Withdrawal Symptoms

I am currently in crisis.  I have just stopped taking my Klonopin after being on it for 6 months.  The highest dose I've taken was 2 mg for about 2 months.  I weaned myself off but not slow enough (7 days @ 1.5, 7 days @ 1 mg, 7 days @.5 then .25 for at least 2 weeks).  My doctor had me stop taking the .25 just 7 days ago and now I am feeling really horrible.  The anxiety is just unbearable.  Particularly bad when I wake up in the morning.  I feel so depressed.  I feel my heart pounding, no appetite, ringing in the ears, scared to be left alone, sweaty hands and feet, shakey and I feel weak.   What can I do?  Please help.  My doctor also put me on Atarax at 250 mg a day.  It's not really helping.  I have been taking Ambien to go sleep (not always) because I have to function and go to work and need my sleep.  My also put me on a very low dose of liquid Celexa (2 mg/day).  Also, last night I was talking to a friend on the phone.  I thought it was dream but apparently, I was really on the phone with her.  What's going on with me?  :'(

Hi SanFrancisco,

 

What you are experiencing could certainly be explained by withdrawal - you have withdrawn too quickly. I should point out that Ambien (a z-drug) is really no different to benzos. They have been marketed as being as a non addictive alternative, and although chemically distinct from benzodiazepines, they have very similar effects upon GABA (benzo) receptors. Withdrawal of a z-drug can be expected to have much the same same effects of withdrawal of of a benzo.

 

The reason the Ambien is not mitegating the withdrawal effects of the Klonopin is because it has a very short half-life (it is metabolised out of your system very quickly). Klonopin has a very much longer half-ilfe.

 

Why were you withdrawn from Klonopin? Might your doctor be willing to reinstate your last dosage (0.25mg) Klonopin? Better still, if you were to take an equivalent dose of Valium (probably about 5mg), you could make very much smaller cuts 2mg tablets of Valium. Assuming there are no exceptional circumstances that have forced you to quit (such as some toxic reaction), can you explain to your doctor that you suffering withdrawal symptoms, and need to reinstate a small dose and withdraw again from that, but very much more slowly?

Hi Colin,

 

Thank you so much for responding so quickly.  I have been taken off Klonopin at my request.  When I read about the effects of this drug, I immediately requested my doctor to take me off it.  She has put me on Celexa (very low dose) because I reacted to it (at 10 mg) with much more anxiety but she thinks that Celexa is still the best for me - so she started the dose at 2 mg.  I am now up to 4 mg and have not had a bad reaction.  Of course, the dose is so low that I hardly feel it working.  She is taking it really slow.  She also put me on Atarax and she did say it might not work as well as Klonopin but at least it is a safer, non-addicting and non-habbit forming drug.  She knows my fear of taking medication and I am now faced with greatest fear. Withdrawal.  I took the Ambien (10 mg) because of the insomnia the Klonopin has left me with.  I talked to her today regarding this and she said, she will switch me to Trazadone for sleep.  Do you have any opinion on this?  Isn't Trazodone an anti-depressant?  Will it interact with the Celexa?  Is Trazodone better for me than taking Ambien for sleep?  Thanks Colin.  I'd appreciate if you can enlighten me a bit.

 

 

Hi,

 

I don't really comment upon ADs (beyond advising that people quit benzos before they tackle any ADs they might be taking) because I've never taken ADs. However, many (probably most) of our members have taken ADs - I'm sure others will reply with their views about your ADs.

 

I understand your desire to quit benzos, but there is nothing to be gained by withdrawing at a faster rate than our bodies can recover. It seems (for very many of us at least) we have a maximum rate of recovery from benzos - a fast withdrawal doesn't mean that we recover more quickly, we just suffer unnecessarily instead. Some even claim that a fast withdrawal can actually lengthen our total recovery time, but I'm less than convinced about that. In your shoes, I'd reverse my last cut (and I'd consider switching to Valium too), and make a slow withdrawal from there. It would make sense to find the lowest dose that makes your fell reasonably comfortable, stick at that dose for a few weeks, and then make a more cautious withdrawal. If your prefer to use Klonopin instead, we can show you how you can make small cuts with Klonopin's small potent tablets.

