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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 16 of 16. This is the beginning of the thread.
Posted by Komet on May 24, 2009, at 0:57:37
I need some input as to how/whether to end a long time use of Klonopin.
Some background. W/O Klonopin (or other benzo) I have GAD and the occasional panic attack as well as fairly persistent insomnia. If I'm really being good about watching stimulants, avoiding all stress, getting sleep and exercising, GAD and panic attacks are mild and rare.
However, I also have a stressful and demanding career that requires long hours at work, little time to exercise, lack of sleep, and of course, I need coffee to get through the day sometimes. All of these are my triggers for anxiety. Throw in insomnia for a week or so and I'm likely to end up in a full fledged panic attack (if not otherwise medicated).
OK, so roughly 5 years ago I went from taking Xanax on an as-needed basis to daily use of .5 of Klonopin. On this dose, I sleep soundly at night, I function without GAD and never have had a panic attack. It has been a very useful drug over a very difficult period of my life.
I drink very moderately (a beer or two a week, I maybe have been drunk once in last three years) and have no other chemical dependencies or history of chemical additions - though I do have a fairly powerful internet addiction.
That being said, I do worry about long term usage and impact on cognitive ability and memory. I also think I lack motivation because of the medication. Though I know I'll never completely live without Klonopin because I never ever want to experience another panic attack, I would like to get back to an "as-needed" basis.
I guess my question is, given the above, is ending my daily usage of Klonopin even a desirable thing. I have to admit, its been very helpful and while I recognize that usage of Klonopin has been a problem, and even nightmarish for some, I seem to have no tolerance issues (never need to increase the dosage). I am worried that if I quit, however, even slowly, that my pre-use anxiety will return.
OTOH - I worry that persistant long-term use is ultimately a bad thing regardless of whether tolerance and increased dependency is a problem for me or not. I worry that my brain isn't functioning as well as it should, in a profession that requires a very high level of cognition. I did take .5mg of Klonopin on a daily basis through law school and still managed to finish in the top 1/4 of my class at a top school (but who knows what I would have be capable without it).
So, is it worth going through withdrawal only to return to GAD and panic attacks to gain back or do less damage to my ability to use my brain to its ultimate capacity. Or, given that I seem to do OK on Klonopin without the need to increase dosage over time, should I spare myself the anxiety and stick with daily use.
Posted by garnet71 on May 24, 2009, at 10:29:18
In reply to Long time user of Klonopin, considering stopping., posted by Komet on May 24, 2009, at 0:57:37
I just happened to be reading up on Klonopin; am considering starting on this drug if my PDoc agrees. You're going to have to google Klonopin-taper-withdrawal or something like that...Paxil Progress forum has a lot of good withdrawal information. From what I remember, people recommended starting a small dose of valium while tapering slowly off Klonopin, then eventually tapering off the Valium. You can also google w/in this forum and perhaps find some answers.
Although if you read all the anxiety posts here, you might just want to stay on the Klonopin.
"That being said, I do worry about long term usage and impact on cognitive ability and memory."
That's my main worry too--but some people swear Klonopin, in smaller doses, does not affect their memory/cognition. I think having anxiety symptoms negatively affects memory cognition w/o meds, and many other anxiolytics affect memory/cognition-there always seems to be a trade-off for anxiety relief.
"I also think I lack motivation because of the medication."
You could supplement w/a stimulant such as a small dose of dextro-amphetamine. That helps me with motivation more than any other drug. D-amp gives me little to no side effects, but I take a small dose-usually just 10 mg./day.
Maybe you have ADD? Anxiety is often comorbid w/ADD, and lacking motivation is a major symptom of ADD....
Good luck!
Posted by garnet71 on May 24, 2009, at 10:44:12
In reply to Long time user of Klonopin, considering stopping., posted by Komet on May 24, 2009, at 0:57:37
I forgot to say...Buspirone is the only anxiolytic I know that does not have any side effects. Some say it does have side effects, but I have had zero. You'll also hear a lot of people say "it doesn't work for anxiety!!".
