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Student of Life
Member Since Mar 2014
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#1
Hi people,
I am asking for your help and support around an issue regarding Klonopin. I have been on 1.5 mg - 2 mg Klonopin for a little while now (probably like 3 months now). However, whenever I try to reduce it even the slightest amount (I am following my doctor's guidelines and the clinical guidelines that are published in certain places), I get so anxious that I think I need the Klonopin. What I'm wondering is, is this just a sign that I'm physically dependent on Klonopin or is it a sign that I need the Klonopin? I was down to 0.75 mg of Klonopin at one point, but I got really anxious again. So I'm wondering if I just need the stuff. __________________ "Whatever you can do, or dream you can, begin it. Boldness has genius, power, and magic in it!” |
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*Beth*
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#2
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Yes you are absolutely dependent on it physically. But no you are not and addicted. Addiction and dependence are two different things. Sent from my iPhone using Tapatalk __________________ "I carried a watermelon?" President of the no F's given society. |
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*Beth*, AncientMelody, WastingAsparagus
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#3
I second what Sarah posted. Do you have another med that treats anxiety? I've been on Klonopin for 20+ years and am very slowly weaning off it. But I'm taking an AP for my extreme anxiety.
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WastingAsparagus
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Student of Life
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#4
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No, literally nothing else works for my severe anxiety. I have tried Buspar, Gabapentin, Pregabalin, and nothing really seems to work. I take two antipsychotics as well, Abilify, and Zyprexa, along with two antidepressants, Effexor and Remeron. It seems like the benzo is the only thing that works - that is why it's super frustrating. __________________ "Whatever you can do, or dream you can, begin it. Boldness has genius, power, and magic in it!” |
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*Beth*
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Student of Life
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#5
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I mean I'm gonna bring up with my doctor that we ought to try Buspar again. I think that might be a solution. I cannot stand the side effects of Klonopin. __________________ "Whatever you can do, or dream you can, begin it. Boldness has genius, power, and magic in it!” |
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*Beth*
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Student of Life
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#6
Thanks for your replies btw.
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*Beth*
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Magnate
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#7
Okay so when you actually start getting to the lower doses= It is very hard I briefly read beyond your OP.
I do not know if this was mentioned. There are other medications that don't deal with the GABA=Glutamate issue so much Sorry for typos Anyway there is pregabalin that can certainly help in the short term. It is a complicated med that does not keep hitting your GABA receptors to leave them dry. It does have some side effects but weigh the pros and cons It will make you want to east ,probably a lot but things like MCT oil can stop those cravings. It is now used off label for eating disorders. I think anorexia. So, instead of rambling on and no pub med studies I am to tired to find and link just know It will get better even if you are quartering your pills Your pdoc should be on it and give you anything that can help Pregabalin does have a tolerance over a pretty quick time but nothing like a benzo withdrawal. So that's my humble opinion. Talk to your pdoc and you can pm me also I have been there before and the last part of the titration down always seems the hardest for everyone I know. Who has done it. Sorry for the grammar It's the point and I am terrible at working with simple words lol As always talk to your pdoc or whatever docs you also use. You can always pm me . I have been through it. Let me also add in my experience . I did have some weird times but the most important is that you do it very slowly and think of a marathon not a sprint. You will probably not like it but the most important is avoiding seizures. So think of that in context, also. __________________ ~"There is a crack in everything. That's how the light gets in."- Leonard Cohen |
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WastingAsparagus
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#8
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Benzos are really tricky, though...they work so well, then your body builds a tolerance to the benzo, it stops working, and you're stuck with a physical dependency on your hands. Nothing has helped long-term with my anxiety except the older AP's. The second generation ones were a complete waste. __________________ |
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WastingAsparagus
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#9
Ask if propranolol is an option. It can be helpful for anxiety but also for physical withdrawal symptoms when coming off alcohol or benzos. It slows the heart rate, relaxes blood vessels. Etc
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WastingAsparagus
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#10
Thanks for the encouragement! I am trying to go super slowly. I am also trying to define success as being able to go down on it a little bit at a time.
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*Beth*, SlumberKitty
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#11
Just wanted to report that I'm down from 1.5 mg of Klonopin to 1 mg Klonopin!
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#12
That's great WastingAsparagus, Good luck with the rest of the taper.
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#13
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#14
If you experience great difficulty tapering off of a benzodiazepine, even if you do it in tiny increments over a long period of time, there are ways to help with this. This I believe is mentioned in the Ashton Manual, which discusses tapering schedules. I unfortunately cannot find any of the websites that used to be around that included these schedules. I guess they got taken down for copyright infringement...
