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RYAN
by fd11, Oct 19, 2007 07:48PM
YOU GUYS ARE STILL LISTENING TO HIM. WATER TITRATION IS THE WAY GO...........
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Oh, almost forgot to mention ~ 311 ******* blows. (haha!)
~Ryan
It's not about that and it's not about taking sides. Fact of the matter is, I really don't care who's wrong or who's right. If you disagree with someone, work it out and don't come on attacking. You are both adults and shoud be able to resolve this maturely. If you guys don't agree, then agree to disagree.
Peace.
(1) I personally am not trying "to come off of Klonopin", I have discontinued the drug one month ago. Furthermore, how could you possibly know what I'm doing? You can make all of the false assumptions that you wish, but the fact of the matter is that you know nothing about me, or my state of health.
(2) I am not a medical school drop-out. One would have to first attend medical school to "drop-out", and I never attended. It was my plan to attend medical school, however a decline in the state of my health changed that ambition over four years ago. I'm an electrical engineer. I have never claimed to be a medical doctor.
(3) There is no cult activity here (yet). However, there is a group of folks from the UK whom are under the false assumption that Benzodiazepines are "evil". I suspect that you represent this group of folks. Such folks are highly suggestible, if not down right hysterical. Such folks are inclined to believe anything, and they will continue to propagate their hysteria. You fell into their trap, along with three others who used to post on this forum whom are now banned.
(4) I don't claim to be a "know-it-all". What I provide is mainstream medical information where appropriate. The information that I provide does not come from the internet, but rather from major medical publications, including, but not limited to: The Physicians' Desk Reference, The Merck Manual, DSM-IV, Current Diagnosis and Treatment, etc. I keep the information that I provide as objective as possible. If something is of my opinion, I will state "it is of my opinion", or "in my opinion", etc. I can back all of the objective information that I provide.
(5) Not all doctors are uneducated. When dealing with psychotropic medications, a psychiatrist should ideally be consulted, as they are the most knowledgable with regard to how these drugs act. A regular family physican or GP, at the most, had about 4 hours of psych training during their residency rotation. While there is no doubt that some doctors are uneducated in a particular area, there are others who are very educated in the same area. Thus if one experiences a problem, they should seek out professional advice from a knowledgable physician who specializes in a particular field.
(6) The major pharmaceutical companies make very little money off of the sales of Benzodiazepines. Roche was the leader in the field of Benzodiazepine research since the late 1950's, however, the drugs are now off patent, and are produced by generic manufacturers such as TEVA, Watson, PurePac, etc. Benzodiazepines are older, well understood agents, and they are no longer advertised. The modern trend has shifted towards the SSRI class of drugs, which are the types that are heavily promoted. They are promoted as the "cure-all" of depression and anxiety, when they are, in fact, not.
(7) I certainly didn't fall into any traps. I specifically requested Klonopin at one time, knowing full well the clinical pharmacology of the drug, the risks involved, etc. In my case, the Klonopin served its intended purpose very well. I never experienced any adverse effects from the drug, with the only reservation being some transient somnolence during the first month of treatment.
(8) Benzodiazepines are lipophillic, they are not water soluble. Thus, the water titration method does not work. However, as with any placebo, if you believe that it will have a beneficial effect, the chances are great that it indeed will. In a number of studies, placebo's have had a greater impact on well-being than did the active drugs themselves. This has been documented throughout history.
(9) Any psychoactive drug alters brain chemistry. In the case of Benzodiazepines, this is easily measurable via an EEG of the brain, measuring of the respiratory rate, etc. The entire concept of taking a psychoactive compound is to alter some aspect of brain chemistry. Otherwise, there would be no useful clinical benefit.
Ryan
(2) If you’re not claiming to be a medical doctor then please stop acting like one.
(3) Those three others you are referring to are doing just great and thank you for caring. There is no trap there, just a bunch a people who actually came off of Klonopin and other benzos successfully and are there to help. Try not to pat your self on the back to much because I have seen many people from your cult on that site so obviously your main stream medical information is not helping all that much.
(4) You may not claim to be a know-it-all, but you sure act like it. Just wondering why you didn’t include the Ashton Manual in your list of major medical publications.
(5) Most doctors are uneducated when it comes to these drugs, and I was speaking about psychiatrist. They don’t understand the withdrawal process and how it affects millions of people. You must be special because you didn’t experience any side affects or withdrawals.
(6) How could you sit here and say that benzodiazepines are well understood agents when millions can’t come of these drugs clean because of the lack of knowledge that these psychiatrist have. As far as I am concerned, these benzodiazepines or SSRI’s don’t cure anything they just cover up the problem. Also, I don’t care if the pharmaceutical company is a major one or the little guy on the market, they still don’t spend enough time researching what they are putting on the market.
(7) In my opinion, requesting Klonopin is either really brave or just stupid; knowing the risks involved. I am glad at least I know of one person who had a great experience on this, because the other hundreds of people I’ve seen are having a hard time on it.
(8) They don’t need to be water soluble. You just need to be sure to get the residue out of the mixer; most of the pill is talc, and the particles will settle fairly rapidly at the bottom of the container. You have a good thirty seconds to adjust your dose before the particles settle.
(9) I though that you said this is mostly placebo and if you think and read about horror stories that they will happen. So why do we need these benzodiazepines? Clinical benefit, there is no benefit involved. It is a proven fact that these benzodiazepines affect your central nervous system among other affects that could possible stay with you for life. I don’t know about you, but I don’t see any benefit in that.
Oh and as for the Klonopin that you claim to have come off of. I don't believe that for one second and I still think you are on it matter of fact I know you are.
a) According to the MSDS sheet, supplied by Roche, a typical Klonopin pill contains primarily: cellulose, and corn starch; the active ingredient, 6-(2-chlorophenyl)-9-nitro-2,5-diazabicyclo[5.4.0]undeca-5,8,10,12-tetraen-3-one aka clonazepam, is present to an extent of <1.2%. It does NOT contain "talc" as you claim.
b) Neither cornstarch, cellulose, nor clonazepam are water soluble. Futhermore, said compounds have quite different densities. This means:
A suspension of each compound in water will settle at a different RATE. Just because the apparant "bulk" sedimentate takes "30 s" to settle that does NOT mean you have 30 s to adjust your dosage - this is utter nonsense. The rate for the klonopin to settle could be in the order of seconds.
