Side effects - Best Benzo for someone with depression?

[baron samedi]

AFA SWIM is aware there are certain benzos which have a more anti-depressant action to them than others. SWIM has sufferered depression for a long time and has sometimes found that certain benzos can accentuate his symptoms. Which are the best for use with someone prone to depressive symptoms?

[Nahbus]

Hmm, perhaps benzos aren't the right drug of choice for these symptoms? Why does SWIY feel the need to take a benzo for depression? You don't want to take benzos everyday for depression, you really shouldn't even take benzos for more than 2 weeks because they can become habit forming and hard to get off of, plus when you do come off of them the symptoms come back in full force.
Have you exhausted all other possibilities? You'd be surprised at what eating healthy and excersicing can do for your mood. Perhaps you could even look into some nootropics? They seem to be very safe and SWIM has been reading wonderful things about them.
I just hate to see people jumping to drugs and anti-depressants for "depression" when they really only mask the issue at hand. I'm not saying you DON'T have depression, and that anti-depressants or something aren't going to be right for you, but I think you should look into healthier alternatives before resorting to taking a habit-forming drug everyday, you know?
I'm sorry I can't suggest a good benzo with anti-depressant qualities, but that's not really what benzos are for and you might be getting a lot more than what you're bargaining for.
Has SWIY seen a professional about SWIYs depression? I would try and get to the root of your depression and start there rather than just hiding it all in a closet, because it will all pile up, and when you reopen that closet it will all come tumbling out.
Good luck!

Reputation Comments on this post:

	Solid response. Definitely good advice.
	i would be proud to give this advice. Excellant!

[tyranny4u]

There is a dispute between scientists if Alprazolam might have anti-
depressive effects or not. in tt's opinion indeed Alprazolam is
the benzo (on the market) that has the best mood stabilizing effect.

But self-medicating with benzos, in particular Alprazolam, Lorazepam
and any other strong anxiolytic is a very dangerous game.

Here is an Alprazolam info-sheet:
h**p://www.realmentalhealth.com/medications/xanax_patient.asp

Please talk to a doc about your situation, if possible.
It is evident that benzos might make one (more) depressive after
a while.

[RaverHippie]

as stated above it seems like a similar argument to "using opiates as antidepressants because they make me happy" which would also lead to addiction. Euphoria is not a valid substitute to antidepressants. I hadn't heard of any anecdotal reports of benzodiazepine use lending itself useful for those suffering from depression. Possibly if the anxiety was the cause for the depression and the benzo eased the anxiety then it could be called antidepressant in a roundabout way.

I definitely support the method of finding roots to depression as it has worked with my raver friend.

[baron samedi]

Sorry if SWIM gave the impression that he thought that benzos are a valid treatment for depression, or that he was intending to take them everyday. He already takes 35ml Methadone, 5mg Olanzapine, 40mg Paroxetine and 15mg Zopiclone everyday so does not want to add anything else to this concoction on a daily basis. Rather he is looking for something for when his anxiety becomes severe, which will not make him MORE depressed. He had read that lorazapam and alprazolam were better for anxiety associated with depression than say diazapam. In other words, there are some benzos more suitable than others when anxiety AND depression are a factor.
Thankyou all for your (very valid) advice!

[neborecovery]

Swiy on quite the combination of meds. Swim's experience is that drug companies marketed Xanax (Alprazolam) and Serax (Oxazepam) for "anxiety with depression". Swim always thought that not correct, but still has coffee mugs from original US Manufacturers that drug reps gave him.

Since Benzos are "downers" swim think any of them fine, but in low dose. Longer acting ones obviously should be dosed less frequently. Swim find most depressed Swimmers on Klonopin (Clonazepam) and Valium (Diazepam) dosed too frequently.

