cold turkey mistake - help

My 20 year old son was abusing benzos for six months before we intervened the end of last year.  He had prescriptions for 200 1mg Klonopins during that six month period and also a drug test that showed he had taken oxazepam/serax after our preliminary intervention end of Nov.  He was also abusing other substances prior to and during that six months.

We made the mistake of taking him off the benzos cold turkey – inadequate knowledge, advice and research.  He went into a drug rehab program early in the year for 40 days and was successful; clean and relatively positive when he finished.  He is now in a transitional living recovery program for young men and has started to exhibit symptoms that could be protracted benzo withdrawal. 

My two questions are:

1. Most of the information on protracted symptoms (Ashton) seems to be based low dosage long-term studies.  What’s the “addiction level” or how “chronic” is an approx 1.5mg Klonopin daily use relative to long term use?

2. Given that he has already gone without benzos for 4 months, what, if any treatment should he get?  Pick up on a low dosage benzo and then complete gradual withdrawal (we are reluctant to do that)?  Or one reference I saw said antiepileptics  - “… may benefit patients who have been taken off benzodiazepines "cold turkey" or over rapidly.”  (see http://www.bcnc.org.uk/drugs.html)?

I would appreciate any information esp. authoritative references – (knuckleheads in the medical profession don’t seem to believe anything unless one of their own tells them!)

I realize this forum/website is for those who are actually withdrawing benzodiazepines and not necessarily for parents or others support.  However, my son has limited communication in his program for now and please consider me inquiring on his behalf.  I have already gotten much useful support and info from other posts here.  Thanks.

(another) Colin

NYColin,

I'm sorry to hear about your son and benzos.

Since he has gone without benzos for 4 months, it is unlikely that he will get any benefit from them should he reinstate on a low dose. However, we do have a member here, Dave, who appears to have done just that. I just checked his signature line--he did a c/t (cold turkey) from 1.5 mg Klonopin and then reinstated on .125 mg eleven months later. I know his taper since then has been difficult, but he did finish and get off the benzos (he eventually crossed to Valium). Maybe if Dave sees this, he would like to add his two cents about how this worked for him.

From what I've read on this forum, protracted withdrawal is more likely to show up in those who quit a benzo c/t. In other words, someone who has been on a benzo for years and tapers properly has a better chance at avoiding protracted w/d than someone who was on a benzo for a shorter time and does a c/t. Regarding your son, 1.5 mg Klonopin isn't a huge dose, but it's not small, either. I would call it moderate. But everyone's body is different with regard to how highly they can become dependent, and in how short a time. Six months is enough time to become pretty dependent. I myself believe I was very dependent at nine months of .75 mg Klonopin.

Our Colin knows more about the antiepileptics and that sort of thing, I believe. I'm not sure they would benefit now; my impression is that they are more for the period immediately after the c/t.

Exactly what symptoms is your son showing?

My son’s symptoms are “insomnia, mood swings with accompanying anxiety/panic attacks. Symptoms include rapid shallow breathing, sweating and palpitations.“ As stated in a psychiatric examine he had two weeks ago. 

That evaluation was based solely on a 1 hour interview, i.e. self reported symptoms by a recovering drug addict.  The psychiatrist diagnosed bipolar I.  He then prescribed ambient, depakote and ….. benzodiazepine – not a gradual withdrawal ongoing dose but a 2mg Klonopin “as needed” not to exceed 1 per day.  We were not satisfied with that analysis. 

Since then observation by an experienced, trained social worker (Masters level) on a daily basis shows anxiety, insomnia, and depression symptoms with some hypo (lower level) mania.  Psychological testing by a Phd (non medical) shows anxiety and possible bipolar II with more indication on the depressive side.  Rob had ADHD diagnosis and treatment by psychiatrist predating his heavy drug use by a few years.  That same early, long term evaluation also indicated anxiety and depression at a sub clinical level.  A significant part of his (everyone’s?) drug abuse were attempts at self medication for these conditions.  However, in his specific case, we have strong, obvious “clinical” evidence (his multi-substance drug abuse) that benzos are NOT the answer to his underlying psychiatric conditions. 

We are seeking alternate psychiatric opinions.  He is however in a somewhat rural area with few alternate resources.  We must decide whether to interrupt, sacrifice his recovery program to seek better psychiatric care elsewhere.  My queries here are to help make that decision and evaluate what that alternate care would be.

Thanks for any and all insights. 

