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Dr. Bob is Robert Hsiung, MD,
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Posted by SLS on December 22, 2012, at 21:28:45
In reply to why some brains can withdraw and others not???, posted by gadchik on December 22, 2012, at 19:09:51
> I would like to know why some people can taper off klonopin, high dose,after years of use,and have no issue with it? Then others,such as me,have such a problem trying to taper down from a small dose. What is it about my brain vs the brain that doesnt experience withdrawal?
Would you consider using Trileptal (oxcarbazepine), an anticonvulsant, to help you discontinue Klonopin? I have no experience with this strategy myself, but their are anecdotes of its effectiveness.
http://www.ncbi.nlm.nih.gov/pubmed/18821451
Several years ago, I suggested that anticonvulsants might be helpful when it occurred to me that there could be a kindling process involved in BZD and SSRI/SNRI withdrawal
http://www.dr-bob.org/babble/wdrawl/20050214/msgs/460726.html
To answer your question, I don't know.
:-(
- Scott
Posted by Phillipa on December 22, 2012, at 21:39:28
In reply to Re: why some brains can withdraw and others not??? » gadchik, posted by SLS on December 22, 2012, at 21:28:45
My use just goes down as my body doesn't seem to need it. Same thing happened to next door neighbor. She completely got off SSRI's lexapro about three years ago and now her xanax is also going down as doesn't seem to need it also. I used to dicontinue when didn't feel a need for it and never any withdrawal. I did this for months at a time. Strange but before I had a computer I didn't know so just stopped a med and was fine. I think now that the stuff is on the internet people feel they can never live without a med again. Granted meds like synthroid are an exception. Phillipa
Posted by jono_in_adelaide on December 22, 2012, at 21:40:37
In reply to Re: clonazepam/Klonopin and HPA axis issues, posted by Beeb on December 22, 2012, at 17:08:42
Would starting an SSRI a few weeks before starting a slwo taper be of assistance if seretonin plays a part in the withdrawl syndrome?
It would certainly be worth a try
Posted by SLS on December 22, 2012, at 22:14:45
In reply to Re: clonazepam/Klonopin and HPA axis issues, posted by jono_in_adelaide on December 22, 2012, at 21:40:37
> Would starting an SSRI a few weeks before starting a slwo taper be of assistance if seretonin plays a part in the withdrawl syndrome?
>
> It would certainly be worth a tryI think glutamate is the culprit. However, your idea might still be helpful.
- Scott
Posted by gadchik on December 23, 2012, at 8:49:29
In reply to Re: why some brains can withdraw and others not??? » gadchik, posted by SLS on December 22, 2012, at 21:28:45
Scott, I read the link about oxcarbazepine.I would like to try that. Also, the mention of ssri due to serotonin, is interesting. I just havent told my pdoc,and I would need her for the oxcarbazepine. I guess when I get really fed up, I will tell her. Im afraid to even mention going off k,dont know why. I guess, I fear she would go way too fast for me,or Id go crazy w/o it,and she might decide I no longer need it. I did also read that melatonin helps. I guess it depends on your brain,and all are different. And, like Philippa said, when you dont need it, perhaps its easier,and also reading about the horror stories influences it.
Posted by jono_in_adelaide on December 23, 2012, at 16:06:53
In reply to Re: why some brains can withdraw and others not??? » SLS, posted by gadchik on December 23, 2012, at 8:49:29
The Ashton protocol is very good for benzo withdrawl, transfer from your current benzo to an equal dose of diazepam or chlordiazepaoxde (very long acting benzos) and reduce by 1mg of diazepam or 2.5mg of chlordiazepoxide every 1-2 weeks.....the body wont notice these timy steps down, and whitdrawl should be painles
Clonazepam is high potency, 1mg is = to 10-20mg of diazepam, so make sure you get the diazepam doseage high enough.
Adding an SSRI or mirtazapine should help with the underlying disorder (or an anti glutamate drug as SLS suggests, or even both!)
