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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 20 of 20. This is the beginning of the thread.
Posted by Maxime on May 3, 2005, at 9:22:33
Yes you heard right. After 10 years at 4 mg, I am coming off the stuff. But I am scared sh*tless. I joined an online support group and the stories I have heard got me into such a state last night that I couldn't sleep. I don't even take the med for anxiety!
I am hoping it will help with my depression to come off this med. If anyone has a withdrawal schedule they would like to share, it would be most appreciated.
I might do the valium substitute thing. I don't know. I am worried that the valium will knock me out. My body is used to the clonazepam.
Anyhow, I am scared. Some people came off cold turkey and suffered brain damage. I just don't know what to believe.
Maxime
Posted by Maxime on May 3, 2005, at 9:29:16
In reply to Coming off Clonazepam, posted by Maxime on May 3, 2005, at 9:22:33
Hi Scott, Larry and anyone who can help me.
I am going to come of 4 mg of clonazepam. I am going to do it VERY slowly. I joined a group that is very anti psych med.
People on that group claim that they came off Clonazepam cold turkey and suffered brain damage and permanent physical disabilities. Is this possible?
I have been taking the med as a mood stabiliser for 10 years. But since I have been so depressed I decided to try coming off the stuff hoping the veil would lift a little for me.
I couldn't sleep last night worrying about this.
Maxime
Posted by SLS on May 3, 2005, at 10:12:46
In reply to Re: SLS? Larry? Anyone?, posted by Maxime on May 3, 2005, at 9:29:16
Hi Maxime.
I'm sorry that I don't have the energy to write a comprehensive post right now.
To allay your fears, I would say that as long as you don't discontinue the drug abruptly (cold turkey), you will not incur any negative long term effects. To discontinue a BZD abruptly might possibliy invite kindling and the possibility of inducing seizures.
If you have the luxury of time, you should be able to discontinue clonazepam without suffering intense withdrawal symptoms. I've been poking at the Web to see if I could find a specific taper schedule, but there don't seem to be too many. From 4.0mg, you can perhaps try decreasing by 0.25mg every week or so. If this is too fast, your body (brain) will tell you by producing withdrawal symptoms. If you remain flexible with your taper dosing, you should be able to fine-tune the rate of decrease to keep up with the body's rate of re-regulation of the neurotransmitter system.
It is the last 25% of the original dose that seems to be the hardest to work with. I advocate the use of a flexible-dosing strategy that will allow you to set the pace of dosage decrease based upon the appearance of withdrawal symptoms. You will need to cut the clonazepam tablets into very small pieces and use them almost like a PRN. I think one should be prepared to take these small doses 2-4 times a day - whenever withdrawal symptoms appear. Please take a look at the previous posting-periods to read how about this system as I have described it. Basically, you want to take as much medication as will allow you to go 6-8 hours without symptoms. However, it is important to wait until they re-appear before taking your next dose. In this way, you can be sure that you are reducing your dosage at a rate optimized to the rate your body is re-regulating itself. Just don't allow the withdrawal symptoms to persist for more than an hour before dosing again. You should find that the amount of drug necessary to last the 6-8 hours becomes less and less. Again, the key word is "flexible". If you are not hitting that 6-8 hour zone exactly, simply take a small dose whenever the symptoms do appear. When you reach a plateau and seem to reach the point where no further dosage reduction will allow for symptom-free periods, then it is time to discontinue the drug entirely. Hopefully, the length of time that you must experience the withdrawal syndrome will be relatively short and mild in intensity.
Do you have any Depakote laying around?
- Scott> Hi Scott, Larry and anyone who can help me.
>
> I am going to come of 4 mg of clonazepam. I am going to do it VERY slowly. I joined a group that is very anti psych med.
>
> People on that group claim that they came off Clonazepam cold turkey and suffered brain damage and permanent physical disabilities. Is this possible?
