Desperate for relief from symptoms of Klonopin weaning/anxiety

October 25, 2016 12:43 PM

PLEASE DO NOT OFFER HOMEOPATHIC SOLUTIONS. I AM NOT INTERESTED. I've been on Klonopin (1mg am / 1mg pm) for longer than I can remember. It is doing nothing at this point. My anxiety is higher than ever and i am sure I've developed tolerance for the medication. I have read nothing but bad things about the drug and I want off. My concern is the awful, awful and prolonged withdrawal period and all of the horrible effects. Is there any relief from this while titrating off?

My psychopharmacologist never explained what a horrific drug Klonopin could be in terms of tolerance and withdrawal, and that its efficacy could just STOP like this. After many man years on this drug--it did work at first--my anxiety is terrible. I throw up every morning which is not good for my throat or teeth, I cry all the time which is not good for the prospect of keeping my job. I want something to help me with this awful anxiety, and clearly 2mg of Klonopin is not doing the job, and with everything I've read about getting off this drug, I am not looking forward to getting off of it. I once had to stop cold turkey and after about four days I thought I was going to die or my brain was going to catch on fire, so I know I can't just stop.

Has anyone got any advice for [[1] getting off Klonopin (2mg a day) with minimal discomfort/ rage/ insomnia/ shaking/ vomiting/ anxiety increase [2] what to do about anxiety when weaning off a non-functioning anxiety medication -- the withdrawal symptoms of which exacerbate anxiety exponentially?

I'm also taking an anti-depressant called Trintellix that's next for the chopping block because it does nothing for my depression and it is contra-indicated with every other single medication on the market, meaning I can't take, say, BuSpar for my anxiety because of the risk of Serotonin Syndrome with the Trintellix.

posted by chonus to Health & Fitness (26 answers total)

You do not have to suffer like this and as hard as it is, please remember that you will not ALWAYS feel this way; that's the anxiety talking. You can and will feel better.

The best advice you're going to get is from your prescribing doctor, you don't mention if you've spoken to yours but I would do that immediately.

You need to get this sorted out by your psychopharmacologist and most definitely not from people here, as smart as they are.

Call your doctor. It will get better.
posted by yes I said yes I will Yes at 12:48 PM on October 25, 2016 [17 favorites]

Please call your doctor and tell them the things you have written here.

When dealing with uncomfortable side effects while changing meds, the best thing I have found is to remind myself that THIS IS TEMPORARY and will pass.
posted by PMdixon at 12:53 PM on October 25, 2016 [6 favorites]

I don't want to make you even more anxious, but this is very important: DO NOT ATTEMPT TO WEAN YOURSELF OFF KLONOPIN EXCEPT UNDER MEDICAL SUPERVISION. People have died of benzo withdrawal before. Your doctor will explain what the best schedule is and what can be done to ease withdrawal symptoms.
posted by praemunire at 12:55 PM on October 25, 2016 [14 favorites]

You must get help from a doctor, if not the original prescribing doctor. Yes, they can absolutely help make it less miserable, which you definitely want, but they can also make it less dangerous. Same with your antidepressant.
posted by Lyn Never at 1:01 PM on October 25, 2016 [1 favorite]

Yeah, you actually can die if you just try to get off Klonopin cold-turkey. I am glad you didn't. There is a very real risk of coma or death that comes with sudden clonazepam cessation.

I have helped some people help some other people step down off of benzodiazepines, and I can maybe ask 'em for pointers and memail you . However, I feel obliged to tell you this: I decided to refresh my memory by Googling about, and I kept on encountering warnings like this:

> As with any benzodiazepine, medical detox is necessary for those withdrawing from clonazepam.

It's necessary because you can die if you do it wrong. "Doing it wrong" might be taking the wrong nutritional supplement, for example. We want you to live, so we're not going to give you advice on how to taper by yourself. Heck, even the threads in the serious druggie forums, replete with refined-opiate-tapering advice, say "Don't post here, ask a doctor." So, go ask a doctor.

