39 replies to this topic

[brzghoff]

couple of questions to throw out there that started off as a PM but on good advice i am sharing with the entire forum.

 

for the most part i try and manage anxiety with cognitive skills as i prefer to avoid meds to deal with something so scary as anxiety. my fear is becoming dependent on something to which i could build up a tolerance - if i can't "feel" the anxiety i won't know how well i can deal with it cognitively and therefore if meds stop working then i am SOL. yes, the good ol' fear of fear.

 

so for those who take clonidone... (is it CLON-i-dine or clo-NI-dine?) 

 

 

how much clonidine do you take and how often? is it something that can be taken "as needed" instead of on a reg basis? do you expect to stay on it for the long term, or do you have a strategy to stop taking it - at least on a reg schedule? can i expect to build up a tolerance? is that bad? i know i can't quit cold turkey if i end up increasing the dose since abrupt stopping jacks up blood pressure in the short term - any other concerns i should know about? 

 

i don't want clonidine to be a regular thing, i don't mind taking it daily for awhile, but i am hoping to use it as an "aid" while i continue to work on the cognitive stuff to deal with anxiety. in your opinion is it a good choice for that strategy?

 

i've just taken .1 mg clonidine for four nights now. the mornings after taking it i get a decent result and am functionable doing the normal stuff for me: work on house projects, take walks, go out to run errands and actually have fun ;-) anxiety has typically been a night time problem for me, after dark. my biggest issue is anything that interrupts my sleep - which in turn exacerbates anxiety. 

 

the clonidine seems to work okay to get to sleep. but i wake up every two hours like clock work - i could set my watch by it. i always get back to sleep within about 5 minutes. even when i have trouble falling asleep and don't take anything, once i do fall asleep i typically stay asleep - so it struck me as strange that i would wake up on the clonidine. regular sleep aids like ambien and benedryl knock me out just fine.

 

thoughts?

[FiveNotions]

Thanks for starting this topic, Brzghoff!
 
I've been taking clonidine for anxiety since July approx. I've found it to work exceptionally well, and have been able to pretty much stop using the diazepam (valium) I'd been prescribed.
 
Here's my question.
 
My starting dose was 0.1 mg. twice a day "as needed." I started taking it only when the anxiety got really bad, but as I moved further into job search, job interviews, and now working two days a week, I began taking it daily.

But I've recently increased to taking 0.2 mg at bedtime and another 0.1 mg mid-morning the next day ... this is working perfectly. Is a daily total of 0.3 mg more than I should be taking?

My reason for increasing the dose the way I did is that my anxiety pattern now is for it to hit pretty hard during the night, or very early in the morning.

Another bit of info is that several weeks ago I thought my bp was running too low (clonidine is for hypertension, anxiety is an off-label use), so I asked FH, and he suggested I try the hydroxyzine.

However, shortly after that, my bp normalized ... I'm now right at 110/70 - 120/80. Also, no more tachycardia. The clonidine seems to be working fine for those two issues as well.

Again, to summarize, is 0.3 mg / day too much?

[fishinghat]

Well, first of all  'CLON-i-dine'

 

I take .25 mg a day. My dr and I are trying to switch off of benzos and ssri to clonidine and other none addictive meds. I take one tablet twice a day (8 AM and 8 PM) and a half one at 2 PM. It can be taken on an as needed basis as long as no more than 1 every six hours (which would be considered a high dose). Drs do not recommend this as needed dosage because they are afraid a person could make a mistake or get carried away and drop their bp too much. For most anxiety patients clonidine is permanent because it is a better option than the addictive benzos and hard hitting ssri/snri.You do noy need to worry about building up tolerance to clonidine and the 'withdrawal' as you mention is mostly high bp and racing pulse, which can easily be avoided by a two or three week taper. It sure doesn't bite like Cymbalta withdrawal.   lol

[fishinghat]

FN - The standard dose is 0.2 mg/day for anxiety. For bp control they some times go as high as 0.6 mg/d, esp in the evening.ay. The only risk is dropping your bp too low. Keep a close eye on it

[FiveNotions]

Thanks, FH!

Yep, I check my bp and pulse 3 x a day ... a.m., mid-day and bedtime ... always before I take any clonidine... there have been times when I can't/don't take it, because my bp/pulse is on the low side ... and, in fact, according to my notes, when my bp/pulse are on the lower end, my anxiety is almost nil ... big connection ...

I'm also planning to wean down a bit after I get better adjusted to working... but will definitely do that slowly ...

And Brzghoff, I'm delighted to hear that this stuff seems to be working well for you!! Yay!!

[brzghoff]

Mr. Hat and Professor Notions, thanks for the feedback ! anyone else with something to add or ask... jump right in. 

one more question does Clonidine cause weight gain? especially if i stick to the .1 once or twice a day? I have been so thrilled with losing weight since getting of the C. its not a total deal breaker, but of course i'd prefer it not. i do eat a very healthy diet, low carb, high veggie protein, small amounts of chicken and fish and lots of fiber and get lots of exercise. 