>
> I have been taking the med as a mood stabiliser for 10 years. But since I have been so depressed I decided to try coming off the stuff hoping the veil would lift a little for me.
>
> I couldn't sleep last night worrying about this.
>
> Maxime
Posted by Lizzyb on May 3, 2005, at 13:27:08
In reply to Re: SLS? Larry? Anyone? » Maxime, posted by SLS on May 3, 2005, at 10:12:46
This is all really new to me. What is "kindling"?
Thanks
Posted by Lizzyb on May 3, 2005, at 13:34:03
In reply to QUESTION FOR SLS, posted by Lizzyb on May 3, 2005, at 13:27:08
> This is all really new to me. What is "kindling"?
> ThanksI read the thread and posts you started about kindling and didn't understand.
Posted by Maxime on May 3, 2005, at 19:31:39
In reply to Re: SLS? Larry? Anyone? » Maxime, posted by SLS on May 3, 2005, at 10:12:46
Actually Scott, you were really helpful. I don't have the fear of God in me any more. :-) I'm allergic to Depakote, I break out into hives.
I think .25 every week may be too fast, but like you said, I will listen to my body.
Thanks for responding when you aren't feeling that great yourself. I hope you feel better soon.
Maxime
> Hi Maxime.
>
> I'm sorry that I don't have the energy to write a comprehensive post right now.
>
> To allay your fears, I would say that as long as you don't discontinue the drug abruptly (cold turkey), you will not incur any negative long term effects. To discontinue a BZD abruptly might possibliy invite kindling and the possibility of inducing seizures.
>
> If you have the luxury of time, you should be able to discontinue clonazepam without suffering intense withdrawal symptoms. I've been poking at the Web to see if I could find a specific taper schedule, but there don't seem to be too many. From 4.0mg, you can perhaps try decreasing by 0.25mg every week or so. If this is too fast, your body (brain) will tell you by producing withdrawal symptoms. If you remain flexible with your taper dosing, you should be able to fine-tune the rate of decrease to keep up with the body's rate of re-regulation of the neurotransmitter system.
>
> It is the last 25% of the original dose that seems to be the hardest to work with. I advocate the use of a flexible-dosing strategy that will allow you to set the pace of dosage decrease based upon the appearance of withdrawal symptoms. You will need to cut the clonazepam tablets into very small pieces and use them almost like a PRN. I think one should be prepared to take these small doses 2-4 times a day - whenever withdrawal symptoms appear. Please take a look at the previous posting-periods to read how about this system as I have described it. Basically, you want to take as much medication as will allow you to go 6-8 hours without symptoms. However, it is important to wait until they re-appear before taking your next dose. In this way, you can be sure that you are reducing your dosage at a rate optimized to the rate your body is re-regulating itself. Just don't allow the withdrawal symptoms to persist for more than an hour before dosing again. You should find that the amount of drug necessary to last the 6-8 hours becomes less and less. Again, the key word is "flexible". If you are not hitting that 6-8 hour zone exactly, simply take a small dose whenever the symptoms do appear. When you reach a plateau and seem to reach the point where no further dosage reduction will allow for symptom-free periods, then it is time to discontinue the drug entirely. Hopefully, the length of time that you must experience the withdrawal syndrome will be relatively short and mild in intensity.
>
> Do you have any Depakote laying around?
>
>
> - Scott
>
>
>
> > Hi Scott, Larry and anyone who can help me.
> >
> > I am going to come of 4 mg of clonazepam. I am going to do it VERY slowly. I joined a group that is very anti psych med.
> >
> > People on that group claim that they came off Clonazepam cold turkey and suffered brain damage and permanent physical disabilities. Is this possible?
> >
> > I have been taking the med as a mood stabiliser for 10 years. But since I have been so depressed I decided to try coming off the stuff hoping the veil would lift a little for me.
> >
> > I couldn't sleep last night worrying about this.
