Psycho-Babble Medication Thread 432239

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Pdoc wants to stop Klonopin: 'short term only'

Posted by HelenInCalif on December 20, 2004, at 20:53:44

I know this isn't an uncommon topic- I'd like to discuss the latest knowledge about longer-term uses of Klonopin for social anxiety. I started Klonopin for extreme stress, and discovered that it stopped a problem I didn't know I had- social anxiety.

My doctor seems to want me off of it soon-- her nurse said its because I've been taking it for about 9 months. The nurse said that its "an extremely addictive drug" and that the fact that I don't want to stop it could be a sign of addiction. I think the fact that I've had 3 deaths in 3 months in my family is the bad sign... plus, I like not having social anxiety: being able to network and schmooze is very useful.

I'm also taking Celexa for depression. I'd taken Paxil, Wellbutrin and Prozac at times in the past for depression and they'd never helped with social anxiety before. Based on those anti-depressant experiences I don't have reason to believe that Celexa alone would help- would it? The Pdoc's nurse said I'll probably have to switch to Buspar. Is that the usual post-benzo anti anxiety medicine?

In April / May I started Klonopin (.5mg 3xday) due to anxiety: extremely ill family members. Many weeks later I also started Celexa (20 mg /day then, 40mg/day now). I found that the Klonopin by itself also really helped social anxiety. Didn't really know that I had it, until experiencing a nervousness-free conference for the first time.

Over the past 3 months I've had 3 relatives die. That's why my Celexa dose went up. Between deaths #2 and #3 I had reduced my Klonopin to 2x day (more like 2.4x day-- every 10 hours instead of 8), but then went back to 3xday after the last death.

The doctor (through the doctor's nurse) seemed unhappy that I was going back to 3x day, even though that's the dose I'd been on most of the past 9 months. The doctor now is only writing 10 day supply prescriptions, so I'm paying 3 times as much per month compared to earlier this year. When I complained about the 3x prices, the nurse seemed unhappy about that too, as if it was a bad sign.

I have no experience with "addictive" drugs, so I wouldn't know what to look for if I've become "addicted" to Klonopin. There've been a few weekends where I'd forgotten to take the Klonopin for 2 days: didn't notice any side effects.

I do know caffeine withdrawal (but that's not a Schedule drug), and I do know what bad withdrawal from Paxil was like- just 1 accidental day without it caused nasty headaches, etc. With Klonopin I've been taking the same dose (2.4 to 3 pills per day) the entire time, and haven't had it stop working. If I were to stop Konopin for more than two days, should I expect withdrawal symptoms? What makes the Klonopin different from Paxil, given the bad effects of stopping Paxil?

 

Re: Pdoc wants to stop Klonopin: 'short term only' HelenInCalif

Posted by Glydin on December 20, 2004, at 23:18:39

In reply to Pdoc wants to stop Klonopin: 'short term only', posted by HelenInCalif on December 20, 2004, at 20:53:44

Despite claims to the contrary, long term successful approiate use of benzos is possible. The following is from a previous post by me to someone who was concerned about their Klonopin use:

****I believe you are probably physically dependent as most of us who use K routinely are. Thus, your symptoms when you miss a dose and their disappearence when your dose is taken. This "medical dependence" is not the same as addiction. Addiction has four characterictics:

1) PsychoSocial disruption - example, "craving"
2) Inapproiate use - example, "to get high"
3) Tolerence - example, not reaching a maintance dose and requiring more and more for the same effect
4) Drug seeking behavior - example, doctor shopping for RX's, "losing RX's" and asking for replacements when one really has not lost RX.

Physical dependence is not uncommon. Psychological dependence is not uncommon either. I don't consider either finding necessarily "bad", and I'm fine with my medical dependence - I've discontunued twice and I'm just better on K, but that comfort varies from person to person.... and if a person mets the criteria for addiction - I feel supervised discontinuing must occur.***

Knowing what the true definition of addiction vs. physical dependence is very important. Also, realizing withdrawal symptoms or discontinuation syndromes are NOT, in and of themselves, an indicator of addiction.

Talking though the nurse may not be the best way to go about getting your point across. I suggest making an appointment and speaking directly to your doc. I'm posting a link to the entire thread from which the above is taken. You may find reading the entire thread helpful.

http://www.dr-bob.org/babble/20041211/msgs/430058.html

You may find some here with very strong feelings that minic the information you have received from your doc's nurse... also, that (short term only recommendation) will be the majority of the information and suggested use warnings you will find if you research on the 'net about these matters. My suggestion is to draw your own conclusions as they apply to your use and what you find as a good treatment plan for you..... that's what did and I have been a successful "K only" user for 3 years.

