How should I withdraw?

November 16, 2005 10:50 PM

Any medication withdrawal advice?

About 5 months ago, I started seeing a psychiatrist. He diagnosed me as early-stage bipolar (which I believe is actually true) and prescribed for me two drugs: Lamictal, which is a mood-stabilizer that works really, really well, and Clonazepam. Clonazepam is useful, vaguely, as an anti-anxiety drug, and while on I, I have had much fewer anxiety attacks. But I was not aware, until I ran out of pills and couldn't get any for 5 days, that Clonzapam is highly addictive, and there is a withdrawal period. It apparently peaks at the 8th day; on the 5th and final day of my first withdrawl, I was spraying myself with Raid because I was...well, I was batshit nuts.
Because the exact nature of Clonazepam wasn't explained to me when I started treatment, I've switched psychiatrists- however, my new one flat-out told me that not only does she not prescribe Clonazepam, but she does not treat anyone on Clonazepam. I really want to get off of it (it causes aphasia and anteriograde amnesia), and now I have to. In two weeks.
I'm planning on tapering the dose, as well as consuming a LOT of pot (which was tacitly suggested by the new psychiatrist), but I'm not really sure where to go from there. Does anyone have any advice?

posted by 235w103 to health & fitness (17 comments total)

Chamomile tea. Lots of fluids. Not a babysitter per se, but maybe alert a trusted nearby friend of what you'll be going through. Keep the pantry stocked, as well. Your new psychiatrist's tacit advice is probably good, too.
posted by jtron at 11:14 PM on November 16, 2005

I have been right where you are. It was the worst time of my life. It also set me off on a new career path. As for what you should do, before you do anything I would suggest you read through this website. There is so much good information there concerning tapering and withdrawal from benzos. I am concerned about your using pot while trying to taper. Here's why: the same receptors in the brain that are reacting to the clonazepam are what gives you your high from marijuana. So, essentially, by using pot to deal with withdrawal symptoms, you are actually adding fuel to the fire by exaggerating the effects of the clonazepam and delaying the recovery process - and making the tapering program much more difficult. I am surprised that a psychiatrist would have - even tacitly - approved of this as a plan of action for tapering from benzodiazepines. Be sure and read through the "benzo portal" linked to above. Best of luck to you!
posted by Independent Scholarship at 11:16 PM on November 16, 2005

Holy crap. Withdrawal in two weeks from a mood altering drug, and one that's highly addictive to boot?

Personal advice- Don't let yourself be alone. Make sure that a rational, capable adult is nearby at all times. Not just on the phone, but as in physically in the same apartment/house to check in on you regularly.

It sounds extreme, but this is for your own safety. You're fighting your own bipolar condition, heavy drug withdrawal, and doing so on a tight schedule that's still unbearably long.

If for some reason you can't have someone on hand at all times, try and have one or two people visit at least a couple times a day. Good luck, and be safe.
posted by Saydur at 11:48 PM on November 16, 2005

Benzodiazepines like Klonopin are immensly physically addictive, probably second only to the purer opiates, and withdrawal issues are a very serious concern. Here's a pretty thorough FAQ. Forget about tea, this is an issue for a real life honest to goodness doctor. Depending on the specifics of your situation the risks vary, but this isn't quitting smoking: it's not just a matter of willpower, there are real medical dangers and you need to find out the best way to mitigate the risks from people who know more about it than us.
posted by moift at 12:24 AM on November 17, 2005

the FAQ is kind of a double, didn't notice Independent Scholarships' link.
posted by moift at 12:25 AM on November 17, 2005

...
Wow, I...I didn't know it was going to be that bad. I mean, I knew it was going to be bad, but...
Shit. See you in two weeks.
posted by 235w103 at 12:47 AM on November 17, 2005

235w103, I had to come off benzodiazepine when I found out that my doctor who'd been prescribing it for three years had led me, to say the least, somewhat astray. I've experienced withdrawal from other drugs and I still maintain that benzos are the most invasive, the most difficult.

Now, having said that, I would also say that I sat on my couch reading Metafilter and Independent Scholarship's link over and over for the first week (which was the worst, so if you haven't gone back to them, you are over the worst.) It was the final reason I decided to pony up my five dollars in thanks for the unfolding drama that carried me through a mental nightmare. Some benzos can cause dangerous reactions if you withdraw from them too abruptly, so if you're not in a position to get more and slowly taper down, try to have someone around who can get you the medical attention you need, if it comes to it. Read benzo.org.uk, and e-mail me if you'd like me to talk more about the things I experienced and what I did about them. My address is in my profile.

More than anything, let me assure you that once you get off this drug, your quality of life will improve a hundredfold. Colors were brighter, details more vivid, and my emotions were finally able to engage in the environment in a way they hadn't in a long time. It is worth the trouble.
posted by rebirtha at 6:43 AM on November 17, 2005

I rapidly withdraw people from clonazepam all the time in my epilepsy monitoring unit, because it alters brain waves and prevents seizures, neither of which is desirable in an EMU.

The withdrawal, by all accounts, is a bitch - not quite as bad as alcohol but almost. Go down on the dose very slowly - about (1 mg/day) per week is a good reduction. I took someone off 4 mg/day once and the poor guy vomited for a day before I relented and gave it back to him.

