# More medication questions...



## Matt210 (Aug 15, 2004)

Hey everyone,

So I went to see my doctor (my GP) to discuss how we would go about the medicaiton maintenance and trying to incorporate some of the advice from the psychiatrist that I saw.

The psychiatirst said I could go up to 20mg of CIpralex (Lexapro, Escitalopram), and my doctor agreed this would be a good idea. I was under the impression that 10mg was the 'normal' dose of Cipralex, however the medication actually comes both in 20mg and 30mg tablets so I am assuming it can't be that uncommon to increase it like this. Any opinions before I go up? I am experiencing positive results right now at 10mg, and while i still have plenty of room for improvement I don't want to screw anything up. If the medication is working for me right now at 10mg, is it possible 20mg could be less effective or will it follow the general logic that more should have more of the positive effects. Any of the few Lexapro/Cipralex users here on any does higher than 10mgs? Assuming i'll have to go through all the lovely side effects again as my body adjusts..yay.

Secondly, I am at a loss with what to do with Clonazepam. I have clearly built up a tolerance to my one dose of 0.5mg per day. My doctor said I could go up to 1mg per day if I want to, but i'm just not sure. I already experience some withdrawal symptoms when I miss my morning dose and i'm only at 0.5mg. I know it will only get worse the higher dose I am on. I don't do well without the benzos in my system yet - so i'm at a loss. 0.5mg is doing next to nothing for me, yet things get ugly if I eliminate it from my system. I'm thinking perhaps of taking 0.5mg each morning and then a second 0.5mg tablet later in the day only when I absolutely need it. Thoughts?


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## egodeath (Oct 27, 2008)

Your doc should have had you skipping days on the kpin.


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## Matt210 (Aug 15, 2004)

egodeath said:


> Your doc should have had you skipping days on the kpin.


Both doctors I saw - the GP and the Psychiatrist said this was not a good idea. They said that with medication it is important to keep consistent, and that using Clonazepam only when I needed it would put me in a constant state of anxiety and then withdrawal. It would also keep me focusing on how I felt, saying "Do I need a pill today?", etc.

I found they were right. I was about to give up on the Klonopin at one point because of what it was doing to me. The consistent days thing was what worked for me - until now. Suppose this is the problem with Benzos...


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## egodeath (Oct 27, 2008)

Shouldn't the SSRI's eliminate the need for benzos once you're over the withdrawal?

I use kpin as needed, but I suppose our situations are different.


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## Matt210 (Aug 15, 2004)

egodeath said:


> Shouldn't the SSRI's eliminate the need for benzos once you're over the withdrawal?
> 
> I use kpin as needed, but I suppose our situations are different.


Yeah that is the idea. I'm going to keep using Benzos while I move first to 15mg and then 20mgs of Cipralex since the increase in dosage causes extra anxiety as a side effect. Then ideally I get off the Benzos.

& Yeah - its much better for you if you are able to use Benzos only when needed. Both because Benzos are shitty for you, and because they'll actually keep working for you without having to increase your dosage. But with the way I hit rock bottom and with my tendency to self monitor and obsess it just makes more sense for me to be taking them daily.


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## Matt210 (Aug 15, 2004)

Blah - two days into 15mg of Cipralex and i'm feeling all anxious and the side effects are back  . Really hope I didn't mess this up because I had a good thing going.


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## Absentis (Jul 10, 2007)

egodeath said:


> Shouldn't the SSRI's eliminate the need for benzos once you're over the withdrawal?


Not necessarily, since clonazepam has anti-convulsant properties that SSRIs do not.


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## nabber (Feb 13, 2009)

I started on 5mg of Lexapro, stayed at that dosage for a few months then went strait to 20mg. For me personally, it was a euphoric
experience for the first couple of months. The fogginess and tiredness will gradually go away and you will be used to the new dosage. I've
tried alot of ssri's as well as wellbutrin, and effexor, and I think Lexapro works best for me. Since you're on such a low dosage
of Klonopin i'd say take it regularily as your doctor suggested, it will only help with anxiety issues


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## chase1121 (Nov 6, 2007)

^ What kind of doctor would I go to see about this?


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## egodeath (Oct 27, 2008)

Absentis said:


> Not necessarily, since clonazepam has anti-convulsant properties that SSRIs do not.


Doesn't that only matter if the patient is having seizures?


