Clonazepam and anxiety.

[puretone]

Does anyone have experience with clonazepam for 'off' period anxiety? Or positive results with other medications? My PWP suffers at times with severe anxiety and fear that seems to interfere with the efficacy of her madopar doses (175mg 5 times a day). She's off more than on at present.

[docjleonard55]

I don't actually get off periods, but I get anxiety. If so my tremor goes crazy. I take Klonopin at those times and it helps calm me and slow my tremor.

[Boscoejean]

this link indicates all the information about this medication including side effects, interactions, etc

webmd.com/drugs/2/drug-920-...

[Grey_Area]

My specialist refuses to prescribe clonazepam (UK) 😞

[Windermere1 in reply to Grey_Area]

why please

[Grey_Area in reply to Windermere1]

He says the drug is not licensed for this purpose (helping me to sleep through Parkinson's symptoms like restless leg syndrome), but only for RBD (Rem sleep disorder) which he says I don't have.

[MarionP in reply to Grey_Area]

Grey, you almost made your neurologist sound like he was dismissing or avoiding his duty... I sure hope not...would think your doctor had some positive solutions for helping. If you have been asking your doctor for something, I would be careful about you or him inappropriately applying the term "anxiety" if it is motor driven or medication driven, because if that was the case then anxiety is not the term to use, because the symptoms has no personality aspects, it may be entirely chemical and a side effect of stimulative medication... If you were having those symptoms in the presence of stimulative medication then they're probably not psychiatric, but chemically induced, i. e., chemical effect of some treatment or excess use of stimulant foods, and serious. As my own neurologist has said to me many times (because he knows I am a psychologist trained in neuropsychology and psychiatry and he has to stay within his ken), he is not at all trained in psychiatry and mental illness. Yet he prescribes clonazepam for sleep for me and for agitation because he knows it is a side effect of another medication I am on or Parkinson's... Because these are matters any physician would have to know as part of his medical practice. We're just careful about its use and talk frequently about side effects, half-life, accumulating holdover effects because of a half-life, etc. You shouldn't have to pull teeth from your doctor and play guessing games, he should be offering solutions including appropriate medication that address the motor symptoms and symptoms that are side effects of stimulation of your main treatment. These are not untroubling symptoms and you are not making them up and he is not without good bevy of reasonable alternatives, including anxiolytics. You make it sound like the guy is just hiding from his job for some reason just not up to it. So I hope your neurologist isn't as clipped as you made him sound, because nothing cheeses my cookies more than a professional who is half assed, for giving you the helpless or dismissive act. My answer to him would be "the medication may not be specifically 'licensed' (actually the term is 'labeled,' people are licensed and he certainly is free to prescribe a medication off-label anytime he wants) for it, but YOU are."

In fact, I have been well maintained with EXACTLY the med and dose LAJ talks about below. Docleonard and Scout also have equivalent solutions that are very low dose and adjustable to need. With just a little bit of information about half-life and overlaps you'll be fine. Same with lamadre and Caitlin's solutions too. And Veronica is spot on about the relatively high madopar dose that could be prone to stimulating agitation, restlessness, sleep deprivation, etc. So honestly if you think your doctor is giving you the slip, try again... And meanwhile I hope puretone does not over attribute what you said about your neurologists opinion about clonazepam.

[Grey_Area in reply to MarionP]

It is unfortunately all attached to the huge stick that the UK has up it's backside about anything that's potentially addictive.

He will however happily prescribe Sertraline, cheerily telling me to "watch out for the suicidal urges for the first four weeks or so..."

Thank you for voicing what I believe (or rather, know) about my so-called "anxiety". What I have is rigidity from my Parkinson's that is now affecting my intercostal muscles, meaning I only breathe shallowly when the meds are wearing off, or not yet taken effect (about two hours, 1 before and 1 after each six hourly dose). If I try to complete any task during this time, I get short of breath. My doctor insists this is "anxiety". I disagree.

So, suicide is acceptable, as long as I'm not addicted. I think I need to go private...but in the UK, for a lifelong condition, that's £millions, not £thousands to make any difference.

Oh and in the UK we do say "licenced" for medications...

[Scout222]

While there are not a lot (that I am aware of in Aust.) tools in the PD carer's toolkit I have had a certain amount of success with Oxazepam (serepax & alepam same stable) in addressing nausea, wearing off chest tightness/discomfort and insomnia to a degree that my wife experiences almost on a daily basis. Usually takes around 15 to 20 minutes to take effect in her case. Been doing same for approx 12 months since symptoms became more of a problem with care to dispense the minimum to introduce the required level of comfort. Generally a half tab unless the attack is more severe. Cheers

[LAJ12345]

yes, my husband has found it very helpful, along with reducing the madopar dose which was causing the anxiety.