It's really hard to say. I've been taking it for about 3 months, and my anxiety could be much worse off if I wasn't taking it-i really have no way of knowing unless I stopped. It doesn't work for severe anxiety i guess, which is my major problem for years. But when I asked PDoc for it, he thought it was the best idea at the time considering my negative reaction to other drugs.
The nice thing about busipirone is you can take a trial of it and not be tired and not have negative side effects. If it doesn't work, you can simply move on to something else. However, if your tapering off Klonopin, you might not know if the drug isn't working, or if you are having klonopin w/d symptoms....
I'm not sure, but I think after taking Buspirone for about a month, now into 3 months, it might be responsible for my mood being an even keel, despite bouts of anxiety, my mood has been consistently good, unlike before I was taking it, where depression symptoms were a side effect of my anxiety. I'm having major stress in my life, which is probably why I can't get the anxiety under control right now...w/o major stressors, i'm wondering if Buspirone would be effective....But I still have motivation issues and ADD, which is why i take the d-amp...It's hard to say, but i really think it is the buspirone that has helped w/mood and I really like it for this reason and don't want to stop taking it.
Posted by Phillipa on May 24, 2009, at 10:49:14
In reply to Long time user of Klonopin, considering stopping., posted by Komet on May 24, 2009, at 0:57:37
Such a small dose I think the positive effects out weight any negative effects but it's your choice. To cut down just take a bit less daily and see. Phillipa
Posted by obsidian on May 24, 2009, at 11:05:05
In reply to Long time user of Klonopin, considering stopping., posted by Komet on May 24, 2009, at 0:57:37
I don't know, it sounds like it has been very helpful for you. I'm inclined to say don't mess with a good thing. You could though maybe skip a day every once in a while to let some of it leave your system (you know it has a long half life), and see how it goes.
good luck,
sid
Posted by Zana on May 24, 2009, at 12:26:37
In reply to Re: Long time user of Klonopin, considering stopping. » Komet, posted by obsidian on May 24, 2009, at 11:05:05
I agree that the positives seem to greatly outweight any negatives. And you are on a really low dose. I have a friend how has panic attacks and PTSD and has used klonopin as needed for many years and is very concerned about memory issues. She recently had a consult with a pdoc here in Boston who was very reassuring about long term effects on cognition and memory.
Sounds like it really helps you do all the other things that you do to keep your anxiety under control. I would be inclined to keep doing what you're doing since it seems to be working.Zanz
Posted by ricker on May 24, 2009, at 13:07:49
In reply to Long time user of Klonopin, considering stopping., posted by Komet on May 24, 2009, at 0:57:37
> So, is it worth going through withdrawal only to return to GAD and panic attacks to gain back or do less damage to my ability to use my brain to its ultimate capacity. Or, given that I seem to do OK on Klonopin without the need to increase dosage over time, should I spare myself the anxiety and stick with daily use.
>Well, as I've mentioned numerous times, I to am a long time clonazepam user. I've taken 0.5/3x day for 22 years.
I also have a fairly stressful job as maintenance supervisor for a hospital and an extended care facility.
I have on occasion, tapered of the clonazepam with minimal withdrawal. However, I always return to it as it does work, for me. 22 years and really no cognitive decline.
Having said that, clonazepam is only part of the equation in terms of anxiety/panic relief. I know for a fact that, on it's own, my anxiety would not be held in check.
A/D's are crucial in my ongoing recovery as slipping into a depressive state only increases the odds of instability for me.
So, in my case, clonazepam works well in conjunction with an A/D along with a mood stabilizer, I would not rely solely on it to relieve my anxiety issues.
I think if you are able to perform your job in an efficient manner.... then yes, "spare yourself the anxiety and stick with daily use".
