[*Laurie*]

Hi, I have been taking 2mgs. of Klonopin for about twenty years. I take 1 in the morning, 1 before bed. About a year and a half ago I had a severe breakdown, marked by extreme anxiety/agitation. I am diagnosed bipolar; my p-doc called the absolutely awful feelings I was experiencing a "mixed-state dysphoric mania". In other words, feeling euphoric/depressed/EXTREMELY anxious/agitated/frantically worried-crippling sense of dread/irritable - and so on, pretty much all at the same time. I have been on so many med combinations it's not even worth mentioning them all.

Now, here's why I'm asking for input:
When I got hooked up with consistent healthcare a year ago I had the goal of very slowly weaning myself off Klonopin. I am physically extremely addicted to the stuff and the physical addiction is of great concern to me. I had big hopes for a psychiatrist who would help me plan a program to eventually stop taking the Klonopin.

Currently I am taking Seroquel, Inderal (which has been surprisingly helpful for the terrible anxiety), a tiny dose of Lexapro, and the Klonopin.

Seroquel helps me sleep and it offers a mild mood stabilizing effect, as well as some help with calming the dysphoric mania (although Seroquel is by no means miraculously helpful. Its effects are quite mild.) My p-doc has halved my original dosage of Seroquel because it has caused me to gain too much weight, but hasn't been of amazing benefit. Instead, she has suggested that I increase my Klonopin to 3mg/day. with the goal of getting off the Seroquel after a while. Her assertion is that while it's frustrating to have a physical addiction to Klonopin, the Klonopin is excellent for treating severe anxiety/agitation, does help stabilize mood, and is much, much less dangerous than Seroquel is (Seroquel being a medication that causes extreme weight gain and can eventually cause cardio-vascular problems and/or diabetes, among other health issues that are very concerning).

But, I am terrified of benzo (Klonopin) withdrawal syndrome, because I've experienced it when I tried to come off the Klonopin some years ago. Benzo w/d syndrome is just about as awful as life can be...it is no joke.

Yet, I understand my p-doc's logic regarding the helpfulness of Klonopin. Over and above any other medication, Klonopin has been immensely helpful for me. It has definitely caused some cognitive (memory and connection) issues for me, but basically the side effects (as long as I don't try to come off the Klonopin) are very, very mild.

For those of you who have experience with Klonopin, what are your thoughts on this issue I'm dealing with? Should I stop concerning myself so much with my fear of taking more Klonopin, thus being even more dependent on the medication? Should I say "No way, I'm not increasing my Klonopin dose"?

Thanks in advance.

[kaliope]

i took .5 for a year and withdrawal was a ***** when i tried to stop. i learned cold turkey wasnt the way to go so i slowly cut it up into smaller and smaller doses for a week or more at a time, depending on how long it felt it took my body to adjust to the lower dose, and it took me over two months to get off that low dose. i had the shakes, sweats, dizzy, nausea, cold, so your pdoc is nuts to say you cant get physically addicted.

i take buspar for my anxiety. it is nonaddicting and works great. i take it daily. my pdoc just upped it to 60 mg. my anxiety was so bad i would hallucinat but i dont anymore. maybe taking it could reduce the need for klonopin. i still have klonopin as a prn for when things get really bad but i rarely have to take it.

[Angelique67]

I don't think you should increase unless there's no alternative and from kaliope's post it sounds like there are alternatives to try. Only go up on the Klonopin if there's no chance anyone will ever turn around and force you off of it... :/

I would gladly go back on Klonopin if it was guaranteed I'd never be forced off of it again.

[*Laurie*]

To be clear my p-doc did not deny the physical addiction. She confirmed that, but said that the physical addiction to Klonopin is ultimately less dangerous than the side effects of Seroquel and other antipsychotics, Depakote, and even lithium.

I probably should have mentioned that I have been on Remeron (mirtazapine), BuSpar, Lamictal, Tegratol, Trileptal, all of the ssri's - to name a few. I've tried all of them at least twice, some three times. Some four times. Every one of those meds kick off the terrible mania. I mean, it is BAD. I have waves of panic, dread, phobia, delusional fear, etc. I cannot live like that. The options at this point are increase the Klonopin or go on another antipsychotic (Geodon, for example).

I know that BuSpar is an amazingly helpful med for many people, but for mixed-state bipolar it can be devastating. The idea of taking the increased Klonopin dose is a last-ditch effort, as far as psych meds go.

I just saw this on another thread about Klonopin dosing: http://www.drugs.com/dosage/clonazepam.html According to this a Klonopin dose for bipolar can go as high as 20mg/day. Even for panic disorder 4mg/day is recommended. The problem being, of course, the eventual tolerance and physical addiction...it's all good until you try to come off the medication.

[Angelique67]

No one can decide for you, of course. I think I know how you feel. If you are OK never coming off of it and if your doc isn't going to force you off it, I'd just go up on it. But be careful because it can get to where you don't feel its effects at all. That happened to me a few times when I kept increasing my dosage.

