Clonazepam

I have been trawling the forums and reading emails sent to me and I thought it was time I said something about the drug Clonazepam. Clonazepam is marketed as Klonopin in the USA and Rivotril in the UK.

Firstly the background info. Clonazepam is a type of benzodiazepine, the type of tranquilizer that includes drugs like Valium and Xanax. These drugs are often used for the treatment or containment of panic disorder and anxiety disorders. This type of drug is known to be habit forming and doctors often only prescribe it for short term use. In is very unwise to buy this kind of drug from an online pharmacy without having a proper face to face consultation with a doctor.

Clonazepam is often prescribed for anxiety and for seizures. Here we concentrate on its anti-anxiety usage.

 

Here are some quotes I have come across regarding what users and ex-users of Clonazepam think. When you read this you should remember that people rarely use the Internet to discuss how fantastic medication is, it is much more common to use the Internet to complain.

 

 

“I was prescribed Clonazepam for nearly a year, it was in short the worst year of my life and nearly the last.

This medication was at first massively effective, it led to over confidence, I moved out of home on my own, found a girlfriend who wasn’t right for me and insulted my father and hurt his feelings without need.

During my time on Clonazepam my personality disorder got worse, I developed insomnia, increased paranoia and experienced my first hallucinations, I would recommend to anyone being prescribed this drug that you ask your doctor for an alternative immediately.


At the end of my time on it after several overdoses I managed to stop taking it, there followed the worst withdrawal symptoms of my life, worse than Marijuana, diazepam and co-proxamol. After this I found out the differing opinions from many doctors on this drug but one theme was clear, a constant which all of them agreed upon except for the doctor that originally prescribed it. This was that this drug makes paranoia and personality disorders worse, far worse.

Ever since this I have been more than hesitant to except medication and always seeking more than one medical opinion on my treatment, I will also NEVER accept a prescription from any doctor who is on temporary rotation as this was the original prescriber of the drug. I don’t advocate giving medication the boot if it works for you but I do suggest that everyone seeks a second opinion always

“Just wanted to say that when I asked my cpn (community psychiatric nurse) for Clonazepam she went apeshit and said no bloody way as she once worked in a pychiatric hospital and saw for herself just what effects they had on people , I want to add my say about the poxy valiums i am on just now not to mention all the other crap over the years that have been prescibed to me. I am at present suing galaxo smithekline for being put on 50mg of paroxatine for years only to be told that there was no withdrawl effects (stupid shrink stopped them abrubtly thus me now being virtually housebound) as are 100 others due to the effects of this drug. Panorama did a telly programme regarding this drug. The valiums were at first great but like you say the great effects only last a few weeks if that, now i have the misfortunate ordeal of withdrawing from them aswell”

 

 


So, obviously emotions run high and those not a simple answer to the question. The important message is to question what medication you need and get the full story from the doctor regarding long term use and withdrawal effects. Also be sure not to take more than your doctor tells you to, that is a sure-fire way of getting you into difficulties with addiction.

 

Kava Kava for anxiety

Hi

I have recently come across questions regarding kava kava and valerian. They are both famous for the relaxing, calming properties and have been muted as fantastic alternatives to conventional tranquilizers such as valium and xanax.

There have also been detractors. Certainly in the UK it is quite hard to fins Kava Kava as many healthfood shops stopped selling it due to somewhat dubious health scares. In truth it has been used for so long and so frequently by Pacific Island communities that it is hard to believe that it is highly toxic. It is not uncommon for alternative medicinal products to get blacklisted if they become to popular or are considered to effective. They pose a threat to the conventional products produced by big drug companies. The belief that kava kava can cause liver damage has not been proven and may well turn out to be erroneous.

In truth the more important question about kava kava is does it work? Like all of these things it seems to work for some people and not for others. A cursory look at user’s reviews shows that in fact many people felt nauseous after taking it. Others found it helped with their anxiety and some found it gave them energy. The answer with Kava Kava is to try a small dose and see what it does. However this can also be misleading, because some people have found that is was effective once and then never again, or certainly not regularly effective.

Pending further reports on Kava Kava’s health benefits and risks, I would say its probably safe to try although you should talk to your doctor first. It might work for you, and many people feel happier on something natural than they do on something chemical and pharmaceutical.