(Maybe not your psychopharmacologist, who might be wholly incompetent if they didn't warn you about benzos in general or clonazepam in particular, but perhaps some other doctor?)
posted by BrunoLatourFanclub at 1:02 PM on October 25, 2016 [3 favorites]

Response by poster: My prescribing doctor is non-responsive. He thinks Klonopin is the BEST. I'm in agony.

I know not to go cold turkey (even though an emergency room psychiatrist who I met with when experiencing the horrible withdrawal symptoms from the time I was forced to go cold turkey for a week said that I should just "tough it out"). This is why I have no faith in any doctors.
posted by chonus at 1:06 PM on October 25, 2016 [2 favorites]

Best answer: At this point you would be quite justified in getting a new doctor, if it's all possible with your insurance situation. Even if your doctor approves of the Klonopin, if you want to come off it, he has no business refusing to assist you in doing so safely.
posted by praemunire at 1:08 PM on October 25, 2016 [25 favorites]

Ya know, if you are hurting that badly and your doctor is nonresponsive you could get yourself to the emergency room and ask for help. With the level of anxiety you are describing you may benefit from inpatient care. I'm not a doctor, I know there is a lot of stigma against inpatient psychiatric hospitalization but in my experience their goal is to get you stable and out the door; you are not stable right now and they may be able to trial different meds for you and you can come off klonopin safely in the inpatient setting.
posted by pintapicasso at 1:26 PM on October 25, 2016 [13 favorites]

Best answer: Get a new doctor. Seriously. If you're in too bad a place to manage that on your own, ask for help from a meatspace friend. This physician isn't meeting your needs, and you need help that isn't willing to give. That's grounds for a new provider.
posted by uberchet at 1:55 PM on October 25, 2016 [7 favorites]

+1 get a new doctor
posted by radicalawyer at 1:58 PM on October 25, 2016 [4 favorites]

Just wanted to say that I was on it for a couple years and did a very slow taper and had no problems at all. Some of that may be lucky physiology but I think of some of it was that I was in no hurry and doctor had me taper gradually. Just saying, it is not hell for everyone.
posted by metahawk at 2:11 PM on October 25, 2016

Please find another doctor! Is there a nearby mental health clinic that might be able to help you? Where are you? Maybe if you tell us where you are someone local can recommend local resources and/or docs. I hope you feel better soon.
posted by mareli at 2:20 PM on October 25, 2016

Best answer: In terms of dealing with the anxiety associated with withdrawal, you're going to want cognitive behavioral therapy. CBT is super effective for the types of anxiety that benzos are typically prescribed for- they often resolve anxiety within a few months and so they're supposed to be offered as a first-line treatment (as an alternative to SSRIs*). CBT clinicians are used to working with patients who have been taking benzos long-term, and CBT has been found to assist with benzo withdrawal in empirical studies of panic disorder (Otto et al., 2010; Bruce et al., 1999). You will want a therapist who is helping you engage in structured exercises to identify and work through specific anxiety triggers rather than talking generally about your anxiety. I'd be happy to help you find a therapist if you'd like- feel free to memail me.

*Depending on the diagnosis, benzos are only recommended in clinical practice guidelines as a long-term treatment after you've tried a couple SSRIs and they haven't worked. They're otherwise sometimes used as a short-term (4-6 week) treatment, but in general, practice guidelines discourage physicians from prescribing them as a first-line or long-term treatment.

Otto MW, McHugh RK, Simon NM, Farach FJ, Worthington JJ, Pollack MH. Efficacy of CBT for benzodiazepine discontinuation in patients with panic disorder: further evaluation. Behav Res Ther. 2010;48:720–727.
Bruce T, Spiegel D, Hegel M. Cognitive-behavioral therapy helps prevent relapse and recurrence of panic disorder following alprazolam discontinuation: a long-term follow-up of the Peoria and Dartmouth studies. J Consult Clin Psychol. 1999;67:151–156.
posted by quiet coyote at 2:23 PM on October 25, 2016 [6 favorites]

I'm sorry you're having such a hard time. It's really frustrating when your doctor won't listen to you. I had a shrink once who wouldn't listen when I told him I wanted off of an SSRI, and he kept putting me on a roller coaster of different drugs with different side effects.