[claroscura]

as mentioned by multiple posters above, no benzo is really appropriate to treat depression. for anxiety, it will depend. usually the most important difference between benzos is their half-life. so if someone is subject to panic attacks, usually a benzo with a relatively short half-life might be selected for them to take sublingually if they feel an attack coming on. if someone is more prone to chronic anxiety that affects their sleep, something like clonazepam (taken once daily or less) or alprazolam (taken multiple times throughout the day, or even only at night, because its half-life is "intermediate") might be prescribed.

it would really vary from individual to individual.

however, it would be irresponsible of me to offer this information without adding that benzodiazepines are a type of drug with a high likelihood of tolerance and dependence. they are not recommended for depressed individuals, although it is common for someone with depression to also suffer from anxiety and vice-versa. somewhere (i really ought to look it up, but for now, i will just leave you with my word) i have read that a few studies examining this issue find a correlation between benzo/alcohol use and depression.

they are also not recommended for use past four weeks. according to some sources, more than two weeks is too long. it is very easy for dependence to develop.

sorry for being so lean on the sources! i read so much, it's easy to forget what i learned where.

i have been on clonazepam for over a year. i cannot sleep without it. benzos are completely fun, if you don't need them. once you do, there is no fun left in the world.

[Laudaphun]

SWIM has read often of alprazolam having an anti-depressant effect. SWIM feels that from her own use of benzos that alprazolam does in fact have a bit of an anti-depressant effect and would be the benzo of choice for someone suffering with anxiety accompanied with mild depression. SWIM has used all benzos commercially available in the U.S. and finds that alprazolam does seem to have a bit of an anti-depressant effect which all others seem to lack. With that said, this is at therapeutic dosages, as recreational dosages seem likely to be counter-productive in that they end up causing depression. And to make sure there is clarification, SWIM speaks about an anti-depressant effect from regular therapeutic use, NOT recreational use by trying to obtain euphoria to cover up depression. SWIM's grandfather for example, began in the years before chlordiazepoxide was available and was put on lithium and meprobromate or some similar concoction for a severe panic disorder/ manic-depressive (bi-polar now days). His current regiment of medicines are alprazolam with sertraline (zoloft), and after 40+ years of daily benzo use, he seems to be doing quite well on his current medicines and only takes 0.5mg alprazolam per day. SWIM herself is a regular benzo user and most benzos seem to have more of a depressive effect on the mood in the long run, whereas she feels much better while on alprazolam. While she does not take any ridiculously high dosages, she is long past the point of getting any euphoric or recreational feelings from benzos and typically takes 2mg alprazolam daily or clonazepam. (not both). Mood is noticably better when a regular daily dose of 2mg alprazolam is consumed as opposed to clonazepam.

Of course it is worth mentioning that depression could easily be a by-product of untreated/undertreated anxiety and relief from anxiety itself could cause depression to dissappear, making it seem that whichever pill cured the anxiety also cured the depression. Psychological issues can be quite complex and often can cause other psychological issues if not properly treated. With that said, self-medicating with alprazolam or any other benzo could also possibly lead to increased depressive mood.

[baron samedi]

SWIM feels that many psychiatric/psychological illnesses overlap anyway, for example when is the anxiety causing the depression and when is the depression causing the anxiety, or are they both just feeding off each other?
He does not want to become a daily benzo user, but has been prescrbed both Diazapam and Lorazapam for use in terms of sever anxiety. Like with most drugs SWIM seems to have a fairly high tolerance, and doses like 5mg Diazapam or 1mg Lorazapam did not give him much relief, unless he upped the dose slightly. Diazapam, in particular seemed to cause SWIM to feel quite depressed, when not on an adequate dose. He thinks that Lorazapam as well as Alprazolam is also meant to have an anti-depressive element to its action, although SWIM needed 2mg of this to feel any significant relief. Someone also mentions Oxazepam earlier in this thread, but SWIM knows little about that one.

[neborecovery]

Originally Posted by baron samedi

Someone also mentions Oxazepam earlier in this thread, but SWIM knows little about that one.

Yeppers Oxazepam. It was Swim. Oxazepam is an active metabolite of Diazepam and other common benzo's. It is under the brand name Serax in the USA. It is a relatively old drug and not prescribed too frequently. It was the first benzo Swim ever took. Swim thinks that was in 1982, but not sure. It has a shorter half-life than Diazepam and it takes longer for it to kick in (onset). The drug company (I think it was Wyeth) marked it as for anxiety with depression.

Sounds like Swiy already on a lot of benzodiazepine. Swim found if Swim takes too much Swim gets more depressed. Swim used to combine them: Clorazepate and Alprazolam, or Diazepam and Lorazepam. Swim found this to cause him to be more bummed.