The shorter the half-life/duration of action of the benzo, the harder it is to taper down and discontinue because the withdrawal symptoms are way worse. @metamorphosis12 mentioned already about GABA/glutamate but didn't really go into much detail. Benzos work by potentiating (making more effective) the activity of GABA at GABA-A receptors. GABA is an inhibitory neurotransmitter, and cancels out the activity of the excitatory neurotransmitter glutamate. As with alcohol withdrawal (alcohol works extremely similarly to benzos on GABA-A receptors), when you try to reduce the dose of a benzo, the activity of GABA will decrease and glutamate activity will increase. For some people, this causes intolerable withdrawal symptoms and makes it incredibly difficult or even impossible to taper/withdraw (both from benzos and alcohol) without some kind of intervention. One method (I believe which is mentioned in the Ashton Manual) is to do a cross-taper from the benzo you're trying to withdraw from over to Valium. Valium is an extremely long-acting benzo with a half-life of 30-60 hours and its active metabolite having a half-life of 30-100 hours (according to Epocrates). Even Klonopin, which is also considered a long-acting benzo, has a shorter half-life than Valium (20-50 hours). Despite this, Klonopin for whatever reason or another tends to be one of the worst benzos for causing withdrawal symptoms (Xanax is probably the number one worst). One method is to convert the total daily dose of the benzo being withdrawn from into the equivalent amount of Valium and then slowly withdraw from that. Another method (I think this is how it works) is to slowly decrease the withdrawing benzo while slowly introducing and increasing the Valium until you're taking the equivalent amount of Valium, and then coming off the Valium very gradually. There are even ways of dissolving valium in a specific volume of water and drinking just enough to get the right dose to taper off in smaller increments than are possible with even the lowest dose of Valium (2 mg). Also, sometimes the psychiatrist/doctor will have smaller doses of Valium compounded by a compounding pharmacy (this tends to be pretty expensive though). This link gives an example of a tapering schedule from an unmentioned benzo (probably Xanax) by tapering off of it without Valium, and an example schedule for tapering off Valium after converting it from its equivalent dose of Xanax (the first method I mentioned). Unfortunately, I can't find any example of the second method I mentioned... So as of 8/23, you said you were down to 1 mg Klonopin. There are many different benzo equivalency tables, but I'm going to refer to the one available in Epocrates, which says that 0.25 mg Klonopin = 5 mg Valium. So 1 mg Klonopin = 20 mg Valium. Disclaimer: I am not a professional, you need to consult your doctor before trying this! So one way would be to switch straight over from 1 mg Klonopin to 20 mg Valium and go down from there in tiny increments (e.g., 2 mg or smaller), or you could gradually decrease the Klonopin in 0.125-0.25 mg increments as you slowly increase the Valium in equivalent dosage increments (which would be 2.5-5 mg), and then when you've reached 20 mg Valium + 0 mg Klonopin, slowly decrease the Valium in tiny increments (e.g., <= 2 mg). How frequently these dose adjustments occur is up to your doctor. You may need to remain on certain dosages of Valium for extended periods of time while tapering (the tables in the link show this). Quote:
It's very concerning that you're on two antipsychotics, though. That's antipsychotic polypharmacy, and Steven Stahl says that's an absolute no-no and reserved for extremely treatment-resistant cases of psychosis associated with severe violence or homicidal ideation/attempts. I would definitely talk with your pdoc about that, and picking one of them to take at a time. Both can be effective at reducing anxiety, but Zyprexa would probably be the better option (though it shouldn't be a long-term option because of its effects on glucose metabolism and its ability to cause diabetes). The combination of Effexor and Remeron is pretty effective for depression. Stahl refers to it as "California Rocket Fuel." However, Effexor may not be the best antidepressant for anxiety. What dose of Effexor are you on? If it's anything over 75-150 mg, it may be making your anxiety much worse. High-dose SSRIs tend to be the antidepressant option of choice for treating severe anxiety, but if these don't work, there are second-line options available. * Cymbalta is an SNRI (like Effexor) that is often used for anxiety and seems to be quite effective and better tolerated than Effexor for that indication. * There is a pretty new class of antidepressants called serotonin modulators and stimulators (SMSs). This includes Viibryd and Trintellix. Viibryd is basically an SSRI + BuSpar (i.e., a weak 5-HT1A partial agonist), except it's a much weaker SSRI (occupying ~50-60% of the serotonin transporters in the brain instead of ~80% like most SSRIs) and a much stronger version of BuSpar (stronger binding to the 5-HT1A receptor, a serotonin receptor, than serotonin itself, so that it stimulates it even in the presence of increased serotonin levels). This enables the same antidepressant/anti-anxiety effects of an SSRI without all the side effects associated, and it is proposed to act much quicker than an SSRI alone. It also causes indirect dopamine release by means of stimulating postsynaptic 5-HT1A receptors. Trintellix is a lot like Viibryd in that it is an SSRI, but instead of a partial agonist at 5-HT1A, it is a full agonist. It also has additional actions at other serotonin receptors, including 5-HT1B partial agonism, 5-HT1D antagonism, 5-HT3 antagonism, and 5-HT7 antagonism. Basically it does the same thing as Viibryd except it also enhances serotonin release and increases dopamine, norepinephrine, acetylcholine, and histamine