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Which is a good benzo for long term anxiety with less sedation?

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My current benzo(clobazam) works great but is causing alot of sedation on target dose(10mg). I take 5mg now. There was no sedation before. I’ve been taking it for 2.5 years. Its like have developed opposite of tolerance.

Here’s list of benzos i have tried

Alprazolam 0.25 → worsening anxiety and psychosis
Alprazolam 0.5 SR + clobazam 15mg → Bed wetting
Clobazam 10mg → Works great for anxiety/jerks but sedation problems from 5mg and memory problems from 10mg and above
Clonazepam 0.25mg + clobazam 10mg → crying spells
Diazepam 2.5mg + clobazam 10mg → bed wetting
Lorazepam 0.5mg + clobazam 10mg - worsening anxiety/psychosis, crying spells, feeling sleepy in afternoon

Edited by clinic

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1 hour ago, clinic said:

My current benzo(clobazam) works great but is causing alot of sedation on target dose(10mg). I take 5mg now. There was no sedation before. I’ve been taking it for 2.5 years. Its like have developed opposite of tolerance.

Here’s list of benzos i have tried

Alprazolam 0.25 → worsening anxiety and psychosis
Alprazolam 0.5 SR + clobazam 15mg → Bed wetting
Clobazam 10mg → Works great for anxiety/jerks but sedation problems from 5mg and memory problems from 10mg and above
Clonazepam 0.25mg + clobazam 10mg → crying spells
Diazepam 2.5mg + clobazam 10mg → bed wetting
Lorazepam 0.5mg + clobazam 10mg - worsening anxiety/psychosis, crying spells, feeling sleepy in afternoon

Did any of the benzos that caused bed wetting work well for you without excessive sedation? I ask this because perhaps you could try desmopressin for bed wetting. It works by decreasing the amount of urine your body produces during the night, and thus helps people with bed wetting. The other option would be an anticholinergic, typically the antidepressant imipramine, but that may worsen your psychosis or possibly cause crying spells.

I think the bed wetting may be because of clozapine. It is a potent muscarinic acetylcholine receptor agonist at M1, and its metabolite, norclozapine, is an agonist at M4. That usually tends to cause excessive salivation (sialorrhea), but can exacerbate other parasympathetic nervous system symptoms like excessive sweating (hyperhidrosis), bronchospasm, heart rhythm problems, etc., and I believe urination is part of the parasympathetic nervous system. I might be wrong though, so don't quote me on that.

But what I'm getting at is that perhaps you could try diazepam + clobazam or just diazepam by itself alongside desmopressin and see if it helps anxiety without excessive sedation and bed wetting.

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59 minutes ago, mikl_pls said:

Did any of the benzos that caused bed wetting work well for you without excessive sedation? I ask this because perhaps you could try desmopressin for bed wetting. It works by decreasing the amount of urine your body produces during the night, and thus helps people with bed wetting. The other option would be an anticholinergic, typically the antidepressant imipramine, but that may worsen your psychosis or possibly cause crying spells.

I think the bed wetting may be because of clozapine. It is a potent muscarinic acetylcholine receptor agonist at M1, and its metabolite, norclozapine, is an agonist at M4. That usually tends to cause excessive salivation (sialorrhea), but can exacerbate other parasympathetic nervous system symptoms like excessive sweating (hyperhidrosis), bronchospasm, heart rhythm problems, etc., and I believe urination is part of the parasympathetic nervous system. I might be wrong though, so don't quote me on that.

But what I'm getting at is that perhaps you could try diazepam + clobazam or just diazepam by itself alongside desmopressin and see if it helps anxiety without excessive sedation and bed wetting.

I quit some benzos too soon. I might try clonazepam again soon for few days and see if crying spells goes away.

Bed wetting starts at 275mg clozapine, not on 200mg clozapine.

Edited by clinic

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11 hours ago, clinic said:

I quit some benzos too soon. I might try clonazepam again soon for few days and see if crying spells goes away.

Bed wetting starts at 275mg clozapine, not on 200mg clozapine.

That might be a good idea to try.

So it is the clozapine that causes the nocturnal enuresis (at or above a certain dose)? If need be, talk with your pdoc about desmopressin for that and see what he says.

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On 9/24/2019 at 9:42 AM, mikl_pls said:

That might be a good idea to try.

So it is the clozapine that causes the nocturnal enuresis (at or above a certain dose)? If need be, talk with your pdoc about desmopressin for that and see what he says.

When i added clonazepam to clobazam, i started crying.

I cant stop or reduce clozapine anyways. Is there any other benzo i can add for anxiety cuz right now clobazam 12.5mg is working but giving me alot of sedation. I take clobazam at 9-20pm and wake up at 2-3pm next day.

Which might be helpful from the following list ? https://www.benzo.org.uk/bzequiv.htm

I'm looking for benzo which works for long term anxiety without tolerance. I might reduce clobazam to 5mg and add another benzo for anxiety. So basically my plan is to take 2 benzos due to side effects of the first benzo.

Here are the meds which i have tried

Alprazolam 0.25 → worsening anxiety/psychosis
Alprazolam 0.5 SR + clobazam 15mg → Bed wetting
Clobazam 10mg(taking since 2.5 years) → Works great for anxiety/jerks but sedation problems and severe cognitive decline(memory problems) from 10mg and above
Clonazepam 0.25mg(Took just 1 dose) + clobazam 10mg → crying spells
Clonazepam 0.75mg → very sedated till afternoon, brain slow down, cognitive impairment, did not work for twitches at this dose, worsening hypotension
Diazepam 2.5mg + clobazam 10mg → bed wetting
Lorazepam 0.5mg + clobazam 10mg - worsening anxiety/psychosis, crying spells, feeling sleepy in afternoon
 

Edited by clinic

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48 minutes ago, clinic said:

When i added clonazepam to clobazam, i started crying.