[baron samedi]

SWIM has mostly been prescribed benzos on an "as and when" basis rather than a sustained course. The trouble SWIM had was that low doses of Diazapam/Lorazapam were not sufficient to relieve his daytime anxiety, higher doses seemed to do the trick, but SWIMs doctor would not prescribe him at more than 10mg Diazapam and 1mg Lorazapam. In any case SWIM never used them regularly enough to develop withdrawls. He uses Zopiclone for getting to sleep, which normally work, although he's now up to 15mg.
SWIM feels that they do interact with anti-depressants, some of them taking the edge of these drugs, hence his original question about which ones can be used more safely (on an "as and when" basis), for people already using anti-depressants, without the benzos ending up making SWIM feel more depressed than he did in the first place.

[soma]

I believe that Alprazolam is the only benzo with known anti-depressant action, however, this is usually augmented by a traditional SSRI. SWIM was on this combo for awhile with good results. However, this is an extremely addictive substance, and if SWIY is prone to addictive behavior, this should be avoided. An addiction is an easy way to turn garden-variety depression into something much more serious (and make SWIY's depression even worse).

Swim would also like to add that many, many people take benzo's for longer than two weeks with no issues whatsoever. I highly dispute the claim that 2 weeks is the max that one should be on benzos, as SWIM, as well has many other people he has known (i.e. his mother) have suffered similar problems as SWIY without developing addiction to *medically supervised* benzo treatment. The key words here are medically supervised, as long as you have a good psychiatrist, many people are able to remain on a stable dose of benzos for decades. If they decide to stop? Yes, it will be a difficult detox, so tapering or medically-supervised detox will be needed to avoid seizures during withdrawal. You won't be able to stop suddenly after any extended duration without serious risks involved.

[baron samedi]

Interesting take on the benzo addiction issue. SWIM has never been on a "course" of benzos before, only being given them on an "as and when" basis. Personally, he thinks it could have been useful to him if he had, when suffering from states of prolonged anxiety, rather than being given anti-psychotics on their own, which at best did little for him mentally, at worst actually made his mental state worse. Actually, SWIM has probably never felt worse than when his only medication was anti-psychotics (Olanzapine) and they didn't even stop the delusional thoughts that he was experiencing at the time. Neither did they relieve any so called negative symptoms, or make him any happier about things. Maybe a course of benzos, either on their own or along with the anti-psychotics would have been far more beneficial.
SWIM should soon have his hands on some Alprazolam, but getting them regularly from his doctor may be more of a problem.

[Jatelka]

I see posted in quite a few places re the antidepressant action of Alprazolam. Can anyone supply references?

[soma]

Originally Posted by Jatelka

I see posted in quite a few places re the antidepressant action of Alprazolam. Can anyone supply references?

Alprazolam appears to be an effective antidepressant in the treatment of outpatients who have a diagnosis of major depressive disorder. The authors have reviewed six controlled double-blind studies of alprazolam in the treatment of depression. Four of the six studies included only outpatients and clearly demonstrated a clinical effectiveness comparable to that of the tricyclics but with fewer, less severe side effects and better tolerance. The other two studies involved both inpatients and outpatients, so no conclusions can be drawn regarding the effectiveness of alprazolam in an inpatient population; further controlled studies are needed to answer this question. No satisfactory explanation exists for the mechanism of alprazolam's proposed antidepressant action.

http://www.ncbi.nlm.nih.gov/pubmed/3281931

On PubMed (a reputable source)

[Jatelka]

Thank you soma.

A paper has also been uploaded to the archive here...

http://www.drugs-forum.com/forum/loc...id=129&id=6832

on the the role of GABA in depression, and the use of benzodiazepines

[Laudaphun]

Originally Posted by Jatelka

Thank you soma.

A paper has also been uploaded to the archive here...

http://www.drugs-forum.com/forum/loc...id=129&id=6832

on the the role of GABA indepression, and the use of benzodiazepines

SWIM thinks that the paper in the link mentioned is fairly accurate in her own experiences. But she has limited experience with diazepam so cannot comment. Chlordiazepoxide was worthless for her with the exception of opiate withdrawl due to it's long-half life. SWIM recently had a alprazolam supply that was running lower than she was comfortable with as that was the only practicle benzo that really helped with social anxiety. So, she stopped taking alprazolam, saving the meager supply for when absolutely necessary. Clonazepam, was used as a substitute as it is always stocked up pretty well. When SWIM finally replenished her supply of alprazolam, it was like night and day. She never really noticed as she hadn't really ever had been in that situation. Suddenly, she started wakng up in the morning and actually "wanting" to get out of bed. SWIM will swear up and down that they in fact do have a unique anti-depressant property, or at least in some individuals. BTW, swim no longer get's any euphoric or recreatonal feelings from these drugs, but the action on the brain is certainly quite diffferent.