 

Also, it would be wise to stop the Ambien too. You will become addicted to just as easily as any benzo. Those occasional doses are likely to increase in frequency, especially as you are suffering benzo-withdrawal at the moment.

Hi, SanFrancisco,

 

Sorry to hear you were tapered from Klonopin too quickly. Many of us have been there. It's hell.

 

I agree that the best course of action would be to reinstate some of the Klonopin until you feel like you are "stabilized"--that is, you feel that you can tolerate your withdrawal symptoms. The symptoms won't be gone, but they won't be unbearable, either.

 

Did you feel okay tapering until you stopped the last .25 mg? If so, that might be enough to stabilize you. I would start there, at the .25 mg. If after a few days things are not improving, you can up the dose in quarter-tablet increments until you feel stabilized. Once you've stabilized, you can either do a liquid taper from Klonopin (we can help you with that) or you can switch to the Valium equivalent and taper from there. I had to switch to Valium when I tapered Klonopin...I couldn't get beyond .25 mg without horrible symptoms like you're experiencing. A Valium taper is also easier to manage from the point of cutting tablets, getting precise dosages, etc.

 

About the sleep, yes, stay away from the Ambien, as any relief you get from that is just going to bite you later. Insomnia is a huge problem for people in w/d. I take melatonin to sleep at night. I took 6 mg a night when I was really having problems and am now down to 3 mg. Another sleep aid is something called "Calms Forte," which you can find at a natural foods store. You can also take that for anxiety during the day. Other members take Benadryl, an over-the-counter antihistamine, for sleep.

 

About your drug questions--call a pharmacist. I have found pharmacists to be very helpful with questions like this. It doesn't even have to be your own pharmacist, if you don't trust him/her. Call a few of them and see what they think about the trazodone and the Celexa combo.

 

I would hazard the guess that taking trazadone would be better than taking Ambien simply because Ambien is going to royally mess with your benzo w/d. But do try the sleep aids I mentioned first. All of them are safer than any prescription meds.

 

Therese

Just to reiterate, personally, if I was reinstating and thinking of switching to Valium, I'd do that now rather than reinstating the Klonopin first. Switching after reinstating seems like another unnecessary hurdle if you already know that you will be making the switch.

Thank you Colin and Therese.  I have been off Klonopin now for 8 days and have been trying to bear with the symptoms.  Do you think I should still reinstate to Valium and taper or if I can handle the symptons, can I just continue not taking anything until the symptoms go away?  I am so scared of getting on another benzo.  My only consolation right now is I have been benzo free fro 8 days and surviving.  Please let me know what you think. 

Hi Colin and Therese, I also forgot to ask you, if I do need to taper off using Valium, what would be the equivalent of .5 mg Klonopin to Valium?  Can you please teach me how to taper off Valium so I can tell my doctor.  A written instruction would be best.  Thank you both.

Thank you Colin and Therese.  I have been off Klonopin now for 8 days and have been trying to bear with the symptoms.  Do you think I should still reinstate to Valium and taper or if I can handle the symptons, can I just continue not taking anything until the symptoms go away?  I am so scared of getting on another benzo.  My only consolation right now is I have been benzo free fro 8 days and surviving.  Please let me know what you think. 

 

Hi,

 

You should do what you feel most comfortable with. It probably isn't a good idea to start with a strategy that makes you feel uncomfortable. You should be able to manage a taper directly from Klonopin. If I sounded as though I was pushing the switch to Valium, that wasn't my intention.

 

Only you can decide if you stick it out or go back to a small dose of Klonopin. If it feels bareable, then maybe you could wait and see for a while longer.