Obviously it is a bad idea to mix kava kava or any other herbal medicine with prescription medicine such as SSRI’s or tranquilizers.

Also read: Anxiety Disorder Herbal Remedies

 

Exercise as anti-depressant? Anti-Anxiety?

I was recently looking at the RemedyFind web site and noticed that the drug or therapy with the highest rating for treating Generalized Anxiety Disorder was Exercise:Aerobics. This is not too surprising as for generations fresh air and exercise have been considered something of a cure-all. But there is in fact probably a valid chemical reason for the anti-depressant effect of aerobic exercise.

 

As both high blood pressure and poor sleep can effect anxiety and depression anything which relieves these problems is liable to be beneficial. What’s more, a good aerobic workout can tackle both of those issues naturally. The evidence of the efficacy of exercise as a long term anxiety solution is anecdotal, and it is probably not the holy grail for people with severe anxiety and depression. But it may will be one more weapon in your arsenal.

 

Certainly I have seen people who claim swimming in the sea everyday to have cured a lingering depression and low mood, and that in a country where the climate is so harsh that swimming in the sea requires courage!

 

The general rule to learn from this is to look after our physical health. Lose a bit of weight, tackle cholesterol and blood pressure, get more fresh air, you will feel better for it. Speak to your doctor before starting to exercise.

 

For many people with minor anxiety or low level depression an exercise regime might prove more beneficial than a course of medication, especially when combined with therapy. In our modern lives it is easy to forget that we have to actually take steps and spend time looking after ourselves.

 

There is really no excuse: For me the best anxiety busting exercises are aerobics, hiking, swimming and jogging.

 

For people who feel such strenuous activity is beyond them yoga and pilates could be good.

 

Hitting a punch bag may or may not be good, some people claim it can make you more aggressive which is probably counter-productive when battling anxiety and depression. I will do some research and get back to you.

 

Slow withdrawal from Citalopram (Cipramil / Celexa) with minimal side effects?

I recently heard advice from doctors on several ways to come of SSRI’s and in particular Citalopram. Many people who suffer from anxiety or depression or both have been put on Citalopram and it has certainly benefited a great many people. Although SSRI’s are controversial, there is sufficient peer-reviewed evidence that they are effective in many patients, and I have personally benefited in my time. Relying on drugs and supplements might not be wise.

It is always important to remember a few things: Nothing works for everyone. Not everyone is suitable for SSRI’s, and you should always speak to your doctor and have them prescribed by a doctor. Do not be tempted to self-medicate using online pharmacies: they are more expensive and you need correct, impartial medical advice with this kind of medication.

Although some people stay on Celexa and other similar drugs for ever, almost everyone comes off them at some point. Ideally people come off at a time when they have dealt with the cause of their anxiety and depression to some extent be it through therapy or a change in life circumstances.

The big question always is: How do you come off Celexa?

The good news is that this type of drug is not addictive. Your body has no physical dependence and you are not likely to experience cravings as if you were giving up smoking. You are, on the other hand, likely to experience withdrawal symptoms as your body adjusts.

Unless specifically advised by a doctor you should never go cold turkey and stop taking your medication suddenly. The easiest way to come off is slowly and two main methods have been suggested.

Method one: Tapered withdrawal.

As the name suggests, you reduce your dose gradually, say a couple of milligrams at a time.

The pros are that this is most likely to be the smoothest transition with potentially only very minor side effects if you take it very slowly, over say a few months or more.

The cons are that tablets like Celexa are often only available in two sizes, so accurately reducing dose can be difficult. Other tablets come in liquid form and are much easier to measure.

Method Two

You lower your dosage on alternate days, taking say a full dose one day and a half dose the next.

Pros: I don’t see any

Cons: you could find your mood yo-yo’s.

Doctors often suggest the latter method, I must admit I don’t know why!

 

Panic Attacks

Hi

I recieved an email requesting help in the case of a teenage boy suffering from panic attacks. As I am not a doctor, and have never met the person in question, I did not want to give out specific advice. I did however want to share some ideas with them, so I wrote the following reply. If anyone cares to differ about any of the advice or has something to add I would be very pleased to hear from you. I have blanked out a small part of the following to protect the privacy of those involved.

