Discontinuing Benzodiazapines

[debaser23]

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!

[RCA7591]

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

[Jessl]

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.

[debaser23]

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.

[Jessl]

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. :)

[RCA7591]

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

[RCA7591]

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

[Jessl]

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.

[turncapp]

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, withdrawal is the same in both camps) .


I was almost killed by thugs six years ago.  I was a basket case for 4 months and then went to a doctor who gave me Xanax.  Seemed to good to be true.  I could focus and ( most importantly ) 'forget'.  Well in time 1.5 mg of Xanax was not good enough and eventually we were on 3, 4, 5 and then Klonopin -- 6mg.

My life has been a living hell since.

Ryan says, 'take these stories with a grain of salt'.  

Take them as a ton of bricks.  If you do decide to stay on any of the 'minor' tranquilizers for a long time there are 3 very important things to consider.

1.  You must have a doctor that understands the nature of these drugs and is willing to work with you ( I happen to live in NY where they CAN NOT write re-fills, so part of my problem is trying to do a safe taper )

2. Again, these ARE very powerful and mind altering substances.  I still can not believe Ryan's comparison of Klonopin to insulin.  Sorry but I don't think anyone has ever been diagnosed with a 'Klonopin' deficiency.

And they do come with side effects: loss of short term memory, ataxia, loss of sex drive, inertia.  

3. Unlike most of the SSRIs, benozos do not help 'fix' your body's chemistry.  Many people can take Zoloft, Prozac, Lexapro, Paxil etc... for a long time, taper off, and find that the medication has actually trained the  body to function properly.  Not so with benzos: if you stop you are not even back where you started – you are twenty steps behind.


Eventually 'white coats' like Ryan will wake up and realize they don't have a clue as to what they are talking about.  Unless you have been through the wringer, you have no business peddling advice.  As Wittgenstein said 'where of one can not speak, one must remain silent'.

Not telling anyone to refuse benzo therapy.  But before its too late,  have a plan.

[turncapp]

Also Ryan -- may I quote thee:

"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). "

Do you work for Roche?? Where is this coming from??  You are incorrect about everything.

The side effects are minimal??

My guess is you are a doctor. But you are a doctor who needs to go back to school.  You have no business giving people some sugar coated bs about something that is very serious.

You can polish coal, but it won't become gold ( rub as hard as you care ).

[bgman]

I agree it is not good be addicted to benzos,but what choice i have?
I tried almost all antidepressannts,herbal remedies,nothing helps):
the only thing that gives me peace and feel like human is klonopin
I also agree it is not insulin,but if it is the only thing that gives you quality
of life and sleep?
excuse my english i am from cyrillic contry and am not fluent in your language

[Alley2]

Benzos have ruined my life.  I was perscribed Ativan ( 1mg ) for anxiety and I developed tolerance in about 6 weeks.  My anxiety increased as did a host of other health problems BECAUSE of the drug.  It almost killed me.  I was switched to Klonopin, which was even worse and I could not get off the drug to save my life...even tapering by mere crumbs.  I had to go to a detox hospital to get off, and even that was barbaric.  My life before benzos was a walk in the park compared to the damage the drug caused me.  I ended up on disability because Ativan and Klonopin destroyed my central nervous system.  There are about 5,000 people like me suffering from benzos on sevarl benzo withdrawal forums.  To say that these drugs are safe is a bold faced lie.

They are made by the devil himself.  I have several friends who work in hospital ER's, and they tell me every single day the number of people who come in with massive anxiety, and neurological problems....the doctors have zero clue what is going on....and every single one of them are on some type of benzo.  

Only a fool would choose to stay on benzos, or endorse them, after reading all the information available about the dangers of this class of drug.  Denial about the danger will not spare you.  You will get bit one day.  There are people on the withdrawal forums who loved their little benzo for 20 years, and are now paying the piper with ill health and becoming disabled and suicidal because the damage is so brutal.

Don't say you weren't warned.  Maybe not now if you are still in the honeymoon phase with the drug, but soon enough, when you start having mysterious health problems that no one can diagnose, take a look at that little pill you are swallowing. It will make you wish you were never born.

[jcrowe00]

I understand people have very strong feelings about this medication and while I agree with both sides of the coin on Klonopin it has helped me greatly.  I "think" the majority of people are like me and can go on and taper off without a very difficult time. I currently am tapering down and have been on Klonopin 3 times over the last 10 years. Each time it has really helped me and helped me make it through the day until I get my feet back under me.  

I think these drugs are a night mare for people who have an addictive trait or personality.

