Clonazepam anxiety

Anxiety disorders are common in the population of opioid-addicted individuals however, treatment studies are lacking. It is uncertain whether the frequency of anxiety disorders contributes to high rates of illicit use of benzodiazepines, which is common in methadone maintenance programs (Ross and Darke 2000). Increased toxicity has been observed when benzodiazepines are co-administered with some opioids (Borron et al. 2002 Caplehorn and Drummer 2002). Although there is an interesting report of clonazepam maintenance treatment for methadone maintenance patients who abuse benzodiazepines, further studies are needed (Bleich et al. 2002). Unfortunately, buspirone, which has low abuse liability, was not effective in an anxiety treatment study in opioid-dependent subjects (McRae et al. 2004). Current clinical practice is to prescribe SSRIs or other antidepressants that have antianxiety actions for these patients. Carefully controlled benzodiazepine prescribing is advocated by some practitioners. 

Table 32.1 describes 30 persons who have been observed to use one of four available therapeutic compounds for the treatment of one of three possible disorders. The four compounds in this measurement table are the benzodiazepine tranquillizers Clonazepam (C), Diazepam (D), Lorazepam (L) and Triazolam (T). The three disorders are anxiety (A), epilepsy (E) and sleep disturbance (S). In this example, both measurements (compounds and disorders) are defined on nominal scales. Measurements can also be defined on ordinal scales, or on interval and ratio scales in which case they need to be subdivided in discrete and non-overlapping categories. 

For example, the observed value for Clonazepam in anxiety has been recorded as 0 in Table 32.4. The corresponding expected value in Table 32.5 has been computed from eq. (32.3) as follows ... 

The effect of these operations is shown in Table 32.6 using the data of our example in Table 32.4. For example, in the case of Clonazepam in anxiety, the observed value. x, has been shown to be equal to 0 in Table 32.4, and the corresponding expected value has been derived to be 2.67 in Table 32.5. The corresponding deviation of the double-closed value from its expected value is then computed as ... 

In Table 32.7 we observe a contrast (in the sense of difference) along the first row-singular vector u, between Clonazepam (0.750) and Lorazepam (-0.619). Similarly we observe a contrast along the first column-singular vector v, between epilepsy (0.762) and anxiety (-0.644). If we combine these two observations then we find that the first singular vector (expressed by both u, and v,) is dominated by the positive correspondence between Clonazepam and epilepsy and between Lorazepam and anxiety. Equivalently, the observations lead to a negative correspondence between Clonazepam and anxiety, and between Lorazepam and epilepsy. In a similar way we can interpret the second singular vector (expressed by both U2 and V2) in terms of positive correspondences between Triazolam and sleep and between Diazepam and anxiety. 

The two plots can be superimposed into a biplot as shown in Fig. 32.7. Such a biplot reveals the correspondences between the rows and columns of the contingency table. The compound Triazolam is specific for the treatment of sleep disturbances. Anxiety is treated preferentially by both Lorazepam and Diazepam. The latter is also used for treating epilepsy. Clonazepam is specifically used with epilepsy. Note that distances between compounds and disorders are not to be considered. This would be a serious error of interpretation. A positive correspondence between a compound and a disorder is evidenced by relatively large distances from the origin and a common orientation (e.g. sleep disturbance and Triazolam). A negative correspondence is manifest in the case of relatively large distances from the origin and opposite orientations (e.g. sleep disturbance and Diazepam). 

Benzodiazepines are used commonly in SAD however, there are limited data supporting their use. Clonazepam has been effective for social anxiety, fear, and phobic avoidance, and it reduced social and work disability during acute treatment.58 Long-term treatment is not desirable for many SAD patients owing to the risk of withdrawal and difficulty with discontinuation, cognitive side effects, and lack of effect on depressive symptoms. Benzodiazepines may be useful for acute relief of physiologic symptoms of anxiety when used concomitantly with antidepressants or psychotherapy. Benzodiazepines are contraindicated in SAD patients with alcohol or substance abuse or history of such. 

Social anxiety disorder Escitalopram Fluvoxamine Paroxetine Sertraline Venlafaxine XR Citalopram Clonazepam Buspirone Gabapentin Miitazapine Phenelzine Pregabalin... 