The point of a "titration" is to determine the EXACT concentration of a substance. This is IMPOSSIBLE to do, with any reasonable degree of accuracy, when the substance in question is NOT soluble in the given solvent as is the case w/ klonopin in water. Particulates will begin to settle IMMEDIATELY after aggitation; the effect of this, is a concentration GRADIENT. Therefore, the "titration method" is highly inaccurate and this is complicated further since the klonopin is the minor constituent of the pill and several other water-insoluble components comprise the bulk of the mixture.
You make several assumptions with this "titration", aka water suspension, method which introduce a huge error in the accuracy of this method; there is a reason why this is not a viable method and information on this can only be found online.
"... I don't believe that for one second and I still think you are on it matter of fact I know you are. "
Since you apparently posess psychic abilities, why is it that you elected to take Klonopin in the first place? Did you, and director of pharmacology at NYU Medical Center who was treating you, fall into a trap??????
And dry cutting a pill will guarantee reasonable accuracy. I don’t think so. My doctor has even said that by dry cutting will make it very difficult to come off any benzo.
"Since you apparently possess psychic abilities, why is it that you elected to take Klonopin in the first place? Did you, and director of pharmacology at NYU Medical Center who was treating you, fall into a trap??????"
I didn't elect to take this s**t. I was put on this to wean off of Paxil which an uneducated psychiatrist put me on because I had one panic attack. Needless to say I don’t see that doctor anymore. If I knew then what I’ve know now, I would have refused it, and there was no trap here sweet heart. I presented all the data and information that I could gather to my doctor. He even went as far as to take a look at the Ashton Manual and he decided that this could be a good process to come off this medication that is prescribed to some many to quickly.
“Particulates will begin to settle IMMEDIATELY after agitation; the effect of this is a concentration GRADIENT. Therefore, the "titration method" is highly inaccurate and this is complicated further since the Klonopin is the minor constituent of the pill and several other water-insoluble components comprise the bulk of the mixture.”
Yes I know Klonopin is not water soluble and the particles will settle fairly rapidly on the bottom of the container. Just be sure to get the residue out of the bottom of the mixer and the graduated cylinder. The advantage to this method is that as long as you have a sufficient supply of pills, you can reduce at your own rate and make tiny reductions. The brain is not going to be able to differentiate between a dose of .5 mg of Klonopin and .498 mg. The cumulative cuts will add up, and if you need to take a break and hold, then you can do that easily with this method. It is a gentile way to taper. By dropping at ¼ of the pill every 4-6 weeks doesn’t give the brain enough time to heal or the GABA enough time reproduce itself naturally.
Oh and one last thing, no one asked for your input. If I was writing to you then I would have posted to you.
^quote
So, in other words, you were placed in four-point restraints and Clonazepam was forced down your throat against your will. Highly unlikely, which means that YOU placed the tablet into your mouth on your own free will. Thus, you elected to take Clonazepam. If you did not understand the particulars about the drug, you should've inquired about them. Thus, the pity party is over. Take some God damn responsibility for your own actions.
You do realize that Paroxetine also carries withdrawal phenomena? You should also realize that what ever disorder you were being treated for may have reemerged upon the cessation of Paroxetine and Clonazepam. Reemergence of the original disorder and symptomatology accounts for the majority of the supposed "withdrawal phenomena".
IF (and that's a big if) Clonazepam withdrawal represented all of the problems that you have described here in the past, 1/8 mg wafers are readily available to help assist you. Thus, there is no need to "dry cut" the tablets, and there is certainly no reason to use bizarre, unapproved methods for discontinuing the drug. This is particularly true when the solvent is an incompatible with the agent to be titrated or discontinued.
I would also note that you were taking a single, oral dose of Clonazepam daily, and thus the drug never reached steady-state, nor did it accumulate. This, coupled with the short duration of use leads me to suspect that the symptomatology that you encountered was not related to Clonazepam withdrawal. Paroxetine withdrawal would be plausible, however the most likely synopsis would be a reemergence of the underlying disorder, or a hysteria reaction due in part to excessive online reading.
-begin quote-
"The brain is not going to be able to differentiate between a dose of .5 mg of Klonopin and .498 mg. "
-end quote-
How are you measuring the Clonazepam in milligrams? High-pressure liquid chromatography? Hint: You can't measure it, as it is lipophillic. The drug is incompatible with water. I'm sorry, but you can't defy the laws of physics.
My only concern with you is the spreading of misinformation. Should someone happen to follow your advice (particularly a long-term user on a moderate dosage of a Benzodiazepine), seizure may be precipitated due to the inherent inaccuracy of this unconventional "water titration" method. No clinical trials exist to support such a method, and none ever will for obvious reasons.
-begin quote-
"By dropping at ¼ of the pill every 4-6 weeks doesn’t give the brain enough time to heal or the GABA enough time reproduce itself naturally. "
-end quote-
Absolute quackery.
You also commented on the "A" Manual. It is not a major medical publication, it's a quack publication. Where was the "A" Manual in 1964, when hundreds of thousands of Diazepam and Oxazepam prescriptions were filled? How did those folks manage to discontinue Benzodiazepines without the "A" Manual? Give me a God damn break. Well, at least those folks back then were better off....no internet access.
As for your final comment, this is a public forum. Everyone has the right to participate in a posting. If you don't like that fact, simply refrain from posting here.
Ryan
Part I of II
1. On most message boards this would be considered a 'call out' thread and be deleted by the mods.
2. Using profane language or asterisks to conceal profane language doesn't add credibility to an argument or to anyone's rebuttal, or to their future posts.
3. Advising people on an internet forum that they shouldn't be relying on the Internet for information, especially when you are in the business of handing our information on the Internet, strikes me as a little counter-intuitive, at best.
