronic psychiatric condition.
> 
> http://ajp.psychiatryonline.org/cgi/content/abstract/152/8/1161


That article doesn't state whether the doses are still as effective for anxiety as they were on day 1. It just proves that people wishing to stop benzos tended to maintain/decrease their dose over time, which is to be expected really.


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## jim_morrison (Aug 17, 2008)

Well I just got home from a party, an hour prior to going to the party I took .5 mg of klonopin to tests its effects on me. It seemed to give me some benefits, I socialised a bit better than usual, but there was still some social anxiety and I think a slightly higher dose perhaps 1 mg would have worked better.


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## DMBfan (Aug 29, 2008)

euphoria said:


> That article doesn't state whether the doses are still as effective for anxiety as they were on day 1. It just proves that people wishing to stop benzos tended to maintain/decrease their dose over time, which is to be expected really.


Euphoria, I really shouldn't have to explain to you that tolerance is the need to take an increasing dose to get the same effect. These studies very clearly show no tendency for long term benzodizepine patients to increase their dose over time (which would be expected if they experienced tolerance.) If you're implying that long term benzo patients continue to take a benzo dose that provides little/no therapeutic benefit you need to back that claim up with research.



euphoria said:


> I didn't say that. I said benzo tolerance is usually slow, and some people take them for decades.


I've backed up my claims with research, can you please provide research that backs up the claim that benzo tolerance is slow?


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## euphoria (Jan 21, 2009)

DMBfan said:


> Euphoria, I really shouldn't have to explain to you that tolerance is the need to take an increasing dose to get the same effect. These studies very clearly show no tendency for long term benzodizepine patients to increase their dose over time (which would be expected if they experienced tolerance.) If you're implying that long term benzo patients continue to take a benzo dose that provides little/no therapeutic benefit you need to back that claim up with research.


The first study I would have to read properly before arriving at that conclusion. Psychiatric patients may be on other medication, which clouds the issue. It's not like they control dosage themselves either. I would need to know ratings of anxiety from the start to 2 years later, at a constant dose (without other meds), to make statements regarding benzo anxiolytic tolerance. Even then it's only a 2-year study which is inadequate when some people take them over 10 times longer, but I would expect some degree of tolerance to happen in 2 years. Obviously there are many factors that affect tolerance.

The second one shows that people *wishing to stop taking benzos* have a tendency to maintain/decrease their dose over time. It proves nothing about benzo patients as a whole.

For the record, I don't believe for one second that tolerance to benzos' anxiolysis doesn't happen. You're gonna run into trouble if you believe every abstract conclusion you read on the internet.



> I've backed up my claims with research, can you please provide research that backs up the claim that benzo tolerance is slow?


It's just common knowledge. When I took benzos daily over about a year I became dependent on them and needed doses ~25-50% higher by the end to achieve similar effects to the first dose. Just read any one of the millions of stories about benzo use & withdrawal. It seems to vary from person to person (and depending on dose/drug/frequency of use), and tolerance to some effects (such as sedation) is faster. Despite this, I'd say the normal time scale of many months for tolerance to appear qualifies it as "slow", but clearly this is a vague term to use.

It's hard to separate initial anxiety from withdrawal symptoms, which is why ratings of anxiety before treatment, from the start to end of treatment, and later are important.


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## DMBfan (Aug 29, 2008)

euphoria said:


> It's not like they control dosage themselves either.


No, when people say say they became tolerant who do you think prescribed them the higher dosage? Exactly, their doctor so it would show up in the research.



> but I would expect some degree of tolerance to happen in 2 years.


Exactly, and yet it didn't show up in any significant way in the research.



> The second one shows that people *wishing to stop taking benzos* have a tendency to maintain/decrease their dose over time. It proves nothing about benzo patients as a whole.


No, again you missed the point, they studied the dosage history of people who were seeking to discontinue use. This was just the source of data for the study. It's absurd to suggest a decision to stop taking Ativan 8 years after starting it had any impact on their dosage patterns over the 8 years they were taking it.



> For the record, I don't believe for one second that tolerance to benzos' anxiolysis doesn't happen. You're gonna run into trouble if you believe every abstract conclusion you read on the internet.It's just common knowledge.


You can't criticize peer reviewed medical research as being flawed and in the same breath claim that your intuition is "common knowledge." Science doesn't work like that.



> When I took benzos daily over about a year I became dependent on them and needed doses ~25-50% higher by the end to achieve similar effects to the first dose.


Nodbody is saying it doesn't happen, just that it's very rare when taken for legitimate reasons. It's also important to distinguish between initial tolerance and continued dose escalation over time. Here is an article that explains why initial tolerance to benzos is common.

http://www.lexington-on-line.com/naf_xanax.html


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## euphoria (Jan 21, 2009)

DMBfan said:


> No, when people say say they became tolerant who do you think prescribed them the higher dosage? Exactly, their doctor so it would show up in the research.
> 
> Exactly, and yet it didn't show up in any significant way in the research.
> 
> ...


The fact remains that nothing is proven about tolerance to benzos' anxiolysis without assessing anxiety levels. If you show me proof that, say, 10mg of diazepam on day 1 offers the same reduction in anxiety as on day 500 (when taken continuously), I will shut up. Otherwise it could easily be patients thinking they're benefiting from benzos when really they're just suppressing withdrawals.


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## RockiNToM (Jun 15, 2009)

The way I see it, wouldn't it be like drinking alcohol? Your tolerance eventually builds and you have to take more to have the same desired effect? Anything like that, that provides pretty immediate effects/relief has the pontential for abuse; painkillers, alcohol, caffeine, etc. It seems like the only ones that don't are the ones that take longer to achieve effectiveness and even then, the effect isn't so dramatic like buspar and various anti-depressants - which have very little or no abuse potential.


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## jim_morrison (Aug 17, 2008)

yeah, generally anything that directly or indirectly activates dopamine, especially ones with immediete effects, like within an hour of consuming the substance have an "abuse potential". For exmaple nicotine has a fairly weak effect on dopamine, but because the high is felt so rapidly (approx 7 seconds after taking a hit) it's highly addictive.


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