[Kajo.Moto]

Having taken 10mg diazepam to no avail brings up some questions. Not wanting to become a daily benzo user is absolutely a wise choice, but keep in mind the ~200hr half-life of diazepam. Not dosing everyday does not guarantee freedom from dependence issues.

Notwithstanding SWIM's initial reaction, clonazepam (Klonopin) has some documented serotonergic activity; its half-life is around 90hrs, however.

Given your current regimen, SWIM thinks anyone--psychiatrists included--would be hard-pressed to make a good/educated medication recommendation for anxiety treatment.

A good diet, exercise, a solid sleep rhythm, and maybe some yoga, meditation, or breath awareness exercises will, at least minimally, push anyone in a healthy direction.

What is SWIY's extracurricular drug use like? What are SWIY's diagnoses, if SWIY doesn't mind sharing?

[Mikeymc]

It sounds like what you would be looking for would be a fast acting benzo with a shorter half life, for example you would be looking at xanax or ativan...these in swim's opinion would be your best bets for situations or break-through anxiety.....typically klonipin and longer acting benzos are used for more constant anxiety and mainteniance.

[baron samedi]

To answer SWIKajo.Moto, SWIM's extracurricular drug use since being on methadone has only consisted of a few days using cannabinoid based smoking blends and 1 day using Tamazepam. He gave up smoking dope early '08, but unfortunately his mental health in general has deteriorated since then. Surprise surprise! After several years of being told that cannabis is accentuating SWIM's problems, he finds the opposite to be true. He has nightmares most nights and being awake is not a great deal better TBH.
AFA his diagnosis, it is Paranoid Schizophrenia, Depression plus Social Anxiety and a lot of normal anxiety and maybe a bit of OCD as well. He's also a long term insomniac, although this isn't a problem on his current regime of drugs. He suffers badly from Anhedonia (inability to feel pleasure) which is a major problem for him. In other words, SWIM's mental illness is pretty complex and there are no easy answers.

[theshiftyshaman]

alprozolam

[Jatelka]

Why is that? One word answers add nothing to the discussion

[Mikeymc]

I wanted to add an additional thought after re reading the thread and my previous post. This is gonna be another one of those areas where I think your indiviual body chemistry is gonna play a great role...Everyones body reacts differently to medication thats a fact that so clearly evident throughout the forums. This is even more so true, in my opinion, with medications dealing with depression ie anti-depressants, anxiety medications such as benzos as well...as much as it can suck, alot of it is trial and error...working to find the best drugs that will work with your body. IN addition have you thought of a mood stabalizer, neurontin, depacote? That might be an avenue to explore as well!

As always I wish you the very best!

Mikey

[baron samedi]

SomeSWIM mentioned Ativan/Lorazepam and SWIM would concur that 2mg of this used to relieve SWIM's anxiety and make him feel quite happy as well, but not many doctors will prescribe doses like this for someone who uses it only from time to time. When SWIM first tried 5mg Diazapam for anxiety, he was in a good mood at the time and found that it just spoiled the day for him really. Nowadays he takes methadone daily and finds 10 to 15mg Diazapam much more useful as a booster if his methadone is not relieving his usual anxiety suficiently. Seems like there is a synergy between the two drugs. He hasn't tried Lorazepam in the same way and his supply has run out, but it would have been an interesting comparison. One problem for SWIM is that he has a generally high tolerance to most drugs, particularly when taken orally, so low doses of benzos might work differently for him to higher (recreational) doses.
Most SWIMMERS in this thread seem to agree that Alprazolam is THE one which displays most anti-depressant action, but is it not the case that this is maybe the hardest benzo to get on prescription because of its addictive potential?
Does anySWIY else agree with SWIsoma that long term use of benzos under supervision is not necessarily a bad thing? SWIM knows that his grandmother was given them for many years for insomnia, without developing any serious mental side-effects.

[theshiftyshaman]

swim was just answereing the question