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Re: Social anxiety
Jul 27, 2003
Actually, even though it is probably the best Social Anxiety treatment out there, Klonopin does not have an official designation for Social Anxiety in the U.S. It's two FDA-approved uses are as an anti-epileptic and for panic disorder. But in reality it's prescribed for almost any anxiety disorder other than OCD, plus for many other uses such as treating Essential Tremor and Restless Legs syndrome.

As hry33 said, benzos and anti-depressants go together very well. A common approach -- at least in the U.S. -- is to use a benzo like Klonopin just in the early weeks of AD therapy in anxious patients, since AD's often *increase* anxiety early on. Unfortunately, when it's discontinued it often turns out the anxiety isn't very well controlled by the AD alone.

Since I haven't been depressed, Klonopin alone has been great. But it's not an anti-depressant. (I've seen some unsubstantiated claims that it can sometimes *cause* or worsen depression after awhile. OTOH, I've seen a few small studies that suggest it has anti-depressant qualities. Bottom line, I wouldn't suggest trying Klonopin alone for depression.)

I was once on Klonopin + Celexa, but after a few weeks the combo had me feeling lethargic and added minimally to the excellent anti-anxiety efect of Klonopin alone. That doesn't mean everyone would have been fatigued on this combo -- it varies by person. And there are strategies to take care of such fatigue, such as adding low-dose Provigil (a non-traditional, milder sort of stimulant that is being used more and more as an adjunct to antidepressant -- and lately anti-anxiety -- treatments...but it's expensive).

As for Zoloft being the only AD for "long-term treatment" of social anxiety, that's simply because the maker, Pfizer, invested in longer-term studies to obtain this designation. Others such as Paxil, Lexapro and Effexor almost certainly could (and maybe will) go after and obtain a similar designation.

Again, the most effective, safest (IF you are not prone to excessive drinking or have addictive tendencies), and lowest side-effect Social Anxiety medication -- Klonopin -- doesn't even have an FDA designation for Social Anxiety, because by the time Social Anxiety became a better-recognized disorder Klonopin was already off patent...and it's too inexpensive (from the manufacturer's viewpoint, that is). Speaking of how the FDA's official designations are not always too relevant, I read that only a small fraction of Provigil prescriptions are for treating narcolepsy, which is currently its only official indication.

As for benzo withdrawal, when you have millions of people taking a class of drugs, there are going to be hundreds -- maybe even thousands -- of withdrawal horror stories. But if tapered slowly, that is very much the exception to the rule. I know a women who came off of Xanax with minimal effort after three years of Xanax + Paxil, but thought she was going to die when she tried to get off the "safe" Paxil. (Maybe you've seen some stories about the lawsuits against Glaxo Smith Kline for hiding data it had about Paxi withdrawal symptoms. But here again, that doesn't mean everyone will have trouble getting off of Paxil.)

My doctor has been practicing psychiaty for 25 years. He assures me that as long as I never exceed a dose of 3 mg Klonopin a day (I only take 1/3 that much), I will never have significant problem tapering off of it slowly.

Rick


[This message has been edited by RickRick (edited 07-28-2003).]





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