[*Laurie*]

You've stated exactly my concerns, Angelique67. If I knew I would never be forced off it I would feel much calmer about increasing the dose. I am terrified, however, of coming up against a situation in which I am forced to quickly reduce or stop the klonopin for exactly the reasons we've discussed on other threads.

I'm thinking it over and I suppose the best thing I can do for now is allow myself to occasionally take as much as 3mg/day, if I'm feeling that I truly need it.

Interestingly, the one medication that has been most helpful for this awful dysphoric mania is the one my general practitioner prescribed for me a few weeks ago, and that's Inderol (proponalol). Inderol is not a psych medication at all, but it's been more helpful than any of the MANY psych meds I've tried these past almost two years.

[Soul Quake]

Go seek out a doctor that is competent. This one is crazy. She wants to increase your Klonopin? That will just increase your addiction. Klonopin is meant as a PRN. It shouldn't be a constant, everyday thing. Just as needed.

I recommend getting on Vistaril and to get with a doctor who is willing to taper you off this drug.

[Jolisse]

I've been on Klonopin for about 20 years and my dose has stayed about the same. For me, Klonopin is a life saver. My anxiety/panic is so severe, I couldn't function without it.

[*Laurie*]

Actually, I DO have a new p-doc. I have Kaiser and there has been all kinds of shuffling around recently in their psych dept. where I live. My original p-doc seems to have disappeared, I had a med appt. with the woman who suggested the 3mg. Klonopin, now I've been assigned to another p-doc & will see her on Friday. I'm curious to find out what her input will be, as I've heard everything from "Klonopin is the CAUSE of severe anxiety" to "Klonopin is the best medication for severe anxiety/bipolar anxiety EVER", all depending upon the p-doc.

As for a p-doc who helps me come off Klonopin...I've given up hope of finding that person unless I somehow become wealthy and can check into a private clinic. The only suggestion "regular" p-docs have for stopping Klonopin use is to taper down slowly and hope for the best. NOT a very promising way to stop the medication, because for effective Klonopin withdrawal there needs to be a substitute medication. For example, another benzo as one tapers off the Klonopin, then - eventually - coming off the new benzo. And all that over a period of several YEARS.

[Angelique67]

Originally Posted by PoppyRoad

Actually, I DO have a new p-doc. I have Kaiser and there has been all kinds of shuffling around recently in their psych dept. where I live. My original p-doc seems to have disappeared, I had a med appt. with the woman who suggested the 3mg. Klonopin, now I've been assigned to another p-doc & will see her on Friday. I'm curious to find out what her input will be, as I've heard everything from "Klonopin is the CAUSE of severe anxiety" to "Klonopin is the best medication for severe anxiety/bipolar anxiety EVER", all depending upon the p-doc.

As for a p-doc who helps me come off Klonopin...I've given up hope of finding that person unless I somehow become wealthy and can check into a private clinic. The only suggestion "regular" p-docs have for stopping Klonopin use is to taper down slowly and hope for the best. NOT a very promising way to stop the medication, because for effective Klonopin withdrawal there needs to be a substitute medication. For example, another benzo as one tapers off the Klonopin, then - eventually - coming off the new benzo. And all that over a period of several YEARS.

But you could taper that way and still have no guarantees. I was a heavy benzo user for 30 years and was forced off in a matter of weeks and it hasn't turned out well. But even if I'd been able to take years, I might not be any better off. No way to know. You might do better on your own tapering very slowly if you can't find a doc to help and you really want to.

[*Laurie*]

Angelique67, yeah...exactly. As far as I can tell there are claims that one way or another is "slightly better" when coming off Klonopin, but I have never heard of anyone who is a daily Klonopin user of many years coming off it without at least some really bad withdrawal symptoms. And most people either never can come off it, or are like you - off it, but extremely sick. I might have mentioned, in another thread, that I did manage to come off Klonopin for one year, some years back, and that year I spent mostly in bed...I was so sick. Getting from my bed to my car and doing a short grocery shopping trip would leave me feeling so sick, I felt like I had the flu, and a really bad case of it. I finally gave in and went back on the Klonopin. The result was that I felt better immediately. But the "feeling better" was not as much because of the medication relieving mental illness symptoms so much as it was the medication relieving withdrawal.

Honestly, as much as I want to come off Klonopin, I really wonder if I ever will be able to. That's why I started this thread...it's kind of like...as long as I'm stuck being on this stuff, maybe I should take a dose that will help me more.

The situation is hugely confusing, unpredictable, and has no fabulous answers.

[Angelique67]

The bad thing is that Klonopin and all benzos are only liable to become less prescribed and you are likely to come across someone at some time who will force you off, like what happened to me. This is still only a possibility but in your place I would not take the higher dose (or I would, only to use the pills to eventually taper off). If Inderal helps, try keeping with that, and also hydroxyzine. Just my two cents. And I wish you wonderful luck. Just like your year in bed, I've spent the last two years sitting on my bed. If I'd been able to schedule my own taper, I might only be finalizing it now and possibly be a whole lot better off.