 

as for taking it on an as needed basis, i would be considering a less, not more situation - such as no more than once a day and perhaps not everyday. typically, i can manage anxiety during the day - its uncomfortable but doable as long as hubby and i work on our CBT skills together 

[FiveNotions]

No weight gain for me Brzgoff ... but I do have one of the possible side-effects ... dry mouth and dry skin ... I'm drinking tons of water and "moisturizing" myself into a ball of slime ... but still dry ...

 

I'll take those issues over anxiety any day

[fishinghat]

Any anxiety medicine carries a risk of weight gain. The only way to curb anxiety with medicine is to slow down your metabolism.

Slow down the metabolism and increase the weight. Sorry to say.

[brzghoff]

Any anxiety medicine carries a risk of weight gain. The only way to curb anxiety with medicine is to slow down your metabolism.

Slow down the metabolism and increase the weight. Sorry to say.

 

well, there goes my anxiety!

 

not really ;-)

[FiveNotions]

Well, these aren't exactly light reading, but they do discuss anxiety, clonidine and cortisol ... I'm going to cross-post these over in FH's topic "Understanding Anxiety" ...

Noradrenergic Dysfunction and the Psychopharmacology of PTSD (full text)
Depression and Anxiety );1-12 (2007)
http://www.researchg...da04321e11e.pdf

Central noradrenergic responsiveness to a clonidine challenge in Generalized Anxiety Disorder: a Single Photon Emission Computed Tomography study.
Journal of Psychopharmacology 26(4):452-60, Sept. 2011
http://www.researchg...omography_study
To view the full article, click the "view" icon on the right side of the page.

[brzghoff]

thanks for the links, guess i have to "join" to read the full text, but at least its free! 

[fishinghat]

Well FN nice articles.

[FiveNotions]

Brzghoff, no need to join "ResearchGate.net" to get that article ... just close the pop-up asking you to join, and the "view article" link is there on the lower right side of the page ... the pesky pop-up is designed to hide it ..

Here's the link, I stole it from behind the "view" button for you ...

http://www.researchg...lication_detail

[FiveNotions]

Clonidine article from Wikipedia
http://en.wikipedia.org/wiki/Clonidine

[FiveNotions]

FH, I see that you're online now, and hope you notice this post ...

I've run out of the clonidine, thanks to a shrink who doesn't respond to calls/emails/faxes from my pharmacy, or calls from me... needed a refill/new Rx to hold me over until my appointment with her first week of October. The Medicaid clinic where I see her tells me that it can take up to 4 days for her to respond to calls from patients and pharmacies ... told me to head to the ER ... nope, no freaking way...

So, in order to avoid the high bp that comes with stopping this stuff cold turkey, will the metoprolol I have on hand help? What can I expect if I have to go three days without the clonidine?

Will the metoprolol help with the anxiety? Which, of course, is setting in big time now, just due to the fact I can't get the refill and can't get any response from the shrink ...

[FiveNotions]

hehehehe .... I found a new way to piss off my shrink ... I did a bit of internet sleuthing, and found her private cell phone number ... called her on it, left a message ... wow, did I get a call back ... immediately!! She was freaked... wanted to know how I got that number, did the clinic give it out, etc etc .. I told her no, I'd just looked her up on the internet, and that it had been really easy to find, asked if she wanted me to tell her the various websites where it's listed so she could contact them to get it removed ... looooooong pause ... then a rather flat response ... "no ... none of my other clients know how to use the internet" .....

I told her that if she'd call in the clonidine refill right after we hung up, and respond to future efforts to contact her when I needed her, then I wouldn't be forced to call her on her private number again.

I'm on her shit list, but at least she now knows I'm not one of the "uneducated unwashed internet illiterates" that she typically gets to ignore and push around.

[FiveNotions]

When (God, Zeus, whoever willing) I get off this Medicaid junk health care, I'm thinking my "last act" is going to be to go to the clinic and pass out cards with the private cell phone numbers of all the doctors to every single person in the waiting room ...

 

Ah, a girl can dream....

[TryinginFL]

FN...

 

 

You go, Girl !!!   I love it !!!

 

Damn, I wish I had your "guts" !!!

[fishinghat]

Good for you FN. Heck with her if she doesn't have a sense of humour!!   lol

 

Metoprolol is a beta blocker so it should help with the bp and increased pulse but it will only help a little with the anxiety.

 

Everyone here should relize that in the event you run out of refills it is legal in the USA for the pharmacy to issue a 7 day refill while waiting on a new script.

[FiveNotions]

Well, wish I could say it was "guts" ... more like a "perfect storm" of anxiety and anger ...

[FiveNotions]

Thanks FH! Unfortunately, the Target pharmacy I use refuses to honor that ... guess I'm going to have to find it online, print it out and take it to them ... gee, I get to piss off more members of the medical field .... this could become my new hobby!