Posted by sigismund on December 23, 2012, at 17:30:47
In reply to Re: clonazepam/Klonopin and HPA axis issues » jono_in_adelaide, posted by SLS on December 22, 2012, at 22:14:45
>I think glutamate is the culprit
I recall a link with a claim that methadone could be withdrawn really quickly and painlessly with high dose memantine.
That would be glutamate related?
I was sceptical but interested.
Posted by rjlockhart37 on December 23, 2012, at 20:09:21
In reply to Re: why some brains can withdraw and others not??? » gadchik, posted by SLS on December 22, 2012, at 21:28:45
Not sure if this is a direct subject....but benzodiapine withdrawl....nuerontin is the "goldstandard" at least for me....when i went off xanax from 6mg daily...it was a taper...then they put me on Nuerontin 800mg X 4 daily. There's something else called Gabitril...but its complicated with some doctors...lastly lyrica would be an option since its similar to nuerontin.
Clonazepam depresses a certain serotonin receptor...ill have to pull the source up where I read it...but it deceases some kinda of nuerotranmitter....it can make you vary depressed...you might want to ask about lorazepam...a bit less potent than klono but hey....it defintly could help....it also is a vary good muscle relexant, it makes you loosened up both nerves and muscles...i took it in 2005 and went through lots of dosages. Xanax XR could be an option if your still wanting to stay on benzos...depakote, tegretol, trileptal, lamictal would be good choices to stop agitation from klono...there also is plant called Muscimol which ... i have no idea how to get a hold of it but it works on GABA too...muscle relexant too....
hope this helps!
r
Posted by SLS on December 23, 2012, at 21:21:14
In reply to Re: clonazepam/Klonopin and HPA axis issues » SLS, posted by sigismund on December 23, 2012, at 17:30:47
> >I think glutamate is the culprit
>
> I recall a link with a claim that methadone could be withdrawn really quickly and painlessly with high dose memantine.
>
> That would be glutamate related?Yes. Good thinking.
> I was sceptical but interested.That is interesting. Memantine is a sort of modulator of glutamate NMDA receptors. It blocks a portion of this receptor and reduces signaling. It might help reduce "background noise", but I am not sure. There are three other subtypes of glutamate receptor. I think drugs like Trileptal (oxcarbazepine) might work better than memantine because they squelch overactive glutamatergic circuits by blocking the sodium channels of those glutamate neurons that use these other three receptors.
I would not rule-out the possibility that memantine might be effective for methadone withdrawal. I don't know enough about it. I'll keep my eyes open for more information on this.
- Scott
Posted by Beeb on December 24, 2012, at 13:08:42
In reply to Re: why some brains can withdraw and others not???, posted by jono_in_adelaide on December 23, 2012, at 16:06:53
> The Ashton protocol is very good for benzo withdrawl, transfer from your current benzo to an equal dose of diazepam or chlordiazepaoxde (very long acting benzos) and reduce by 1mg of diazepam or 2.5mg of chlordiazepoxide every 1-2 weeks.....the body wont notice these timy steps down, and whitdrawl should be painles
>
> Clonazepam is high potency, 1mg is = to 10-20mg of diazepam, so make sure you get the diazepam doseage high enough.
>
> Adding an SSRI or mirtazapine should help with the underlying disorder (or an anti glutamate drug as SLS suggests, or even both!)The Ashton protocol is overrated.
It works for SOME people.
Diazepam is not a miracle drug. Some people just cannot tolerate it at all. Like me.It's also not unusual that people will notice every tiny cut and suffer. To taper that way for a long time ? But then, how would you know if they had done well if they had quit 'cold turkey' or if they had done a fast taper ?
Serotonin, norepinephrine, gaba, glutamate are are related/connected. If you affect one you affect the other.
I've seen anecdotal reports of success with anticonvulsants. In theory, starting an SSRI could help. But just as well they could make things worse.
Posted by Beeb on December 24, 2012, at 13:31:56
In reply to why some brains can withdraw and others not???, posted by gadchik on December 22, 2012, at 19:09:51
> I would like to know why some people can taper off klonopin, high dose,after years of use,and have no issue with it? Then others,such as me,have such a problem trying to taper down from a small dose. What is it about my brain vs the brain that doesnt experience withdrawal?
