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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 11 of 11. This is the beginning of the thread.
Posted by numbers on September 11, 2000, at 1:05:40
Hi all. Sure glad I found this forum and hope somebody can help me. I've been on 1 mg of Klonopin daily for years (6-7). It has controlled what was diagnosed as GAD. For all these years, I've taken it every night and have never had to increase or change. Sometimes, I would forget to take it and would realize it the next night (i.e., 48 hours between doses) and never had a problem. 3 weeks ago, literally overnight, what was working fine for almost 48 hours wouldn't last 12 hours. I started having severe withdrawal symptoms after about 10 hours. I have increased the dose to 1.5 mg with my docs OK but that also only lasts for about 10 hours. Suddenly, I'm looking at going from 1 mg to 3-4 in a 24 period to stay at therapuetic effect. Something is terribly wrong. I had a complete physical done to see if there was some physiological problem and there is not. I've been trying to get by on 1.5 to 2 mg per day for the last 3 weeks but withdrawal symptoms are getting worse. I am at a loss as to what is going on or what to do. Unfortunately, so is my pdoc. He wants to put me on an SSRI. I don't want one. I've come to the conclusion I have to get off this benzo but don't know how to start or how to deal with the withdrawal symptoms. I have trouble sleeping with the Klonopin; without it, I'm in deep doo-doo. Someone help. Someone else here must have been in this situation before. What did you do? Please help. I feel like my life has just taken a big, big hit and I'm sinking fast. Thanks for any help you can give me.
Posted by stjames on September 11, 2000, at 1:28:31
In reply to Newbie to this forum that is drowning, posted by numbers on September 11, 2000, at 1:05:40
You should try an antidepressant.
james
Posted by Rick on September 11, 2000, at 4:33:24
In reply to Newbie to this forum that is drowning, posted by numbers on September 11, 2000, at 1:05:40
> Hi all. Sure glad I found this forum and hope somebody can help me. I've been on 1 mg of Klonopin daily for years (6-7). It has controlled what was diagnosed as GAD. For all these years, I've taken it every night and have never had to increase or change. Sometimes, I would forget to take it and would realize it the next night (i.e., 48 hours between doses) and never had a problem. 3 weeks ago, literally overnight, what was working fine for almost 48 hours wouldn't last 12 hours. I started having severe withdrawal symptoms after about 10 hours. I have increased the dose to 1.5 mg with my docs OK but that also only lasts for about 10 hours. Suddenly, I'm looking at going from 1 mg to 3-4 in a 24 period to stay at therapuetic effect. Something is terribly wrong. I had a complete physical done to see if there was some physiological problem and there is not. I've been trying to get by on 1.5 to 2 mg per day for the last 3 weeks but withdrawal symptoms are getting worse. I am at a loss as to what is going on or what to do. Unfortunately, so is my pdoc. He wants to put me on an SSRI. I don't want one. I've come to the conclusion I have to get off this benzo but don't know how to start or how to deal with the withdrawal symptoms. I have trouble sleeping with the Klonopin; without it, I'm in deep doo-doo. Someone help. Someone else here must have been in this situation before. What did you do? Please help. I feel like my life has just taken a big, big hit and I'm sinking fast. Thanks for any help you can give me.
Numbers, what are your symptoms? Given your low dosage of Klonopin, and the fact that you did not reduce it, this is likely not withdrawal at all, but a new manifestation of anxiety or depression.
In fact, there is some belief that Klonopin usage can lead to depression in certain susceptible individuals, but a causal relationship has never been proven.Could it be tolerance? Well, while some people do develop tolerance to a benzo, it tends to be a gradual process, not as sudden and extreme as what you're experiencing.
Instead of taking more daily Klonopin, did you first try spreading the 1 mg through the day (1.5 might be more realistic here), instead of taking it all at bedtime? In fact, if it has been creating sleeping difficulties for you, why do you continue to take it at bedtime? When I took some at bedtime, it always made me a little groggy the next day. No such problem when taken at, say, 8 a.m., 2 p.m., and 6 p.m.
Are you taking branded Klonopin or a generic? What other prescription meds, non-prescription meds, herbs or supplements (if any) are you taking? Has there been any change in your daily regimen over the last few months? Have you increased your alcohol consumption? Have you had a thyroid test? I can think of lots of other questions which could suggest possible sources of your dilemma, but your doctor should be asking these and others.
