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Discontinuing Benzodiazapines

by debaser23, Mar 24, 2007 12:00AM
Tags: Anxiety, xanax
On another forum, someone is scaring people about benzo addiction.  I just started Klonopin and have never taken any others, so I cannot speak from experience.  However, from what I've been told, if a person is disciplined and tapers properly under a doctor's supervision, it's not THAT bad.

I'm looking for people who'd like to share their knowledge (professional or first hand experience) about discontinuing drugs of this class.

Thanks!
Member Comments (16)

by RCA7591, Mar 24, 2007 12:00AM
Benzodiazepines have similar characteristics as compared to Carbamates (Miltown/Meprobamate), and Barbituates (Seconal/Nembutal). Withdrawal symptoms similar to those of Barbituates and alcohol have been noted with long term Benzodiazepine use (use greater than 4 months).
As with any psychotropic drug that alters brain chemistry, dependency will result (but dependency is *not* addiction).
The two are completely different subjects.

However, in general, Benzodiazepines used at therapeutic levels for anxiety states (low doses), rarely cause problems if tapered gradually. The key IS gradual taper. 1/2 mg Klonopin BID is a typical therapeutic dose that is easily tapered by one of two methods:

(1) Direct taper from the Klonopin itself (most common). A dose reduction of 0.125 mg every two weeks is sufficient in most cases. If problems arrise, the dose may be tapered every four weeks by 0.125 mg instead. Due to Klonopin's long half-life, the withdrawal is usually very smooth.

(2) For unusual (severe) cases of withdrawal phenomenon, a longer acting Benzodiazepine such as Valium may be substituted (1 mg Klonopin = 20 mg Valium). Valium has several active metabolites with extremely long half-lives. Once the cross over to Valium is made, the Valium may be tapered by 1 mg every two weeks until the drug is completely removed.
Valium is typically used when tapering from higher doses of other Benzodiazepines (ie: 4 mg of Klonopin).

The shorter acting Benzodiazepines (Ativan, Xanax, Serax) present more of a withdrawal phenomenon, as their half-lives are much shorter. In the case of these drugs, a cross over to Klonopin or Valium will aid in their discontinuation.

I would imagine that the vast majority of horror stories you read were from folks who attempted a rapid taper, or folks who attempted to remove the drug abruptly. Obviously, this is not the correct way to discontinue Benzodiazepines (or many other drugs), so I would take such stories with a grain of salt. A proper taper will minimize or prevent withdrawal symptoms.

And, it is highly possible that those folks who discontinued their treatment relapsed back into their former anxiety states (only to blame the drug(s) for contributing to the relapse). In the vast majority of cases, anxiety (of any form), is a long-term illness that needs proper treatment (just as any other medical condition).

The fact of the matter is, Benzodiazepines are, by far, the safest drugs used to treat anxiety states. Their side effect profile is minimal. The only caveat is *dependency*, but properly managed, dependency is, for all practical purposes, a non-issue. You are taking Klonopin for a medical reason, Klonopin improves the quality of your life, and that is a *very* good thing (the best possible outcome). Dwelling over thoughts of dependency will only hinder your progress. IF the time comes that the drug loses efficacy or must be discontinued for some reason, it can be done very easily (despite the horror stories you've read).

My advice: Stop reading the "benzophobic" stories and take the Klonopin as prescribed (provided it does help you). The "gates of hell" won't be opened should you decide to discontinue it properly.

A diabetic wouldn't stop taking his insulin for fear of "dependency", nor would a hypertensive taking a beta-blocker. *Dependency* appears in all forms of medical treatment. Klonopin is no different.

-Ryan

by Jessl, Mar 24, 2007 12:00AM
I think the scaring thing is because some people, even on a slow taper, do experiance bad symptoms. I know because I am currently doing this. My benzo, Xanax, gave me major depression as a side effect so I had to get off it. A crisis team was called to my house to "evaluate me" and told me the dangers of benzo's. This scared me. I think everybody is different and for some people it is a horror story while for others it isn't. It all depends on the person. People who have bad experiances are only trying to warn others because they feel they would have liked to have been told that when they began taking them. I am one of them.

by debaser23, Mar 24, 2007 12:00AM
To: RCA
Thanks.

It's not really me who's worried.  I was actually posting in another forum about how well I was doing on the Klonopin, and someone comes along and starts freaking out, saying what a horror they can be and so forth.  It kind of made me angry, actually, because there were other people I was talking to who also had bottles of benzodiazapines their doctors had prescribed but they were afraid to take.

My point was, I need help and I needed it badly.  For whatever reason, the last several weeks just got out of control.  I was shocked at my own behavior!  Not going to work, not visiting family, etc.  My stomach was churning so badly that I had a nasty, nasty case of gastritis and couldn't eat.

In short, I needed an answer.  It took me a while to take my Klonopin because of my general aversion to meds and because my stomach had become so incredibly sensitive.  However, I overcame those fears, took the medicine and got much better.

I didn't really have an alternative.  As a result of the medicine I can finally see hope again...I'm absolutely thrilled with it as I haven't had a single panic attack in five full days (started taking the K six days ago).  I won't say I "have my life back" yet because during my anxiety episode I developed some pretty bad habits.  I've started breaking them but it'll take a little time.

Unless this stuff just stops working out of the blue, I know I WILL have my life back.  That means working 40 or 50 hours, making money, enjoying art and music and photography.  Visiting friends and family out of town and out of state.  Taking long drives through the countryside.  Hiking in the woods.  You name it.