Hi Colin and Therese, I also forgot to ask you, if I do need to taper off using Valium, what would be the equivalent of .5 mg Klonopin to Valium?  Can you please teach me how to taper off Valium so I can tell my doctor.   A written instruction would be best.  Thank you both.

 

What is equivalent is variable. Prof Ashton's experience from her clinic was that 0.5mg Klonopin is equivalent to about 10mg Valium. This is irrelevant though. If your switch or not, you should only take enough for you to feel reasonably OK. Your GABA system will have repairing itself to some degree since you quit, so you might only require a very small dose to gain the relief you need from the withdrawal symptoms.

 

Whichever benzo you take, tapering off is just about making small cuts your dose. This is trickier with Klonopin as it very potent and comes in reletively lerge dose (but small phisical size) tablets. This makes cutting the dose by small amount more complicated. We have method to get around this though.

 

http://www.benzobuddies.org/forum/titration-tapers/titration-instructions!/msg55024/#msg55024

The reason I recommended stabilizing on Klonopin first, rather than going directly to Valium, is that you already know what Klonopin feels like. Adverse reactions to Valium are rare, but it does have a different "feeling" than Klonopin. Some people notice that more than others. It wouldn't be *required* to stabilize on Klonopin first; that was just my suggestion since it is familiar to you.

 

About going back on a small dose of Klonopin...it's really a gamble. Some people have a week or two of hell and then they're fine. But others can go months with terrible symptoms. Please note that after being off benzos for two or three weeks, some people lose the ability to gain any benefit from reinstating. Their bodies have decided they no longer want the benzo. So you can end up in a situation where reinstating the benzo won't work, and you are stuck with the withdrawal symptoms for a long time. So I would not wait too much longer before reinstating the benzo if you want to try that route.

 

I think that the biggest danger with regard to symptoms not being controlled by a slow taper is that you can develop symptoms secondary to anxiety. That is, if you are having a lot of anxiety, your body gets really burned out. Then all kinds of things start to go. Your digestion tanks, for instance. Then you can't take in the food you need to heal from the benzos. Your immune system may get stressed from the constant anxiety, at which point you could get an infection, which is very bad for someone in w/d. These are some of the possible pitfalls of not doing a slow-enough taper.

 

Ashton's Valium equivalencies are well researched, so I wouldn't worry too much about whether you need more or less than 10 mg. 10 mg Valium would be the place to start if you want to switch over. Have your read her manual? It's at http://www.benzo.org.uk/manual/index.htm. If you want to take something to your doctor, that is what I would take.

 

Therese

 

 

SanFrancisco,

 

As Therese wrote, it is a gamble. There are few things that are definitely right or definitely wrong with a benzo withdrawal. You should read around, look at the different options, and go with what you feel will best suit you - you are the best judge of you!

gigi

 

you can get addicted to benzos in as little as 2-4 weeks.  you started and a high dose of 2mgs and while you withdrew  too fast, you are off.  unless you are laying in bed, moaning all day, i would just try to stay off benzos and let your body and brain heal.  insomnia will probably be your biggest problem but hey, i haven't been on benzos in 1 1/2 years and i still can't sleep.

 

my situation was completely different than yours.  i was on benzos for 7 years and switched to 30mgs valium to taper.  i was one of the faster taperers and finished in 4 1/2 motns.

 

you need to listen to your own body and not anyone else.  you also might need more than 10mgs valium to crossover to.  10mg wiped me out at first.

 

joan

Hi Colin, Therese and Joan,

 

My doctor switched me over to Diazepam at 10 mg/night from Clonazepan .5mg.  She said, I can go up to 20 mg of Diazepam need be.  That'll be our ceiling she said.  I've been trying to stay at 10 mg.  I tried 5 but could not go to sleep.  Took 10 mg and woke up anyway after 3 hours with terrible anxiety.  I was miserable. 