> >
> > Maxime
>
>
Posted by Maxime on May 3, 2005, at 20:01:02
In reply to one more thing Re: QUESTION FOR SLS, posted by Lizzyb on May 3, 2005, at 13:34:03
> > This is all really new to me. What is "kindling"?
> > Thanks
>
> I read the thread and posts you started about kindling and didn't understand.
>
>I understand it from a bipolar perspective. First,
the name "kindling" was chosen because the process is likened to a log fire.It might be suitable fuel for a fire, is very hard to set afire in the first place. But surround it by smaller, easy to light pieces of wood - kindling - and set these blazing, and soon the log itself will catch fire.In bipolar disorder initial periods of cycling may begin with an environmental stressor, but if the cycles continue or occur unchecked, the brain becomes kindled or sensitized - pathways inside the central nervous system are reinforced so to speak - and future episodes of depression, hypomania, or mania will occur by themselves (independently of an outside stimulus), with greater and greater frequency. In other words, brain cells that have been involved in an episode once are more likely to do so again, and more cells will become sensitized over time. For example, there is evidence that the more mood episodes a person has, the harder it is to treat each subsequent episode... thus taking the kindling analogy one step further: that a fire which has spread is harder to put out.
So Scott is saying (and tell me if I am wrong Scott) that one could prevent withdrawal symptoms from anti-depressants from happening by preventing the fire before it starts by using anticonvulsants, or benzos or neurontin etc. Anything that has anti-convulsant properties.
Does that make sense?
Maxime
Posted by SLS on May 3, 2005, at 20:10:03
In reply to QUESTION FOR SLS, posted by Lizzyb on May 3, 2005, at 13:27:08
> This is all really new to me. What is "kindling"?
> ThanksKindling is a process that occurs in certain regions of the brain whereby neural circuits become hyperexcitable from previous excessive activity. Once they become hypersensitive to stimuli, these neurons require less and less to become excited. This is how epilepsy works. I believe that certain aspects of drug withdrawal syndromes resemble this kindling model.
- Scott
Posted by SLS on May 3, 2005, at 20:18:43
In reply to one more thing Re: QUESTION FOR SLS, posted by Lizzyb on May 3, 2005, at 13:34:03
> > This is all really new to me. What is "kindling"?
> > Thanks
>
> I read the thread and posts you started about kindling and didn't understand.
>
>I hope my previous post was helpful.
Kindling has also been shown to serve as a model for both bipolar disorder and alcohol withdrawal syndrome.
- Scott
Posted by SLS on May 3, 2005, at 20:23:12
In reply to Re: one more thing Re: QUESTION FOR SLS » Lizzyb, posted by Maxime on May 3, 2005, at 20:01:02
Maxime,
You did a much better job of describing kindling than I could have. Thanks.
:-)
- Scott
> > > This is all really new to me. What is "kindling"?
> > > Thanks
> >
> > I read the thread and posts you started about kindling and didn't understand.
> >
> >
>
> I understand it from a bipolar perspective. First,
> the name "kindling" was chosen because the process is likened to a log fire.It might be suitable fuel for a fire, is very hard to set afire in the first place. But surround it by smaller, easy to light pieces of wood - kindling - and set these blazing, and soon the log itself will catch fire.
>
> In bipolar disorder initial periods of cycling may begin with an environmental stressor, but if the cycles continue or occur unchecked, the brain becomes kindled or sensitized - pathways inside the central nervous system are reinforced so to speak - and future episodes of depression, hypomania, or mania will occur by themselves (independently of an outside stimulus), with greater and greater frequency. In other words, brain cells that have been involved in an episode once are more likely to do so again, and more cells will become sensitized over time. For example, there is evidence that the more mood episodes a person has, the harder it is to treat each subsequent episode... thus taking the kindling analogy one step further: that a fire which has spread is harder to put out.
>
> So Scott is saying (and tell me if I am wrong Scott) that one could prevent withdrawal symptoms from anti-depressants from happening by preventing the fire before it starts by using anticonvulsants, or benzos or neurontin etc. Anything that has anti-convulsant properties.
