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To substitute or not? I'm so confused.


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I am having terrible anxiety that I think is really interdose withdrawal.  I'm on roughly 3.5mg of Klonopin.  I made a TINY cut and it made me even more of a mess because I think I'm in tolerance.

 

The idea of not having interdose withdrawal (which my doc doesn't believe in by the way) sounds great, but then I've heard some really negative stories of switching from K or Valium.  I don't know what to think or believe.  I just know that I experience terrible anxiety and other wd symptoms every day and I have such a long road ahead -- imagine it will get worse, right?

 

 

Everyone says Dr. Ashton is the expert, so should I switch to valium because that's her method?  I'm a bit scared to try something new -- I really don't want to make things worse.  I've got kids to take care of, so I need to be functional.  How do I know what to do?

 

 

 

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Hi Twell,

 

I and many others have tapered directly off klonopin. Actually my former psychiatrist told me he usually crosses his patients to klonopin (from shorter acting benzos such as xanax and ativan) for the purposes of tapering.

 

How many times a day do you take a dose? Klonopin has a half life of 18-50 hours. Taking it 2 or even three times a day would probably ease any interdosewithdrawal you are experiencing.

 

What you are experiencing may not even be interdose withdrawal, but just plain old withdrawal. Do you feel a bit better for awhile after your dose, and then worse as you get closer to your next dose? This would be interdose wd. If you just feel bad all the time, that's probably just wd.

 

As you mention, some people experience difficulty with Valium. I would first try spreading your dose out over the day a bit, if you aren't already doing so. If that doesn't seem to bring relief, then crossing to Valium might be an option if your doc is agreeable.   

 

 

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And no, your experience of negative symptoms won't neccessarily get worse. I actually felt generally better as I tapered!
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Eljay,

Thanks so much for your reply.  I take it 3 times per day, so I shouldn't be having interdose withdrawal, right?

 

I can't figure it out.  I usually take my morning dose around 5:30 or 6:00.  Then I start having really bad anxiety around 8am that can last a long time.  I feel my best at night.  I have not figured out any rhyme or reason for it all.

T

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Mornings are rough for most folks, we hear this is due to low blood sugar and high cortisol, how long after you wake up do you eat?
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You really should try to get some food in your body, I've heard this really helps set the tone for the entire day.  You might also try some of the hints listed in this article.

Understanding Early Morning Anxiety

By Deanne Repich

           

Are mornings the worst time for your anxiety? When the alarm clock rings do you experience a feeling of dread? Do the symptoms kick in, making you tempted to roll over and snooze for hours so you don't have to face the day?

 

One reason why anxiety can be worse in the morning is that waking up is a sharp contrast to the sleep environment, which is perceived as pleasant for most people.

 

Picture this: You're sleeping peacefully in your warm, cozy bed, (for some, after many hours of insomnia). You are at peace, finally getting a break from the cares and tasks of the day. Then, BOOM! Suddenly, the shrill sound of your alarm clock jerks you awake. It triggers the "fight or flight" response, our body's inborn self-protective mechanism. And to top it off, the room is cold and dark. The dreaded worries and symptoms kick in.

 

There are several things you can do to make your "waking up" environment more pleasant. For example, get a radio alarm clock that wakes you up to your favorite music. Another alternative is an alarm clock that wakes you up gradually with pleasant chimes of increasing volume and frequency.

 

Keep a robe and slippers next to the bed so that you can warm up quickly and minimize a drop in body temperature as you get out of bed. If the bright lights of the room bother you, install a dimmer switch near your bed. You can gradually increase the light's intensity over a period of several minutes after you awaken.

 

Another reason why symptoms can be worse in the morning is because your blood sugar is low when you first wake up. You have gone all night without food. It's important to maintain a constant blood sugar level because the brain uses glucose as its fuel. If blood sugar levels are too low or drop too fast, then the brain starts running out of fuel. This causes the brain to trigger the "fight or flight" response.

 

The "fight or flight" response sends a rush of adrenaline, cortisol, and other neurotransmitters through your body to prepare you to fight or flee the perceived threat (low fuel). This process can trigger physical reactions ("symptoms") such as trembling, rapid heartbeat, sweating, panic attacks, fatigue, insomnia, mental confusion, nervousness, dizziness, and more.

