Need help with a taper plan

I am currently in 2.5 mg Clonazepam daily for GAD, severe panic attacks with agoraphobia. I have been on Clonazepam for 7 years slowly increasing the dose as I gain tolerance. I’ve read and been told that the Clonazepam is most likely not helping at all with my panic and anxiety anymore and is most likely making it worse. I feel trapped by this drug and am terrified to get off of it due to the withdraw symptoms. My doctor told me to cut .5 mg a week earlier this year and I did by the time got down to .5mg after 6 weeks ( I went a little slower than he said) I ended up in the ER twice where they had me go up on my dose somewhat to relive withdraw symptoms till I could see my doctor. When I saw my doctor he told me to just start taking my 2.5 mg again and we would try other drugs. My doctor said if I followed his instructions I would have been fine and shouldn’t have had any issues. I WANT OFF THIS DRUG but following that terrible experience I’m afraid to try again even though I know I need to. I was wondering if anyone could give advice on how to and at what speed to taper so my symptoms are manageable. I don’t mind if it takes a long time even a year to get off as long as I don’t have to go trough that hell again. I know it won’t be easy and I can manage mild symptoms I just need to know what speed to go and how to do it. Also I did get of Paxil and survived that hell and felt much better for it so I know I can do it I just need to know how.

I am currently in 2.5 mg Clonazepam daily for GAD, severe panic attacks with agoraphobia. I have been on Clonazepam for 7 years slowly increasing the dose as I gain tolerance. I’ve read and been told that the Clonazepam is most likely not helping at all with my panic and anxiety anymore and is most likely making it worse. I feel trapped by this drug and am terrified to get off of it due to the withdraw symptoms. My doctor told me to cut .5 mg a week earlier this year and I did by the time got down to .5mg after 6 weeks ( I went a little slower than he said) I ended up in the ER twice where they had me go up on my dose somewhat to relive withdraw symptoms till I could see my doctor. When I saw my doctor he told me to just start taking my 2.5 mg again and we would try other drugs. My doctor said if I followed his instructions I would have been fine and shouldn’t have had any issues. I WANT OFF THIS DRUG but following that terrible experience I’m afraid to try again even though I know I need to. I was wondering if anyone could give advice on how to and at what speed to taper so my symptoms are manageable. I don’t mind if it takes a long time even a year to get off as long as I don’t have to go trough that hell again. I know it won’t be easy and I can manage mild symptoms I just need to know what speed to go and how to do it. Also I did get of Paxil and survived that hell and felt much better for it so I know I can do it I just need to know how.

 

Jeremy,

Clonazepam is a very potent benzo. Cutting .5 K/week (equiv to cutting 10 mg Valium) is a massive shock to those billions of nerves which are water logged in benzo soup.  Also take into account that benzos have a 1/2 life, thus (with each cut) it remains in your system for a period of time (longer than a week).  My experience of the "rapid taper" (last year) from K had me call "the hotline" at least twice.  Even the 3 - 6 month hold and updose was brutal until I finally stabilized (months later).

You mentioned you and the doc agree "we would try other drugs" - to my knowledge there doesn't appear to be a "magic bullet".

If your PCP is open to suggestions, an idea is to study the Ashton Manual (given on your first post) and give a copy to your doctor (highlighting the important parts) in hopes of getting his/her attention.  Ashton and other people on BB may suggest tapering at a maximum of 5 to 10% every 10 to 14 days (or slower). 

Breck

I agree with Breck - the 0.5 mg cuts were clearly too large for you.  That's too large a cut for most of the people here. 

 

I would consider allotting at least a year to your taper (perhaps two).  Also - unless your p-doc has been giving you good coping skills during your tenure with her/him, I'd consider finding a good therapist.  You've seen what the symptoms can be like.  A slower taper should lessen those symptoms somewhat, but it's likely they will still be there to some degree.  Effective coping skills can help get you thru those bad days/weeks.  Therapists seem more likely to help their clients develop those skills.  P-docs tend to hand out more drugs instead.

 

As for the taper rate - it's very individual.  Nobody has your specific physiology or history.  You can see what a 5% or 10% cut does to you, then adjust as needed.  A lot of people end up tapering 1% instead of 5% or 10% (which is why it can take two years).  You may end up adjusting your taper rate several times before you're done, but try to consistently go in a down direction.  Try to avoid up-doses, rescue doses, reinstatements.  Again, that's why it's important to have good coping skills.