You need to go to a new doctor. Forget this a-hole who isn't listening to you! A reasonable doctor will hear your concerns and help you taper off.

I know you're stressed and it's hard to focus, so here are some concrete steps:

1. Call your primary, tell them you need a new psych because yours isn't listening to your concerns, and ask for several recs.
2. Look them up on your insurance's website. If none are, call your doctor back and repeat steps 1 and 2.
3. Call each one who is on your insurance, ask if they are taking new patients. (If none are, call you primary back and repeat steps 1 and 2.) If they are, tell them that you're experiencing acute anxiety with physical symptoms and your current medication isn't working, and you need to see someone ASAP so you can come up with a treatment plan. (If they can't see you quickly, repeat 1 and 2 again.)
4. Before the appointment, write down your history and symptoms and why you want to get off klonapin or switch to a new drug.
5. Take notes at the appointment so you understand the exact instructions. Repeat your notes back to the doctor.
posted by radioamy at 2:26 PM on October 25, 2016 [6 favorites]

I agree with what others have said: find a new doctor, taper slowly under their supervision. There are ways to stagger doses/pulse doses/cut pills in tiny pieces/use a liquid version from a compounding pharmacy, and your doctor should help you find the best strategy for doing this. If this doctor isn't doing this, you really need to find a new one. Obviously, this can be hard with as much anxiety as you're already experiencing, so I like uberchet's suggestion to ask someone you know in person, in your area, to help you find a new doctor.

In the meantime, think about stocking your "toolbox" to help you with the anxiety you're dealing now and any (hopefully very small, if your doctor helps you do it right) spike in anxiety as you wean yourself off. For me, my toolbox is a list of things I can do when feeling anxious that help, including:

* Yoga
* Going for a walk
* Deep breathing
* Mindless iPhone games
* Taking a hot shower
* Knitting
* Calling a friend

But whatever works for you is what's important. Try a few things (Google "self care" if you need help coming up with more ideas) and maybe write a physical list you can carry around with you with things that help, so that even if you need to duck into the restroom at work for 5 minutes, you can breath deeply or play Candy Crush or whatever.

But yeah, I think the most important thing is to get a new doctor who will actually help you with this.

Finally, just wanted to add that my mom took Xanax daily for a long time and had crippling anxiety, similar to what you describe, after years of being on it. Now that she's weaned off of it, she's like a whole different (happier, calmer) person. So there's definitely light at the end of the tunnel.

Good luck!
posted by bananacabana at 3:18 PM on October 25, 2016 [4 favorites]

Toxicologist chiming in. If your prescribing doctor is not responsive, I encourage you to find a different physician. Coming off of a medication like this is best done under medical supervision, and with someone whose practice gives you confidence. Don't be scared off by the title of this page, but it can give you some useful language to use when discussing your request with your current physician, a new physician, and/or your insurer.
posted by late afternoon dreaming hotel at 4:41 PM on October 25, 2016 [3 favorites]

This is why I have no faith in any doctors.

That's two. Two doctors who haven't been great. Please do not use this as an excuse for being really aggressive about getting help.
posted by listen, lady at 5:11 PM on October 25, 2016 [2 favorites]

Someone close to me is weaning off Klonopin with the help of Librium, which was prescribed by a psychiatrist. I know almost nothing about it, but it's something you can check out.
posted by wryly at 5:19 PM on October 25, 2016 [1 favorite]

If your insurance requires you to get a referral from your doc and you take radioamy's advice, you could also print off the list of approved providers in your area and send it to your primary care doc. Explain that these are the psychopharmacologists covered by your insurance, and ask them if they can refer you to someone on that list. Might save you a little time.

