clonazepam and me, sitting in a tree

March 21, 2008 12:21 PM

Clonazepam is my go-to workhorse drug. But am I setting myself up for addiction?

I have problems with overwhelming anxiety at times, a condition which my psychiatrist prescribed me clonazepam. I love the stuff. I take .5 to 1mg a day whenever I feel panicky (along with a mt dew to offset drowsiness). A typical day of usage is a dose in the morning to confront the workday and sometimes a dose at night if i can't sleep.

I love the drug and it works wonders, making me productive and helping me reach my potential.

BUT, I have concerns regarding addiction. I have read that clonazepam is supposed to be less addicting than other anxiety medications, but that it is not without risks. I have also read that it can be accompanied with some serious withdrawal symptoms. As a test, I did slowly decrease my dosage and then go off of it for a month and noticed no withdrawal, but I found my anxiety problems unmanageable.

The bottom line is: Is it safe for me to continue using clonazepam in the manner which I do for a long period of time, perhaps the rest of my life?

posted by anonymous to health & fitness (20 answers total)

If you are not exceeding the amount your doctor prescribed, then probably not.

I would ask your psychiatrist this question and see what he/she says.
posted by aheckler at 12:39 PM on March 21, 2008

IANAD, but know from experience that Clonazepam is highly addictive. Although less addictive than other anxiety drugs, I experienced a slight dependence after only using half the recommended dosage after a week! It is a psychological rather than physical dependence for the most part, and I would say that weaning yourself by taking one at bedtime per day for a week, then one every other day at bedtime for a week, simultaneously doing breathing exercises, and learning to focus on "relaxing" thoughts (in other words: "meditate") and this will definitely help. You should probably consult your doctor on an exact weaning dosage, and maybe just keep some around for the inevitable "panic attacks". I have found for my anxiety that yoga, avoiding too much stress, getting enough sleep/exercise, eating well, and concentrating as much as possible on every positive thing I can think of has helped to manage without drugs most of the time. This may or may not work for you. Good Luck!
posted by nikksioux at 12:41 PM on March 21, 2008

Ack, premature post-ulation. Here's the full paper in PDF form.
posted by aheckler at 12:41 PM on March 21, 2008

I just started on it and I guess I should be worried about it but I'm just not. I hate my anxiety. Anxiety ruins my life experience. It's impossible to avoid stress, because a lot of stuff stresses me out. I'm the source of my own stress. It's the way I process the world. It isn't that there are specific triggers for stress. I worry about a lot of things, nothing specific.

Be glad it works. Be glad it lets you relax. Don't worry about addiction, because if your anxiety is bad enough to warrant medication, you're going to need it for the rest of your life.

Unless you have a trust fund and don't need to work for a living, you're not going to have the time or money needed to "work" on your anxiety or be able to avoid anxiety.

Just my two cents. My only worry is not being able to afford it, but I'm covering it now.
posted by onepapertiger at 12:47 PM on March 21, 2008

Clonazepam is a powerful tool, and immensely helpful for a lot of people. However, it's important to note that benzodiazepines are addictive as all hell. Not just psychologically. You can have seizures coming off of them. Also, caffeine reduces the amount of BDZ in your bloodstream, so you might just take a lower dose and skip the Mt. Dew.
posted by solipsophistocracy at 1:12 PM on March 21, 2008

i was on klonopin for a period of several months, a number of years ago (i was 19-20, at the time). i don't remember what my dose was, but i was taking it primarily as a sleep aid, with the added benefit of alleviating some of my anxiety during the day, as well. my psychiatrist at the time (not really the most scrupulous character, in retrospect), happily upped my dose twice, as the drug gradually became less effective. it certainly felt as though i was becoming dependent on the stuff, but i couldn't really tell you whether it was more psychological or physical.

eventually, i stopped seeing that particular doctor (for a number of reasons), and concurrently dropped the klonopin. i experienced some withdrawal symptoms--obviously a sudden upsurge in anxiety, but also some mild visual hallucinations (spiders on the ceiling when trying to sleep, etc.). those subsided pretty quickly, however.

what was more upsetting about the whole affair was one side effect of the drug while i was still taking it: it rather seriously compromised my, ehr, impulse control. i was and, to an extent, remain a pretty high-strung person, but this normally manifests itself as extreme shyness. while taking the clonazepam, i became uncharacteristically argumentative. this came to a head during a class critique (i was in art school) when this one guy i found particularly irritating, under the best of circumstances, made a series of condescending remarks to a female friend and classmate. long story short, i had a screwdriver in my pocket, and i may or may not have, uh, "jokingly" threatened to stab him with it.

but! i was nineteen, might have been taking too much of it, and was more than a little unhinged to begin with. my advice would be to take no more than what you're prescribed, think carefully about raising dosages, in the future, and be on the lookout for negative personality changes. benzos obviously change your personality--that's why people take them, but if things start to drift into shanking territory, it should be cause for some concern.
posted by wreckingball at 1:14 PM on March 21, 2008 [1 favorite]

The deal I have with myself is that if I'm going to be on an anti-anxiety drug, I must be improving my anxiety-management regimen aggressively at the same time. That means monitoring anxiety levels, improving my lifestyle toward health and fitness, practicing stress management techniques and reviewing panic-offsetting exercises I learned here.