Impossible to say.
But perhaps your past use of Zoloft and Remeron plays a role. Usually, there are some long lasting changes after extended use of the drugs.
They act primarily on serotonin, but indirectly on other neurotransmitters as well.
Endocrine and thyroid function may also be affected.
Posted by Beeb on December 24, 2012, at 13:38:32
In reply to Re: clonazepam/Klonopin and HPA axis issues » Beeb, posted by gadchik on December 22, 2012, at 13:02:04
> Hello, Beeb. Im curious about these issues too. Ive also read that klonopin increases/decreases or just affects serotonin in some way. Ive taken it 4 years at .5mg nightime only.Ive felt the need to raise the dose lately,and I really dont want to. Ive tried to taper off,and its extremely difficult,for me. I havent been able to. And I did taper off of zoloft and remeron after 2 yrs of use. I hope someone can answer your ?s.
0.5 mg is not that much, but this is a potent drug. Do you take it for sleep ?
Have you considered just stopping the drug, and starting something else that works for you/is therapeutically effective ?
If you can't taper, stopping the drug and possibly starting something else seems worth considering.
Posted by Beeb on December 24, 2012, at 13:41:46
In reply to clonazepam/Klonopin and HPA axis issues, posted by Beeb on December 22, 2012, at 12:12:08
If someone has a response to my original question it would be much appreciated !
Posted by gadchik on December 24, 2012, at 14:53:44
In reply to Re: clonazepam/Klonopin and HPA axis issues, posted by Beeb on December 24, 2012, at 13:38:32
Beeb, Klonopin was just added to my original regimen,with the zoloft and remeron. I was able to taper two, but saved the klonopin for last, which may have been a misstake. At this point,I dont know whether Im taking it for sleep or anxiety. I just know that I function very well on .5mg of it. I also wonder if I might function very well without it. And yes, I sometimes think,just chuck it, and see what happens, that perhaps the tapering is just prolonging bad things. Yet,everything I read says DO NOT STOP COLD TURKEY!!! I believe your original ? got lost in the shuffle. I want to know those things too.
Posted by Beeb on December 24, 2012, at 15:23:20
In reply to Re: clonazepam/Klonopin and HPA axis issues » Beeb, posted by gadchik on December 24, 2012, at 14:53:44
> Beeb, Klonopin was just added to my original regimen,with the zoloft and remeron. I was able to taper two, but saved the klonopin for last, which may have been a misstake. At this point,I dont know whether Im taking it for sleep or anxiety. I just know that I function very well on .5mg of it. I also wonder if I might function very well without it. And yes, I sometimes think,just chuck it, and see what happens, that perhaps the tapering is just prolonging bad things. Yet,everything I read says DO NOT STOP COLD TURKEY!!! I believe your original ? got lost in the shuffle. I want to know those things too.
>
>About the 'DO NOT STOP COLD TURKEY':
0.5 mg isn't that much. There are some crazy ideas that a slower withdrawal is always better.
Prof. Ashton has quite a cult (?) following.
For some people withdrawal is easy, for a few it can be extremely hard. Fear is a poor guide.It may be quite responsible to just stop. Would you have to remain on it forever because you simply cannot taper ??
Sometimes I wonder if a taper doesn't cause sensitization and makes things worse.On the other hand, 4 years is a bit long.
I do not suggest you stop on your own. Discuss this with your doctor ? That's probably the best thing to do. Maybe you can switch to something else or take something that will ease withdrawal.
And yes, I'd like to get a response to my original question :)
Posted by gadchik on December 24, 2012, at 15:39:41
In reply to Re: clonazepam/Klonopin and HPA axis issues, posted by Beeb on December 24, 2012, at 15:23:20
I did get down to a very small amt of zoloft when tapering, and I read from somewhere that getting down to tiny amts just prolonged the withdrawal. So I just stopped,and that solved alot of issues. I do have an emotional attachment to this k. And wonder,if .5mg is even enough to treat an anxiety disorder.Oh well, I will revisit this tapering thing in the new year. I wish all a Merry Christmas!