Good luck!
posted by bunderful at 5:43 PM on October 25, 2016

Just my own experience ... I got off a benzo by scaling back the dose slowly (as directed by my dr) and it ended up being much easier then the horror stories I read about online. Re coping techniques, I did whatever I could to distract myself from anxious thoughts. Good luck to you.
posted by soakimbo at 7:49 PM on October 25, 2016 [1 favorite]

nthing doing this with advice from a good doctor.

IANAD. Ask your doctor about using over the counter sleep aids (Tylenol PM, Unisom) to help if you have insomnia during the tapering period. They work through a different mechanism than benzos and so probably aren't subject to the tolerance you've developed. There are also some other non-benzo non-buspar prescription anti-anxiety meds that your doctor might suggest.
posted by duoshao at 5:05 AM on October 26, 2016

I'm not sure how things work in your area, but I have an appointment next week with a pharmacist to formulate a plan for potentially tapering off Klonopin. He's not going to supervise the actual process, but I can take his plan to my Doctor and tell her "Hey, this is the plan and you're going to help me." Does your pharmacy offer medication consultations?
posted by Secret Sparrow at 5:55 AM on October 26, 2016

A quick thought about your past bad experience in the ER: mental health care is really a specialty. Some ER docs probably are not as skilled in this area as they should be. In the health care system in my region (in Canada), there are specific hospitals which manage mental health concerns in the ER--in other hospitals, the ER doesn't usually see folks with mental health concerns, and that expertise may not be there.

If you look for a new doctor who has some specialisation in mental health care, I think and hope that your experiences will be better. And if this is getting to be an emergent situation for you now, yes definitely go to the ER--but if you are able, either go to the ER at a dedicated mental health hospital, or seek some information about which other sites in your region offer specialised emergency mental health services.
posted by snorkmaiden at 7:16 AM on October 26, 2016

I quit Klonopin once (since went back on indefinitely), and while it was possibly the hardest thing I've been through, it was made easier by tapering down very slowly using Valium. Valium works well because of the long half-life as well as the relative ease of small dosage changes, since you take more Valium on a milligram basis compared to many other benzos.
posted by ligerpants at 3:20 PM on October 26, 2016 [2 favorites]

To ease your mind a little, your dose is low enough that severe withdrawal symptoms are unlikely if you do any kind of taper at all. For the most part (and that most part part is why you should involve a doctor in this) it is people on much higher doses that have serious trouble with benzo withdrawal. Death from abruptly stopping 2mg daily of any benzo is pretty much unheard of, but stopping cold turkey very well could put you in a serious anxiety spiral.

As far as treatment going forward, CBT is often a big help, as are some SSRIs and SNRIs, but the mindfulness that CBT provides is often enough. Do be aware that if you go a long time without practicing what you are taught in CBT you can and will forget how to do what you need to do. At that point, further CBT sessions are a help.

If you absolutely insist on doing it without a doctor, cut your dose by a small amount every week or two. It's usually the first and last steps that are hardest, FWIW. The first more from fear than anything and the last because of the actual drug.

Really, though, involving your doctor is best. Even if you can't find another doctor, tell the one you have in no uncertain terms that you will be stopping the Klonopin and ask how best to accomplish that safely.
posted by wierdo at 5:27 PM on October 26, 2016 [1 favorite]

Response by poster: Thank you all for your answers. My mom found a doctor who specializes in this stuff and is going to pay the bills for him to work with me (naturally he is not on my insurance plan). I am not looking forward to the unbelievably awful withdrawal symptoms, and the very very long time it's going to take to taper off, but at least there's someone who agrees with me that I should do so and will help me. It's so upsetting to look back over the past ten years and realize that all of these things that I thought were just "because" (increased, daily anxiety, awful unabated depression, total loss of energy, weight gain, anhedonia, crying jags, complete social withdrawal, etc.) are actually "because you are on this horrible horrible medication that no one should ever be on."
posted by chonus at 1:35 PM on October 27, 2016