Good Luck,
Glydin

 

Re: Pdoc wants to stop Klonopin: 'short term only'

Posted by Lucylooo on December 21, 2004, at 2:45:48

In reply to Re: Pdoc wants to stop Klonopin: 'short term only' HelenInCalif, posted by Glydin on December 20, 2004, at 23:18:39

Hi Helen & Glydin,

Thanks for the link to the other thread. It's really good to know you all are here, willing to share. I really appreciate it, I don't have friends who deal with this stuff and it is very isolating. Years ago I tried 4 different anti-depressants and had bad-to-awful experiences with each; 20 minutes after taking xanax I felt blessed relief from the chronic anxiety that had become nearly debilitating. After taking it for 7 months I had convinced myself that I had to discontinue it. When I found that hard to do the doc put me on paxil while weaning from the xanax.

I haven't used meds in several years, I've tried to deal with GAD holistically, with more or less success at different times. But the last few years have been full of pressure and too much loss; anxiety is relentless and I'm beginning to feel desperate for relief. The doctor who put me on xanax years ago is no longer available. A year ago I tried another doc who gave me a 10-day prescriptions for ativan, and then only authorized 2 refills. A few days ago I went to the city's mental health crisis clinic (I'm a student, quite broke). I did not abuse the prescriptions I have been able to get, I never raised my dosage over those 7 months. But they sent me away with remeron which I don't want to take, and 10 precious tablets of .5 mg clonazepam. No refill possible on the benzo of course. I have an appointment in 3 weeks with another psych, a referral through the city clinic.

Glydin, how did you find a doctor who was willing to work with you? I would like the clonazapam to last as long as possible but I suppose I should take it as directed (1/2 pill twice a day for a week and then 1/2 pill a day)? It sounds like it works differently than zanax or ativan, do you know?

Best wishes,
L

 

Re: Pdoc wants to stop Klonopin: 'short term only' Lucylooo

Posted by Glydin on December 21, 2004, at 7:12:07

In reply to Re: Pdoc wants to stop Klonopin: 'short term only', posted by Lucylooo on December 21, 2004, at 2:45:48

> Glydin, how did you find a doctor who was willing to work with you?

~~~I can't take alot of credit for that - I was lucky to find a doc who had expereience with long term benzo use and was willing to engage in intense followup to insure things went "right" for me. K wasn't first line treatment for me and I'm not sure it should be for anyone, but if trials and trials of other meds have failed, benzo's - used in monotherapy or as an addition - can be a very effective and safe treatment for some.

> I would like the clonazapam to last as long as possible but I suppose I should take it as directed (1/2 pill twice a day for a week and then 1/2 pill a day)? It sounds like it works differently than zanax or ativan, do you know?

~~~Taking as directed is the best practice is my opinion. While I believe the mode of action is similar for benzo's, there are difference in brain receptor sites and the like. There are those here with much more knowledge than I on that part of "How this chemical effects the brain". In general, these meds calm the brain's "spin up for action" system. There are differences in dosing and there are benzo conversion charts available on the 'net as well as one offered on this site.

I always try to make clear, benzo aren't for everyone - things can go awry. But, I'm of the opinion the meds themselves are not "bad". There can be inapprioate prescibers, inapproiate consumers, and plain lack of correct information for folks to make informed decisions. And... There's also the assumed information (they're ALWAYS abused and addiction producing), doc liability, and state regulations to contend with. It's not an easy choice in treatment and it is one where one may find themselves having to "prove" correct use - sometimes over and over..

I hope you can work things out.

 

Re: Pdoc wants to stop Klonopin: 'short term only'

Posted by HelenInCalif on December 21, 2004, at 14:19:56

In reply to Re: Pdoc wants to stop Klonopin: 'short term only' Lucylooo, posted by Glydin on December 21, 2004, at 7:12:07

> > Glydin, how did you find a doctor who was willing to work with you?
>
> ~~~I can't take alot of credit for that - I was lucky to find a doc who had expereience with long term benzo use and was willing to engage in intense followup to insure things went "right" for me. K wasn't first line treatment for me and I'm not sure it should be for anyone, but if trials and trials of other meds have failed, benzo's - used in monotherapy or as an addition - can be a very effective and safe treatment for some.

The medications nurse at my Pdocs office (an HMO) said that none of the doctors there like long-term use of K or benzos. She did get the pdoc-on-call to write a 30 day prescription, so at least I save 1/3 of my co-pay.

I am going to have to figure out an approach. The nurse's ideas of what the pdoc will suggest once my crisis time is over
1. more antidepressants,
2. C.B.Therapy (group classes: they don't do individual CBT therapy. Boo.)
3. Buspar
Doesn't sit well with me. 1 and 2 didn't help with my anxiety in the past. For Buspar or other meds- I'm certainly willing to find an alternative, but I want it to be on my schedule, not theirs. I'm about to go job hunting, for example, and less anxiety is very, very useful when you are in fact being judged by other people.

