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Old 10-03-2009, 04:20 AM   #1 (permalink)
 
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Unhappy Clonazepam (Klonopin)

Hi everyone!

I have been using clonazepam to help me to cope with SA since 1996. It worked great in the beginning then it lost its "power" due to tolerance but always seemed to help a little. I tried to stop many time but I would get severe anxiety and withdrawal symptoms. However, after reading about the "dangers" of long term use of benzos I decided to stop. So in July of 2008 I started my taper (substituting clon. for equivalent diazepam) and finished it in July of 2009. Since then my life is been a nightmare! My social anxiety is back (sometimes I manage to cope), I also have depression since I stopped clonazepam (I'm currently on 45mg of mirtazapine but it's not really helping). I'm participating of a online group for people coming off benzos and they said that all these will pass but I'm not that hopeful as it has been 2 months since I had my last pill and the symptom of SA and depression don't improve.
I will see a doc on Monday and I'm thinking of asking for Nardil and Tiagabine to help with my symptoms.

Anyway....

Please leave your comments, opinions and suggestions.

Thanks,

Fabian
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Old 10-03-2009, 05:18 AM   #2 (permalink)
 
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Have you tried adding an SSRI with mirtazapine? I would try that before moving on to the MAOIs, it can be very effective, comparable to the MAOI Parnate without as many side-effects:

http://ajp.psychiatryonline.org/cgi/...act/163/9/1531

An SSRI would be better than an SNRI in benzo withdrawal, you don't need the increase in adrenaline.
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Old 10-03-2009, 07:28 AM   #3 (permalink)
 
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Sounds like something called PAWS (post-acute withdrawal syndrome.)

If you were dependent on benzos for 12 years it's going to take a while. One of the really compelling reasons to not get hooked in the first place is that you can be suffering from stuff like this for months (sometimes even years ) after going completely off the drug.

The good news is that in all likelihood this is not your new baseline. PAWS will pass, and even though it's not as severe as acute withdrawal, it's harder to deal with for a lot of people because of the sheer length of time involved.

I REALLY want to commend you for toughing it out and looking for a better long-term solution, rather than just do the easy thing and get back on the benzos. Many, if not most, don't have that kind of strength.

Unfortunately, given how long you were on clonazepam, still feeling crappy after two months is not really a surprise at all. So don't worry that this is how you're going to feel like for the rest of the life.

Now there are people on this board with a better knowledge of psychopharmacology than I, but I feel that switching to other GABAergic drugs (Nardil and Tiagabine) is not all that different than using a benzo to deal with the PAWS. It seems really counter-productive. Maybe somebody with much deeper knowledge on the matter can chime in and disagree.
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Old 10-03-2009, 08:41 AM   #4 (permalink)
 
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As I'm currently taking clonazepam and considering tapering off, I've taken notes on what some others have said on the forum about how to make the process easier (to talk to my psychiatrist about).

Most of the posts are from the user medline. I hope he doesn't mind that I repost them.

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Everyone who is moderately-severe physically dependent on benzodiazepines should consider the method of substituting the benzo with an ~ equivalent dose of phenobarbital / primidone and then tapering the dose of that drug down without feeling withdrawal symptoms nor sedation for about 3-4 weeks...

---

Medline I know phenobarbital is getting more difficult to find in the US. I was wondering if that will happen internationally? I have no plans to taper from valium but I really would like the option of pheno if/when I ever make that decision.

---

Phenobarbital / Primidone can still be prescribed in many countries internationally and getting them online without a prescription is pretty easy, although I can't name sources because of bourd rules of course.

---

DMBfan:
Medline, since phenobarbital seems to commonl be sold in 100mg pills how do you go about dosing it below 25mg (quartering it)? If people are taking the equivelant of 1mg of klonopin or less it would be difficult to cut the pill small enought to get the right pheno equivelancy. At what point in the taper do you switch to pheno? And do you just take the pheno for 3-4 weeks and then stop cold turkey or do you taper off of the pheno at the end?

Medline:
There exists liquid Phenobarbital and I also think cutting the pills shouldn't be a very big problem. I don't taper benzos when I have Phenobarbital, I just stop the benzos and always take enough Pheno to not feel withdrawal symptoms nor sedation. I used Pheno for ~ 3-4 weeks, but that was probably longer than necessary as I wasn't a hardcore benzo addict who eat 40 pills daily. I made a fast Pheno taper, but with it's very long half-life this drug is kind of self-tapering. Keep in mind that this is just from my personal experience mixed with some info from my Pdoc. I'm sure there exists professional (older) manuals for benzo withdrawal using phenobarbital on the internet.

---

If benzodiazepine withdrawal is really bad the fastest and IMHO most pain free method is to detox with (Desoxy)Phenobarbital which takes about two weeks. The other option is tapering down very slowly with long acting benzos.