He only needs 1.25 tablets of 0.5mg clonazapam cut into 1/4s to feel normal. He takes 1/4 when he wakes, and at 10.30am and 3.30pm, and 1/2 before bed.

when dopamine breaks down the product is noradrenaline which I think is what causes the anxiety feeling.

“What does norepinephrine do in the body?

First identified in the 1940s by Swedish physiologist Ulf von Euler, norepinephrine, also known as noradrenaline, is a neurotransmitter of the brain that plays an essential role in the regulation of arousal, attention, cognitive function, and stress reactions.”

[Lamadre]

Hi, I’ve been prescribed Clonazepam 0.5mg to take at night for restless legs. Occasionally I’ve taken 1 in the day to help with anxiety as that makes my hand tremor so much worse and yes the Clonazepam calms my tremor noticeably but it’s not a long term option obviously. I also use slow deep breathing. There are lots of apps to help with anxiety, Calm is excellent, also Headspace and I like the music on Evolutioner. I’ve done a few online courses and understanding anxiety as a response has been key, not a cure but I’m better equipped to deal with it. Wishing your PWP well.

[caitilin]

I take Mirtazapine 7.5 mg for antidepressant; and Hydroxyzine HCL 25 mg every six hours as needed for anxiety.

This has been working well for me.

[veronicacoath]

That sounds quite a high dose of Madopar and generally speaking levodopa only helps with motor symptoms rather than non motor (e.g. anxiety or insomnia). My husband finds it no help with either - in fact he doesn't get on or off times, just anxiety, insomnia, fatigue, rigidity and some tremor all the time. We refused Clonezepam because of its possible cognitive effects in the elderly but have had some benefit from Gabapentin, particularly at bed time. Insomnia is associated with depression and anxiety. I sometimes wonder whether constantly increasing dosage of Madopar is too stimulating for a defective neural network, and Gabapentin balances it up.

[Despe]

Good recipe for dementia!

[TL500]

I saw the list of symptoms in Dr Carolyn Dean's book included restless legs syndrome and be helped by supplement with magnesium. I'm thinking would magnesium combine with calcium and or electrolytes help RLS.

[Grey_Area in reply to TL500]

From what I read, Magnesium only helps if you're short on it (PD People often are)...no proven benefit from adding more?

[nsofka]

I have been using clonazepam now for 2 years. I have had much success with it. I initially began using it due to anxiety attacks and discovered it by accident. I started these attacks and they would come and go. Then one day I had a really bad one and immediately needed to see a doctor. My neurologist was out of town so I went to my GP while under a full on attack! He immediately prescribed me clonazepam, I take it twice a day, one in the late morning and one at bedtime along with my PD meds of carbidopa/levodopa 2 -4 X a day. It calmed down my off periods for a good while. So much so that people couldn't believe I had PD.

[puretone]

Thanks for all your contributions! Any thoughts on SSRIs vs Benzodiazepenes for anxiety? My wife's neurologist won't prescribe any anti-anxiety med and suggests she sees a shrink. He's fairly adamant that there is no such thing as Parkinson-induced anxiety. He prescribed mirtazapine some time ago which made her feel quite strange and after 8-10 days use she went down with a chest infection the likes of which I'd never seen with her. After some digging it turns out mirtazapine can initially crash the white cell count, it would have been nice to have been told that. Her neurologist maintains there is no such effect. On entacapone and ongentys my wife starts to develop breathing difficulties after two days usage. This could be caused by respiratory diskenesia (?) and I suspect might be fixed by lowering her madopar dose although none of this has been mentioned as a possibility by her neurologist. He also is adamant that COMT inhibitors cannot cause breathing distress. So we're now in a position where her neurologist seems to think she is willfully avoiding the prescriptions he has written and has done all he can for her which caused her to melt down on the Zoom call. He's a nice enough guy but I think he lacks the inquisitiveness required to operate in the wide-ranging sphere of Parkinson's disease. Will be seeing her GP today and I hope I can successfully put our case to her, my wife needs immediate intervention.

[Juliegrace in reply to puretone]

I get my clonazepam from my PCP, although it think my neurologist would prescribe it. MyPCP is very helpful and has prescribed several medications for me to try to help with PD symptoms. Hopefully your wife’s doc is like mine.

[puretone in reply to puretone]

Visited my wife's GP yesterday, I asked but she wouldn't entertain prescribing a benzodiazepine but gave her a script for sertraline ssri. I'm a bit concerned about potential weight loss as my partner is already below healthy weight as well as worsened insomnia as she only sleeps 4-5 hours. But I guess we need to apply the 'doctor knows best' principle.