>
> Does that make sense?
>
> Maxime
Posted by Maxime on May 3, 2005, at 22:08:38
In reply to Re: one more thing Re: QUESTION FOR SLS » Maxime, posted by SLS on May 3, 2005, at 20:23:12
:-) You're too sweet. But you are the expert on meds.
Maxime.
> Maxime,
>
> You did a much better job of describing kindling than I could have. Thanks.
>
> :-)
>
>
> - Scott
>
>
> > > > This is all really new to me. What is "kindling"?
> > > > Thanks
> > >
> > > I read the thread and posts you started about kindling and didn't understand.
> > >
> > >
> >
> > I understand it from a bipolar perspective. First,
> > the name "kindling" was chosen because the process is likened to a log fire.It might be suitable fuel for a fire, is very hard to set afire in the first place. But surround it by smaller, easy to light pieces of wood - kindling - and set these blazing, and soon the log itself will catch fire.
> >
> > In bipolar disorder initial periods of cycling may begin with an environmental stressor, but if the cycles continue or occur unchecked, the brain becomes kindled or sensitized - pathways inside the central nervous system are reinforced so to speak - and future episodes of depression, hypomania, or mania will occur by themselves (independently of an outside stimulus), with greater and greater frequency. In other words, brain cells that have been involved in an episode once are more likely to do so again, and more cells will become sensitized over time. For example, there is evidence that the more mood episodes a person has, the harder it is to treat each subsequent episode... thus taking the kindling analogy one step further: that a fire which has spread is harder to put out.
> >
> > So Scott is saying (and tell me if I am wrong Scott) that one could prevent withdrawal symptoms from anti-depressants from happening by preventing the fire before it starts by using anticonvulsants, or benzos or neurontin etc. Anything that has anti-convulsant properties.
> >
> > Does that make sense?
> >
> > Maxime
>
>
Posted by Maxime on May 3, 2005, at 22:15:19
In reply to Re: SLS? Larry? Anyone? » Maxime, posted by SLS on May 3, 2005, at 10:12:46
Me again. Scott, I can't take any depakote but I forgot to mention I will be remaining on 450 mg of trileptal, so that should help. I'll keep you posted.
Maxime
> Hi Maxime.
>
> I'm sorry that I don't have the energy to write a comprehensive post right now.
>
> To allay your fears, I would say that as long as you don't discontinue the drug abruptly (cold turkey), you will not incur any negative long term effects. To discontinue a BZD abruptly might possibliy invite kindling and the possibility of inducing seizures.
>
> If you have the luxury of time, you should be able to discontinue clonazepam without suffering intense withdrawal symptoms. I've been poking at the Web to see if I could find a specific taper schedule, but there don't seem to be too many. From 4.0mg, you can perhaps try decreasing by 0.25mg every week or so. If this is too fast, your body (brain) will tell you by producing withdrawal symptoms. If you remain flexible with your taper dosing, you should be able to fine-tune the rate of decrease to keep up with the body's rate of re-regulation of the neurotransmitter system.
>
> It is the last 25% of the original dose that seems to be the hardest to work with. I advocate the use of a flexible-dosing strategy that will allow you to set the pace of dosage decrease based upon the appearance of withdrawal symptoms. You will need to cut the clonazepam tablets into very small pieces and use them almost like a PRN. I think one should be prepared to take these small doses 2-4 times a day - whenever withdrawal symptoms appear. Please take a look at the previous posting-periods to read how about this system as I have described it. Basically, you want to take as much medication as will allow you to go 6-8 hours without symptoms. However, it is important to wait until they re-appear before taking your next dose. In this way, you can be sure that you are reducing your dosage at a rate optimized to the rate your body is re-regulating itself. Just don't allow the withdrawal symptoms to persist for more than an hour before dosing again. You should find that the amount of drug necessary to last the 6-8 hours becomes less and less. Again, the key word is "flexible". If you are not hitting that 6-8 hour zone exactly, simply take a small dose whenever the symptoms do appear. When you reach a plateau and seem to reach the point where no further dosage reduction will allow for symptom-free periods, then it is time to discontinue the drug entirely. Hopefully, the length of time that you must experience the withdrawal syndrome will be relatively short and mild in intensity.
