Clonazepam worries...please help!

Question

I've been on 2mg of Clonazepam per day (taken at bedtime) for treatment of mild/moderate anxiety for two years (going on three).  I've been considering going off the drug because of the sexual side of effects (lack of desire-orgasm).  I recently did some web research and that has frightened me about the drug and my doctor.  

I'm concerned that I'm dependent on the drug because it seems way stronger (and addictive) than I thought it was and, to make matters worse, it appears I've been on a high dosage (perhaps the top end of of the 'normal' range).  Withdrawal symptoms appear horrible and even include death for sudden withdrawal (when on high dosage--like me).

I'm concerned that my doctor is perhaps a bad doctor and that I should seek a new one.  I read that you should only be on Clonazepam short term and my doctor has had me on it for two years (going on three)!  I'm pretty confident this was good information because the article even quoted a study: "If used for antianxiety treatment: This drugs should not be taken for more than four weeks ( Yudofsky, Hales and Ferguson . )"

So to sum it up it seems my doctor prescribed me too much, too strong and for too long.  I can't really confront my doctor with this information as I cannot think of any way to present it that wouldn't put her on the defensive.  Please help!!

anxeffect · Answer

I mean klonopin should not be used for anxiety as the long term side effects include impaired motor function,cognitive decline,loss of libido,,memory loss..etc.Even Its offlabel use as a muscle relaxant and sleep inducer should not be encouraged as it is a highly potent anticonvulsant and can cause structural damage to the brain (it is a proved fact).even though  experts know all these they will never like to discuss the side effects with you.If you are not addicted to it,my advice is to go off it ASAP.Replace it with cardio vascualar activities like,running and breathing exercises(I have found running very effective,but if u have panic attacks slowly and steadily increase the speed as an elevated heart rate can bring about furthur panic symptoms..

I agree to paxiled that beta blocker works for anxiety caused by heart irregularities and not that great for clinical anxiety.It is not officially approved as an anxiolytic,however some betas like propanolol and all cross the blood brain barrier and affect central nervous system to reduce sympathetic activity and cardiac o/p as well.So it can be resorted towards the end stage of taperage to control mild anxiety...Hope i have made myself clear now..good luck

dancingheart · Answer

I agree with Paxiled... and I disagree with anxeffect.  I don't know what country you are from, but I feel sorry for you in a way. If you are suffering from severe anxiety it can be quite a relief.  I am on a Beta Blockers and I STILL SUFFER from the affects of that anxiety and panic has on my body including my heart.  The Clonazepam that was given to me was not just prescribed by my psychiatrist but was recommended by my cardiologist also.  How would you explain that one?  Sorry but I feel a bit defensive here..  My heart irregularities come from the panic and generalized anxiety that I fight with day to day.  Clonazepam just makes it a little easier for me.  I am not addicted as I can go without it!!! I just have to deal with more anxiety and more panic attacks.  If my Beta Blockers where made for this then they would have worked before this as I have been on them forever...even before I took Clonazepam.  Are you telling me that I abuse it and that my psychiatrist and cardiologist are not experts???... I'd like you to tell them that!  Sorry...

Paxiled · Answer

Klonopin isn't used for anxiety?  Gee, that's going to be a surprise to all of use who use it for anxiety!  And a betablocker only works for anxiety caused by heart irregularities and even then only for social anxieties usually.  They are not particularly effective for other kinds of panic attacks, though of course any individual is different from any other one.

anxeffect · Answer

First of all clonazepam is not used for anxiety treatments.In fact it is abused for anxiety and stress related problems(Even I had it on /off for shorter periods)  clonazepam(rivotril/epitril in my country) is used as the first line treatment for epilepsy/seizures and nt anxiety.But today world over people use it as an anti-anxylotic with/without properly consulting with experts.It can be tapered effectively substituting with a betablocker(atonolol) towards the end of taperage as betablockers are good for panic/anxiety/palpitations asit cuts the adrenaline/noradrenaline effect

pat608 · Answer

I have been on Klonopin for 10 years off and on.  I was pretty afraid at first, but after trying other things, I like it because I can take it if I need it and not if I don't.  I was on it for 2 years regularly then took myself off of it.  My Zoloft did a good enough job of controlling my symptoms. I take it pretty regularly now just to sleep, but in December had a few glasses of wine at a Christmas party, so skipped it and had no problem. I have read all the scary things also, and even had my alcoholic sister, while she was drunk, preach to me about how her counselor told her that I SHOULD NOT BE TAKING KLONOPIN.  My reply was, "Oh really? And did your counselor attend 8 years of medical school, then go on to specialize in Psychiatry? Because the doctor who prescribed it to me did"  I suppose it's like anything and can be abused, but it doesn't sound like that would be a problem for you.

dancingheart · Answer

Wellbutrin is not a medication that is really approved for anxiety.  In fact for most people I know, including myself, have actually experienced more anxiety.  I couldn't take it along with simular drugs Cymbalta, and Remeron. Any medicine for depression has the potential for sexual problem side effects.  Actually most drugs that affect the mental state have the potential to this side affect (including other meds. like sleeping meds, heart meds. and numerous others), it all depends on the individual.  