 

My doctor said she'll start the taper as soon as the antidepressant meds (Celexa) kicks in.  Do you know of anyone who is trying to withdraw from Benzos and was put on antidepressants?  She said, when the Celexa starts working, my withdrawal will not be so bad.  I am so confused and scared.  I was taking 1 mg of Klonopin for about 3 weeks then went up to 2 mg.  (It was human error - I didn't know they were 2 mg tablets, I thought I was still taking 1 mg until I saw the back of the tablet and said "2".)  I took 2 mg Clonazepam or almost 2 months and started my taper.  I tapered to fast.  My total Clonazepam use (of different doses ranging from 2 mg to as low as .25) is almost 6 months.  I was already experiencing anxiety at .75 mg.

 

Please let me know if you know if anyone who has experienced less withdrawal when switched to an antidepressant.  That was the original plan by my doctor until I prolonged getting on Celexa.  I stuck with the Clonazepam instead of taking them at the same time.  Now I'm miserable.

 

Help me, please.

 

Hi Joan,

 

I've tried to stay off the benzos but it seems like I cannot handle the abrupt withdrawal.  I am so miserable, that's why my doctor put me back on Diazepam (at my request) so I can taper off it.  She agreed.  You did taper off pretty quickly from Valium.  Did you have any serious symptoms during the tapering and withdrawal from it?

Hi SF,

 

It takes time for benzos to build up in your bloodstream, especially with long half-life benzos, such as Valium. In your shoes, I'd take just the 5mg (should be equivalent to about 0.25mg of Clonazepam) for at least a week and see how it goes. Because comparatively little of the Valium is metabolised between doses, subsequent doses add significatly to your blood levels of Valium. This keeps happening until the blood levels reach an amount where the propertion of the Valium that is metabolised between doses equals the amount the enters the bloodsteam with each new dose. How long this takes will vary a lot from individual-to-individual, but my guess is that it could take a couple of weeks before you near equalisation of your blood levels.

colin

 

HUH!!!!!!!!!!.  i don't even have benzo brain anymore and i didn't comprehend one word you just said.  lol lol.  this poor girl. 

Colin--do you mean 10 mg Valium? SF was on .5 mg Klon, and Ashton's equivalence is 10 mg Valium. I assume that equivalence takes into account the metabolization buildup.

 

SF, it does take a while for the body to adjust to the new benzo. I switched from Klonopin to Valium in two steps: during the first two weeks, I took half my dose as Klonopin and half as Valium. I had light sleep and panic attacks for about a week, then things evened out. Then I switched everything to Valium for two weeks. I had more panic attacks and nasty insomnia for a week, then things again evened out. Then I began cutting the Valium.

 

I was very scared too. I thought to myself, Am I doing the right thing? But I was. So it may take your body awhile to adjust to the Valium, especially because it needs to build up in your bloodstream. As Colin suggested, I would give it a couple of weeks. If it's very difficult, maybe you would want to talk to your doctor about switching over in a couple of steps, like I did.

 

Whether an a/d helps you in withdrawal varies from person to person. Most of the people on this site who are on a/d's were on them before they started tapering their benzos, so they were already stabilized on their a/d's. Professor Ashton does say that a/d's do help some people with the depression that often comes during w/d. One of our members, Twitch, went on Lexapro (similar to Celexa) after doing a cold-turkey withdrawal, and he said it's helping him deal with the symptoms. It's really an individual thing.

 

Therese

Hi therese,

 

I thought SF went down to 0.25mg - I could be wrong. Ashton found that you about 20 times the dose of Valium to substiture for Clonazepam.

 

SF,

 

Benzos (all drugs) with short half-lives take a shorter amount of time for the levels to build up to stable level compared to benzos with long half-lives.

Hi Colin, Therese and Joan,

 

Thank you all for replying.  I am so glad I found you guys.  Therese, how many mg of Valium did you taper from.  My doctor wants me to take up to 15 mg. which she said is equivalent to .75 Clonazepam.  For some reason, she thinks that Clonazepam is a more potent drug.  Were you under a doctor's supervision when you tapered off?  Also, if you can still remember, can you give me your tapering schedule or did you follow the Ashton one?