Theresa, thank you also for the support, it is greatly appreciated

NYColin

You probably already know from reading material on this site that Ambien and other sleep aids (Sonata, etc.) work like benzos. I would definitely recommend you stay away from those. And I think that first psychiatrist was not worth the money you paid him if he prescribed those drugs knowing your son's problem with benzos.

One thing about bipolar disorder--I don't know your son's history, but diagnosing people as bipolar is the "thing" these days. I myself was diagnosed with it when what I was suffering was benzo w/d. The doctor refused to help me unless I went on antipsychotics. I refused, because I believed I was not bipolar. And my progress during the benzo taper has borne that out. So be wary about this diagnosis and be sure to do your research. Antipsychotics can be very dangerous drugs, especially in the long-term.

It's unfortunate, but good psychiatrists are few and far between. Many of them like to throw a bunch of drugs at you without waiting to see how one drug affects you first. That means that once the ball gets rolling, it's impossible to discover what symptoms are coming from what. Some people find that general practice physicians are more conservative in this regard--and more willing to listen to the patient.

If your son is having insomnia, have you tried melatonin for sleep? Your body produces it naturally, and many people here use it for help with sleep. I use 6 mg a night. I have also used something called Calms Forte, which you can get at a natural foods store. Other people here have used Benadryl, an antihistamine, and Tylenol PM. These things will not affect his w/d.

Is your son eating plenty of protein? The body needs a lot of protein to heal from benzo use. One of our former moderators was a big believer in whey protein powder. She wasn't getting enough protein in her diet and supplemented this way and felt much better. Of course, everyone's body is different. But a protein-rich diet is very important.

Hi nycolin,

I too think that there is little to be gained from reinstating a small amount of benzo this far out. If it had been a week or two after a cold turkey withdrawal, then I think it might have been an option. Four months is actually not that long to be still experiencing withdrawal symptoms, especially after a cold turkey withdrawal. We each have our own rate of recovery from benzos, and it seems (for many at least) a cold turkey withdrawal does not speed up the total recovery time. Tapers seem to allow us to recover at the same time as tapering - the last dose does not have to be the beginning of recovery.

Clonazepam binds particularly tightly to the benzo receptors, so a longer recovery after CT might be expected. Ashton found that by switching people from Clonazepam to Valium, the Valium seemed to compete for binding at GABA receptors, so displacing the Clonazepam. It is a double edged sword though, as others seemed to find the switch from Clonazepam to Valium particularly difficult. Anyway, the upshot is that I don't think you should worry too much about the amount of time taken so far. I understand how painful it must be to witness these symptoms, but he needs more time to recover.

I've not come across any good evidence that anticonvulsants help. They may may well be needed if someone is cold turkeyed off of a sizeable dose of benzo to protect against the possibility of seizure. They cannot help with the recovery process. We experience withdrawal symptoms until the GABA system is repaired - this takes time. Anything that really does take the symptoms away, must act on the receptors in a similar way to benzos - how would that enable the receptors to recover? I know Ashton states in her manual that she has not found any of these treatments to be at all helpful.

Colin

Thank you for creating and maintaining this website.  I do web work myself and know it is not a trivial thing, a lot of your time as well as some expense for hosting etc.  It is so good to get information from people who have been there and to get it presented in a balanced, neutral way instead of with the preaching and arrogance from some of the “professionals” here in the US.  Most of them do not even know about tapered benzo withdrawal let alone protracted withdrawal syndrome (PWS). 

I am not a professional and do not want to be like them.  I am not necessarily rejecting my son’s bipolar diagnosis or the impact of my son’s previously diagnosed conditions.  However, they are not even evaluating my son for PWS.  I must decide whether to remove him to a different treatment setting from where he is making some progress and where any change in environment would adversely affect his anxiety level and ongoing multi-use addiction recovery.  This gets me back to the anticonvulsants.  They will proscribe depakote (Valproate semisodium) which, while intended specifically for bipolar disorder, contains valproic acid which is an anticonvulsant.

Here’s the references about the possible use of anticonvulsants for brenzo withdrawal:  Antiepileptics “…. medication may benefit patients who have been taken off benzodiazepines "cold turkey" or over rapidly” (see http://www.bcnc.org.uk/drugs.html )  There was also an article on “A Role For Valproate in the Treatment of Sedative–Hypnotic Withdrawal and for Relapse Prevention” http://alcalc.oxfordjournals.org/cgi/content/full/35/4/319.  Depakote, which is under consideration for my son, is a valproate.  The Sedative–Hypnotic substances they discuss are ethanol (alcohol) and benzodiazepines though it gets a bit complicated because apparently benzos are sometimes used to treat alcohol abuse.  The article posits that “Valproate may return the GABA type A receptor function to a state more closely resembling its normal function.”  There are also a number of studies on file with the US National Institute of Health that indicate valproate is useful in helping alcoholics reduce their abuse.  I can send references for those if you like.  I think some of them are sited in the footnotes of the article I referenced.  My next research is to follow those footnotes.