4. There seems to be no shortage of posters here who seem unaware of the proper dosaging of benzodiazepines they've been prescribed, or of the likelihood of dependency (addiction), or of the risks associated with abrupt withdrawal, or of the very careful and lengthy process that must be followed if and when they choose to cease using the drug. It might be tempting to blame these patients for not carefully investigating the particulars of the drugs they were prescribed. On the other hand, a reasonable person might ask whether the medical professionals are doing enough to educate their patients about these issues. In any event, one can't help but wonder why so many people are searching for answers on the Internet...
mark
"And dry cutting a pill will guarantee reasonable accuracy. I don’t think so. My doctor has even said that by dry cutting will make it very difficult to come off any benzo."
As I posted earlier, the point of a "titration" is to determine the EXACT concentration of a substance. This is IMPOSSIBLE to do, with any reasonable degree of accuracy, when the substance in question is NOT soluble in the given solvent as is the case w/ klonopin in water.
What does the accuracy of the dry cutting method have to do with the wet suspension method?
"I didn't elect to take this s**t. "
Yes you did. See Ryans comment for further comment.
'The brain is not going to be able to differentiate between a dose of .5 mg of Klonopin and .498 mg. "
Unfortunately, neither will this method. To achieve this particular dosing (0.498 mg from a 0.500 mg pill) the method must have a level of accuracy that is substantially LESS than the 0.4% you cut your dose by. Depending on the kind of measuring cylinder you have, your error will range from 1-5%; yours is likely to be on the higher end. Anyway, for the sake of argument, "If" the rest of the procedure did not introduce any level of error into this measurement (CLEARLY it does, and this error is HIGHER than that from the measuring cylinder) then the error in measuring out a volume of pill suspension is already HIGHER (1-5%) than the tolerance level (less than 0.4%, ideally 0.02% is what you would aim for).
"Oh and one last thing, no one asked for your input. If I was writing to you then I would have posted to you."
Clearly your lack of understanding regarding the concept of water "titration" (on an insoluble material) extends to how a PUBLIC forum works.
First of all I have never heard of these drugs until about a year ago. I never had to take medication before so like many doctors and people out there, I was uneducated about it, my mistake for taking a doctors word on it (“As you say, consult your doctor first”. Look where I am now, posting to people I don’t even know looking for answers). Second of all when I wanted to get off the Paxil I was told that this is the only way to do it. There is no way to wean off of Paxil unless you cross over with another drug which makes it easier to get off, once again taking my doctors word for it. SO NO, I DIDN”T ELECT TO TAKE THIS S***. Lastly no one is asking for your or anyone else’s pity.
“You do realize that Paroxetine also carries withdrawal phenomena? You should also realize that what ever disorder you were being treated for may have reemerged upon the cessation of Paroxetine and Clonazepam. Reemergence of the original disorder and symptomatology accounts for the majority of the supposed "withdrawal phenomena".
I have been off the Paxil for 5 months now so I really don’t believe that the Paxil would have anything to do with it. I haven’t had a Panic Attack since that first day which was 14 months ago. So I can say that this all very well be drug related.
“IF (and that's a big if) Clonazepam withdrawal represented all of the problems that you have described here in the past, 1/8 mg wafers are readily available to help assist you. Thus, there is no need to "dry cut" the tablets, and there is certainly no reason to use bizarre, unapproved methods for discontinuing the drug. This is particularly true when the solvent is an incompatible with the agent to be titrated or discontinued.”
I truly believe that this is all withdrawal because I never felt good or stable on either the Paroxetine or Clonazepam. The side affects just kicked my a**. I was unaware that there are 1/8 wafers available to help with the withdrawal process. I will have to speak with my doctor and ask him why I wasn’t told about this.
As for your other comments, I am starting to become confused because I don’t have any of the symptoms of a panic attack and I believe that the why I feel the way I do is because I am on a drug that I shouldn’t be on. My problem is that I have gone to 4 different physiatrists and they have all done wrong by me. This current doctor is the only doctor that is willing to work with me.
You know what, I agree with you and I apologize if I used any profanity on this form that offended anyone. I should have been the bigger person.
Everyone here talks about the internet and how the water titration is not a valid way to withdraw from benzos or other drugs. Then tell me why I have seen more people have success with the water titration and why my doctor thinks it is a good idea. Also I never see any information about some one dry cutting or use the wafers to come of this stuff successfully. This is what is confusing. The only one that I have heard to come of this stuff without the water titration is supposedly Ryan.
The fact you are on a public forum spreading misinformation, that has no credence, and could be potentially dangerous warrants intervention. From a scientific standpoint, the "method" you present is FLAWED as any individual with basic scientific knowledge will tell you. The level of accurancy involved with your measuring devices, can not ensure an ACCURATE cut of the klonopin for a start.
Whether or not you choose to "waste your breath on me" is something I couldnt care less about. However, I DO care that you spreed rubbish which could put people in a dangerous situation. I AM prepared to waste my breath on you to refute what scientifically, inaccurate, statements you make so anyone who has the misfortune of coming across your posts on the "water titration method" are actually informed on the subject.
You begin this thread as an ATTACK on another member, then proceed to make wild assumptions and accusations and you demonstrate your immaturity with your choice of language. It is quite clear, the only reason you are posting in this forum is to create an argument. This is a SUPPORT forum - use it for what it was intended.
Beware folks, she's another sockpuppet from that UK cult.
mark
It's not necessary to start namecalling on this forum. It certainly shows me that I wouldn't want to know the person doing the namecalling.