[FiveNotions]

FH, what's the source for that 7 day refill policy? I might as well find it, print it out, and take it with me to the pharmacy when I go later this afternoon....

[fishinghat]

I really can't tell you FN. I have always been told that at any pharmacy I have ever used. I would imagine FDA but don't know for sure.

[FiveNotions]

Not to worry ... I'll track it down, and will share it on the forum ... useful info. for everyone here.

 

Hey, this is OT for clonidine, but how are you feeling these days? And how's it going with the lorazepam weaning? What level are you at currently?

[fishinghat]

I am going real slow so there is little or no bite. I am currently down 25% and 75% more to go!!!  UUUGGG!!

[FiveNotions]

Any chance you have access to the full text of this article, FH? It's an oldie, but looks like it might be worth reading ... I can't find it on the internet....

Effects of Clonidine on Anxiety Disorders
Rudolf Hoehn-Saric, MD; Altaf F. Merchant, MD; Mary L. Keyser; n Virginia K. Smith
Arch Gen Psychiatry. 1981;38(11):1278-1282. doi:10.1001/archpsyc.1981.01780360094011.
http://www.ncbi.nlm..../pubmed/7305609

[FiveNotions]

Yeah, the benzo withdrawal process, at least if we want to avoid as much "bite" as possible, is a slow one... can't believe it took me 2 full years ... but I had to do it that way, or I wouldn't have been able to keep working full time ... I also now know that I'm really sensitive/responsive to the stuff, others I've known have had virtually no trouble getting off of them....

Maybe we need a thread on benzos and getting off them as well? Like the clonidine, there are a lot of folks who want / need to know more ...?

[fishinghat]

FN

 

I can't get access to the full article either. Sorry

 

As far as a 'benzo thread', it is up to you guys. As always, I would be glad to contribute.

[brzghoff]

clonidine update. its been about a week and i am taking .1 mg every night before bed. just one. works well to make me drowsey and relaxed. even if i don't fall asleep right away i am comfortable until i do. the next day i do well without more anxiety than i can handle. i still wake up every couple of hours during the night, but usually no prob getting back to sleep. i did take an extra .1 mg this afternoon after a specific stressful event i wasn't expecting. as a result i don't think i need one tonight - i hope to be going to bed soon. its important to me that the clonidine take the edge off but not cover up the anxiety completely. i want to be able to "feel" that i am succeeding in using strategies as mindullness and rational thinking cognitive skills to manage the anxiety. 

 

the following technique is my latest fave (i copy and pasted and don't know why it came out in different font sizes, it also wont let me fix it):

 

The “Just Worrying” Labelling Technique

 

Before practicing this technique it is often helpful to differentiate worrying from constructive problem solving. Worrying involves repetitive circular thinking, which is associated with anxiety and produces no enactable practical outcomes.

 

This technique simply involves a person labelling worry as “just worrying” and then bringing their attention back to their breath or to simply change the subject of their thinking. Every time a person catches themselves worrying they just label it again and change the subject. It doesn't matter if a person does it 10 times in one minute or if they only realize they have been worrying after a period of 2 hours and then apply the technique. The important thing is that the person applies the technique when they realize they are worrying.

 

This technique involves no criticism or internal struggle, just simple non-judgemental labelling. Therefore it is important in this regard that the client does not change the label from “just worrying” to “don’t worry”.

 

This technique is very powerful and most people find that their worrying thoughts dissipate almost totally within a few days. Then they usually start worrying about a week later because they have forgotten about the technique through lack of need to use it. At that point a reminder of the technique usually suffices.

 

The same technique can be applied to other disturbing repetitive mental events using labels such as “just doubting” or “just criticizing”. This is subtly but significantly different to avoidance. It is not running away from the aversive mental stimulus. Rather it is the non-judgemental labelling which is encapsulated in the word “just”.

 

Source: Acceptance and Commitment Therapy (ACT) Advanced Workshop Handout 2007. Dr Russell Harris, M.B.B.S, M.A.C. Psych. Med. 

[FiveNotions]

wow, awesome post, Brzghoff .... am going to start this for myself ... tonight !
 
Also glad to hear the clonidine is still working for you ... I like what you said about still waking up in the night, but being able to go back to sleep ... and that you regulate the dose because you want the clonidine to

"take the edge off but not cover up the anxiety completely. i want to be able to "feel" that i am succeeding in using strategies as mindfulness and rational thinking cognitive skills to manage the anxiety" ...

I hadn't thought about anxiety from this perspective, or about regulating the clonidine, or any anti anxiety med, is this way / for this purpose ... I think I'm so afraid of feeling anxiety that I try to "obliterate" it ... hmmmm... gotta' observe myself and see about this ...

Would you cross-post this thought/observation and the great excerpt on ACT over in the "dealing with anxiety" thread (is that what it's called? sorry crapalta brain has kicked in...)