I know this may not be a comforting idea, but doctors can go through a battery of physical tests and fail to uncover a real (this does not have to mean "serious"!) problem. Recently, it took months for doctors to figure out the cause of my boss's sudden, intense lethargy and physical/mental weakness: He had walking pneumonia. (They honed in on the problem just as he was finally feeling better!)
Regardless, I agree with St. James that you should take an antidepressant. Effexor-XR (essentially an SSRI at lower doses) would seem to make a lot of sense (but with careful monitoring if you have high blood pressure), because it has proven extremely effective and fast-acting for GAD at low doses, and is a good antidepressant. It is also reported to work quicker than other AD's on panic. Effexor CAN cause withdrawal problems when discontinued, especially without a gradual weaning-off.
Serzone, which is not an SSRI (although related) has also been shown to work well and quickly for many GAD sufferers, and tends to be a good choice for anxious depression. Moreover, it lacks the sexual dysfunction frequently seen with SSRI's and Effexor. But you mst remember to take it twice a day.
Hang in there. I know it's very difficult for you, but keep telling yourself to relax. Try to keep in mind that it may be quick, or it may take a little longer, but you'll get through this.
Rick
Posted by Cam W. on September 11, 2000, at 7:13:29
In reply to Re: Newbie to this forum that is drowning, posted by Rick on September 11, 2000, at 4:33:24
Numbers - As above, low dose Effexor (18.375mg - half of a 37.5mg tab or cap) daily can help many with GAD. This doesn't sound like benzodiazepine withdrawl to me (although I have been wrong in the past). Why the aversion to SSRIs? They may really help in a situation like this.
2¢ - Cam
Posted by stjames on September 11, 2000, at 21:15:59
In reply to Re: Newbie to this forum that is drowning, posted by Rick on September 11, 2000, at 4:33:24
James here....
Rick makes a really good point about generic or branded
Klonipin. If you are taking generic the actual manufacture
varies. You might want to try the brand or ask your Rx if they
switched to a different manufacture for the generic reciently.
Some are sensitive to the slight difference of drand vs generic.james
Posted by numbers on September 11, 2000, at 23:00:08
In reply to Re: Newbie to this forum that is drowning, posted by stjames on September 11, 2000, at 21:15:59
I want to thank James, Rick, and Cam for responding with the useful info. My brain wasn't functioning very well last night when I posted my original message. I was really in the hurt-bag. I don't exactly know why but am much better tonight and have not taken a Klonopin since last night. Let me give you guys some more info and answer some of Rick's questions.
My symptoms: I have withdrawn from short-acting benzos twice before because they just were not working; they were too short-acting. These were Xanax and Serax and it was several years ago but I remember well what it was like coming off them. It starts with sweating hands and feet for 24-48 hours; then my stomach starts to knot up, my brain gets fuzzy, I can't concentrate, and I feel like if I don't take another benzo pill I'm going to die. After stopping Xanax and Serax I tried some tri-cyclics but they just didn't work so I tried a long-acting benzo. The first one was Centrax and I was on 10 mg per day for 2-3 years when the FDA shut down the Parke-
Davis manufacturing plant in Puerto Rico and and P-D wasn't selling enough to justify the cost of complying with FDA requirements so they stopped selling Centrax (prazepam). I then went to the next longest benzo, Klonopin, and have been on 1 mg per day ever since with no problems. It must be 5 or 6 years that I've been on Klonopin. 3 weeks ago on a Saturday night while watching TV I noticed my hands and feet were sweating for no reason. I was astounded because I knew from past experience that was a symptom of benzo withdrawal but I had no anziety symptoms and the Klonopin seemed to be working fine like it had for years. The sweating continued through Sunday and into Monday. Then Monday afternoon the next stage of withdrawal-like symptoms hit me; i.e., a craving for the benzo that was no longer in my system, knotted stomach, fuzzy head, couldn't focus or concentrate. I called my psych doc's nurse and told her to give him the message about what was happening, that I was going to move up to 1.5 mg and would get an appointment to see him in a couple days. I took the 1.5 mg late Monday afternoon and felt fine again and assumed I had to now go to 1.5 mg and it would last for up to 48 hours just like 1 mg always had. Still no anxiety symptoms. About 10 years later I couldn't believe what was happening because I could tell the the med was wearing off. I was absolutely blown away. I still had no anxiety symptoms. Withdrawal symptoms, but no anxiety symptoms. It then hit me that I was in deep doo-doo. Given what I was experiencing, I knew I would have to take at least 3 and maybe more Klonopin to get through 24 hours when the day before 1 mg was lasting 48 hours. That is when my anxiety level started to escalate big-time. I didn't know what was going on but I knew something was very wrong if I have to take 3-4 times the benzo dose I was taking just the previous day. I know what it's like to come off these things (not easy) and there was no way I was just going to start taking 3-4 times the dose I was at the previous day. I have experienced anxiety symptoms and benzo withdrawal symptoms and these were benzo withdrawal symptoms initially. Then, after I realized I was in serious trouble with this benzo, my anxiety kicked in. Over the past 3 weeks I have tried everything, highrer doses, speading the doses, nothing worked accept higher and more frequent doses of Klonopin. I couldn't believe what was happening to me, literally over night.Branded Klonopin: Yes.