Hi

I am sorry to hear about this chaps current problems, sadly these difficulties are not uncommon amongst teenagers and young adults. I will advise you as best I can as someone who has been in a similar situation and come through it, but I should stress now it would be unethical of me to diagnose or be overly prescriptive as to your next step. I can however give you food for thought.

Also, I don’t know the — area but I think the treatments available should be more or less uniform across the UK. I don’t know what relation you are to the chap involved, but I will address this email to "you" assuming you are a close friend or relative!

OK, the first thing I want to say comes directly from my personal experience. When something like this happens (a series of nasty panic attacks) the first casualty can be your self-esteem. You don’t know what’s wrong with you, you think you are mad, people think you are mentally ill, they talk about you behind your back, it can be a really demeaning experience. So my first piece of advice is do not treat him any differently, he is not mentally ill and is just as capable as anyone else. Make sure he is in control and that his personal space is respected. Make sure his point of view is listened to and his decisions about his own life are treated with respect. Never, and I mean Never, run rough shod over his opinions are try and take the reigns of his life in any way shape or form, however frustrating it might be if you think he is doing some wrong. Of course those around him will make suggestions, but they must stay as suggestions which he clearly has the right to disregard, not the kind of suggestions that demand to be acted on. Respect him as a young adult, don’t be a busy body, even if you think you are just being caring. This is not your problem, it his his problem, which he has to get over with the kind support of those around him. Stop and think about whether you are caring or controlling, don’t worry if you think you have been controlling, just change. From personal experience I think this issue is very important.

Secondly, attitude is very important. You mention he thinks he is going to die. This is natural it is also extremely distressing. The truth is panic attacks are harmless: don’t kill, don’t make you mad, don’t have long lasting effects. Just very very unpleasant. I really recommend the books and tapes/cds by Dr Claire Weekes. They are fantastic and not very expensive, you can I am sure get them second hand on amazon. I have said a bit more about them here.

You say he has been put on medication. I wonder which sort. Probably either a SSRI, a tranquilizer like Valium, or beta blockers. Either way in my personal experience, and accepted psychological opinion, it is imperative that these drugs are not treated as a cure. They are not a cure they are an aid while a cure is sort. There are all sorts of weird and wonderful cures on the market, most of which are complete rubbish. Please save your money and don’t go for anything which promises instant success. The power of marketing is strong and these people are after your money. I can not stress this enough!!!!!!!!!!!!!!! I don’t want you to waste the thousands I wasted!

That brings us to counseling and therapy. In my experience the NHS has been very bad about anxiety issues. I can’t tell what your friend needs in terms of counseling and therapy. I do know that he needs a several month long weekly or fortnightly programme. Ideally this would start with Cognitive Behaviour Therapy (CBT) and maybe assertiveness training where necessary. If CBT was not fully successful (and it is very good!) then other types of more analytical therapy should be considered. Bad news: the NHS uses almost all of its budget for this kind of thing on serious mental illness. Care for those with panic attacks is sadly lacking as you have found out. It is worth demanding CBT and seeing where it gets you. The only option might be private consultation which is likely to cost somewhere between £25 and £50 a session. There is also a book called Mind over Mood which is good.

I expect there is a local support group who will be able to advise you further on what is available in your area and where you might find a therapist. I would speak to MIND, the mental health charity. They are bound to know of something in your area, and you can find your nearest Mind office through their website.

Anyway, I hope this has been some help to you, and please to write back with any further questions and do let me know how your friend gets on!

Expressing emotion and anxiety.

Sometimes we need to get things off our chests. People who suffer from anxiety and panic attacks, and especially agoraphobia and social phobia often don’t like to show their emotions and feel afraid of confrontation. This can result in an unpleasant build up of negative emotion which can leave you feeling frustrated and angry.

 

Some people believe that anxiety is nothing more than a build up of unexpressed anger, guilt or shame. That may be something of an over statement but in truth unexpressed emotion does nothing good for us and may well actually increase feelings of anxiety, not least because unexpressed emotion makes us feel even less in control of our lives, if for instance we feel anger towards someone but can’t quite bring ourselves to tell them, or don’t want to do something but can’t bring ourselves to say “no” for fear of causing uproar.