Any thoughts? Have you heard any negatives to using anticonvulsant, other than “standard side effects” (“some people die” kidding - but not far off the mark – few cases of serious liver damage), for benzo withdrawal?  Again the point being they want to treat him with Depakote for bipolar (possibly misdiagnosed) so what effect would it have if instead he’s PWS (which they don’t know about so therefore can’t exist  )?

Colin

 

Thank you for creating and maintaining this website.  I do web work myself and know it is not a trivial thing, a lot of your time as well as some expense for hosting etc.  It is so good to get information from people who have been there and to get it presented in a balanced, neutral way instead of with the preaching and arrogance from some of the “professionals” here in the US.  Most of them do not even know about tapered benzo withdrawal let alone protracted withdrawal syndrome (PWS).

Yes, we have an experience that even the most open and knowledgeable 'experts' can never have.

I am not a professional and do not want to be like them.  I am not necessarily rejecting my son’s bipolar diagnosis or the impact of my son’s previously diagnosed conditions.  However, they are not even evaluating my son for PWS.  I must decide whether to remove him to a different treatment setting from where he is making some progress and where any change in environment would adversely affect his anxiety level and ongoing multi-use addiction recovery.  This gets me back to the anticonvulsants.  They will proscribe depakote (Valproate semisodium) which, while intended specifically for bipolar disorder, contains valproic acid which is an anticonvulsant.

No, you are wise to not dismiss the diagnosis. At the same time, it appears (reading between the lines) you also realise that people are regularly misdiagnosed with neurological and psychological disorders instead of benzo withdrawal syndrome. There must be some psychiatrists that understand that drugs are last resort, and are not the panacea as adverticed by the drug industry.

Here’s the references about the possible use of anticonvulsants for brenzo withdrawal:  Antiepileptics “…. medication may benefit patients who have been taken off benzodiazepines "cold turkey" or over rapidly” (see http://www.bcnc.org.uk/drugs.html )  There was also an article on “A Role For Valproate in the Treatment of Sedative–Hypnotic Withdrawal and for Relapse Prevention” http://alcalc.oxfordjournals.org/cgi/content/full/35/4/319.  Depakote, which is under consideration for my son, is a valproate.  The Sedative–Hypnotic substances they discuss are ethanol (alcohol) and benzodiazepines though it gets a bit complicated because apparently benzos are sometimes used to treat alcohol abuse.  The article posits that “Valproate may return the GABA type A receptor function to a state more closely resembling its normal function.”  There are also a number of studies on file with the US National Institute of Health that indicate valproate is useful in helping alcoholics reduce their abuse.  I can send references for those if you like.  I think some of them are sited in the footnotes of the article I referenced.  My next research is to follow those footnotes.

I'm not convinced of the advantages of anti-epileptics after the cold turkey episode. They are potentially dangerous drugs, and ten have their own fogging effects. I am only expressing an opinion though. We do not pretend to have all the answers around here: we are discussional and support site. Not that I think doctors have all the answers either! I'll read through the second link when I have some more time. We should always be open to ideas. I have a lot of respect for Ashton in research efforts, and if she is of the opinion that none of these therapies are yet effective, I'm inclined to believe it to be correct. I don't believe that she is wedded to her own research that she is not open to to other possibilities.

Any thoughts? Have you heard any negatives to using anticonvulsant, other than “standard side effects” (“some people die” kidding - but not far off the mark – few cases of serious liver damage), for benzo withdrawal?  Again the point being they want to treat him with Depakote for bipolar (possibly misdiagnosed) so what effect would it have if instead he’s PWS (which they don’t know about so therefore can’t exist  )?

You will need to carefully research the individual drugs. I've taken a lot of anti-epilieptics in the past (I was misdiagnosed with epilepsy for about ten years). The one I took longest was Sodium Valporate. I think it fogged me, but it was very long time ago.

Colin (& Therese)

Thanks so much for your replies.  They have been very helpful.  It is also good to know there are people out there who have had these kinds of problems and are now not only doing welll but helping others.  It gives me hope for my son.

Thanks Again

Other Colin

Hi nycolin,

If you come across information that you think useful, or would just like to discuss, please continue to post it here. It's only through discussion that we can improve what might be available.

Let us know how things proceed with your son.