Sent from my A0001

[*Laurie*]

I'm thinking along the same lines as you are, Angelique67. I deeply appreciate that you share your experience with Klonopin with me. I'm wary of Vistaril, as it will probably be another med that triggers dysphoric mania for me. I am, in fact, wary at this point in my life of psych meds in general. When I was younger, several psych meds were immensely helpful for me. I feel that they saved my life. At this time, however (I'm 52) I'm having perimenopausal (hormonal) stuff go on and that seems to have influenced the way psychiatric medication affects me. The meds are definitely not working the way they used to work for me. It's strange...I'm feeling that I have to approach my bipolar symptoms in a different way than I did in an earlier stage of my life. No wonder this time in a woman's life has been referred to as "the change"!!

[Angelique67]

That's interesting. I guess in some people it makes sense for meds to change how they feel or affect you. I went through menopause a year or two before the calamity with the benzos. I didn't notice a change in how the benzos affected me though. That was all I was on then. Except for gabapentin.

ETA: Poppy, there's no guarantee it would be as bad as it was during that year that you came off K. It might go a lot better a second time. Some people do report very few difficulties coming off benzos. Just wanted to throw that out there.

[*Laurie*]

Thank you so much, Angelique, for your encouragement. It means so much to me. I hope you have a sweet day

[*Laurie*]

It took me some time to process, but I have arrived at an excellent compromise with regard to this Klonopin issue. On the days when I feel really anxious/panicky (to the point at which I cannot take deep breaths or focus), I think one way to do this is to take the second Klonopin 1mg. in the afternoon instead of at bedtime. So 1mg. morning, 1mg. afternoon. That way I obtain the benefit of the medication without increasing the dosage.

[Angelique67]

That sounds smart. I never used to take it at bedtime.

[FlowerChild67]

I stopped Klonopin cold turkey after 1.5 years and I was on 3mg. I was hell for 2 weeks but after that I was fine other then I needed something for my anxiety badly, but I went a year before my doctor gave me anything.

[*Laurie*]

Thanks so much to everyone who has responded to this thread. I kind of feel like a dummy because it took me a long time to come to arrive at the idea of taking the other 1mg. of Klonopin in the afternoon. I'm not sure why no p-doc has recommended changing the time of my dose, rather than increasing it....

[AncientMelody]

Originally Posted by PoppyRoad

Thanks so much to everyone who has responded to this thread. I kind of feel like a dummy because it took me a long time to come to arrive at the idea of taking the other 1mg. of Klonopin in the afternoon. I'm not sure why no p-doc has recommended changing the time of my dose, rather than increasing it....

Indeed! Glad you found a solution that is reasonable for you. Also, what dose of the inderal are you taking? Perhaps increasing that if needed is another option?
I have GAD no bipolar, but I agree that sometimes when my anxiety is severe inderal can be very helpful. I take 20 mg as needed myself.

[pharmd2015]

PoppyRoad,

Hi I am new to this forum. I saw your thread and decided to make an account to hopefully add some helpful input!

I am a 4th year pharmacy student so medications are my life at this point! Ha

In regards to your Klonopin use, your dose is technically not that high. For use in anxiety/panic attacks, the highest "normal" dose is 4mg/day. Personally, I also take 2mg per day for generalized anxiety disorder.

I would not recommend asking for Vistaril (hydroxyzine) as it would greatly increase CNS depression which would lead to more sedation and respiratory depression.

Inderal is a great medication for anxiety!! It's a blood pressure medication but it works by slowing the heart rate and bringing down your blood pressure which helps you feel more calm. Just watch out for dizziness and such with it as it may lower it too much.

Benzo tapers can be done. In your case, since you've been on clonazepam for so long your taper would be very slow. However, you're lucky in the fact that it is a long acting benzo and those are usually easier to come off of than short acting ones like Xanax (which is by far the worst). If you want more info on a safe taper you can ask me and then talk about it with your doctor. However, if klonopin works that well for you, I wouldn't try to get off just yet. If your dose is increased to 3mg/day, try and save the extra pill for when you need it and for a time when you may start tapering off the medication.

I fully support you and am very proud of you for sticking with finding the right mix of medications for you! I know it can be frustrating!

Gotta go! Have projects to work on...blah

[*Laurie*]

pharmd2015, I am immensely grateful for your excellent post. Thank you, thank you! You've given me so much good, solid information and I deeply appreciate your encouragement.

[*Laurie*]

Originally Posted by AncientMelody

Indeed! Glad you found a solution that is reasonable for you. Also, what dose of the inderal are you taking? Perhaps increasing that if needed is another option?
I have GAD no bipolar, but I agree that sometimes when my anxiety is severe inderal can be very helpful. I take 20 mg as needed myself.

Hi, My GP prescribed 20mg. Inderal and said I can take more if needed. I started out taking 20mg (10mg twice/day), but found I was awfully...I'm not sure of exactly the feeling...kind-of lightheaded and "flat" feeling. So I've been taking 10mg and it has helped my anxiety more than anything I've ever tried in my life without causing any bad mood issues. I wish someone would have prescribed Inderal decades ago...I might have avoided taking the 20-plus medications I've tried for severe anxiety/agitation.

I'm thinking of trying 15mg/day of the Inderal to see if I can lower the anxious feeling even more, but not have quit the "flat" feeling.