For many people, an essential part of recovery from anxiety in all it’s forms, and sometimes also from depression, is coming out of their shell and daring to show their emotions more and more. The trick is finding a balance between keeping it bottled up and blowing their top at the least little thing.

 

The easiest thing to do is act early. Make a short calm statement at the very beginning of a situation to say “I am not happy with this”. This is much easier, and much more socially acceptable, than getting into a mood or a sulk and then going crazy later, or worse keeping it locked up, and leaving the situation feeling out of control and unlooked after.

 

Unlooked after because sometimes when we bottle up emotion we think that people don’t care about us because they never take our feelings into account. In truth it is impossible for people to take our feelings into account unless they know what we are feeling!

 

So by letting on a little of what we are feeling we can take more control, feel better, get more of what we want, and quite probably lessen anxiety. Seems like something worth doing!

 

Millions ‘hit by toilet phobia’

This from the BBC News this morning. Here’s the link.

A campaign is being launched to raise awareness of the crippling impact of toilet phobia.

The National Phobics Society estimates at least four million Britons are affected – but the true number could be many more.

In some cases people refuse to leave their homes, and risk their health.

The society has classified the disorder as an anxiety condition in its own right, and is launching a self help book and DVD.

Toilet phobia can simply be manifest as a mild distaste for public loos.

But some people develop such an intense obsession that they are left housebound, and may refuse to undergo potentially life-saving medical examinations.

They may deny themselves fluids, which can harm the kidneys, or take drugs to avoid "accidents".

Many sufferers will not even take a job if a toilet is located off a communal area and they can be observed going in or out.

And routine situations requiring the provision a urine sample fill some patients with terror.

Experts believe that the stigma surrounding the phobia means that many people refuse to admit they have a problem.

The National Phobics Society (NPS) hopes its new campaign will go some way to tackling this issue.

It also argues the medical profession needs educating about toilet phobia in order to encourage sufferers to come forward.

Taboo

Nicky Lidbetter, NPS manager, said: "Few people will talk about having an anxiety disorder in the first place, but for them to admit that they have a toilet-related phobia is rare because of the obvious embarrassment and humiliation of being laughed at or not being taken seriously.

"But, no matter how funny we might find it, it’s certainly no laughing matter. We have to tackle this condition head on."

Professor Paul Salkovskis, a leading clinical psychologist, said part of the problem was society’s squimishness about going to the toilet.

"Around the world we use a lot of humour and euphemism to describe what is a basic human function.

"We say ‘I’m going to the bathroom’ or ‘I’m going to powder my nose’ because there is a taboo surrounding using the toilet."

Several conditions are thought to be behind toilet phobia. These include:

  • Obsessive Compulsive Disorder (OCD) linked to a fear of contamination
  • Agoraphobia – an anxiety disorder manifesting itself in a sense of feeling trapped and the need to escape
  • Paruresis (‘shy bladder’ syndrome) – the fear of urinating in the company of others
  • Parcopresis (‘bashful bowel’ syndrome) – the inability to defecate in public toilets

Treatments include cognitive behaviour therapy, which helps people to break the cycle of faulty thinking, and hypnosis.

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Coming off SSRI’s

In the great anti-anxiety medication debate one question seems to come up again and again. It revolves around the use of SSRI’s or Selective Serotonin Re-uptake Inhibitors. These drugs are normally taken, if tolerated, for six months or more, and although they can be very effective there can be some worry and anxiety about how those drugs can effect you long and short term.

One of the first questions to cross most people’s mind goes something like this:

 

 

I’ve been taking Paxil for one week and three days now. I am anxiety-free, and depression-free. It is wonderful. Unfortunately I’m also orgasm-free, but I haven’t felt such relief for the past two years or so. My therapist said that I’d be on it for six months, so I’m wondering what is going to happen when I stop taking it. I know already about the withdrawal symptoms, and that they go away eventually, but will my anxiety just come back once I’m no longer medicated? Will I have to be on meds forever to feel normal? Or will I be healed somehow? Will my chemicals stay balanced?

 

There were claims at one point that drugs alone could cure depression and anxiety. That they would actually permanently correct the production and absorption of neuro-transmitters like Serotonin. That claim seems to be a bit baseless, although it has been suggested that slowly tapering off the drugs can cause your brain to learn to manufacture the same level of the chemicals it has been used to.