"Good Morning All,
Well I am new to this group and I hope everyone is having a great weekend. My
story started about 14 months ago; I was not taking care of my self. For a good
year I was working 16 hours a day 6 days a week (while drinking at night so I
could do my work), taking a diet pill, smoking cigarettes and doing chewing
tobacco on top of it. I would get 3-5 hours of sleep a night and then go to the
gym in the morning around 5 am. I decided to quit smoking (18 months without a cigarette) but kept on going with the other nonsense. Then it happen, one night after my in laws left from having dinner and I continued to do work. My chest felt like it was going to explode and I felt like I was going to die. I was
rushed to the emergency room where they said that I was having panic attacks. So a week went by and I had to take a 3 month leave of absent from work, I would just lie in bed crying and was afraid to drive and go out of the house. My primary physician (we did every test you could imagine and I am extremely healthy) and I decided that I should see a psychiatrist and every psychiatrist I went to wanted to give me a medicine. So I found a doctor I was comfortable with I we started to do sessions once a week. I was trying this without the meds and I felt helpless, so I know of some friends who have taken Paxil in the past and I asked my doctor if I should go on Paxil. He said sure and I started to take Paxil. I took this stuff for 9 months and hated it. I do think it did its job over time but the side affects were killing me. I kept telling the doctor that I need to get off this stuff and he said that it wasn’t side affects it was my anxiety. I was trying to explain to him that this was not anxiety. So he finally said that I could wean off of the Paxil and I asked him if I should take the pill every other day and he said yea lets try that. When I tell you the withdrawal that I went thought was unbearable. Needless to say I found a new doctor and he weaned me off the Paxil within 10 days, right before my wedding, the only problem was that he put me on Clonazepam. Now I have been on
this for a little over 4 months and I want to come off. Even thought I was only
taking .5 MG before bedtime, I fell like this is a nightmare; muscle aches,
tension between my eyes, blurred vision, my balance is off, back and neck pain, my legs always week and depression. My doctors told me we can wean off the pill and to do so I would need to dry cut the pill ¼ every 10 days until I am off. Well obviously this is too quick and I started to have withdrawals. So I went back up to ¾ of the pill and started to wean off of the Clonazepam again by dry cutting the pill ¼ every 5 weeks and I have been stuck and ¾ of .5 MG for a 5 weeks now. I wanted to know if the water titration is the way to go because I am nervous to try this. I brought all the information to my doctor regarding the water titration and he thought it was a great idea even though it isn’t medically approved. So I started it last night and I am still nervous. Has anyone had success with this and were you nervous at first. I really need to get off this stuff because I have my first baby on the way this February and I want to be my self again to give my son what I never had; Love. Well thanks for letting me babble and your thoughts are extremely appreciated. Thanks."
--blockquote--
In this man's case, a combination of poor lifestyle, stress, inadequate sleep, and and the concomitant use of stimulants and alcohol ultimately precipitated the onset of a panic attack.
Panic attacks are common, affecting greater than 1/3 of the population in any given year. The majority of persons who experience a panic attack recover without incident. However, in this man's case, he went on to develop panic disorder. He had recurring thoughts about the consequences of the initial attack, and recurring thoughts about the possibility of future attacks, along with the potential consequences of those attacks. His biggest mistake was taking a 3-month leave of absence, as he had 3 months to sit around and *think*. Panic disorder is a progressive illness, simply meaning that it grows worse over an "X" amount of time. The key to beating panic disorder early on is to retrain your thought pattern *quickly*, and to expose yourself to your fears (ie: driving an automobile). If you do not, it will progress beyond the scope of what you can manage in most cases.
A physician was consulted, and apparently excluded a physical etiology to explain the symptoms, thus they were deemed psychogenic in origin. Psychiatric consulation was recommended, however this man was reluctant to try medicine in favor of weekly sessions. At this point, the panic disorder had progressed beyond the scope of what the sessions could address. Thus, to halt the progression of the panic disorder, the patient inquired about Paroxetine. What the patient (and apparently the doctor) did not realize is that Paroxetine is largely ineffective for the treatment of panic disorder. Regardless, some benefit was noted, however, the side effect profile was intolerable according to the patient. He had remained on Paroxetine for a duration of nine months (a substantial period of time), and expressed interest in discontinuing the drug due to adverse side effects.
Unfortunately, the patient was not instructed on the proper discontinuation of Paroxetine, which has been noted to cause the most severe withdrawal effects of the SSRI class of drugs. A 10-day withdrawal period for this particular SSRI was not sufficient. Rather than reinstate the full dosage of Paroxetine and begin a slow taper regimen, it was discontinued rapidly, and Clonazepam was implemented to "mask the withdrawal". Big mistake, as these two agents target separate neurotransmitters within the brain. The two are not interchangable. While Clonazepam may offer some benefit, it is not targetng neurotransmitter 5-HT-1 (the one responsible for Paroxetine withdrawal).
I might also point out that the Clonazepam was not properly prescribed, and any benefical effect that the drug may have had was simply never obtained. The benefits were not obtained, as the Clonazepam never reached steady-state. For the maximum benefit of Clonazepam to be obtained, it must be dosed at least twice daily.
The symptoms described were: - muscle aches,tension between the eyes, blurred vision, my balance is off, back and neck pain, my legs always weak and depression. Every one of these is attributable to the abrupt cessation of Paroxetine, and to a much lesser extent, the peaks and troughs in the Clonazepam plasma level. Clonazepam has a 12-hour duration of action.
The man in the story posted above falsely assumed that the Clonazepam solely was responsible for his symptomatology, when it, in fact, was not. There are four factors involved here (in the order of their severity):
(1) The abrupt cessation of Paroxetine, and discontinuation syndrome.
(2) The reemergence of the underlying disorder
(3) Improper dosing of Clonazepam, and the resultant peaks and troughs in the blood plasma level. This gives rise to the "rollercoaster effect"
(4) A hysteria reaction regarding the discontinuation of Clonazepam due solely to improper research on the drug.
