Clonazepam and Panic Disorder

Dr. Gould,

I have been on 1 mg bid of clonazepam for 11 years now for extreme panic disorder which has worked wonderfully for me.  If an attack was coming on, I could feel it, but it wouldn't break through.  This has been a wonder drug for me that gave my life back.  I have no side effects - it just makes me feel normal again.  Beforehand, I tried SSRIs (Prozac and Paxil) which made me sick.

A few weeks ago, I had heightened anxiety for some reason (maybe peri-menopause - I'm 42) allowing attacks to break through.  My new doctor (who is opposed to benzos lumping them all as bad) increased my dose to 1.5 mgs bid, wanted to add Paxil CR, then wean off Clonazepam.   I took one 12.5 dose of Paxil CR, and it made me very ill, so I opted to not take any more. It was like ingesting poison, and have been too nervous to go back to him as he'll try to get me to take another SSRI or stop my Clonazepam rx.  I would much rather stay on Clonazepam which was the med "for me".

There is so much controversy on the tolerance issue with Clonazepam and I wanted your opinion on it, please.  I thought if it was a tolerance issue, it would have happened before 11 years.  The doctor that originally put me on it said I would not develop a tolerance to Clonazepam, and he specialized in panic disorder.

Also, do you consider my dose of 2.5 mgs per day to be excessive?  Between that and the tolerance issue, this has exacerbated my anxiety with worry.  If I decide to wean back down to my maintenance dose of 2mgs per day, can you offer me a safe way of doing so?

Thanks in advance.

[Roger Gould, M.D.]

I favor clonazepam, and do not believe it is a tolerance effect, its just that sometimes you are more anxious than other times because of what is going on in your life. That said, occasionally increasing the dose and then lowering it back to  baseline is an easy way to handle that, and does not require any weaning off schedule.

[Pa1965]

Thank you so much.  This is great to know.  I feel much better and your reply is very much appreciated.