You're doing well to be in therapy and to be keeping to your prescription, but yes, it's likely that you will be put under stress by the simple withdrawal of the drug. That's what a crutch is, you know? You might first experience addiction by needing to take a larger dose at especially tense times. Treat that seriously, as a red flag. I don't want to be down on responsible drug use, I'm certainly not, but protect yourself by bolstering your ability to rely on alternatives. It's safer that way. Are you talking goals with your therapist?
posted by Ambrosia Voyeur at 1:23 PM on March 21, 2008 [1 favorite]

I've tried different things for anxiety and have found nothing that works better than the benzos. They really are the best thing available for nipping an anxiety attack in the bud. But when I'm also taking an antidepressant, I rarely need anything additional for anxiety. I don't know if you also have depression as well as anxiety, but for me the two are very closely linked.

As for dependence/addiction issues: Do you find you need higher doses to get the same relief? If so, you might have an issue. If not, then there isn't really anything to worry about. You might be dependent on clonopin to stop an anxiety attack just as an asthmatic is dependant on an inhaler to stop an asthma attack, but having the anxiety attack is the greater evil to be avoided.
posted by happyturtle at 1:33 PM on March 21, 2008

Benzodiazepine withdrawal syndrome.

I don't agree that it's just a psychological dependence. I was prescribed a high dose of clonazepam when I was in my teens, and I had no idea that it was considered to be a habituating drug. (In other words, you won't necessarily need more and more of it, but you will become habituated to its effects, and you may experience some level of withdrawal when you stop taking it.) I tapered quickly off the medication several times within the course of treatment, and each time experienced brutal withdrawal symptoms. I didn't realize they were withdrawal symptoms at the time; I thought it was just my moderate anxiety resurfacing, and would consequently start taking it again. After a few years, I decided to taper off it for good. My subsequent withdrawal was marked by insomnia, night terrors, muscle cramps, panic, tooth-grinding, and what seemed to be aphasia. These symptoms were severe for several months, and came and went intermittently over the next year. During that time I had a great deal of trouble speaking--as soon as I finished a sentence, I would be seized with an irrational fear that what I just said had been completely nonsensical. It was like--you know when you're walking up or down steps, and you think there's another step to go, but there isn't, and you come down too hard and feel a weird jolt of disorientation? It was like that all the time, except in my brain.

I'm not trying to frighten you. My dosage was a little higher than yours, and I probably didn't taper slowly enough. However, I want to stress that I was not primed to think I would be going through withdrawal when I stopped. I had no idea what was happening, so I have to conclude that it was an actual physical response to cessation of the drug. This may not be your experience. I thought it was a really useful medication while I was taking it, but I would never touch it again.
posted by Powerful Religious Baby at 1:37 PM on March 21, 2008 [2 favorites]

I don't agree that it's just a psychological dependence.

You don't have to agree or disagree; this is a question of fact, not opinion, and you are correct. Clonazepam is highly addictive physically.

I love the stuff. I take .5 to 1mg a day whenever I feel panicky (along with a mt dew to offset drowsiness). A typical day of usage is a dose in the morning to confront the workday and sometimes a dose at night if i can't sleep.

I hate to tell you this but you are already addicted. If you've been taking clonazepam twice a day pretty much every day for more than about two weeks you are already physically addicted to the stuff.

Is it safe for me to continue using clonazepam in the manner which I do for a long period of time, perhaps the rest of my life?

You need to ask your doctor about this. You'll have to decide, along with your doctor, whether a long term addiction to clonazepam is a necessary evil to dealing with your anxiety. I'm not saying it isn't; I'd rather take clonazepam forever than have crippling anxiety. On the other hand, the longer your take clonazepam the harder it will be to stop and the more likely you are to experience long term effects if you quit.

But the important takeaway here is that the time to confront whether you want to get addicted to clonazepam was before you started taking it. At this point you're probably already hooked if it has been more than about two weeks.
posted by Justinian at 1:43 PM on March 21, 2008

Oh, if you want to be pedantic you should replace my uses of "addicted" with "physically dependant". You're alreadly physically dependant but I suppose that is, clinically speaking, not quite the same as addicted.
posted by Justinian at 1:44 PM on March 21, 2008

IAalsoNAD, and have mentioned this before, but I will mention it again - I have had really good results with these guys www.neurogistics.com but it is a lot more work and $$ than just buying prescription clonazepam, which is ridiculously cheap, in my experience. Obviously everbody is different in terms of severity of problem, case, etc. The clonazepam works really quickly and well, for sure, but if I had a choice I would avoid having to take it regularly. Sort of save it only for emergency-type situations. Of course you need to ultimately do what works well for you : )
posted by bitterkitten at 2:08 PM on March 21, 2008

Look, there are plenty of anti-anxiety drugs that are safer for long term use. Benzos are great, but the side effects aren't great.