Regards, Rick
Posted by Neal on May 24, 2009, at 17:51:39
In reply to Long time user of Klonopin, considering stopping., posted by Komet on May 24, 2009, at 0:57:37
I had to give up coffee, or else take more benzo - that was the choice. For me, coffee was related to panic attacks.
when taking benzo, drinking is problematic, as it potentiates the benzo.
as was said, your taking a low dose of Klonopin, don't worry too much. If, at some time, you want to see how you do without it, try halving the dose and see how you feel in a month. (Do it at a time of low-stress). But warning - going down with benzos can be hard for some - there are techniques mentioned on this board.
that said, some of us feel a little guilty about taking meds at times. It's a common complaint. But a lot of people take them, so don't beat-up on yourself if you feel better taking them, you don't need to feel bad about it. (and this may not apply to you - I'm just talking about a common feeling).
just my 2 cents . . . . .
Posted by greywolf on May 25, 2009, at 1:50:35
In reply to Re: Long time user of Klonopin, considering stopping., posted by Neal on May 24, 2009, at 17:51:39
At a low dosage of Klonopin, I doubt that you will see any effect on your intellectual capacity if you decided to stop using it. On the other hand, whatever Klonopin is doing for your anxiety will be lost, and the anxiety could certainly have an effect on intellectual ability.
Overall, I would stick with the Klonopin. I have a similar career, and I wouldn't be able to function without my 4.5mg Xanax every day.
Greywolf
Posted by Elanor Roosevelt on May 25, 2009, at 20:04:21
In reply to Re: Long time user of Klonopin, considering stopping., posted by greywolf on May 25, 2009, at 1:50:35
i prefer xanax over klonopin because i prefer the "as needed" aspect
but you sound like you are doing pretty well
although my full time job now is looking for work, i used to have a very crazy corporate job
it seemed impossible but i scheduled in time to work out and it made all the difference
working out hard helped my head and my energy level a lot
Posted by newquestions on May 26, 2009, at 8:16:00
In reply to Re: Long time user of Klonopin, considering stoppi, posted by Elanor Roosevelt on May 25, 2009, at 20:04:21
As someone who has had drugs poop out on them, and experiencing major neurological difficulties, I would not be so sure you can take a benzo for ever... I would wean off and take another one only as needed...
Posted by Komet on May 27, 2009, at 22:19:03
In reply to Long time user of Klonopin, considering stopping., posted by Komet on May 24, 2009, at 0:57:37
Thank you for all your responses.
I'm not looking for a substitute for Klonopin, because truthfully, it has worked very well for me allowing me to cope through some very tough years. My question is whether I should try to end my long-term use of Klonopin (without substituting it for another).
My primary motivation for going off a daily dose is, frankly reading the horror stories on some of the websites that are anti-benzo. Though my experience has not been bad (actually, on the whole I have to say my experience with Klonopin has been nothing but positive), I do get nervous reading some of the postings and I certainly want to avoid getting caught up in something I can't control.
Upon reading some of your responses, I realize I need to amend my OP.
About a year ago this month, a person very very close to me committed suicide. Around this time, I was having dizzy spells in the afternoon. After ruling out other possibilies, my MD urged me to go up to 1.0mg. I resisted for the reasons in my OP. However, after the suicide, I decided to follow the MD's advice and up the dose - which I had been on up until about a month ago. I decreased the doseage to .75 and held at that level for 3 weeks. I then decreased to .5.
I don't know why I ommited this information, perhaps it was to keep the question simpler. However, reading some of your responses, it now seems like pertinent information.
Anyway, I'm going to see how I do at .5 for the next few weeks and evaluate what to do from there.
One option is to continue at that doseage as it seems to control my anxiety effectively and doesn't have any bad side effects that I can pinpoint.
Another option is to try to get off a daily dose - I'd be interest in hearing what's the best way to go from .5 to zero, that seems tougher than from going from 1.0 to .5.
A third option might be to see if the dizziness comes back and if so, go back to 1.0 - I am most reluctant to follow this option.
Any advice is greatly appreciated.
Thanks - Komet
Posted by Komet on May 29, 2009, at 13:06:38
In reply to Re: Long time user of Klonopin, considering stopping., posted by garnet71 on May 24, 2009, at 10:29:18
> You could supplement w/a stimulant such as a small dose of dextro-amphetamine. That helps me with motivation more than any other drug. D-amp gives me little to no side effects, but I take a small dose-usually just 10 mg./day.