The only thing I'm concerned about is my doctor.  When it comes time to discontinue, will he know how to do it?  Take Jessl's case, for example.  It seems to me she's having a hard time with Xanax withdrawal.  If what you say is true, shouldn't her doctor switch her to another drug for her taper?  By the time this situation comes to me, I'll be as well researched as a lay person can be, but if it so happens that my doctor tries to do the wrong thing with me it's going to be an awkward situation.  Well, I'll cross that bridge when I come to it.

Literally the only concern I have right now is the Klonopin losing effectiveness.  You say (and I've read elsewhere) that 1 mg daily is the optimal therapeutic dosage for anxiety/panic disorder.  I just started (.5 mg BID) at that dose.  Does Klonopin lose effectiveness in everyone, or is it a phenomena that only some patients experience?  And if it does happen to me, what are the options?

I don't know if you're a doctor or a pharmacist or what, but I've double checked everything you've ever written to me in this forum and it's all checked out.  It's well-reasoned and well-written.  I want to thank you for that.

by Jessl, Mar 24, 2007 12:00AM
They actually did switch me over to Valium to taper. I started tapering, but became inceadaly naseaus from constant anxiety. The doctor suggested to go up again. It helped a little. But having a phobia of being sick meant that I couldn't go anywhere cos I felt sick all the time. So I became agoraphobic. My pshychiatrist said to stop the taper until I am stable. And I will also be doing NLP. I didn't taper off xanax directly as the docters said it was too dangerous in my case as I get side effects easily. Paranoia, hearing things, thinking things were on my face. That sought of stuff. But for everyone its different. I am starting to stabalise now, although panic attacks have come back at night if I eat and feel a bit full, which is distressing.
But all will be well, I am optomistic. I have found a great site for helping with tapering benzo's: www.benzobuddies.org
They have been a great help. :)

by RCA7591, Mar 26, 2007 12:00AM
Klonopin (and most other benzodiazepines) rarely lose their anxiolytic properties (that is, their ability to manage anxiety states).

Some attribute a reduction in effectiveness to a reduction in side effects (sedation, ataxia, unsteadiness), however, reduction of these side effects is both typical and desirable. However, the *anxiolytic* effect is maintained in 70% of patients using the medicine as prescribed ( a fairly high figure).

Most are able to remain on the starting dose for many years (or in some instances, for life if necessary) without a reduction in efficacy (effectiveness). If warranted, the Klonopin dose may be increased to a maximum of 4 mg (per Roche), however, I'd advise not to exceed to 2 mg daily.

Some are even able to *reduce* their daily dose from that of the prescribed dose. Often times, 1/4 mg BID is highly effective (the initial starting dose). But for the vast majority, the target dose of 1/2 mg BID proves to be the most effective.

So, chances are that the Klonopin will not "stop working out of the blue for you". Do not attribute a reduction in side effects to a reduction in effectiveness. Reduction (or resolution) of side effects is very typical (and desirable).

-Ryan

by RCA7591, Mar 26, 2007 12:00AM
Jess,

Could you go into further detail with regards to your history (ie: why were you prescribed the Xanax initially?). Did you have a history of depression (objective or subjective) prior to starting Xanax?

The reason why I ask is because benzodiazepines in general are contraindicated in depressive states (they can compund depression). Xanax is the only benzo that supposedly has an anti-depressive effect, but I have not seen much proof of this in medical literature.

Are you currently fully stabilized on the Valium? In other words, does the Valium (in your opinion) fully replace the Xanax in terms of its anti-anxiety properties? Have you developed an increase in anxiety (or other symptoms) while on the Valium? Keep in mind that it may take several weeks to fully stabilize on the Valium (due to its extremely long half-life).
Also keep in mind that it does not act immediately like Xanax does. While the two drugs are similar in clinical action, they differ grossly in their onset and duration of action.

Once you are fully stabilized on Valium (and by stabilized, I mean equal to the effects of the Xanax from YOUR point of view), you can begin the taper regimen. 1 mg of Valium may be removed every two weeks until the drug is discontinued. If you are having a difficult time, the drug may be tapered by 1 mg every four weeks instead. You should not begin the taper until you are fully stabilized.

Once you are off of all benzodiazepines, another agent may prove beneficial. The one that comes to mind is Sinequan (Doxepin), which has beneficial effects for both depression and anxiety combined. Sinequan is particularly useful for those who suffer from both depression and anxiety states.

Good luck,

Ryan



by Jessl, Mar 27, 2007 12:00AM
I was prescribed Xanax for panic attacks and agoraphobia. I do not have any previous history of depression. The only times I have become depressed is from drugs. Xanax, ritalin and valium all did that to me. I was never depressed before. I was diagnosed with GAD, emetophobia and panic disorder and possibly ADD.
I have had an increase of anxiety on the valium switch over. I also take Largactil to sleep at night as the Valium doesn't really relax my mind that much.

by turncapp, Apr 13, 2007 12:00AM
To: Klonopin
Don't let anyone fool you.  

These are very powerful and mind altering chemicals.  

Ryan's comparison of Klonpin to insulin is ludicrous,  as is his dichotomy between 'chemical dependency' and 'addiction'.  

News flash -- drugs do not discriminate ( does not matter if you are a responsible patient or a garbage head