SSRI's - Klonopin & Weaning

[Sozo]

Hi Dr. Gould,

First, thank you for providing the invaluable information on this web site.

I'm a 45 year old male in average physical condition. 6' - 175lbs
My quick history - In January I began having major panic and major anxiety attacks. During the prior two years I was self medicating (heavily) with alcohol with the average of 3-4 glasses of scotch per night after work and on each weeked evening. Although I have had minor panic attacks off and on for the past 20 years I had never experienced anxiety and panic to this degree.

I went to my family DR. and he prescribed Zoloft. I began taking Zoloft the same day and my Dr. left for a three week vacation the following day. Over the next week I feel into a deep depression and my anxiety went through the roof. I even experienced hallucinations at one point. I called the Dr's office and his staff told me that the meds were not causing any of these conditions and to continue taking the meds or I would likely get worse. After two weeks of pure hell I was able to see a local psychiatrist who quickly switched me from Zoloft to Lexapro. Getting on Lexapro was a misearble experience, but it was better that my Zoloft experience so I stuck with it. It took me almost 5 months to fully metabolize the Lexapro (15 mg per day) which I stayed on for three years. During those three years I experience migrane headaches and occasional naseua.

I weaned off of Lexapro over a 7 week period (misery) and I was Lexapro free for 8 weeks. During the 8 weeks I was off I continued to experience mild depression and mild anxiety dizziness, headaches, etc. My psychiatrist (who turned out to be very inexperienced) told me that I was well past the withdrawal stage and what I was experiencing was my own chemical imbalance. He suggested that I get back on medication immediately. He prescibed Effexor this time around believing that I would experience fewer headaches...wrong. Not only did the headaches increase, but my anxiety went through the roof and I feel into the deepest depression I have ever experienced. I was at the point of suicide by day four so he swithced me back to Lexapro. I assumed (wrongly) that since I was on Lexapro in the past that getting back on this drug would be a walk in the park. Once again, my anxiety increase dramatically as did the depression. (Before I forget to mention it, I've never experience real depression until I started taking SSRI's). This particular Dr. told me to stick with it and that some people have a hard time getting on SSRI's.

I stayed on the Lexapro with no improvement for 3 months (missed a lot of work) before seeing another psychiatrist for a second opinion. Dr #3 instructed me to begin tapering off of the Lexapro immediately, saying that some people simply cannot properly metabolize SSRI's. He immediately prescribed Klonopin (1mg at bedtime). Once again I've been Lexapro free for 8 weeks now. I'm past most of the nasty withdrawals. I still have some headches and the anxiety is manageable, not fun, but manageable. I've been on 1mg of Klonopin for 11 weeks now. My Dr. suggested waiting until after the stress of the holidays before starting the weaning process. After my experience with SSRI's and all the horror stories I've hear about people trying to wean off of Klonopin it's got me very concerned and obviously anxious about staying on Klonopin any longer than necessary. Is 1mg that difficult to wean off of? Will staying on the Klonopin make it any more difficult to wean off than if I started now? What rate of weaning do you suggest?

The irony in all of this is that I was less anxious after weaning off of Lexapro the first time than I am now

[Sozo]

Thank you for putting my mind at ease about the Klonopin. I've been seeing a therapist for 8 weeks now. She's been great and I think we're well on the road to finding the root cause of my anxiety issues. I'm also working through the "Feeling Good" book and applying the CBT techniques daily as much as possible. I'm determined to get my life back! Thanks again!

- Jeff

[Roger Gould, M.D.]

First of all, you should know that klonopin is probably one of the best and safest drugs to be on for panic and anxiety, and it can be used safely for a long time at that dose. I suggest that instead of relying on drugs, you use this opportunity of relatively in control anxiety to start talking to a therapist about what you are really anxious about at this time in your life, and stay on the klonopin until you feel you are master in your own mind, and don't need the medication anymore.  If you are determined to get off of it, do it over 3 weeks, decreasing the dose and the intervals until you are taking the lowest dose every other day during the third week, before you stop altogether.

[Sozo]

To clairy the beginning of the message above. I began having major panic and major anxiety attacks. January of 2004