 

To balance your blood sugar levels and minimize symptoms, keep a snack that contains "good" complex carbohydrates and protein by your bed. Eat it when you first wake up. You will likely notice that your symptoms improve shortly after eating the snack. You might try a combination of whole grain crackers and a handful of nuts, or a high-protein granola bar with some whole-wheat pretzels. The "good" carbohydrates will give you energy, and the protein will help to keep your blood sugar level steady over time.

 

Finally, dead-end thoughts play a huge role in creating early morning anxiety, as well as anxiety at any other time of day. Once you learn to overcome dead-end thoughts, you stop the anxiety cycle in its tracks.

 

Dead-end thoughts are negative, anxious, obsessive, or racing thoughts, that do not promote your well-being. They are based on faulty thinking patterns. These thoughts of helplessness, negativity, or anxious predictions about the future, give away your personal power and create the anxiety cycle. Here are a few examples of dead-end thoughts:

 

    * "I can't get out of bed feeling like this."

    * "Why do I feel this way? There must be something really wrong with me!"

    * "Everything is going to go wrong at the work meeting."

    * "It's a horrible day."

    * "When will this ever stop!"

 

The most important thing you can do to conquer early morning anxiety is to change how you PERCEIVE waking up. Change the dead-end thoughts that create the anxiety. Remember, physical symptoms by themselves are not anxiety. Negative perceptions are what create and perpetuate the anxiety cycle.

 

Choose to perceive waking up as a positive event - yes, you have a choice! Habitual dead-end thoughts can be unlearned and replaced with healthier self-talk. Of course, like any new skill you learn, it requires practice and patient persistence on your part to make healthier thoughts automatic.

 

Change your perception by creating a morning ritual that replaces the dead-end thoughts with healthier ones. Create a sequence of positive steps you can take when you first wake up to conquer early morning anxiety.

 

Positive rituals are helpful because they get you fully involved in the present moment (instead of the future), by focusing on one task at one time. Make the ritual automatic by taking the same steps every day in the same sequence. Here is an example of an anxiety-busting morning ritual. Use the ideas in this ritual as a starting off point to help you create your own personalized morning ritual.

 

    * Step 1: As you get ready for bed at night, place your alarm clock out of arm's reach from the bed. This action will motivate you to get out of bed to turn off the alarm when it rings the following morning.

 

      When the alarm rings, get out of bed immediately. Turn off the alarm and put on the robe next to your bed. As you do so, say aloud three times in an enthusiastic, cheery voice: "I am SO glad to be alive! What a WONDERFUL day!" Make sure to smile as you do this.

 

    * Step 2: Mentally and physically "check in" with the present moment. Accept any physical sensations without placing a negative judgment on them. Simply observe. Touch your face, hands, and legs a few times and observe the sensations. Focus intently on a few items in the room for several seconds. These simple activities help you to switch your focus from the future back to the present moment.

 

      If dead-end thoughts occur at this time (which they likely will), immediately replace them with healthier thoughts. It often helps to say the positive thoughts aloud. For example, if you're thinking: "I can't get out of bed feeling like this," replace it with: "These physical sensations might be uncomfortable, yet I know they are harmless. I am completely safe. I am physically able to get out of bed and have a great day. Watch. I can get out of bed just fine!" Then DO it!

 

    * Step 3: Turn on your favorite upbeat music CD. (Keep a CD player in your bedroom.) Sing along and dance for a minute or two.

 

    * Step 4: Eat the snack on your bedside table to help level your blood sugar.

 

    * Step 5: Take a shower and dress. Then continue with your day.

 

Once you find a pattern that works for you, use the same morning ritual -- the same steps in the same sequence -- every day. Repetition helps you to effectively unlearn old thoughts and behaviors and make the new ones automatic.

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Pamster,

 

Thanks for asking about the blood sugar thing.  I didn't know.  I'll give it a try --even though I'm pretty nauseous usually.

 

I will try the other tips too.

 

T

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Good Morning Twell,

I'm not on the same benzo as you.  I was on 20 mg of Ativan and one week away from complete C/O to valium and have done very

well.  A little drowsiness but no W/D symptoms.  I do however still experience morning nausea and Pam is right, get food in

your body as soon as possible it really, really works for me.  Good luck.....i'll be thinking of you!  Proudpam

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