in the brain, which theoretically equates to improved antidepressant/anti-anxiety effects with the benefit of improved cognition, memory, circadian rhythm regulation, and wakefulness/alertness. * A few of the older tricyclic antidepressants are good for anxiety, mostly imipramine (Tofranil) and clomipramine (Anafranil). Anafranil is the absolute most potent SNRI on the market (low doses work on serotonin reuptake inhibition, and even the lowest dose of 25 mg is more potent than the max dose of some of the newer SSRIs, but as the dose increases, its active metabolite, N-desmethylclomipramine, increases, which acts as an extremely potent norepinephrine reuptake inhibitor). The tricyclics tend to have more side effects than the SSRs/SNRIs since they're "dirtier" drugs. * Lastly, the MAOIs can be a good option for anxiety, especially Nardil. These are largely not prescribed because of their dietary restrictions and drug-drug interactions that can be fatal if not followed. However, these meds are extremely effective (probably the most effective antidepressants, especially in those with treatment-resistant anxiety and depression), and are actually much better tolerated than even the SSRIs/SNRIs. Most doctors/psychiatrists refuse to prescribe them simply because they have no experience with them and aren't familiar enough with the dietary restrictions and drug interactions... Basically they're afraid of them because of what they don't know about them. Quote:
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Also, if OP cross-titrates to something like Valium, seizures might not be as much of a concern. Quote:
Propranolol is good for anxiety, but to my understanding it is more for the physical symptoms of anxiety (tremor, racing heart, chest pain, etc.) I have never heard of it being used for benzo withdrawal, but I wouldn't be surprised if it was effective. I don't think propranolol relaxes blood vessels though, I think that would be more of what the calcium channel blockers do. __________________ Diagnoses: Tourette's Disorder, OCD, ADHD-PI, Bipolar I Disorder, Borderline Personality Disorder, Anxiety Disorder Unspecified Medications: Dyanavel XR 15 mg 30 mg/day Lamictal 300 mg/day Cymbalta 90 mg/day Lunesta 3 mg/night Dayvigo 10 mg/night |
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metamorphosis12, WastingAsparagus
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Student of Life
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#15
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Wow, thanks for all the info. I am on a high dose of Effexor (450 mg). So perhaps that is causing the anxiety. __________________ "Whatever you can do, or dream you can, begin it. Boldness has genius, power, and magic in it!” |
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Student of Life
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#16
I also always worried that I am on two antipsychotics. I need to get off of one of them.
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Magnate
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#17
The Ashton method is probably the most successful way my pdoc has weaned people off of benzos. Especially, when switching someone from say clonazepam over to diazepam. Which, has a longer half life and makes the whole tapering issue more controlled and is done in slow increments
Ashton method: benzo.org.uk : Benzodiazepines: How They Work & How to Withdraw, Prof C H Ashton DM, FRCP, 2002 All of the information is in the link ^ benzo.org.uk : Benzodiazepines: How They Work & How to Withdraw, Prof C H Ashton DM, FRCP, 2002 benzo.org.uk : Benzodiazepines: How They Work & How to Withdraw, Prof C H Ashton DM, FRCP, 2002 This should definitely be done with a pdoc and/or in an inpatient setting. As far as other meds. -Vraylar - Deplin (l-methofolate - Trintellix Which has 5HT1A partial agonist activity - Lamictal - Gabapentin - Tricyclics It's tough. I have had general and social anxiety for most of my life. I think a combination of CBT and ACT therapy along with exercise, eating well, getting enough sleep, supplementation, and the use of a medication, if needed are the best options. Finding the right or best medication in psychiatry for the brain is still difficult. __________________ ~"There is a crack in everything. That's how the light gets in."- Leonard Cohen Last edited by metamorphosis12; Sep 17, 2021 at 11:06 AM.. |
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*Beth*, WastingAsparagus
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#18
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How's it going with the Klonopin? I'm finding myself in exactly the same spot you were in with not knowing whether withdrawal is causing major anxiety, or whether I really do need the Klonopin. __________________ |
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WastingAsparagus
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#19
For anyone interested in tapering off a benzo, there's a great site benzobuddies.org that provides support forums, much like here for people tapering off. It also has a lot of good information on different taper methods, including the Ashton manual. The Ashton schedule is what I used.
As for being on 2 anti-psychotics, I'm on 2 and am ok. They're for different things, one boosts my mood so augments my antidepressant, while the other is for anxiety. The only bad thing about being on 2 is that some side effects seem to be amplified- namely muscle stiffness. |
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WastingAsparagus
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#20
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Be careful. I developed TD and had to stop the ap and start ingrezza Sent from my iPhone using Tapatalk __________________ "I carried a watermelon?" President of the no F's given society. |
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