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## voidvoid (Sep 5, 2008)

I am currently on 20mg Cipralex. I used to be on 30mg not so long ago. I think I started on 10 or 15mg. To be honest I dont really notice any difference, Im starting to think I am immune to SSRI?s. It could also be because I take 2mg klonopin in the morning and 2mg in the evening, that was the starting dose my doc put me on hehe.. Clonazepam is not a widely used benzo for anxiety/dp/depression here in Sweden I believe, It is only listed as an anti-epileptic. Thus I think my doc had lacking knowledge of it. I should probably cut down on it. That being said, I do not feel withdrawal from it if i miss it, nor do I feel that i crave it.

So my advice is dont be afraid of upping your Cipralex and Clonazepam dosages. People have different thresholds regarding Cipralex as to what dosage is effective. and Clonazepam well, as I said I am on 4mg per day and I know Comfortably Numb on the forum take 4-6mg per day aswell.

That being said, I want to cut down on both because I feel more energetic/positive in the morning BEFORE I take these pills. So you have to make sure you gain more from taking the pills than what you lose. Good Luck.


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## Matt210 (Aug 15, 2004)

So i'm at 4 weeks on 20 mg of Cipralex, and i'm still not feeling as good as I was when I was at 10mg. Is it possible for MORE of the same drug that made you feel better to make you feel worse? The logic doesn't quite make sense there to me - i'm wondering if it was mostly the Clonazepam that was making me feel better.

I know with any SSRI they say 4-6 weeks. I have one more month left on my Cipralex prescription - if by the time that runs out I am still not feeling any benefit from it i'm going to taper off it completely and try Zoloft.

I am frustrated because I really thought Cipralex was working for me, and am confused why a higher dose would cause it to stop working.


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## voidvoid (Sep 5, 2008)

People metabolize (?) Cipralex very differently, and adding to that Cipralex is actually not a standard SSRI but an SSAI. I dont know the difference really, nor do the people that designed them. Also, Cipralex has a fast onset of acton, much faster then normal SSRI?s. And it is very possible from what I know to react badly to a higher dose of what helped you on a lower dose.

It most likely was/is the Klonopin helping. I have lost hope in antidepressants, aka anything that starts with Selective Serotonin **.

Keep in mind im no expert.


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## Matt210 (Aug 15, 2004)

Inzom said:


> People metabolize (?) Cipralex very differently, and adding to that Cipralex is actually not a standard SSRI but an SSAI. I dont know the difference really, nor do the people that designed them. Also, Cipralex has a fast onset of acton, much faster then normal SSRI?s. And it is very possible from what I know to react badly to a higher dose of what helped you on a lower dose.
> 
> It most likely was/is the Klonopin helping. I have lost hope in antidepressants, aka anything that starts with Selective Serotonin **.
> 
> Keep in mind im no expert.


Fair enough. Cipralex was my first go with an anti-depressant, and I thought it was worth a shot. As I said, i'll give one more a try - probably Zoloft as I hear mostly good things about it. If that doesn't help either I will explore other options. Might be smartest for me to just stay on Klonopin and focus on getting into intense therapy. Will go a little longer on Cipralex - and then start the withdrawal process I guess which i'm sure will be tons of fun.


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## voidvoid (Sep 5, 2008)

And stay of sugar and coffee, but keep your bloodsugar up, and take regular walks/jogs for excersise and fresh air. If only I could follow my own advice... Im way down in the shit right now. I can relate to your troubles.


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## Absentis (Jul 10, 2007)

egodeath said:


> Absentis said:
> 
> 
> > Not necessarily, since clonazepam has anti-convulsant properties that SSRIs do not.
> ...


Short answer is no. Slightly longer answer is that depersonalization may be caused by sub-seizure epileptic activity, which may be treated with clonazepam. In many people's experience they require a maintenance dose.

Really, one of the biggest problems with treating DP/DR is that the majority of physicians use treatment guidelines for different disorders. This is the best they can do since the research is lacking, and they can only do what they've been taught to do. For example if they suspect epilepsy as the underlying cause, they'll use the treatment guidelines for Lamictal which is to titrate up from 25 to 150 mg over the span of a few weeks. Lamictal appears to work for some people, but at lower or much higher doses. When using clonazepam for anxiety, physicians tend to use a benzo short-term because for anxiety sufferers the benzo treatment may lead to "addiction". But if it isn't anxiety, then trying to get off clonazepam is the incorrect course of action because it is based on an erroneous assumption.


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