With the false assumption that Clonazepam was the culprit, this man sought advice via the Internet, and was unfortunate in that he was mislead by a group of folks on a quack forum. Said folks failed to look at the entire picture, focusing solely on the Clonazepam alone, and disregarding the other factors involved. Thus, their advice, was of course, to discontinue the Clonazepam via a modality which is not effective - The water titration method:
Part I of II
Ryan
"Hi there guys, I started the water titration 3 nights ago. My physical symptoms
have some what subsited (still annoying) but I had a panic attack today which i
haven't had in months. Is that normal and should I hold my taper for a couple
of days?"
and:
"Good Afternoon All,
Today I had a massive panic attack driving to work today. Called my wife
crying and I couldn't breath or feel anything (I though i was going to get into
an accident). My legs and arms went numb and tingling. I haven't had one of
these in like 8 months. Now I don't know if i should hold my taper or continue
to go down. I truly though I was going to die. What does everyone think. I
mean I was never on a high dose (.5MG - started 41/2 months ago) and I am doing a 200ML taper. Now I don't know if this was due to sitting in traffic or what, because I woke up feeling great and by 10:30 am it hit me like a ton of bricks. I believe that this is part of withdrawals, am I correct. Thanks all."
--blockquote--
This is not withdrawal phenomena, nor is it progress. It is a combination of two factors, and those two factors at this point are panic disorder and a hysteria reaction. The latter of the two was imparted on this man's mind by a group of suggestible folks who failed to look at the bigger picture. Bear in mind two things (1) The Clonazepam never reached steady-state, and (2) The duration of use was limited. Those two factors severely reduce the risk of dependency. Withdrawal phenomena is non-existant, particularly when reduced by 1/8 mg every four weeks.
In this man's case, the symptoms will reemerge. Once they do, immediate action should be initiated to prevent the progression of the panic disorder. I would recommend that this man consult with a psychiatrist. I would recommend 5 mg of Diazepam, three times daily, in conjunction with CBT and exposure therapy.
You posted back here for a reason, Dominick, and I don't think it was to "call me out". I believe that you're having a difficult time, but that's just my opinion.
Part II of II
Ryan
Several years ago... well after I'd started klonopin for panic attacks, I had a very negative reaction to an over-the-counter cold medication. I was aware of my sensitivity to cold medications containing pseudophedrin, but made the mistake of taking Alka Seltzer Plus. Within 30 minutes, I was in an ambulance on the way to the hospital.
I explained to the ER physicians what medications I was on, and what over-the-counter drug I'd taken, and that I'd had a severe reaction to Robitussan several years earlier. They kept me in the ER for about an hour until I felt better and my family came to pick me up.
Before I left, I consulted with the physician, who assured me I was had simply had a panic attack. I asked what I should take for my flu symptoms. Her response? "Whatever you were taking before was probably good."
Caution. Question EVERYTHING an MD tells you. And be even more skeptical of diagnoses and treatment recommendations doled out by experts on Internet forums.
mark
=)
Hey listen I sincerely apologize if I have offended or hurt your feelings in any way. As for Cathyj, she is a good person and she is going through a tough time as well. I know you are extremely intelligent person and I thank you for those last two posts, it really put everything in perspective for me. I need to come up with a plan to get my self back to normal.
Thanks again
Dominick
Although this guy's tests may have come back okay, but someone who is smoking, chewing tobacco, taking diet pills, drinking every night, and not getting adequate sleep and exercise is definitely not "extremely healthy." In fact, a person doing all that is putting his very life in peril and ruining his health. And a person with those problems is in not state to begin a marriage and possibly bring children into the world. I know that sounds judgmental, but really, it's just my opinion.
As for medications and how to stop them, I don't think there's any one way that works for everyone. I stopped Sinequan abruptly (I was only taking 25 mg. a day, though) with no bad side effects. I stopped Valium abruptly, after many years of use, with no withdrawal. I stopped Paxil 40 mg. at bedtime abruptly because of a medical problem after two or three weeks of use and I did have insomnia and vivid dreams for two weeks, then everything was fine. As I've said before, I don't recommend anyone stop any psychotropic drug abruptly, like I did. I think I'm just one of the fortunate and lucky people who don't become either phsycially or psychologically addicted. I have no idea why I didn't have more withdrawal symptoms, but I'm certainly glad I didn't.
Second - I was doing all of this because of the stress that comes with my job. I was trying to find ways to relieve the stress and possibly work harder, obviously that wasn't the way to go. I have worked entirely too hard to get were I am at in this point of my career and all I could think about is supporting my family and making sure they have everything that they need to be healthy and happy. When you are what they label a work alcoholic, these are the things that you can fall victim too.
Third - I know your not perfect, because no one is, so don't sit hear like you have never made a mistake before when it came to something in your life that you may regret. Yes that is something in my past that I regret.
Just to end this; I haven’t had a cigarette in 18 months, a drink in 14 months nor have I done the chewing tobacco in 14 months. I used to drink once a month if that, when I felt fine. This excessive drinking only came about 3 months before I had my first panic attack.
I am truly happy to hear that you were able to quit all those drugs abruptly with no side affects and yes you are the lucky one, not all of us are as lucky as you. I also hope that your test and medically issue come out fine.
I was in a very similar predicament three years ago. At the time, I was working in the mining industry. I built large, long-wall miners, and serviced them out in the field. Before I knew it, I found myself working 12-18 hour shifts (and 12 hours on Saturday). I bit off far more than I could chew, but also thought that I was "invincible". I couldn't have been more wrong.
I smoked two packs of Marlboro 100's, and chewed three cans of Copenhagen each day. I also had bad allergies, and used two bottles of OTC nose spray per week. I drank 6-8 beers a day, and about two shots of Jack Daniels per day. Most of the people I worked with did the same. Everyone is different, and I wasn't as fortunate as they were.
Then it happened.....On Sept 8 of '04. I actually had the afternoon off, and was working on some side projects. It struck at 6:00 PM that evening. All of a sudden, I couldn't breathe, felt a massive pressure in my chest, and eveything went numb. My hands became "clenched shut". My GF called for an ambulance, and I was off to the ER. I never experienced anything like this before, and I thought I was dying. I was convinced I would die.
Well, I didn't die, and the ER didn't find anything wrong. They attributed my symptoms to "lead posioning", from soldering. They are idiots.
Soon after, the symptoms came back, this time even worse. I didn't get out of bed for a month, I resigned from my former job, and I lost my girlfriend and the support of my family. My girlfriend and I had a wedding planned for late September '04, but it never happened. From this point on, my life went to hell. I had no idea what was happening to me.