The best anti-depressants that work for anxiety control are Zoloft, Paxil, Paxil CR and Prozac.  Asked my psychiatrist and did quite a bit of study myself on this.

To Paxiled:  I agree with the sleep issue.  For me Clonazepam has worked for sleep, but because of the addictions that it carries it should not be used exclusively for that purpose, in most people.  I take it for sleep, because most of my anxiety happens within 2-3 hours after falling asleep and tachycardia wakes me up...and for me it gets my mind to shut down the adrenalin problem that causes my sleep issue.  I know that I can fall asleep without the Clonazepam, I just don't want to experience my heart issues that interrupt my sleep.  In some people Clonazepam can keep them awake... as that is one of the rarer side affects... especially if you are taking it for seizure controll and not for anxiety.  I take Chloral Hydrate for sleep... this can be addicting too... But I take it as needed and I will go many sleepless nights before I take it.  Remember all sleep meds including Ambien can be addictive.  But natural remedies are better...  Word of caution...if you are taking psych meds....do not take herbal supplements without talking to your doctor or pharmacist, Mixing can cause serious implications!

Paxiled · Answer

Careful with wellbutrin, it can cause anxiety.  Sometime it's used as a compliment to ssris to help with sexual function, but I'm not sure about adding it to a benzo.

To Nora:  Sedation isn't a sleep remedy.  For anxiety sufferers, sedation usually just brings us back to normal, it doesn't necessarily make us tired.  But it depends on the drug.  But because is sedating in the beginning doesn't mean it will stay so, you usually get used to them.  That's why they're not so hot for sleep.  GABA, again, while in a relaxed person would make them tired, in an anxious person it reduces the stress anxiety is putting on the person, so if it works, the person wouldn't necessarily feel tired for a long period of time, just at the beginning.  Just like many ssris or trycyclics are very sedating in the beginning, but aren't really a sleep remedy.  Sleep remedies should be occasional and mild until the person can get back to a normal rhythm.  My opinion, and this is just opinion, is that natural remedies should be used for sleep problems, not strong drugs that the person will develop a resistance to as a sleep aid.  Melatonin is a good one for some, and other herbs or foods high in tryptophane or many other techniques should be tried first and if that doesn't work, then go for the actual sleep remedies such as Ambien.  

What do you think?

tomandlis · Answer

Sorry, I meant to say taken MOSTLY at nighttime ( I take 1.5 mg at night and .5 in the morning)

I talked to my doctor and she suggested something similar to what you all have been saying: taper slowly over several months.  She is also having me switch to Wellbutrin and I begin the Wellbutrin ramp-up during my Clonazepam ramp-down period.  

This new script really I wonder if my doctor is just clueless: Wellbutrin doesn't make much sense to me as it seems to be for depression whereas I have high stress-anxiety, but I do like that it doesn't have sexual side effects.   http://en.wikipedia.org/wiki/Bupropion

It just seems like drugs aren't the answer.  Can't anxiety be cured?  Do I really need to take a pill all my life?   I think I'm going to look into non-drug therapies as drugs can't cure--only mask.

Some of you had questions above and here are some links that show what I'm talking about:

Here is the wiki for the drug which mentions the sexual side effects: http://en.wikipedia.org/wiki/Clonazepam

Here is a link to the place I found Yudofsky, Hales and Ferguson study first mentioned which indicated max 4 weeks when treating anxiety because of high addiction risk:
http://psyweb.com/Drughtm/jsp/klonopin.jsp

dancingheart · Answer

Hi, I have been on Clonazepam/Klonopin since 1996. I actually like the drug as I have tried many other benzos such as xanax and valium and they didn't work well for me. I have been on as little as .05 as needed to as high as 3 mg taken evenly throughout the day on a daily basis. I taper up and down...some days more some days less....more or less my psychiatrist lets me taper on my own depending on my needs. But he has taught me safe ways to do this. Normally I would divide the doses throughout the day...this is a standard way of taking it anyway, unless you are taking it on as an as needed basis. Normally you do not take more than 1 mg as one dosing or you'll "zonk" yourself out. Here is my current regimen .75 3x's a day that's 1 and 1/2 of .05mg tab. If during the day I feel too out of it and I am not anxious I will break my second half into a quarter pill...every other day I may break my morning as a quarter too. I try to take mine evenly throughout the day. 7:00 am, 2:30 pm, and at bedtime 9:00-10:30 pm. And yes, when my anxiety was bad I was taking it for just sleep...it has slowed down my nighttime wakeups with the bouts of tachycardia. My dreams are a little crazy though if I go higher at bedtime. Yes, Clonazepam is addictive and I have had some really nasty stuff happen to me that put me in the hospital when I thought I could just cut it all out in a week (I learned the hard way...but it was not life threatening...it maybe if you have epilepsy too, but I do not) Higher doses of over 2 mg, I have learned can take 3-6 months to wean off of and I have sucessfully done it 2 times before. So as for me not to get so addicted my body is used to different doses monthly and sometimes daily. I have not had any sexual problems on Clonazepam, it wasn't until 100 mg of Zoloft was added that I had troubles in this area...and the way I see it I am addicted more to the Zoloft than I am to the Clonazepam... I have tried to taper that many times and my panic and heart problems get worse and I can't function. Tapering the way that jakegorzen said in the above post above is about how I would do it...except I have to taper my afternoon dose up and down (depending if I am at home or out) as that is the one I have the most problem with when it comes to drowziness and anxiety... hard to choose between the two! I do most of my work and driving my car in the afternoon...so my dose is tailored daily to that days needs. Remember as you cut down you will have some break through anxiety, this is common, I had to deal with it too, but it lessens. The longer you take to wean off it the less you will notice it. The pills can be cut off the score line, a very sharp paring knife will yield the best results, at getting the doses closer to even. I hope I have helped some...but as always remember it is always best to check with your doctor and have his/her help in the process. Best of luck...

