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clinic

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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