I cant stop or reduce clozapine anyways. Is there any other benzo i can add for anxiety cuz right now clobazam 12.5mg is working but giving me alot of sedation. I take clobazam at 9-20pm and wake up at 2-3pm next day.

Which might be helpful from the following list ? https://www.benzo.org.uk/bzequiv.htm

I'm looking for benzo which works for long term anxiety without tolerance. I might reduce clobazam to 5mg and add another benzo for anxiety. So basically my plan is to take 2 benzos due to side effects of the first benzo.

Here are the meds which i have tried

Alprazolam 0.25 → worsening anxiety/psychosis
Alprazolam 0.5 SR + clobazam 15mg → Bed wetting
Clobazam 10mg(taking since 2.5 years) → Works great for anxiety/jerks but sedation problems and severe cognitive decline(memory problems) from 10mg and above
Clonazepam 0.25mg(Took just 1 dose) + clobazam 10mg → crying spells
Clonazepam 0.75mg → very sedated till afternoon, brain slow down, cognitive impairment, did not work for twitches at this dose, worsening hypotension
Diazepam 2.5mg + clobazam 10mg → bed wetting
Lorazepam 0.5mg + clobazam 10mg - worsening anxiety/psychosis, crying spells, feeling sleepy in afternoon
 

Serax? 

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On 10/31/2019 at 11:50 AM, clinic said:

When i added clonazepam to clobazam, i started crying.

I cant stop or reduce clozapine anyways. Is there any other benzo i can add for anxiety cuz right now clobazam 12.5mg is working but giving me alot of sedation. I take clobazam at 9-20pm and wake up at 2-3pm next day.

Which might be helpful from the following list ? https://www.benzo.org.uk/bzequiv.htm

I'm looking for benzo which works for long term anxiety without tolerance. I might reduce clobazam to 5mg and add another benzo for anxiety. So basically my plan is to take 2 benzos due to side effects of the first benzo.

Here are the meds which i have tried

Alprazolam 0.25 → worsening anxiety/psychosis
Alprazolam 0.5 SR + clobazam 15mg → Bed wetting
Clobazam 10mg(taking since 2.5 years) → Works great for anxiety/jerks but sedation problems and severe cognitive decline(memory problems) from 10mg and above
Clonazepam 0.25mg(Took just 1 dose) + clobazam 10mg → crying spells
Clonazepam 0.75mg → very sedated till afternoon, brain slow down, cognitive impairment, did not work for twitches at this dose, worsening hypotension
Diazepam 2.5mg + clobazam 10mg → bed wetting
Lorazepam 0.5mg + clobazam 10mg - worsening anxiety/psychosis, crying spells, feeling sleepy in afternoon
 

Bromazepam (Lexotan, Lexomil), if available where you live, is said to have similar side effects to diazepam (Valium).

Have you tried chlordiazepoxide (Librium)? It wasn't very sedating for me, but then again, it wasn't very effective for anxiety either. It's a pretty long-acting benzo.

Flunitrazepam (Rohypnol) is typically used for insomnia... so it must be pretty sedating. (It may or may not be available where you live though.)

Halazepam (Paxipam) I'm not sure is available anymore. If it is where you live, then it could be a possibility. It does say drowsiness is an adverse effect though.

Ketazolam (Anxon) is said to produce a reduced level of side effects such as sedation compared with diazepam (Valium) and the side effects when they occur tend to be milder.

Loprazolam (Dormonoct) appears to be (or was) marketed for insomnia, so probably don't want to try that one (if it's even available where you live).

Lormetazepam (Noctamid) also appears to be marketed for insomnia.

Medazepam (Nobrium) acts as a prodrug to diazepam (Valium), as well as nordazepam (Nordaz, Calmday), temazepam (Restoril), and oxazepam (Serax).

Nitraxepam (Mogadon) has sedating properties...

Nordazepam (Nordaz, Calmday) is primarily used for anxiety, so may be a good option. It is an active metabolite of diazepam (Valium), chlordiazepoxide (Librium), clorazepate (Tranxene), prazepam (Centrax, Lysanxia), pinazepam, and medazepam (Nobrium).

Oxazepam (Serax) is said to be a good benzo for those who have concurrent anxiety and depression. It is an active metabolite of diazepam (Valium) and temazepam (Restoril). I personally really like oxazepam. It might be a good option if it's available where you live.

Prazepam (Centrax, Lysanxia) is a prodrug for desmethyldiazepam which is responsible for the therapeutic effects of prazepam. It's indicated for anxiety, and is a long-acting benzo (at least its metabolite is). If available where you live, this might be a good option.

Quazepam (Doral) is mainly used as a hypnotic, so that might not be a good one for anxiety.

Temazepam (Restoril, Normison, Euhypnos) is also used mainly as a hypnotic...

Triazolam (Halcion) is also used mainly as a hypnotic...

On 10/31/2019 at 12:38 PM, Iceberg said:

Serax? 

Yes, oxazepam would be a good one to try. It's pretty short-acting and takes a while to start acting, but it's one of the only benzos that work for me anymore. I'm a big fan of oxazepam.

 

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