Diphenhydramine or hydroxyzine can help with the sleeplessness; nothing helps with the jitteriness or nausea, so if you get those, you're withdrawing too fast.

Good luck. I'm with your psychiatrist, by the way; I think clonazepam often causes more problems than it solves.
posted by ikkyu2 at 8:29 AM on November 17, 2005

Alright. You People are freaking me right the fuck out. I have been taking clonazepam for Restless Legs Syndrome every night for about 6 years. I take a very small dose - .25 mg. Do I need to worry about this? FWIW, there are some nights when I fall asleep early, or for some other reason miss taking it, and it doesn't seem to make much of a difference except that I'm not as well-rested the next day.
posted by ereshkigal45 at 8:39 AM on November 17, 2005

Ereshkigal45 - I visited a neurologist a few months ago about my RLS. It was getting to be so bad that it affected me during the day, and I was taking Klonopin nightly. There are much better, nonaddictive medications to use for RLS. I began taking Mirapex daily (a Parkinson drug), and experienced minimal side effects that wore off after a couple of days. It also took the edge off the Klonopin withdrawal. I also learned that a slight iron deficiency was exacerbating the RLS (this is a very common cause of RLS). I just got off of the iron supplementation and discovered that this more or less cured my very severe RLS. I don't even have to use the Mirapex. I would highly recommend speaking to a neurologist.
posted by lunalaguna at 10:13 AM on November 17, 2005

Klonopin (Clonazepam) hasn't bothered me one bit and I've been on it over 2 years. Furthermore, it's been 0.5mg PRN - as needed - up to 2 times daily - and I've never gotten addicted. I need it maybe once or twice a week.

Ereshkigal45, I wouldn't freak out. While it can have serious side-effects, obviously with some people it doesn't. A doctor who says something like "I don't treat anyone on that drug" is just panicking people for no reason. He/she should just wean the person off.
posted by IndigoRain at 10:24 AM on November 17, 2005

IndogoRain, With all due respect, your comment:
"Klonopin (Clonazepam) hasn't bothered me one bit and I've been on it over 2 years."
is a lot like saying, "I have run back and forth across that freeway and jumping between cars for 2 days and haven't been hit one time." You are a lucky one, because there is no question that benzos are highly addictive.

ikkyu2, Again with all due respect to your your 'Rapid Withdrawal' procedure, it is almost always a failure in the long-run. Many people do not even begin to feel the serious withdrawal symptoms until weeks after stopping benzos. While RW with benzos may appear to be a success, upon follow-up, it is most often seen as disastrous. This paper from Professor Heather Ashton has some good insight into the problem. Professor Ashton's paper here deals with the problem of protracted withdrawal symptoms which are, unfortunately, often linked to the Rapid Withdrawal programs still used for benzos in some addiction medicine clinics.

-
posted by Independent Scholarship at 11:22 AM on November 17, 2005

Thanks, lunalaguna. Will investigate the iron deficiency angle. There is a mild-form of anemia that runs in my family, so that's a definite possibility. I'm having my annual checkup in a couple of weeks, and I'll ask about the Mirapex. The Klonapin was originally prescribed by a neurologist/sleep specialist, but the continuing prescription has just been regenerated by my regular doctor since then.

I guess I'm wondering if there is a qualitative difference, from the standpoint of addiction/withdrawal, between taking a very small dose of clonazepam once a night (.25 mg is half of the smallest pill available) and taking it 24 hours a day as is usually prescribed for anxiety disorders.
posted by ereshkigal45 at 11:31 AM on November 17, 2005

Not sure about dosages and likelyhood of dependency, but I suppose you would know if you're dependent, yeah?

I meant to tell you that your doctor should test your serum ferritin level. (My regular doctor was clueless, while my neurologist said this is first thing she test RLS patients for.) The common advice if you have RLS symptoms and the test comes out less that 50 ng/ml, take iron supplementation (even though this is technically in the normal range). I believe I was around 28 ng/ml (low end of normal). Also, I had a horrible GI problems with over-the-counter iron supplementation (Feosol) for anemia and had switch to prescription iron supplements.
posted by lunalaguna at 12:05 PM on November 17, 2005

The best website I've found that is incredibly honest about side effects and withdrawl information is CrazyMeds. Take a look around the site and you'll find all kinds of great information.
posted by Serena at 8:49 PM on November 17, 2005

There is no question that Benzos are an addictive substance, perhaps, but obviously not everyone gets addicted.

I don't think it's quite like running across a freeway, though.
posted by IndigoRain at 6:48 PM on November 19, 2005

Independent Scholarship: you misinterpreted me. I don't rapidly withdraw people from clonazepam for the purpose of getting them off an addictive compound permanently. I do it in the epilepsy monitoring unit because clonazepam prevents seizures and I don't want seizures prevented when I'm hospitalizing someone to record their seizures. Before they leave they can go back on it.

I'm sure that clonazepam's super-addictive and that people have trouble getting off it; I'm glad it's not my job to deal with that.
posted by ikkyu2 at 7:39 PM on November 19, 2005