I quit smoking, drinking, etc. However, it was too late. The damage was done.
This was my life story for 2 1/2 years. I had a "mystery illness", and no doctor could figure out what it was. In December '06, I had a complete mental breakdown while undergoing a heart catheterization. It was suggested that I consult with a psychiatrist, which I did. I requested Klonopin, as I thought it might help me. He seemed to agree that this was a good choice.
So, I got the Klonopin filled. I said to myself "there is no way in hell I'm taking this garbage", despite the fact that I asked for it. I stared at the container for two weeks, and finally had the balls to take one. From that point on, I took it as prescribed (0.5 mg twice daily). I took it for a total of 9 1/2 months.
Over the past three years, I developed certain phobia's, but by far the worst one was a driving phobia. I could drive maybe 5 miles at the most. If I drove on the highway, or got stuck in traffic, the symptoms would appear. They were always the same - breathlessness, numbness, and weakness of the legs. Often times I would have to pull off the road, as I couldn't push the clutch, shift gears, or hardly steer. I would pull over and lay down, sometimes for an hour until the numbness went away. Once I started the Klonopin, this gradually improved, but it never went away. Ultimately, I just said "phuck it", I'm going to drive anyway. Exposing myself to my driving fear helped more than anything else. I can now drive anywhere 90% of the time.
In my case, Klonopin didn't do very much (or I should say, very much good). It did turn me into a zombie, and made me depressed. It wasn't until July that the true problem was revealed - lung cancer and heart failure. I went through three years of hell, and spent thousands of dollars seeing more than a dozen specialists, and not one of those idiots could make this diagnosis. One brilliant team consisting of a Cardiologist, Endocrinologist, and Oncologist finally figured out what was wrong with me.
I discontinued the Klonopin rapidly, over four weeks, and had no obvious withdrawal. Perhaps some dizziness is all. My team of doctors prescribed Diazepam in its place. Let me tell you Diazepam is superior to Klonopin. I am now well enough to teach electricity and physics courses, and to operate a side business. Even though I am worse off now than I was three years ago from a physical perspective, I don't feel like it.
Of course, I take other drugs as well (for heart), and am awaiting for them to improve my cardiac function. November 7th, I will see the doctors for a progress report.
In some respect, out stories are very similar. The symptoms are those of panic. It doesn't really matter what caused them. The only thing that matters is that they are addressed, and that the quality of life is improved. In my case, I waited too long. Even so, things still improved. They will improve for you, too.
My insurance didn't cover psychiatry either. The initial visit cost $275, and each followup visit costed $65. $120/week is rediculous, but if he's good, it might be worth it. Next time you consult with him, tell him everything. Tell him exactly how you feel, and that you're having a difficult time. Get your money's worth out of the appointment! Don't leave until you are satisfied.
In your post above, you mention that you "feel much better since I have been cutting; the blurred vision, depression and other minor things have disappeared."
If those are what you consider to be the minor things, what are the *major* things? Are you still having panic attacks?
Ryan
I really haven’t had any panic attacks, just 2 in the last year or so; one being massive that Wednesday. I still get to the point were my calves go so numb that it is hard to stand. I feel like I am starting to have a panic attack, but it doesn’t happen, just a lot of side affects. When I feel stressed or even think about work, everything gets worse. Now I have been doing that water titration for the last 2 weeks and I don’t know if I should go back to cutting or cross over to something else. If it is Panic attacks, I really don’t want to be on any meds either way. I want to do this naturally with will power. I guess you can say in a way I am afraid to come off the drug but I truly feel I need to get off. I don’t feel the way I did in the being. I took that 3 month leave from work because I couldn’t drive and I would lye in bed crying and was afraid to go out of my house. I do think that this Klonopin is not doing me any justice. The Paxil was just killing me and I feel they should have put me on something milder. Do you still think I could be suffering from the withdrawal process from the Paxil?
I used to be the type of person were I could just get up and do anything, playing football on the weekends with the guys, taking my wife to dinner or shopping. Now I don’t know if I am going to wake up feeling ok or just out of it. I was always a strong willed person and now I feel like there is something controlling me. I just want my son to have a healthy set of parents. I don’t want him to have the childhood I had. My father was put in jail when I was 3 years old and got out when I was 22. I never knew him, met him when I was 23 and he died of a drug overdose when I was 24. I was taken away from my mother (drug attic and alcoholic) when I was 6 years old and lived with my grandmother until I was 10 when she pasted away. Then moved in with my uncle and his wife until I was 15 years old and then left home putting myself through high school and then college. So I don’t know if I was hiding from something my whole life or if it was from my drinking, smoking and diet pill tirade. Like I said, just confused on what steps to take.
The objective information that I post to this forum comes from major medical publications - not from the internet. It is the same material that a medical doctor would have access to, and rely on in his practice of medicine.
My goal is to help the "ill informed" become "well informed", as there is no shortage of ill-informed doctors (or patients). I would state, however, the the number of well-informed doctors outnumbers those whom are ill-informed.
"he is not qualified, nor does he know.......the co morbidity, the confounding factors, or the case history"
^quote
I never claimed to be qualified. I've made that fact very clear. The co-morbidity is largely unknown in any case. In the case of anxiety disorders, it would be exceedingly difficult to quantify with any degree of accuracy. The case history on the other hand, is usually represented quite accurately by the poster. I would venture to say that many folks are more inclined to disclose more information to an internet group of strangers, rather than to their own doctors.
"the very fact that medication is important to this extent, is a call for co depnedency and a need that I think can be better met in other, more productive ways"
^quote
Please provide a sample list of these productive ways.
" And there is no proof of that regarding these addictive drugs."
^quote
This is of your opinion. I can provide many citations, as well as many clinical situations which would necessitate a physiological need for the use of Benzodiazepines. My own case is one of them. I would be more than happy to elaborate on this.