Posted by jono_in_adelaide on December 24, 2012, at 17:45:45
In reply to Re: clonazepam/Klonopin and HPA axis issues, posted by Beeb on December 24, 2012, at 15:23:20
The slow taper is the best way of stopping if there is no rush, because it ensures there is no risk or discomfort.
If there is some pressing need then obvioudly one can quit more quickly, at the risk of suffering some withdrawl symptoms.
I'd suggest your inability to tolorate diazepam under any circumstances while gobbling down clonazepam like Elvis is most likely to be a hysterical reaction.
If you can find me one person taking 15mg of diazepam per day who can differentiate a 1mg drop in dose under blind conditions, then I'll beleive you, otherwise, I call b*llsh*t.
Posted by rjlockhart37 on December 24, 2012, at 20:35:51
In reply to Re: why some brains can withdraw and others not???, posted by rjlockhart37 on December 23, 2012, at 20:09:21
i read my post concering your post...i swear i could either rip my fingers off my hand or the frountal lobe out completly....i posted it the wrong way.
no what I ment, the medications that would help getting off klono depakote, tegretol, trileptal, lamictal....GABA agonists are a choice for this....getting off klono...it decreases certain serotonin stuff...it can make people depressed....check out betablockers for cotisol issues.
Posted by Beeb on December 25, 2012, at 5:05:18
In reply to Re: clonazepam/Klonopin and HPA axis issues, posted by jono_in_adelaide on December 24, 2012, at 17:45:45
> The slow taper is the best way of stopping if there is no rush, because it ensures there is no risk or discomfort.
>
> If there is some pressing need then obvioudly one can quit more quickly, at the risk of suffering some withdrawl symptoms.
>
> I'd suggest your inability to tolorate diazepam under any circumstances while gobbling down clonazepam like Elvis is most likely to be a hysterical reaction.
>
> If you can find me one person taking 15mg of diazepam per day who can differentiate a 1mg drop in dose under blind conditions, then I'll beleive you, otherwise, I call b*llsh*t.Part #1: 'The slow taper is the best way of stopping if there is no rush, because it ensures there is no risk or discomfort.'
That is so stupid. If that would work noone would ever suffer from withdrawal from a benzodiazepine following an Ashton style taper.
There are many people following exactly that kind of taper who are suffering greatly. Just look around on the internet. Easy.'I'd suggest your inability to tolorate diazepam under any circumstances while gobbling down clonazepam like Elvis is most likely to be a hysterical reaction.'
Are you doing your best to be rude or talk nonsense ?Please don't respond to my thread if you have nothing positive to contribute.
Posted by SLS on December 25, 2012, at 5:37:58
In reply to Re: repost, posted by rjlockhart37 on December 24, 2012, at 20:35:51
> no what I ment, the medications that would help getting off klono depakote, tegretol, trileptal, lamictal....GABA agonists
Those are all reasonable choices theoretically. Where did you find information regarding GABA agonists? What about Gabitril? The other drugs you mentioned are sodium channel inhibitors that reduce glutamatergic transmission. Depakote additionally inhibits GABA transaminase. I thought this property would make it an effective drug to aid in BZD withdrawals. However, I don't see much written about it. Someone here had some success discontinuing Klonopin using Trileptal. To my knowledge, Trileptal has no direct effects on GABA neurotransmission.
> ...getting off klono...it decreases certain serotonin stuff...
Do recall where you saw this? Some old studies reported that Klonopin reduced serotonin release.
> it can make people depressed....
I would say that this occurs in a sizeable proportion of people taking Klonopin. I am guessing that it is a minority, though. I wonder if this depressive reaction to Klonopin is significantly more common in people with underlying mood disorders.
- Scott
Posted by SLS on December 25, 2012, at 5:57:21
In reply to clonazepam/Klonopin and HPA axis issues, posted by Beeb on December 22, 2012, at 12:12:08
Hi Beeb.