>
> Do you have any Depakote laying around?
>
>
> - Scott
>
>
>
> > Hi Scott, Larry and anyone who can help me.
> >
> > I am going to come of 4 mg of clonazepam. I am going to do it VERY slowly. I joined a group that is very anti psych med.
> >
> > People on that group claim that they came off Clonazepam cold turkey and suffered brain damage and permanent physical disabilities. Is this possible?
> >
> > I have been taking the med as a mood stabiliser for 10 years. But since I have been so depressed I decided to try coming off the stuff hoping the veil would lift a little for me.
> >
> > I couldn't sleep last night worrying about this.
> >
> > Maxime
>
>
Posted by Lizzyb on May 3, 2005, at 23:02:36
In reply to Re: one more thing Re: QUESTION FOR SLS » Lizzyb, posted by Maxime on May 3, 2005, at 20:01:02
Maxime and SLS -
Thank you. Both explanations were very helpful. I'm starting to get it now. So maybe that is the reason my pdoc wants me to go cold turkey off benzo's and take Phenobarb to prevent seizures?
Am I on the right track to getting it?
Posted by SLS on May 4, 2005, at 5:36:26
In reply to Maxime and SLS, posted by Lizzyb on May 3, 2005, at 23:02:36
> Maxime and SLS -
> Thank you. Both explanations were very helpful. I'm starting to get it now. So maybe that is the reason my pdoc wants me to go cold turkey off benzo's and take Phenobarb to prevent seizures?
> Am I on the right track to getting it?That certainly is an interesting way to go about it. It might work very well. I hope you'll share your experiences with this method of BZD (benzodiazepine) discontinuation as you progress. I hope your withdrawal is uneventful.
Good luck.
- Scott
Posted by Lizzyb on May 4, 2005, at 14:39:11
In reply to Re: Maxime and SLS, posted by SLS on May 4, 2005, at 5:36:26
> That certainly is an interesting way to go about it. It might work very well. I hope you'll share your experiences with this method of BZD (benzodiazepine) discontinuation as you progress. I hope your withdrawal is uneventful.
>
> Good luck.
>
> - ScottHi Scott-
I was having horrible withdrawl(I think), shakes, meltdowns, headaches,insomnia, nausea and I felt like I was in a fog for five days. I can't distinguish whether it was withdrawl or the Phenobarbital.
After reading this board from top to bottom I went for a second opinion.
The new pdoc was floored by the long list of meds I had been on and off of in such a short period of time. Her choice is to ween me off S-L-O-W-L-Y xanax first, then the klonopin. She said even though I had been on a low dose, what concerned her was the fact I had been on it all for nine years. She also said she did not want to replace one perscribed addiction with another.
She is sending me for labs and a complete work up with an internal medicine doc. They will share information and work together so I can hopefully be benzo free.
I felt like my original pdoc who touted himself as "an addiction specialist" was in the business of creating addictions, taking my money, hoping I would not educate myself. I got a call from him today, after I told his receptionist to cancel my next appointment. Ha called explaining what he was trying to do with my meds and why. I still don't get why you stop both xanax an klonopin cold turkey and replace it with phenobarb.
I walked around for five days like a phenobarb/seroquel, etc induced nut who was going through benzo withdrawls. Enough was enough. Something drastic had to be done.
The new pdoc has at least appeared to take an interest in helping me and has listened to my concerns. I am back on my original low benzo doses in an attempt for be to get back to what I thought was "normal". In seven to ten days I will start the slow withdrawl process. I'd be lying if I said I wasn't scared about it, I am.