For example, one of the side effects is depression. Is that an OK risk? I would say no.
posted by sondrialiac at 5:30 PM on March 21, 2008

Oh, and why not ramp up another anxiety drug while slowly going off the benzos? It might work as a strategy. I have definitely been where you are before--and benzos were wonderful--but again, long-term I was a lot more comfortable with something else.
posted by sondrialiac at 5:31 PM on March 21, 2008

Addiction is *not* physical dependence and it's not just pedantic. Here's why: if anyone takes an opioid or alcohol or a benzodiazepine long enough (and this varies between people how long is "long enough"), they will become physically dependent and suffer withdrawal symptoms if they do not very slowly taper the drug when they stop.

Addiction is compulsive use of a substance despite negative consequences-- in other words, your life is worse with the drug than without it, you are obsessed with the drug and have difficulty staying within prescribed dose and want to be "out of it" all the time. This is the official DSM definition-- if you define addiction as physical dependence, coke isn't addictive because you don't get sick when you stop taking it, only cranky. This is why it is defined the way it is-- to include cocaine (which is obviously addictive) and exclude pain and anxiety patients whose lives are improved by appropriate use of their meds.

Physical dependence is needing something to function. We're all physically dependent on air, water, food-- and some need antidepressants, blood pressure meds, many other things to function best. This doesn't mean those things are addictive. If you want to equate physical dependence with addiction then diabetics are insulin addicts, people with high blood pressure are blood pressure medication addicts, people with organ transplants are anti-rejection medication addicts, people with HIV are HAART addicts... it is silly.

The distinction is important because physical dependence is not really a problem unless you want to stop taking the drug or are forced to do so for some reason. Addiction is always a problem because by definition it gets in the way of love and work.

So, it's really up to you: physical dependence is virtually inevitable with daily long term use of benzodiazepines; addiction is actually rare in people who take it as prescribed. However, because there are lots of ignorant people (including doctors) who don't know the difference, being physically dependent makes you vulnerable (your doc could freak out and decide to cut you off because he's scared because a friend of his got busted for prescribing) and some people do have rebound effects when they stop.

Basically, the best thing to do is avoid physical dependence if you can, but if you can't and this is the best treatment you've found, protect yourself from ignorant people and be sure you have a good relationship with your doctor and clear records indicating your history of anxiety.
posted by Maias at 5:32 PM on March 21, 2008 [1 favorite]

Addiction is *not* physical dependence and it's not just pedantic.

Which is why I pointed out you should substitute the two in my answer. However... my strong suspicion is that when the OP used the word "addicted" he or she was using it in the colloquial sense where a "physical dependence" with regard to a prescribed pharmaceutical can be called an addiction.
posted by Justinian at 6:17 PM on March 21, 2008

Physical dependence is needing something to function. We're all physically dependent on air, water, food-- and some need antidepressants, blood pressure meds, many other things to function best. This doesn't mean those things are addictive. If you want to equate physical dependence with addiction then diabetics are insulin addicts, people with high blood pressure are blood pressure medication addicts, people with organ transplants are anti-rejection medication addicts, people with HIV are HAART addicts... it is silly.

This is a misleading equivalence, I think. If a person who does not particularly "need" a benzodiazepine is prescribed a benzodiazepine, she will become physically dependent on it just the same as a person who requires it to live. The same is not true of blood pressure meds, anti-rejection medication, or HAART. If a high blood pressure patient takes medication, his physical dependence on the drug exists because of his high blood pressure. The drug itself does not induce dependence, as is the case with benzodiazepines.
posted by Powerful Religious Baby at 8:11 PM on March 21, 2008

Semantics aside, no it's not safe the way you're going. I take only half of a .5mg pill everyday and a year later when I went in and asked my dr for a year refill he decided then to helpfully reveal to me that it's very addictive. Now I try to take it only about 5 days a wk. When I tried to taper off further, I experienced increased anxiety (obviously), trouble sleeping, and extremely irrational anger. My fuse was impossibly short, I would fly off the handle all the time. Definitely try cutting back and skip the Dew chaser. It makes you groggy cuz you're taking so much. That's why I only take half. Good luck, I can sympathize.
posted by CwgrlUp at 9:41 AM on March 22, 2008

I have had a standing prescription for Klonopin for 4 years. During a time of low anxiety, I went without taking any for 6 months or more. I have not ever experienced any addiction or withdrawal symptoms.
posted by IndigoRain at 5:05 PM on March 23, 2008

Have you ever lied, cheated, or stolen to get your drug? No? Then you are probably not addicted. You may be dependent, but that is just a side effect. As with any drug, you have to decide if the benefits outweigh the side effects
posted by ryanissuper at 5:48 PM on March 24, 2008