>I do not mix well with stimulants of any kind. If I drink a few cubs of coffee over a couple of days I will begin to develop anxiety that can ultimately lead to panic attacks.
> Maybe you have ADD? Anxiety is often
comorbid w/ADD, and lacking motivation is a major symptom of ADD....
I highly highly doubt I have ADD - never had problems focusing for long periods of time - did very well all throughout school.
Posted by Neal on May 30, 2009, at 0:17:53
In reply to Re: Long time user of Klonopin, considering stopping., posted by Komet on May 27, 2009, at 22:19:03
You're asking a question that only you can really answer, but:
I. Don't worry about a lot of speculation and hearsay on the net.
2. You've just lowered your dosage by I/3, so wait for another 2 weeks to a month.
3. At that time you can decide what you want to do.
4. Strategies for lowering have been discussed many times on this board. Use "search" at the top of the page. (It's a little hard to find).
5. Go slow, whatever you decide. The last .5 is the toughest, they say. So if you go further, it will be .5, .4, .3, .25, .2 and so on, usually.
Posted by Komet on May 30, 2009, at 17:55:30
In reply to Re: Long time user of Klonopin, considering stopping., posted by Neal on May 30, 2009, at 0:17:53
Neal, thanks,
With regards to your first point - I agree. But if you read some of the boards (such as benzobuddies, etc.) you see nothing but horror stories that make me question my sanity for using these meds at all.
I've been at .5 for a bit and feel stable on it. A little discomfort for a couple of days at first and some lingering mild tinnitus - but nothing too bad.
I'll stay here for a couple of weeks before tapering lower. Going down from .5 to .4, etc. seems like too much touble in pill cutting. Ideally, I'd like to go to .25 and then down to nothing. . .but could cut pill into 1/4 and go to .375, .25, .125 and then nothing. . .This seems like a long taper to me (4 months start to beginning and who knows how long to stabilize afterwards). . I would hate to streatch it out longer than this.
Posted by Neal on May 30, 2009, at 22:48:53
In reply to Re: Long time user of Klonopin, considering stopping., posted by Komet on May 30, 2009, at 17:55:30
> Neal, thanks,
>
> With regards to your first point - I agree. But if you read some of the boards (such as benzobuddies, etc.) you see nothing but horror stories that make me question my sanity for using these meds at all.I haven't gone there, but may check it out. The rule on the net (and on this board) is that those who have no problems with a med rarely post, those with problems post often.
>
> I've been at .5 for a bit and feel stable on it. A little discomfort for a couple of days at first and some lingering mild tinnitus - but nothing too bad.The reason for going slow is that you may not know all the things that med was doing for you. You just want to make sure that there's not going to be to much of a shock to your system, that's all. With other meds, you can be more cavalier - but not benzos.
>
> I'll stay here for a couple of weeks before tapering lower. Going down from .5 to .4, etc. seems like too much touble in pill cutting. Ideally, I'd like to go to .25 and then down to nothing. . .but could cut pill into 1/4 and go to .375, .25, .125 and then nothing. . .This seems like a long taper to me (4 months start to beginning and who knows how long to stabilize afterwards). . I would hate to streatch it out longer than this.It usually takes 3 days to a week to know how your body is going to react to a lowering of the med. But the best is to wait 2 weeks between each cut. You have to remember that just going from .5 to .4 is a 20% cut. Going from .4 to .3 is a 25% cut. Get me?
I once cut my benzo dose in half on the spur of the moment. After 2 days I felt fine. The third day was one of the unhappiest I have ever had. Maybe you're different, but frankly, I would feel unresponsible if I gave you any other advice. I've taken benzos for about 7 years, so I have some personal experience with that family of meds, but I'm not a Pdoc. I just don't want you to have some very uncomfortable days, if you're sure you want to go without.
BTW, if you DO get into trouble, your medicine is at hand, just raise your dose.
This is the end of the thread.
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