Let me say that this what I feel is right for me at this time in my life and in no way do I sit in judgement of anyone else who is on medication. I have found everyone's posts on here to be and educational eye opener for me. I am grateful people are sharing their experiences here.
Sorry if this post was long, I guess I needed the vent. I'll be posting in the future I'm sure.
Thanks,
Lizzy
Posted by Chairman_MAO on May 7, 2005, at 13:51:03
In reply to Re: Maxime and SLS, posted by SLS on May 4, 2005, at 5:36:26
I tried the cold turkey and phenobarb substitution thing years ago in an attempt at self-managed detox, and I Can tell you that it is quite uncomfortable. You won't get seizures, and mentally you will be SOMEWHAT ok, but it is much preferable to taper with a benzo, trust me. I remember muscle tension and nerve pains that I never had before as one of the worst parts of the experience. You see, barbiturates INCREASE pain sensations in many cases ...
Posted by SLS on May 7, 2005, at 16:28:11
In reply to Re: Maxime and SLS » SLS, posted by Chairman_MAO on May 7, 2005, at 13:51:03
Hi.
Have you ever heard of the use of Depakote to ease the withdrawal syndrome of benzodiazepines?
- Scott
> I tried the cold turkey and phenobarb substitution thing years ago in an attempt at self-managed detox, and I Can tell you that it is quite uncomfortable. You won't get seizures, and mentally you will be SOMEWHAT ok, but it is much preferable to taper with a benzo, trust me. I remember muscle tension and nerve pains that I never had before as one of the worst parts of the experience. You see, barbiturates INCREASE pain sensations in many cases ...
Posted by Chairman_MAO on May 8, 2005, at 11:29:30
In reply to Re: Maxime and SLS » Chairman_MAO, posted by SLS on May 7, 2005, at 16:28:11
Yeah, one of my better shrinks in the past told me he used valproate (and/oror gabapentin, IIRC) sometimes to ease the transition off the drug toward the end of the taper, especially for patients who'd been on the drug for a long time. I suppose you could even use carbamazepine or topiramate, but valproate is obviously way more GABAnergic (and calming for most folks).
He was the one also who told me that tapering using a benzo was always preferred to tapering with phenobarbital, simply because it's always best to use a drug in the same class as the drug the patient is on for the taper unless it's not practical, e.g. with alcohol, where tapering is impossible. My own experience trying to detox myself (*shudder*, those were the darkest days of my life, for sure) from diazepam 40mg/day using phenobarbital bears that out, for sure.
Posted by SLS on May 9, 2005, at 7:43:35
In reply to Re: Maxime and SLS » SLS, posted by Chairman_MAO on May 8, 2005, at 11:29:30
> He was the one also who told me that tapering using a benzo was always preferred to tapering with phenobarbital, simply because it's always best to use a drug in the same class as the drug the patient is on for the taper unless it's not practical, e.g. with alcohol, where tapering is impossible.
This is also my impression based on personal experience and witnessing what goes on here. Did your doctor have a preference as to which BZD to cross-over to should it be desirable to do so? Which BZDs are those that are most likely to require a cross-over?
- Scott
Posted by Chairman_MAO on May 12, 2005, at 13:51:21
In reply to Re: Maxime and SLS » Chairman_MAO, posted by SLS on May 9, 2005, at 7:43:35
I do not remember exactly what his benzo of choice was. Another shrink I had years ago from academia told me that on an outpatient basis (she said inpatient she gives lorazepam, or sometimes diazepam in severe cases of agitation), she sees no reason to prescribe anything but clonazepam unless the patient does not respond to it. She said that she had patients that would escalate their dose of diazepam, but could use clonazepam without a problem.
If you really want to know, I can ask for you. Personally, I would use either clonazepam or clorazepate for a taper. Diazepam is not practical, IMHO, because it has weird central kinetics, accumulation, and a bunch of active metabolites that counfound the situation.
This is the end of the thread.
Psycho-Babble Withdrawal | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
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Script revised: February 4, 2008
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