More usually a withdrawal from the drugs would result in a relapse of symptoms unless something else changes.

For example, if in the intervening six months your situation has rectified itself and the cause of the anxiety or depression is no longer relevant then your symptoms shouldn’t return. Or if you have had some kind of treatment, perhaps CBT or psychoanalysis, and now have the skills to deal with whatever it was in your life that was bothering you likewise you shouldn’t have trouble coming off the medication.

Problems start when people stop medication at the wrong time. Maybe too soon, maybe when their life is too unstable, maybe without the correct supervision from their doctor, maybe too quickly, and most importantly without having done anything to change or effect the core of their problem. This is a common problem in the USA due to a lack of resources available to many in terms of psychological care on their health insurance policies. In these cases people and medical professionals tend to rely on medication too much, which can be a recipe for problems later.

To avoid problems, start taking action now, so you are ready to come off when you agree with your doctor and therapist that the time is right!

 

Talking to the Inner Child

Anxiety, panic attacks, OCD, depression and many other disorders have often been put down to experiences in early life. In last decade or so more and more psychological research has suggested that dealing with the past is unlikely to change the future or present situation in terms of anxiety levels or low self-esteem. The traditional psychoanalysis and regression based approaches have been replaced with faster and more topical CBT.

As was discussed in this blog some time ago though, CBT is only half the picture. It’s fine for relatively simple phobias but when a client has multiple phobias, low self esteem and depression it is often necessary to treat more than just the symptom (although CBT is likely to be of benefit here to).

 

Making a connection with the inner child and working with it, re-parenting it, is one technique that many have found useful (although I should point out that this based on anecdotal evidence, not peer-reviewed science). How does one start to contact the inner child and re-parent him? There are several approaches:

 

    • Through art

 

    • Through meditation

 

    • Through writing

 

 

The artistic approach, at it’s most basic level, consists of drawing scenes of your youth, showing your emotions and what was going on. Then perhaps drawing pictures of you giving the inner child what it lacked. For more information on this approach refer to Recovery of Your Inner Child by Lucia Capacchione available from the book shop (Search for it!).

 

To use the meditation approach I recommend Homecoming by John Bradshaw. The word meditation often scares people as they think it will be too hard, but actually the process is very easy and Bradshaw sets everything out marvelously.

 

Both of these books deal with the writing method, as I am sure to many others that I haven’t read. Shortly I will have an area of Anxiety 2 Calm dedicated to Inner Child Healing where I will detail my own experiences.

 

Self Esteem and Anxiety

There has often been thought to be a link between how we feel about ourselves, how we feel others feel about us, and our mood.

 

Of course this situation is something of a chicken and an egg; did the low self esteem come first and help cause an increased level of anxiety or did it come as a result of the anxiety? No doubt the answer to that question is different for different people.

 

The fact is that most anxiety sufferers, like most people in general, are going to feel better all round when they feel good about themselves. This may, or may not, lead to a significant change in their anxiety levels.

One important part of how we feel about ourselves is how we look at other people. There is a tendency, when we are feeling bad about ourselves, to look at others in a somewhat “rose tinted” way. We tend to make them into gods, perfect human specimens. Before we know it our imagination has run away with us, and we forget that they have faults at all, sometimes have bad days, and are not universally loved. At this point two things can happen:

 

Firstly, we can turn nasty and start to take glee and happiness from other people’s misfortune because it brings them down to our lowly level. This tends to have the result of losing you friends in the long term and also seems to provoke a cynical attitude to success and happiness. Also, if we start to take pride in other people’s failures we tend to assume other people will take pride in ours, likewise if we never forget their failure we assume they will never forget ours. Eventually we may start to avoid taking risks to improve ourselves or to try something new and exciting in fear of our failure becoming the focus of other’s attention, as their failures have become the focus of ours.

 

Secondly we see ourselves as inferior to other, more successful people. This can lead to a negative cycle of anxiety or depression and a belief that we can never reach their perfect level.

 

The only way to avoid this is to catch yourself thinking about yourself and others in dysfunctional ways. Don’t take glee in other people’s failures and don’t make them god-like when they are successful. Look out for your thoughts and behaviours towards others and just remind yourself that life has ups and downs for us all. These people who you think are gods are normal, so just treat them as such.