nora006 · Answer

Paxiled Hi!:)

SOME of the benzos are actually indicated for sleep, they are classified as Hypnotica(means "sleep" in greek), and some of them of course also carries anticonvulsant and anxiolytic properties to some degree :) i.e Nitrazepam, Flunitrazepam and Temazepam and Midazolam... It depends on how strong affinity the drug has for binding to the benzodiazepine receptor site on the GABA A complex . High afffinity to the A1 is associated with strong sedative qualities. Clonazepam also modulates the GABAergic function on the A1 but not as strongly as the above-mentioned drugs. That's why sedation is common initially.

Well,
I sure know that I would be indifferent to any sexual desires after 2 mg clonazepam:)
Especially when it is taken only once per day. The rebound then occurs every night and 2 mg in one go is quite heavy. Strange choice of medicating clonazepam in the case of anxiety treatment if you ask me.


Nora

bosnianworrier · Answer

2 mg is not too high. Some people take it for many many years. Taper off slowly with your doctors supervision.

PS. How do you know it causes sexual side effxts? I never heared klonopin can do that.

treeman · Answer

hello.   I have been on this med for almost 17 years. I am on a lower dose .5 two times a day.  The only bad thing I have read is that it can be tough to quit without side effects. Hopefully someday I will be off of it.

Paxiled · Answer

You're not on a particularly high dosage, though it would usually be divided into twice a day.  Also, klonopin is fine for long term usage insofar as any drugs are fine for long-term usage.  I wouldn't taper without consulting a good psychiatrist, though one is very hard to find.  It can be difficult, and must be slowly done.  And you might find yourself with the same problem you had,  I also don't know why you would take any benzo at bedtime, they're for anxiety, not sleep.  I would also say if you don't trust your doctor, trust your instincts.  A bad one killed me.  Also, I don't know that benzos are that implicated in reduced sex drive; usually that's the antidepressants.

nora006 · Answer

I'm sorry that you have become frightened from reading negative stuff about the drug. The dosage is not THAT high, but somewhat higher than the "target dosage" for treating anxiety. And the only thing I do not understand is why the dosage was not divided into 2 or 3 in a day. You might have had just as good a therapeutic effect on smaller singular dosages administered at least every 12 hour.

This discussion might be of some interest to you:

http://www.medhelp.org/posts/Anxiety/Klonopin-dosage-anxiety/show/415660

Kind regards,
Nora

jakegorzen · Answer

Just tapre on your own, you dont need to tell the Doc.
If you tell the Doc all of this, he/she will most likely treat you like a idiot, thats because Doctors are the most egotistical people out there, if you question there diagnosis and prescriptions, they will feel that "you" think you know more then them..and most likely "punnish you" for you self diagnosis, or realization.


First off, you need to take the Klonopin the right way...2 MGs once daily is not the right way.
Cut the Dose in half and take 1 mg in the morning, then 1mg at night, it will take around 2 weeks to get stable, but trust me....after that you will probably feel better taking it like this, then how your Doctor prescribed it.

After you get stable, you will need to start to taper.

Cut you dose by 10%, so now you will be taking 1.8 mgs split it up twice daily again "0.9 mgs in morning, and at night"
Might be a little hard to drycut...You will definently need smaller pill sizes to reduce, 1/2 mgs and 1/4 mgs.

After you level off cut another 10% for 2 weeks, always taking your doses split up equal twice a day

Keep doing this until you reach 1/2 of your original dose and slow it down a bit, take atleast 3 weeks to get stable

slow down you taper and cuts when you get to the real low stuff "around .50mg"
Make your cuts by somewhere in the line of 5% instaed of 10%
The slower the better, it will take some time, so dont rush it.

You probably wont notice to much withdraw until you get to the lower doses, thats why I say take it slow.

Klonopin is actually prescribed for long term use, because its longer lasting compard to the other short life Benzos like Xanax, so atleast your not DT'n from the short lasting because Im sure you would be in more of a situation with those.

If you have any questions feel free to ask.
Good luck