No other prescription meds but lots of vitamins and amino acids for an allergy therapy protocol I'm on but I've been on the same regimen for over 3 years with the vitamins without any problems.
Alcohol consumption: none, I don't drink.
Thyroid test: Yes, but don't have the results yet. I've had several of them in the past and they have all been normal.
Why the aversion to SSRI's? Because I read the PDR on these meds and am not impressed with the list of side effects. I'm in my early 50s and my wife and I have a very good sex life and I don't want to destroy it with
SSRIs.I'm not sure why I'm feeling better today but I am even though I haven't taken a benzo in 24 hours. I started taking SAM-e a week ago; maybe it's working.
Sleeping: Klonopin does not interfere with my sleep which is why I take it at night. My wording of my post in that regard was really screwed up. Having said that, I have always been a "night owl". I sleep fine once I get to sleep but find it difficult to get to sleep before 1-2 in the morning. Of course, since my anxiety meter has blown a gasket over this Klonopin situation, I'm not sleeping well at all and need to get something for that. I do feel better tonight though, and 25 mg of Benedryl (an antihistamine) may do the trick for me. It always has in the past when I have used it to get to sleep.
The more I have reflected on what you guys have posted, I think I better see my psychologist (not the same guy I get the Klonopin from) for some counseling on this. I'm thinking you guys are right. This has to be some break-through anxiety/depression cause. It's just not logical that I would have to go from 1 mg to 3-4 virtually overnight due to a physiological problem. Time for some counseling and adding a low dose anti-depressant. Thanks again for the info. Any other suggestions?
Posted by stjames on September 12, 2000, at 1:24:37
In reply to Re: Newbie to this forum that is drowning, posted by numbers on September 11, 2000, at 23:00:08
SSRI's are very sucessful for many people and for
anxiety. Don't know what you are reading but they are
very sucessful for many. You will not know till you try
and you can stop if you don't like them. It does not
seem logical to summarly dismiss very efective meds
w/o a trial because some have problems.james
Posted by Rick on September 12, 2000, at 3:32:41
In reply to Re: Newbie to this forum that is drowning, posted by numbers on September 11, 2000, at 23:00:08
> I want to thank James, Rick, and Cam for responding with the useful info. My brain wasn't functioning very well last night when I posted my original message. I was really in the hurt-bag. I don't exactly know why but am much better tonight and have not taken a Klonopin since last night. Let me give you guys some more info and answer some of Rick's questions.
