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Klonopin, mania treatment, and dependency (Dr. G question)
reneegigliotti posted:
Hi Dr. G,

How exactly does klonopin fit into a medication regiment to manage a severe manic episode? When I begin to show signs of true mania, the first thing my psychiatrist does is put me on klonopin 4x daily (I can't remember the dose. maybe 0.5 mg?). He knows I HATE the drug because I worry about becoming dependent on it if the manic episode is a long one. He always reassures me that this will not happen. I have no addiction history at all, I'm just addiction phobic. I have to confess, the regular doses of klonopin do help when I'm seriously manic. It's actually more effective than increasing my seroquel (except if I am also psychotic at the time). When the episode is resolved to his satisfaction he weans me off the klonopin and I am then klonopin free. He and I have this endless klonopin battle though. I think he'd like it if I let him off the hook. I'd like to understand the drug's effects a bit better. That might help. Feel like educating me?

Joseph F Goldberg, MD responded:
Dear Renee,
Klonopin is a sedative-hypnotic that has some modest antimanic properties, mainly because of its sedative effects, which can help dampen agitation or restlessness and possibly help with sleep. It doesn't particularly treat "core" mania symptoms like expansive mood or grandiosity. We sometimes think of the image of a "slowed down manic" as someone who remains very activity driven but going in slow motion. The core medicines in mania remain mood stabilizers (lithium, Depakote and Tegretol) with or without an atypical antipsychotic. Klonopin (or other benzodiazepines, like Ativan) is to mania what Tylenol is to the flu -- can make things more comfortable on a short-term basis, but more as an accessory treatment than a mainstay.

Dr. G.
reneegigliotti replied to Joseph F Goldberg, MD's response:
Thank you. I think that's what he's aiming for. Reduction in agitation. A serious problem for me when I'm manic. It is effective at that. I have to admit. I like the Tylenol analogy. It fits.


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