I still can't answer your questions. I am not knowledgeable enough to impart to you any understandings that you don't already have. If no one here is able to address your post in its entirety, perhaps attacking one issue at a time would produce answers. It has been a long time since I took a look at CRH stuff. CRH receptor antagonists were thought to hold promise in treating depression. I once tried mifepristone. The protocol was to take it for 8 consecutive days and then sit back and wait for the depression to disappear. I felt "washed out" after completing the trial. It did not help with my non-psychotic depression, which is very likely bipolar in origin.
Some general mifepristone information:
http://www.eje-online.org/content/157/5/561.full
- Scott
Posted by SLS on December 25, 2012, at 5:59:04
In reply to Merry Christmas!, posted by gadchik on December 24, 2012, at 15:39:41
> I wish all a Merry Christmas!
Ditto!
- Scott
Posted by rjlockhart37 on December 25, 2012, at 20:42:57
In reply to Re: repost » rjlockhart37, posted by SLS on December 25, 2012, at 5:37:58
clonazpeam reduces the utilization of serotonin....i know that sounds wierd, but clonazepam itself does downgrade serotonin in some cases....i've read diffrent sources that are conflicting, but this came straight from medpedia
http://wiki.medpedia.com/Clonazepam
2nd paragraph end of the sentence...i again didnt think before i wrote...what i ment was klono makes the person depressed...and getting off it it would increase the release of sero....but also anxiety is associated with withdrawl...that's why sodium channel blockers would stop glumate release, even though like lamictal and trileptal are not GABA meds...they reduce the firing in the brain, calming it in a wierd manner....
Yes Gabatril....its a GABA reptake inhibtor, its vary good for siezures, and over active firing which could cause anixety from little GABA.
once source directly states depakote is effective...but the downside is that it was only 1 study...its not widely published that its effective.
http://clinicaltrials.gov/show/NCT00570219i ran across too...this is a big site on benzos....withdrawls
http://www.benzo.org.uk/manual/bzcha03.htm
"Several other drugs have been tested in clinical trials of benzodiazepine withdrawal to see if they could speed the process, prevent or alleviate withdrawal symptoms, or improve the long-term success rate. Many of these trials have involved what is considered here as over-rapid withdrawal. For example, a recent US study of benzodiazepine withdrawal in long-term users (Rickels, Schweizer et al. Psychopharmacology 141,1-5,1999) tested the effects of a sedative antidepressant (trazodone, Desyrel) and an anticonvulsant drug (sodium valproate, Depakote). "that site should help beeb too...
but to get back....you know lorazepam in my opinion is a bit better than klono beccause its used so widely in hospitals, psych wards, for agitated patients and its recorded that it work well...that's why they don't use xanax or klono when to sedate a violent patient, they use ativan. I think its a good benzo...but back to what i was saying....beeb should work with the doctor...its difficult to work with some, and persuation with difficult doctors is a good stradegy.
thanks scott....
r
Posted by Phillipa on December 26, 2012, at 18:02:48
In reply to Re: clonazepam/Klonopin and HPA axis issues » Beeb, posted by SLS on December 25, 2012, at 5:57:21
The abortion med? I was testing for Cushings with dexamethasone challenge test all was fine. When I tried klonopin it depressed me and taken off right away and back to xanax. So how does this correlate to withdrawal of konopin? And valium as takes a lot of valium to withdraw from klonopin. For someone on it a long time just wean off slowly. If you no longer need it. Phillipa
Posted by g_g_g_unit on December 27, 2012, at 8:50:27
In reply to clonazepam/Klonopin and HPA axis issues, posted by Beeb on December 22, 2012, at 12:12:08
Just wanted to say that I found your post interesting. I was trying 0.5mg of clonazepam as a sleep-aid for a little while in conjunction with various drugs and often could have sworn it was making me more alert and stimulated if I dosed at night (around 11pm). I was convinced this was a placebo effect, though your reaction confirms my suspicions ...
These days, I will sometimes take 2mg at bedtime if I can't sleep, which reliably knocks me out. Though I sometimes need to be in bed for it to actually take effect .. it's 1.49am and I took 2mg two hours ago and am still up on the 'net, though feeling calm/sedated.
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