xanax vs klonipin

[catgirl1]

Hi- I developed severe akathisia after taking risperdal at night for sleep- it has been over 3 months since I have been off the meds and am suffering terribly.  The neurologist I saw put me on xanax and I am up to 2 mg a day- divided throughout the day. As soon as the dose wears off I begin feeling horribly, anxious, more restless.  I have been taking the xanax since May- and origionally was on a dose anywhere between .75 a day to maximum 1.5 a day- now I need the 2 mg a day to barely scratch the surface. The akathisia is so unbearable at times it brings me to tears- then the xanax helps a little but it all comes back full force. I don't know how much the interdosing withdrawal is causing more symptoms of restlessness and am wondering if Klonipin would be a better choice.  Is it less addictive and easier to taper off of in the end?  Alll I know is i feel such a roller coaster throughout the day with the xanax coming in and out of me- including at 2 am in the morning when I need to get up and take another .5 xanax because the akathisia is still bad.  I was wondering your thoughts on this. By the way- I am only 107 pounds- so to me I think I am taking a lot of xanax.  

[Jeffrey T Junig, MD PhD]

Akathisia is a side effect from dopamine-blocking meds (and occasionally from other meds).  The confusing thing here is that I have never heard of a case of akathisia that continued after the medication is discontinued.  There is some confusion with akathisia in that some people confuse it with tardive dyskinesia, a long-term, even permanent movement disorder that comes from dopamine blocking medications generally after long-term use.  But akathisia is in a different category of side effects;  it is usuallly a problem during the early use of a med and it goes away quickly after stopping the med.

I have to wonder, therefore, if you are truly having akathisia of whether something else is going on.  There is a common pattern with Xanax that always causes problems-- the person takes it, feels relaxed, then as it wears off the anxiety returns.  The anxiety at this point is 'rebound anxiety', a form of withdrawal, but the person thinks it is the anxiety 'disorder'... the dynamic leads to more and more use of Xanax or other benzos.  Then you have the tolerance that occurs very fast, as well.

Akathisia sometimes responds to beta blockers.  Clonazepam has less of the rebound effects since it has such a long half life;;  you can dose it twice per day, or even once every night-- the half life of 24 hours means it will hang around the entire next day to help keep the anxiety at bay.  As for the akathisia, it has been caused by prozac and a host of other meds;  make certain you are not still contributing to the condition with other medications, and try some inderal throughout the day to reduce the symptoms if you have them.  
JJ.  

[catgirl1]

Hi- thanks for your thorough response. I know most cases of akathisia remit after the medication is stopped, but i have found in research some cases of akathisia can last over 2 years- which is horrible. I am seeing a movement disorders specialist and she thinks it is akathisia, not TD, becuase we can't visibly see the muscle spasms that I feel- it is all internal. She said in TD one would see it on the outside.  I was on risperdal for a few months before this started, prozac for about a month or 2 and seroquel for 4 years- for sleep issues. The only thing new in the mix was the risperdal so we are thinking that is what has caused it. I switched to the klonipin on friday and already I feel better than with the xanax- I feel much more even throughout the day.  Also- I am taking Propranolol, 60 mg- started it 3 weeks ago, and no change yet- however, I don't know how much the ups and downs of the xanax contributed to that.  How long does one need to stay on propranolol- until the symptoms subside? She wanted to switch me to the klonipin before increasing the propranolol further because it is causing terrible insomnia- which i already struggle terribly with.  Is klonipin easier to taper off of in the end?  I seem to be doing fine with the switch from xanax to klonipin- no  withdrawals yet or anything. And the klonipin is helping much more with my insomnia.   I don't know what else this could be other than akathisisa- it is not anxiety thats for sure- even my psychiatrist doesn't think it is anxiety and i have never been one to feel my anxiety physically like this. It is just the worst feeling in the world.