Taking K for the first time was an eye-opener. I just hadn't known how much anxiety I had learned to tolerate. Being able to face tough situations without anxiety and with just strong regular emotions is new to me. By "regular" I mean that for example when I knew someone was going to die I felt grief and sadness and love and loss and other emotions all very strongly. But I didn't feel a 'fight-or-flight' adrenalin spike (which would have been useless, worse than useless, then).

My anxiety seems to be only lightly connected with my seretonin levels, given the ADs I'd had before. And the CBT / RET therapy sessions and relaxation methods classes I had in the past helped with depression, but hadn't changed my anxiety to the point where I knew I had it. Not like K did.

Of course now that I know what "not feeling anxious" feels like, I'll be better able to judge what does or doesn't help it.

 

Re: Pdoc wants to stop Klonopin: 'short term only' HelenInCalif

Posted by Glydin on December 21, 2004, at 14:39:08

In reply to Re: Pdoc wants to stop Klonopin: 'short term only', posted by HelenInCalif on December 21, 2004, at 14:19:56


> Of course now that I know what "not feeling anxious" feels like, I'll be better able to judge what does or doesn't help it.

~~~You have summed it up well with that very statement. I feel sure you are well equipped to advocate for yourself. It is difficult when one is dependent for scripts, but it can be done. I do wish the current mindset would take into account the individual and we would stop this "one size fits all" mentality. I feel a number of factors have led to this and patients suffer because of it.

Helen, I wish you wellness and successful treatment.

Glydin

 

Re: Pdoc wants to stop Klonopin: 'short term only'

Posted by Lucylooo on December 21, 2004, at 14:48:56

In reply to Re: Pdoc wants to stop Klonopin: 'short term only' HelenInCalif, posted by Glydin on December 21, 2004, at 14:39:08

Glydin,
Thank you for your reasoned, compassionate response.

Helen,
I would love to hear how it goes with your negotiations with your p-doc and what happens next for you.

I wish you both well.

Lucy

 

Re: Pdoc wants to stop Klonopin: 'short term only' Lucylooo

Posted by Glydin on December 21, 2004, at 15:07:54

In reply to Re: Pdoc wants to stop Klonopin: 'short term only', posted by Lucylooo on December 21, 2004, at 14:48:56

> Glydin,
> Thank you for your reasoned, compassionate response.

~~~All the best to you too, Lucy. Us toxic anxiety challenged folks gotta stick together - there's power in numbers. (smile)

Glydin

 

:-) (nm) Glydin

Posted by Lucylooo on December 21, 2004, at 15:42:15

In reply to Re: Pdoc wants to stop Klonopin: 'short term only' Lucylooo, posted by Glydin on December 21, 2004, at 15:07:54

 

Re: Pdoc wants to stop Klonopin: 'short term only' HelenInCalif

Posted by Fred23 on December 21, 2004, at 18:47:03

In reply to Pdoc wants to stop Klonopin: 'short term only', posted by HelenInCalif on December 20, 2004, at 20:53:44

> My doctor seems to want me off of it soon-- her nurse said its because I've been taking it for about 9 months.

Elsewhere on this site is:

Dr. Bob's Psychopharmacology Tips "Appropriateness of long-term treatment with benzodiazepines" at:

http://www.dr-bob.org/tips/split/Appropriateness-of-long-te.html

And somebody else here posted a link to a similarly useful site:

http://www.panic411.com/pd.html

 

Re: Pdoc wants to stop Klonopin: 'short term only' Glydin

Posted by Fred23 on December 21, 2004, at 19:05:06

In reply to Re: Pdoc wants to stop Klonopin: 'short term only' Lucylooo, posted by Glydin on December 21, 2004, at 15:07:54

> ~~~All the best to you too, Lucy. Us toxic anxiety challenged folks gotta stick together - there's power in numbers. (smile)

Glydin, you might want to make some sort of a FAQ, akin to Dr. Bob's own "Appropriateness of long-term treatment with benzodiazepines".

A key finding I've cited in these discussions is that some have faulty GABA processing due to genetic reasons. Trying benzos for the first time causes that "aha" reaction to the sensation of feeling normal for the first time ever.

That Panic411 document compares it to essential hypertension, which also can't be cured, and needs to be controlled by medications *lifelong*. What is so different about needing benzos lifelong to aloow proper GABA regulation?

 

Re: Pdoc wants to stop Klonopin: 'short term only' Fred23

Posted by Glydin on December 21, 2004, at 20:46:46

In reply to Re: Pdoc wants to stop Klonopin: 'short term only' Glydin, posted by Fred23 on December 21, 2004, at 19:05:06


Fred,

Thank you for those links. I was not aware of them. In addition to the feeling of isolation from mental health issues, I have felt isolated regarding my stance on benzo's.... comfortable with my truth, but certainly isolated.

Glydin


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