Psychotropic drugs are not addictive. There is a major difference between the terms "addiction" and "dependency". Unfortunately, psychoactive compunds are singled out, however, I do admit that they are overprescribed. The typical beta-blocker also causes physical dependency, but you won't read horror stories about those. In my opinion, rebound tachycardia, angina, and hypertension is more terrifying than rebound anxiety.
Ryan
Thank you. I certainly hope that things will turn out well (for the both of us). I wasn't too mature, either, and I apologize.
I'm not sure if you were aware or not, but there was actually a class-action lawsuit filed against Glaxo-Smithklike, makers of Paxil. Apparently, GSK failed to disclose the side effects/withdrawal effects of the drug. There is a plethora of information online. A Google search will reveal the particulars. Simply search under "Paxil lawsuit".
Here is the prescribing information for Paxil. Page 13 is of particular interest, and describes the withdrawal phenomena (it is a bit sugar coated, IMHO):
http://us.gsk.com/products/assets/us_paxilcr.pdf
It would be hard to say with any certainty what exactly is causing your symptoms, but some of them do seem to resemble Paroxetine withdrawal. Certainly, it would be plausible, particularly after nine months of use without a proper taper. The effects could last for many months afterwards.
Then, there are phenomena known as "atypical" or "modified" panic attacks, also known as "mini" panic attacks. Here, you'd get some of the physical symptoms of a panic attack, but without experiencing a full blown attack (with the breathlessness, numbness, etc). The fact that you're not experiencing the full blown attacks frequently is a very good sign. Still, it is understandable that the symptoms (although not "full blown") are still quite disturbing. Stress would precipitate them.
It's more likely a combination of everything, past and present. Your childhood, a stressful work environment, the prior use of stimulants and alcohol, the initial panic attack, the development of a panic disorder, the use of Paroxetine and it's withdrawal effects, and the improper dispensing of Clonazepam. All of those factors add up.
You may consider running some of these factors by your doctor (even the part about your childhood). I would gather up as many thoughts as possible, and write them down for the doctor to review (including your physical symptoms). All of this is significant.
As for the Klonopin, no, it never benefited you. It would've been impossible at the dosage you were prescribed. However, if the continued reduction of the dosage precipitates severe symptoms, you should probably inquire about switching to Diazepam (or perhaps, trying the Klonopin wafers first). I personally don't believe in the water titration theory, given the huge margin of error involved. You really never know what dosage you're receiving. Accuracy would be key. The wafers would give you an accuracy down to 1/8 of a milligram (equal to 2.5 mg of Diazepam).
Ryan
Paxil –
I didn’t know that Glaxo-Smithklike was being sued. I will have to read about that. I remember reading some where that Paxil can cause permanent damaged to certain parts of the brain. I don’t know how true this is though. Also, how long until the withdrawals would subside with the discontinuation of Paxil, I know you said months, but I have been off for 5 months so in your opinion do you think that isn’t the case for me?
Panic Attacks –
I will give you an example: I had that first one about 14 months ago (muscle tension, hyperventilating, numbness - the works). Now since then I have never had an issue catching my breath. Now on last Wednesday when I had that massive Panic attack I started to hyperventilate and since then I have been having issues trying to catch my breath. Now can these symptoms last as long as a week? I have finally differentiated the difference from being medication dizzy and anxiety dizzy which for me is a plus.
Clonazepam and Klonopin –
Now I know that Clonazepam is the generic form of Klonopin, but do they have the same exact ingredients and if I were to wean off of the Clonazepam (which I am), how would I go about that. Do I go back to .375 were I dried cut the pill and stayed for 6 weeks and start to taper from there, or do those wafer come in a dose of .125, .25, .375 and .5 and start from one of them. What would 1/8 of .5MG of Clonazepam be?
I wish you the very, very best of luck in over coming this, it is hard and frustrating.
Take Care, t.
Maybe it's me who's the anomaly. I've never had any significant trouble stopping any drug and never craved one afterward. I don't think people should stop cold turkey, but it seems to work for me. I think you're going to have to accept the fact that stopping any drug is going to feel bad for awhile.
Everyone is different. I smoked cigarettes and drank you to 3 cups of coffee a day and one morning decided to quit and never went back. That never bothered me, but my aunt tried to stop the coffee and she would break out in sweats and get dizzy. Maybe this is why I feel the way I do today – LOL. That was a year and a half ago. You are extremely lucky because I have never heard of someone just stopping a drug like that and they were fine.
^quote
The mere fact that he wasn't aware of the existence of Klonopin (and generic Clonazepam) wafers is disturbing, particularly given the fact that he is the "director of pharmacology". Any major pharmacy would stock these. The purpose of the wafers is two-fold: (1) They may be used as-needed for anticipatory anxiety (or during a panic attack), and (2) To aid in the discontinuation of the tablets. I wasn't aware that the tablet form is available in dosages under 0.5 mg, but that is good to know.
He likely knows that titrating Klonopin via water doesn't actually work, although I doubt that he'd admit it. I think his main goal is to take your money, and get you out of his office ASAP. Many doctors will attribute symptoms to those of a purely psychogenic origin, and are inclined to let the patient govern his own treatment (placebo effect). Sometimes, that isn't a bad idea (particularly if it works). It is a bad idea, however, when dealing with Benzodiazepines, as there are risks involved. He probably figures at your dosage, there is no risk. If you were on a higher dosage (say, 1-2 mg daily), I believe he would've handled your case differently.
I would find another doctor, but before I did, I'd let this one have it. You have a few days to arm yourself with some information. I would inquire about the 1/8 (0.125 mg) wafers, as well as the validity of the "water titration method". I believe you already have the information about the wafers from your pharmacy.
1,4 Benzodiazepines, such as Clonazepam, are not water soluble. The only Benzodiazepine that is water soluble is Versed (Midazolam), which is used in hospitals only, as a pre-medicant. All of the others are insoluble in water.