[Peaches5036]

I am in the taper process from Xanax. I have gone from 3mgs a day to currently 1.75 mgs. The first few days of the taper  are rough. I'm tapering in .25mg increments and maintaining that level for a month.I tried a .5 mg taper and got very sick, was in terrible pain and sought advice of my psychiatrist. I keep a medication log, have a schedule of small doses, taken 5-6 small doses a day.
I'm in day 14 of my latest taper and feel pretty good.
I don't want to substitute another benzo, even though some are succesful with this method. The last part of the taper I may do in-patient at a good hospital.
I was prescribed xanax in1991 and it is addicting, though I never abused my dosage. After getting sober off alcohol  5years ago I decided it was time to get off xanax.
My first prority was to remain alcohol free. After 2 years I becan reducing xanax. It is an insidious drug.Getting off too quickly causes havoc in the nervous system.Dr. Ashtons manual describes many of the withdrawl symptoms, some can be extremely intense.
I am thinking of also consulting a neurolgist.
Best wishes to you all.
Peaches

[Peaches5036]

Also I find the 12 steps of AA can help alot with dealing with this insidious ADDICTING drug. In AA, and NA, many folks have reported that getting off heroin is not nearly as painful as xanax. People can die from cold-turkey off of alcohol I have several friends who flat-lined from alcohol and were brought back. My daughter, who was a drug rehab counselor in a 28 day program in California, told me folks getting off prescription meds , had to be monitored much more closely for seizures and stroke that alkies and street drug addicts..

What is the definition of an addicting substance? Well , it's not such psychological dependence, removal of an addiction substance causes severe withdrawl symptoms. Stomach aches, headaches, body aches, flu like symptoms, the possibility of seizure, disorientation, dizzyness, extreme sensitivity to light, sound and smell among others.

DO NOT DO THIS BY YOURSELF ALONE.
Work carefully with your doctor. Find a good psychiatrist who has some experience in this field. I had to find a different psychiatrist cause my other one wanted to keep me on xanax forever.( Drug pushers with M.D.s)

I justified it for the same reason the "diabetics take insulin". Nope. I have to look at the cause of my anxiety,(I DON'T HAVE A XANAX DEFICENCY) be very pro-active with my own mental health. WE DO HAVE A BIG PART IS BECOMMING AND STAYING HEALTHY.TAKE RESPONSIBILITY.

Step 2 of AA, "Came to believe that a Power greater than ourselves could restore us to sanity"

Weel I ain't crazy no more. The Creator of The universe, The Designer of my DNA, the source of my being, The Living God, is helping me. Yes,I  probably am more sensitive than the average bear. That can be a gift, doesn't have to be a curse. Some folks are way more sensitive than others

I cry alot and laugh alot, sometimes both at once. Right now I want to feel my feelings, why am I scared/anxious? Maybe I need a good lifestyle change. Get back in touch with nature, seek more peaceful enviornments and companions. , work at a less stressful job if need be. I've know many alcoholics after acheiving sobriety, leave their high pressure do-eat-dog careers and do something that they enjoy, maybe for lesser pay. My soul is more important than money.

Sincere prayer helps alot. We are precious children of God who have lost our way, temporarily. maybe we sought the answer in medicine. We are not to blame.Ask and ye shall receive.

ANYTHING THAT SEEMS TO GO TO BE TRUE, IS PROBABLY DANGEROUS

Great blessings on you all.

[heartfluttersflyawayplz]

i was on klonopin and it was a great med for me got me back on my feet i can not take ssri and it was only thing for me . i got back off of it with no problems , if you need it take it and if you have to stay on it do its a life time drug for anxiety. if i ever need it again i will take it .

[sleeplesss]

I've read thru all these great posts.  I'm just going to throw my 2 cents in.  I was on Xanax for about 8 years.  .25mg 3 times/day.  My life was just fine.  I took no more, no less.  (I was having severe anxiety attacks which is why I was put on this med)  2 years ago, because of society's stigma about this drug, I decided to get off of it.  I tapered with a dr. help, and was also put on neurotin to help prevent any possible seizures.  I got off of it.  Took many months...but I did it.
THen....my life became H**L.  I had vertigo so bad I almost had to quit my job....almost became agraphobic. Anxiety attacks returned.  Was put on all different kinds of anti-depressents to try to control veritgo.  Had several tests to rule out anything else serious.   Could not shop in a grocery store, go walk in a mall, go to a concert, do anything normal people do.  I lived that way for a YEAR.  It was horrible.

Went to a new dr finally.  He put me back on Xanax, same dosage.  Vertigo gone, no more anxiety attacks.  So again, I take no more than prescribed, and no less.  Seems like my body does not need more.  I realize most people require more after time, but I have not.  

I also realize that this med should not be prescribed for a long period of time.  I'm glad my dr. disagrees with that.  

I'm sure many of you will find this appalling, but, like I said...just throwing my 2 cents in.