>
> My symptoms: I have withdrawn from short-acting benzos twice before because they just were not working; they were too short-acting. These were Xanax and Serax and it was several years ago but I remember well what it was like coming off them. It starts with sweating hands and feet for 24-48 hours; then my stomach starts to knot up, my brain gets fuzzy, I can't concentrate, and I feel like if I don't take another benzo pill I'm going to die. After stopping Xanax and Serax I tried some tri-cyclics but they just didn't work so I tried a long-acting benzo. The first one was Centrax and I was on 10 mg per day for 2-3 years when the FDA shut down the Parke-
> Davis manufacturing plant in Puerto Rico and and P-D wasn't selling enough to justify the cost of complying with FDA requirements so they stopped selling Centrax (prazepam). I then went to the next longest benzo, Klonopin, and have been on 1 mg per day ever since with no problems. It must be 5 or 6 years that I've been on Klonopin. 3 weeks ago on a Saturday night while watching TV I noticed my hands and feet were sweating for no reason. I was astounded because I knew from past experience that was a symptom of benzo withdrawal but I had no anziety symptoms and the Klonopin seemed to be working fine like it had for years. The sweating continued through Sunday and into Monday. Then Monday afternoon the next stage of withdrawal-like symptoms hit me; i.e., a craving for the benzo that was no longer in my system, knotted stomach, fuzzy head, couldn't focus or concentrate. I called my psych doc's nurse and told her to give him the message about what was happening, that I was going to move up to 1.5 mg and would get an appointment to see him in a couple days. I took the 1.5 mg late Monday afternoon and felt fine again and assumed I had to now go to 1.5 mg and it would last for up to 48 hours just like 1 mg always had. Still no anxiety symptoms. About 10 years later I couldn't believe what was happening because I could tell the the med was wearing off. I was absolutely blown away. I still had no anxiety symptoms. Withdrawal symptoms, but no anxiety symptoms. It then hit me that I was in deep doo-doo. Given what I was experiencing, I knew I would have to take at least 3 and maybe more Klonopin to get through 24 hours when the day before 1 mg was lasting 48 hours. That is when my anxiety level started to escalate big-time. I didn't know what was going on but I knew something was very wrong if I have to take 3-4 times the benzo dose I was taking just the previous day. I know what it's like to come off these things (not easy) and there was no way I was just going to start taking 3-4 times the dose I was at the previous day. I have experienced anxiety symptoms and benzo withdrawal symptoms and these were benzo withdrawal symptoms initially. Then, after I realized I was in serious trouble with this benzo, my anxiety kicked in. Over the past 3 weeks I have tried everything, highrer doses, speading the doses, nothing worked accept higher and more frequent doses of Klonopin. I couldn't believe what was happening to me, literally over night.
>
> Branded Klonopin: Yes.
>
> No other prescription meds but lots of vitamins and amino acids for an allergy therapy protocol I'm on but I've been on the same regimen for over 3 years with the vitamins without any problems.
>
> Alcohol consumption: none, I don't drink.
>
> Thyroid test: Yes, but don't have the results yet. I've had several of them in the past and they have all been normal.
>
> Why the aversion to SSRI's? Because I read the PDR on these meds and am not impressed with the list of side effects. I'm in my early 50s and my wife and I have a very good sex life and I don't want to destroy it with
> SSRIs.
>
> I'm not sure why I'm feeling better today but I am even though I haven't taken a benzo in 24 hours. I started taking SAM-e a week ago; maybe it's working.
>
> Sleeping: Klonopin does not interfere with my sleep which is why I take it at night. My wording of my post in that regard was really screwed up. Having said that, I have always been a "night owl". I sleep fine once I get to sleep but find it difficult to get to sleep before 1-2 in the morning. Of course, since my anxiety meter has blown a gasket over this Klonopin situation, I'm not sleeping well at all and need to get something for that. I do feel better tonight though, and 25 mg of Benedryl (an antihistamine) may do the trick for me. It always has in the past when I have used it to get to sleep.
>
> The more I have reflected on what you guys have posted, I think I better see my psychologist (not the same guy I get the Klonopin from) for some counseling on this. I'm thinking you guys are right. This has to be some break-through anxiety/depression cause. It's just not logical that I would have to go from 1 mg to 3-4 virtually overnight due to a physiological problem. Time for some counseling and adding a low dose anti-depressant. Thanks again for the info. Any other suggestions?
Glad you're feeling better!One quick thought: I've read that SamE is believed to increase dopamine levels. Dopaminergic
agents often worsen anxiety, especially until your body adjusts. I know that when I tried selegiline and later Wellbutrin, I ended up moderately increasing my Klonopin dosage each time, and then was able to lower it back down when I quit the dopaminergic meds because they continued to make me too on-edge (even though they were both beneficial in terms of cognition and alertness). I don't think there's been much study on SamE's potential interaction and safety profile in tandem with synthetic meds. Maybe you were suffering an initial anxious reaction to SamE, similar to the paradoxical reactions that can often occur in the initial days on SSRI's. I know that Celexa made my Klonopin feel as if it had totally pooped out during the fist week, but later allowed me to DECREASEmy pre-Celexa dose of Klonopin.By the way, Serzone, which is often great for anxiety, rarely causes sexual problems. For me it actually *increses* sex drive and performance. (I'm currently taking it with my mainstay Klonopin, as well as Provigil, all for Social Anxiety. BTW, some believe Serzone may increase blood levels of Klonopin as it does to Xanax, although this is just conjecture.) And, at the low doses Cam suggested, Effexor is less likely to cause sexual problems than at the much-higher doses often used for depression.