 

Thanks guys!  You're great!

 

Ashton's figures suggest that 0.75mg Clonazepam is equivalent to about 15mg of Valium - Clonazpam is indeed far more potent. We vary in what is an equivalent for us as individuals though. There is no need to take more than what makes you feel reasonably OK - you are not going to feel great by taking more than is necessary!

 

There is no magic to tapering off benzos. It would be advisable to take the Valium two or three times a day, at equal intervals. Cuts to your dose should be no more than about 10% of your overall daily dose. When it becomes impossible to manage cuts of this size (because you cannot divide the tablets small enough), we can help you with a method (titration) that will get around this for you, if you need it.

Thanks Colin!  You are wonderful! Once I start tapering (slow) from Diazepam, will the symptoms be bearable?  I think I got traumatized because of the symtoms I had when I tapered off Clonazepam.  I'm still suffering from it now.  Will the symptoms I'm having now subside now that I have reinstated to Diazepam?    My psychiatrist said, as soon as I feel better from the Celexa, she will start tapering off the Diazepam.  She also promised me she wouldn't keep me on the Diazepam for a long time.  I've expressed to her my fear of being on a benzo.  She needs to put me on an antidepressant med because my original diagnosis is depression/anxiety.  Unfortunately, I took the anti-anxiety and left the antidepressant out of my treatment.  Now I have to start from the beginning.  She also told me that being on the antidepressant will help ease the symptoms of withdrawing from the benzo.  She said some of her patients who started on antidepressants and benzos stop their benzos after feeling good (when the antidepressant starts working) without even consulting with her.  I just hope I have a soft landing when she gets me off the Diazepam.

 

 

Hi, SF,

 

I switched to Valium when I was at .25 mg Klonopin. I switched to 5 mg Valium. Before that, I had direct-tapered from .75 mg Klonopin, just by cutting tablets. The cuts past .25 mg will just too awful for me to handle, which is why I switched.

 

Yes, I was under medical supervision. It was hard to find a decent doctor, though! You are unusual in that your doctor was willing to switch you and even willing to be flexible about the amount of Valium you need. So it sounds like your doctor knows something about benzos.

 

When I switched to Valium, I started cutting .5 mg every two weeks. I did this until I got about halfway through, to about 3 mg or so, at which point I had to cut every three weeks because the cuts were harder to handle. Then we decided I would go back to cutting every two weeks but at a slower rate--only .2 mg (my doctor wrote me a script for liquid Valium, which is how I could make this kind of cut). When I got to the very end, at about .5 mg, I had to slow down again, to .1 mg every two weeks, but then I finished off by doing tiny daily cuts. The whole ordeal took me nine months. But I'm glad I took a long time, because the symptoms were bearable that way.

 

If your symptoms are causing you too much trouble, the answer is to make smaller cuts and to go as slow as you need to go. Things won't be comfortable, but they'll be bearable. It took me much longer to get off than I thought it would, but I listened to my body and changed my tapering schedule accordingly.

Hi Therese,

 

Thanks for the very informative response.  I've been on day 3 on 10 mg of Valium taken before bedtime.  I get to sleep but the problem is, I wake in the morning feeling horrible.  I feel so exhausted and depressed about it.  Hard to get out of bed but I have to force myself because of work.  I thought this would disappear after the switch to Valium.  Why is this still happening?  I am trying to stay on 10 mg of Valium and not increase the dose and just bear with the morning dreadful feeling.  Will this ever go away?  What were your withdrawal symptoms?  I am also suffering from mild tremors in my hands.  This is getting be so frustrating.  Will this really ever end?

 

What kind of symptoms did you get?

Hi SF,

 

It will take quite a bit longer than three days for the Valium to build up in your system. I think you might well benefit from splitting the Valium into two doses over the day instead.

 

I don't have any figures for how long it takes for benzo levels to stabilise after commencement, but I think you are probably looking at something like a couple of weeks. It should be improving over this time though as your blood levels slowly increase.