High-potency benzodiazepines (e.g., clonazepam and lorazepam) are common alternatives to or in combination with antipsychotics for acute mania, agitation, anxiety, panic, and insomnia or in those who cannot take mood stabilizers. Lorazepam IM may be used for acute agitation. A relative contraindication for long-term benzodiazepines is a history of drug or alcohol abuse or dependency. 

Because Rohypnol is banned in the United States, there is an emerging trend for young people to start abusing two other Rohypnol-like drugs that are still legal in the United States clonazepam (Klonopin ) and alprazolam (Xanax). Both Klonopin and Xanax are benzodiazepines that are used for the treatment of anxiety and insomnia. Although they are less potent than Rohypnol, they can produce similar effects when mixed with alcohol and also have been reported to enhance the effects of heroin. 

Clonazepam Klonopin Oral Long 0.5-4 Anxiety disorders, epilepsy, mania... 

We do not use benzodiazepines as readily when treating GAD as we do when treating panic disorder. In comparison to those with panic disorder, most patients with GAD can more easily tolerate the delay in treatment response and even any transient exacerbation of anxiety associated with antidepressant therapy. Benzodiazepines are reserved for those who present with especially severe anxiety that necessitates more rapid relief than an antidepressant can afford and for those who do not achieve a satisfactory response to antidepressant or buspirone therapy. Due to the persistent nature of the anxiety experienced by patients with GAD, shortacting benzodiazepines such as alprazolam are not especially helpful unless dosed 3-4 times per day. Instead, we prefer long-acting agents such as clonazepam. When used to treat GAD, clonazepam should be started at a low dose (0.25-0.5 mg/day) and titrated to higher doses (1-4 mg/day) if clinically necessary. 

Benzodiazepines. Although a cornerstone of anxiety disorder pharmacotherapy, in general, there is snrprising little data regarding benzodiazepine therapy for OCD. Controlled stndies of clonazepam have produced mixed results. Consequently, benzodiazepines are seldom used in the treatment of OCD. 

Benzodiazepines. The best studied of the benzodiazepines for social anxiety disorder, clonazepam has been demonstrated in controlled trials to be effective during both acute treatment (at an average dose of 2.4mg/day) and long-term maintenance therapy lasting up to 2 years. A controlled study of another high potency benzodiazepine, alprazolam, also proved effective, though it was outperformed by the MAOI antidepressant phenelzine and exhibited response rates lower than those reported with clonazepam. 

Benzodiazepines. These agents, particularly alprazolam and clonazepam, have been widely used in the treatment of PTSD, despite little evidence to demonstrate their effectiveness. The few studies exploring the effectiveness of benzodiazepines for PTSD suggest that they provide modest relief for anxiety in general but offer no benefit for the core symptoms of PTSD, namely, intrusive recollections and emotional numbing. Furthermore, a small controlled study investigating prophylactic treatment with a benzodiazepine in the immediate aftermath of trauma exposure failed to protect patients from the subsequent development of PTSD symptoms. Consequently, we do not recommend benzodiazepines for the routine management of PTSD. 

Benzodiazepines. Longer-acting clonazepam and shorter-acting alprazolam have also been used in the treatment of social anxiety disorder, and controlled trials have shown them to be quite effective. In our experience, alprazolam is best suited for discrete periods of intermittent anxiety, though both clonazepam and the new long-acting alprazolam (Xanax XR) are likely effective for long-term treatment. 

Barnett SD, Kramer ML, Casat CD, Connor KM, Davidson JR (2002) Efficacy of olanzapine in social anxiety disorder a pilot study. J Psychopharmacol 16 365-368 Beauclair L, Fontaine R, Annable L, Holobow N, Chouinard G (1994) Clonazepam in the treatment of panic disorder a double-blind, placebo-controlled trial investigating the correlation between clonazepam concentrations in plasma and clinical response. J Clin Psychopharmacol 14 111-118... 

Graae, E, Milner, J., Rizzotto, L., and Klein, R.G. (1994) Clonazepam in childhood anxiety disorders. / Am Acad Child Adolesc Psychiatry 33 372-376. 

Benzodiazepine Alprazolam Clonazepam 0.25-6 mg/day 0.5-6 mg/day Reduces anxiety, insomnia little effect on core PTSD symptom clusters... 

---