Below are some links:
http://www.rocheusa.com/products/klonopin/
This is the prescribing information for Klonopin and Klonopin Wafers. This proves that the wafers exist (just in case there is any doubt)
http://www.rocheusa.com/Programs/MSDS/Klonopin/KlonopinTablets0.5mgMSDS.pdf
This is the MSDS sheet for Klonopin, outlining each individual ingredient. None of the ingredients listed is soluble in water.
http://www.roche-australia.com/downloads/rivotril-pi.cfm?action=get
This one is the prescribing information for Rivotril (same as Klonopin/Clonazepam). Under description, it clearly states that Clonazepam is not water soluble.
http://www.bcnc.org.uk/water_titration_method.html
This one describes the water titration method. Note the following passage in quotations below:
"I am unsure of the distribution of benzodiazepine's in water. They are not water soluble as such they are fat soluble drugs so whether they accumulate at the top or sink to the bottom I am unsure. I did make enquiries with pharmacists but unfortunately they could not provide this kind of information relating to benzodiazepines and their solubility in water."
When the inventor of the method is unsure himself, that's a major problem. To promote a method that is flawed to a public audience is an even bigger problem. However, the info on Diazepam is all true.
I will try to obtain more comprehensive answers for you, but these should be a good starting point.
Ryan
“The mere fact that he wasn't aware of the existence of Klonopin (and generic Clonazepam) wafers is disturbing, particularly given the fact that he is the "director of pharmacology". Any major pharmacy would stock these. The purpose of the wafers is two-fold: (1) They may be used as-needed for anticipatory anxiety (or during a panic attack), and (2) To aid in the discontinuation of the tablets. I wasn't aware that the tablet form is available in dosages under 0.5 mg, but that is good to know.”
^End quote
I couldn’t agree more. He, believe it or not is highly recommended and this scares me. As for the tablet, I am pretty sure there is a lower dose in a tablet form unless I am mistaking. The pharmacist gave me an information sheet that reads exactly like this:
# Drug Description
1 Clonazepam 0.5 MG Tablet APO
2 Clonazepam 0.5 MG Tablet IVX
3 Clonazepam 0.25 MG DIS TAB PAR
4 Clonazepam 0.25 MG DIS TABLBRR
5 Clonazepam 0.5 MG DIS TABLEBRR
6 Clonazepam 0.125 MG DIS TABPAR
7 Clonazepam 1 MG DIS TABLET PAR
8 Clonazepam 0.5 MG DIS TAB PAR
Now what the above info means, I have no idea. Also thanks for the link; I will be bringing this to his attention. My wife is actually coming with me so there is no police activity - LOL. I am sick of getting jerked around by these doctors.
Thanks Again
Dominick
Another point to discuss w/ your doctor is the "accuracy" of the method. Simple ask how you are supposed to obtain the required precision of measurement when the instruments (measuring cylinder or syringe) have a high error associated w/ them; take it from someone with a PhD in chemistry, 14 years experience, and over 5 years teaching gen chem and organic chemistry. Then of course bring up the fact klonopin (and the inactive ingredients) is insoluble in water - this makes it impossible to obtain a uniform suspension which makes the method even more inaccurate.
Finally, Ryan wrote:
"He likely knows that titrating Klonopin via water doesn't actually work, although I doubt that he'd admit it. I think his main goal is to take your money, and get you out of his office ASAP"
I agree with part of this statement - the psychiatrist is probably just out to get your money. In terms of him "knowing" the water titration method doesn't work? This is debatable.... he didn't know what dosings of klonopin were available which leads me to believe he isnt as intelligent/book smart as one might assume.
In plain English means:
These are the orally disintegrating tablets (wafers), made by PAR Pharmaceuticals. 1/8 of a milligram.
mark
And I wasn't judging you by any means. I don't judge anyone unless they really do something terrible, like deliberately hurt another person or something similar. I understand that you were only trying to help a very terrible problem. I'm glad to hear you managed to stop smoking and drinking and taking diet pills. To me, that shows you're very strong and can overcome this latest problem, too. It might be hard, but I have no doubt stopping smoking and drinking is very, very hard. If you can do that, you can do just about anything. I wish you the best.
The major problem is that you are taking the Klonopin once daily, and have done so daily over a prolonged period (over 4 months, if I'm not mistaken).
The issue with Klonopin, when it is dosed once daily, is lack of efficacy. In other words, the effects of the drug wear off after 12 hours. After 12-18 hours, withdrawal symptoms manifest.
You see, Klonopin relies on the prinicipals of steady-state and accumulation. It is dosed two to three times daily. When dosed at least twice daily, it reaches steady-state and accumulates. Since you have been taking it only once daily, there is no accumulation level in your blood plasma to subtract from. This makes it more difficult to withdrawal from Klonopin. When the plasma level is decreased very slowly, the chances of withdrawal pheomena are reduced or prevented entirely.
There are two good options:
(1) Speak with the doctor about implementing the Klonopin at a dosage of 0.25 mg twice daily. The benefits will be reached in two weeks, and full accumulation will take place after one month. This will make it much easier to withdrawal from, as you will have a plasma accumulation to gradually subtract from. Currently, you don't have a plasma level. What you have is a peak and trough in the plasma level, and that's no good. There is a two-week adjustment period with this dosing schedule. The taper can be initiated after one month.
(2) Speak with the dcotor about implementing Valium (Diazepam) at a dosage of 5 mg, twice daily. Valium's active metabolite Desmethyldiazepam reaches steady-state in one month. Valium is easier to withdrawal from. Since you never took Klonopin daily, there should be little issue converting directly to Valium at the stated dosage. This is the best option in my opinion.
At any rate, establishing an accumulation is key. Once an accumulation level is established, the level may be subtracted from very slowly.
Good luck to you.
Ryan
As for now, I have been having a really hard time breathing everyday since my Panic Attack a week ago. Do you recommend that I go up to .375MG until I see him, because I have a huge project at work coming up and I need to start prepping for this tomorrow?
Also, I heard that Valium is the worse thing to take. I brought it up to my doctor and all she said was “well I wouldn’t recommend that because back in the 60’s people had an extremely difficult time coming off that stuff.”
Thanks Again
Dominick
I know you came off the Klonopin, but are you on any other benzo and if so do you like that one better and what is it. I need to get off this stuff.
Thanks
Dominick