Thank you for your responses it just makes me feel better about doing this already knowing there are people out there will to listen and lend a hand. To clarify I was seeing a neurologist who attempted to get me off at .5mg a week and he is also the same doctor who got me off paxil. He gave me 3mg klonopin a day and told me I would need it to get off of the paxil. I was taking 1.5mg daily before then, I was able to only go up to 2.5mg during the paxil withdraw but after that I was then hooked on even more klonopin. I have since stopped seeing the neurologist because his answer after my relapse was to just throw all kinds of drugs at me and wanted me just to stay on the klonopin. I have since found a new physiatrist who is trying to help me adjust mood stabilizers and wanted me to give buspar a shot to see if we can get my anxiety level down before I try to taper again. He seems to be confident in being able to get me off klonopin but hasn’t told me how he is going to do it yet. My plan is to get as much information as possible before we have that conversation, I’d like to have my own taper schedule that I can present to him, one that is slow and steady and hopefully he will agree. I thank you for the advice so far 5-10% seems a lot better then dropping .5mg a week. Also I do see a therapist regularly now and we have been aggressively doing exposure therapy to help me claim some of my life back( I cannot travel far from my house) also we have been working on coping techniques to help with that , and I hope to use them during my taper as well.

Thank you for your responses it just makes me feel better about doing this already knowing there are people out there will to listen and lend a hand. To clarify I was seeing a neurologist who attempted to get me off at .5mg a week and he is also the same doctor who got me off paxil. He gave me 3mg klonopin a day and told me I would need it to get off of the paxil. I was taking 1.5mg daily before then, I was able to only go up to 2.5mg during the paxil withdraw but after that I was then hooked on even more klonopin. I have since stopped seeing the neurologist because his answer after my relapse was to just throw all kinds of drugs at me and wanted me just to stay on the klonopin. I have since found a new physiatrist who is trying to help me adjust mood stabilizers and wanted me to give buspar a shot to see if we can get my anxiety level down before I try to taper again. He seems to be confident in being able to get me off klonopin but hasn’t told me how he is going to do it yet. My plan is to get as much information as possible before we have that conversation, I’d like to have my own taper schedule that I can present to him, one that is slow and steady and hopefully he will agree. I thank you for the advice so far 5-10% seems a lot better then dropping .5mg a week. Also I do see a therapist regularly now and we have been aggressively doing exposure therapy to help me claim some of my life back( I cannot travel far from my house) also we have been working on coping techniques to help with that , and I hope to use them during my taper as well.

 

Jeremy,

That Neurologist appeared to be throwing Klonopin at you "willy nilly", thus you were wise to find another prescribing physician.  Others can "weigh in" but decades ago I took Buspar and as I recall, that medication wasn't a problem.  In fact, it had "calming" effect without lowering inhibitions (no buzz).  For whatever reason I finally stopped taking it without any issue.

Again, on planning your taper please remember about the 1/2 life of your benzo.  My experience is that even cutting on a well thought out schedule.....often the prior cuts aren't totally out of the system and out of the blue, may hit a rough stretch, which is when coping skills kick in (for me it's distraction - meaning staying busy).

In my opinion, tapering at larger doses was somewhat easier - thus at some point,  it's easy to get "lulled" into the next cut too quickly.  As Badsocref mentioned, the taper rate is an individual thing, most likely it will evolve as you progress. 

I'm glad you've found a new physician and hopefully he'll be understanding and taper to the rate with suits you.

Breck

Breck,  thanks for the advice I believe the buspar may actually be helping but it’s hard to tell with anxiety, as you are aware I’m sure, it has ups and downs and I’ve had a rough 2 months since the failed klonopin taper. I’ve hit a lot of my stressors as well over the past few months so I think I really need to give the buspar a chance. Also I’m never very enthusiastic about starting new medicines because of what I’ve went through with SSRIs and Benzos, I know there is a time and place for both of them but a little warning of the side effects and withdraws would have been a nice thing for my doctor to tell me years ago. I find that the words as “take as needed”on a Benzo bottle are about the worst thing to put for a anxious person. I also find that staying busy helps keep my mind distracted  and helps, every person in my family doesn’t have to worry about doing any yard work these days because I just show up and get it all done to help distract me and it’s something I enjoy doing.

         

fwiw - I completely agree about staying busy.  Find simple little tasks and do them all day. 

 

I'm glad you found a doc that seems willing to work with you.  I'm also glad you're working with a therapist.

 

(I have no experience with buspar.  I hope it works for you)

Breck,  thanks for the advice I believe the buspar may actually be helping but it’s hard to tell with anxiety, as you are aware I’m sure, it has ups and downs and I’ve had a rough 2 months since the failed klonopin taper. I’ve hit a lot of my stressors as well over the past few months so I think I really need to give the buspar a chance. Also I’m never very enthusiastic about starting new medicines because of what I’ve went through with SSRIs and Benzos, I know there is a time and place for both of them but a little warning of the side effects and withdraws would have been a nice thing for my doctor to tell me years ago. I find that the words as “take as needed”on a Benzo bottle are about the worst thing to put for a anxious person. I also find that staying busy helps keep my mind distracted  and helps, every person in my family doesn’t have to worry about doing any yard work these days because I just show up and get it all done to help distract me and it’s something I enjoy doing.

 

My years of benzos were also for anxiety with the instructions "take as needed", thus I agree with you 100%.