---

One can use Klonopin (or any benzo) for 3-4 months and then replace it with an adequate dose of Phenobarbital or Primidone (Desoxyphenobarbital) for 10-14 days, then the tolerance / physical dependence is gone so one could take benzos again. But not many Pdocs will prescribe this old meds nowadays. Personally I like this strategy of benzo withdrawal much more then slowly tapering (it also works for severe hypnotics withdrawal if the Phenobarbital dose is chosen right).

---

Tapering off benzos can be slow and hell, detoxing with phenobarbital is fast and easy IMHO.
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Old 10-03-2009, 08:49 AM   #5 (permalink)
 
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Drew, (s)he's already tapered off completely for 2 months now, none of that stuff is really going to help her.
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Old 10-03-2009, 08:52 AM   #6 (permalink)
 
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Quote:
Originally Posted by meyaj View Post
Drew, (s)he's already tapered off completely for 2 months now, none of that stuff is really going to help her.
Ah, ok, thanks for the correction! I wasn't sure if it would still help at this point.
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Old 10-03-2009, 09:20 AM   #7 (permalink)
 
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lol, I just re-read my post and to me it seems like it may have been a bit blunt and rude... sorry if it was
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Old 10-03-2009, 09:25 AM   #8 (permalink)
 
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Quote:
Originally Posted by meyaj View Post
lol, I just re-read my post and to me it seems like it may have been a bit blunt and rude... sorry if it was
No apology needed! I didn't take it that way at all. I'm well aware that most of you guys who post regularly in the Medication forum know a lot more than I do.
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Old 10-03-2009, 10:35 AM   #9 (permalink)
 
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Quote:
Originally Posted by Drew View Post
Most of the posts are from the user medline. I hope he doesn't mind that I repost them.
No problem with that. When I see all my positive posts about (desoxy)phenobarbital for benzo withdrawal listed here it nearly seems I'm the guy who has the exclusive rights to sell Pheno worldwide. But my experiences with Pheno for (acute) benzo withdrawal were really all positive.

I think i read once that in case of protracted benzodiazepine withdrawal (PBW) going on low-dose phenobarbital for some time and then tapering it down helps, but I can't find that article right now and I really can't say if Pheno helps with PBW.

Some controlled studies show that the benzo antagonist flumazenil helps with PBW, but receiving this intravenous drug treatment will be very hard.
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Old 10-03-2009, 11:25 AM   #10 (permalink)
 
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Thank you all guys for your replies!

Medline is right, flumazenil would help but I don't think I could get a doctor to prescribe me that. They don't take withdrawal that serious and think that what I'm having is my baseline anxiety accompanied by its symptoms (I know it's not).
I'm desperate because I started my second year at Uni and I am having a hell of a time and was thinking of putting it on hold (what I can't really afford to do) until I am completely free of symptoms.

I have been reading some replies and other threads and realised that some of you guys are quiet well versed on this subject (pharmacology in general), so I would appreciate more advice in what to do.

What should I get to help with my severe SA, depression, anxiety and withdrawal symptoms?

I thought of tiagabine because it's used to help people coming off of alcohol and it's not addictive and doesn't seem to develop tolerance.

What about baclofen?

Maybe take 1 clonazepam pill now and again with d-cycloserine (I looked online to get it and it's quiet expensive) to help with the "extinction" of my SA?

Anyway, thanks once again and please leave more opinions, advice, comments, experiences .... anything.
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Old 10-03-2009, 11:33 AM   #11 (permalink)
 
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Baclofen works on GABA-B, but your long-term benzo use has probably "messed up" you're GABA-A system. I think you could try Lyrica (Pregabalin). It is approved in the EU for generalized anxiety disorder and has shown to be an effective and well tolerated treatment for social phobia in a multicenter, double-blind, randomized, placebo-controlled study @600mg / day (http://cat.inist.fr/?aModele=afficheN&cpsidt=15707506). It can be combined with antidepressants if neccessary.
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Old 10-03-2009, 11:39 AM   #12 (permalink)
 
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I tried pregabalin on withdrawal from about 2-4mg clonazepam, it helped anxiety a bit but made me so depressed it wasn't worth it. Truly horrible feeling. I was still shaking like a leaf, and had to sit an exam... I failed.

OP, for 'resetting' your GABA receptors, flumazenil one of the best methods in PAWS. Or, as suggested, phenobarbital may work. I don't think GABA(B) agonists will target the right receptors.
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Old 10-03-2009, 11:43 AM   #13 (permalink)
 
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Another thing guys: is there anything that I could use to up-regulate (even temporary) my GABA system? Or something that I could use for my anxiety (and or) GABA that doesn't develop tolerance (at least not as fast as benzos). I have heard of Vigabatrin, Tiagabine others similar.