Rick
Posted by numbers on September 13, 2000, at 17:48:32
In reply to Re: Newbie to this forum that is drowning, posted by stjames on September 12, 2000, at 1:24:37
I'm reading the PDR (Physician's Desk Reference) which is the Bible regarding prescription medication of any kind. If you read the side effects associated with SSRIs, it will scare the hell out of you.
I got a trial pack of Serzone from my doc and took 50 mg last night. Big mistake. I woke up at 3:00 AM after about 4 hours sleep and couldn't go back to sleep.
Side effects from 50 mgs: anxiety, insomnia, and an allergic reaction. I don't know how long it takes for this stuff to clear out of your body but it is now 19 hours since I took the 50 mgs and I feel worse than I've felt in since the worst days of my anxiety 2 weeks ago.
Conclusion: the cure is worse than the disease.
Posted by Cindy W on September 14, 2000, at 9:52:51
In reply to Re: Newbie to this forum that is drowning, posted by numbers on September 13, 2000, at 17:48:32
> I'm reading the PDR (Physician's Desk Reference) which is the Bible regarding prescription medication of any kind. If you read the side effects associated with SSRIs, it will scare the hell out of you.
>
> I got a trial pack of Serzone from my doc and took 50 mg last night. Big mistake. I woke up at 3:00 AM after about 4 hours sleep and couldn't go back to sleep.
>
> Side effects from 50 mgs: anxiety, insomnia, and an allergic reaction. I don't know how long it takes for this stuff to clear out of your body but it is now 19 hours since I took the 50 mgs and I feel worse than I've felt in since the worst days of my anxiety 2 weeks ago.
>
> Conclusion: the cure is worse than the disease.numbers, I take Serzone at night...to help me sleep. Talk to your pdoc before you decide to stop taking it. It took me a couple of weeks to adjust to some of the stuff it did at first (nervousness, mood swings) but once they disappeared, it really made me feel much better. So talk to your pdoc, and good luck to you!--Cindy W
Posted by Rick on September 22, 2000, at 2:55:04
In reply to Re: Newbie to this forum that is drowning, posted by numbers on September 13, 2000, at 17:48:32
Numbers --
First of all, the PDR is full of side effects that hardly anyone gets. And people who do get side effects don't usually get more than a couple of them. Conversely, to be fair, frequency of some of the side effects is understated; for AD's this would include notably sexual dysfuntion (but NOT for Serzone, Wellbutrin, or Remeron) and withdrawal (Paxil and Effexor).
BUT...as I believe I mentioned before, anxiety-relieving AD's often paradoxically INCREASE anxiety for anywhere from a few days to a few weeks. Fatigue can take anywhere from a weeek to a month to completely subside, but the first few days after starting or increasing dosage is usually the worst. But, over the long haul, you could be very glad you stuck it out! I recall that during the second-to-fourth days of my Celexa trial, I was more anxious than I had been since starting Klonopin a year earlier. After that, the added anxiety completely disappeared. I eventually replaced the Celexa with Serzone in a successful attempt to find greater efficacy and also ditch the moderate sexual dysfunction I was experiencing (that's one side effect that can tend to hang around).
Rick
> I'm reading the PDR (Physician's Desk Reference) which is the Bible regarding prescription medication of any kind. If you read the side effects associated with SSRIs, it will scare the hell out of you.
>
> I got a trial pack of Serzone from my doc and took 50 mg last night. Big mistake. I woke up at 3:00 AM after about 4 hours sleep and couldn't go back to sleep.
>
> Side effects from 50 mgs: anxiety, insomnia, and an allergic reaction. I don't know how long it takes for this stuff to clear out of your body but it is now 19 hours since I took the 50 mgs and I feel worse than I've felt in since the worst days of my anxiety 2 weeks ago.
>
> Conclusion: the cure is worse than the disease.
This is the end of the thread.
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