Any ideas and suggestions are welcomed!

Thanks.
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Old 10-03-2009, 11:48 AM   #14 (permalink)
 
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You can forget about Vigabatrin because of toxicity.
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Old 10-03-2009, 11:49 AM   #15 (permalink)
 
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I tried pregabalin and it did work reasonably for SA but I had restless legs syndrome while on it so I had to stop. Besides, withdrawal from it is somewhat similar to benzo w/d.
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Old 10-03-2009, 11:52 AM   #16 (permalink)
 
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Quote:
Originally Posted by Medline View Post
You can forget about Vigabatrin because of toxicity.
Ok, I won't mention this one to my doctor.

I have been waiting to see him for so long that during the appointment I have on Monday I need to know the best path to suggest to him otherwise he will just switch the antidepressant or increase the dose.

Thanks for your advices!
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Old 10-03-2009, 11:54 AM   #17 (permalink)
 
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Quote:
Maybe take 1 clonazepam pill now and again with d-cycloserine (I looked online to get it and it's quiet expensive) to help with the "extinction" of my SA?
I wouldn't take cycloserine at all really, but definitely not on benzo withdrawal. As an NMDA agonist it could cause excitotoxicity.

I stick by my recommendation of an SSRI with your mirtazapine. Tiagabine could probably work for the GABA, yeah. Also, if you don't already, take magnesium supplements. This should help depression & anxiety in benzo w/d, and act as a general neuroprotective. Don't take too much though.
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Old 10-03-2009, 12:07 PM   #18 (permalink)
 
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Quote:
Originally Posted by euphoria View Post
I wouldn't take cycloserine at all really, but definitely not on benzo withdrawal. As an NMDA agonist it could cause excitotoxicity.

I stick by my recommendation of an SSRI with your mirtazapine. Tiagabine could probably work for the GABA, yeah. Also, if you don't already, take magnesium supplements. This should help depression & anxiety in benzo w/d, and act as a general neuroprotective. Don't take too much though.
Thanks Euphoria!

What kinds of magnesium supplements do you suggest (reliable sources) and other supplements?

Thanks.
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Old 10-03-2009, 12:40 PM   #19 (permalink)
 
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I take KAL magnesium glycinate supplements, 400mg/day... my doctor recommended that specific form, much more absorbable and doesn't act like a laxative like other forms of magnesium. It does help.

Again, I would urge staying away from any GABAergic drug to lessen symptoms. Benzodiazepines have a particularly bad reputation, but going on Lyrica or other GABAergic drug to deal with PAWS is going to be like giving a recovering heroin addict some oxycodone. It's only going to serve to keep your GABA receptors downregulated, and rather than helping get you through this uncomfortable period, it's really just going to delay it, possibly making you start back from step one.

You've been strong for 2 months now which is more than most can say, and although the GABAergic drugs may seem like an easy and enticing way to make things more comfortable for you, it's not going to let your body get back to its own homeostatic balance. I promise you'll get through this with a little patience, and there are many drugs that can help mitigate the PAWS that have no gaba activity... it just takes a bit of work finding the right one.
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Old 10-03-2009, 10:27 PM   #20 (permalink)
 
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Originally Posted by meyaj View Post
I take KAL magnesium glycinate supplements, 400mg/day... my doctor recommended that specific form, much more absorbable and doesn't act like a laxative like other forms of magnesium. It does help.

Again, I would urge staying away from any GABAergic drug to lessen symptoms. Benzodiazepines have a particularly bad reputation, but going on Lyrica or other GABAergic drug to deal with PAWS is going to be like giving a recovering heroin addict some oxycodone. It's only going to serve to keep your GABA receptors downregulated, and rather than helping get you through this uncomfortable period, it's really just going to delay it, possibly making you start back from step one.

You've been strong for 2 months now which is more than most can say, and although the GABAergic drugs may seem like an easy and enticing way to make things more comfortable for you, it's not going to let your body get back to its own homeostatic balance. I promise you'll get through this with a little patience, and there are many drugs that can help mitigate the PAWS that have no gaba activity... it just takes a bit of work finding the right one.
That's probably the best form of magnesium, yeah. His benzodiazepine (BDZ)/GABA-A receptor complex is "messed up", so I agree that going on benzos again is very likely a bad idea. But other GABAergic drugs like Nardil (which metabolite acts as an GABA-transaminase inhibitor) or Tiagabine (which acts as a selective GABA reuptake inhibitor) might effectively lessen his anxiety (Nardil his depression too) without being counterproductive, because they act on the GABA system completely different than benzos.

Phenobarbital is a strong GABAergic, but useful for at least acute benzodiazepine withdrawal because it allows the (BDZ)/GABA-A receptor complex to normalize while lessening or eliminating the withdrawal symptoms at the same time because it acts completely different than benzos on the GABA system.
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