First off: Yep, I know you’re not a doctor, or if you are a doctor, I know you’re not my doctor. I’ll be seeing my shrink on Friday and this isn’t an emergency situation, just an uncomfortable one.
I’ve got panic disorder, for which I’m taking Klonopin 1mg thrice a day. Yes, before anyone mentions it *(BigT I’m looking in your direction!), *I know benzos are Of The Devil, yes, I know they’re addictive, but it works, and fuck it, I need something that works because the panic attacks and the dread of them have just about taken over my life, which wasn’t exactly sunshine and roses in the first place (I also have major depression). So far Klonopin – well, generic clonazepam – is the only thing that’s kept the attacks relatively rareish. By which I mean once every couple of weeks, and usually I’ve been able to ride through them to the point where it’s just my heart-rate going faster, I take deep breaths, distract myself with a videogame or sitcom, and the panic subsides and doesn’t blossom into a full attack.
Anyway. After being on this regimen for a couple of months, like a total idiot I let myself run out of Klonopin by miscalculating when I’d need to get my refill, and couldn’t get hold of my doctor to get me a new Rx. So there were two days where I was off the Klonopin cold turkey… well, let’s say a day and a half. And again, YES I know that’s a big fat no-no. However, very fortunately, I didn’t feel any negative withdrawal effects so I thought I’d dodged a bullet. Yesterday I got my meds and started back on the regimen (not taking any extras to make up the missed doses, obviously, I’m not that big an idiot).
Tonight, the first full day back on my meds, however, I got walloped with some incredibly uncomfortable anxiety feelings – most panic attack suffers will recognize them: this stretchy, adrenaline-rushing feeling in my muscles like I was jumping out of my skin, a burning sensation from inside out as if my face, chest and legs were sitting on a stove, and that old favorite, a racing heart, though not as bad as a full-on attack… my pulse was just over 100bpm and that quickly went back down to a more reasonable 93, where it is now; high normal, but not uncomfortable.
(God, that stretchy muscle/teeth-hurting/tightness feeling is just horrible. It’s… it’s like your body’s desperately trying to turn itself inside out and your skin is the only thing preventing it. It makes me want to lie stiff as a board on my bed, afraid any touch or any movement will cause me pain. I tried some brief exercises hoping it would relieve that restless feeling, but it just made it worse.)
So here, at long last, is the question. Normally I don’t really need a reason to have a panic attack; they’re not spurred on by anything, not related to something bad I’m thinking or dreading, they’re utterly unpredictable bastards which is why they’re so fucking scary. But I find myself wondering: **is it possible that I’m having sort of a delayed reaction to the 1.5 days of not taking the meds? ** Even though I’m back on them?
It seems hard to fathom because Klonopin isn’t like an SSRI that takes weeks to kick in; having started up again I would expect it to act relatively quickly, though not as quickly as Xanax. (I’m actually rather proud to have weathered this one without reaching for my emergency Xanax.) As I said, I’ve been back on the Klonopin since last night, meaning I took 2 yesterday, 3 today. But despite being back on them, is it possible that my body’s still dealing with the sudden withdrawal?
A gentle plea: Please please no lectures about a) being an idiot for taking a benzo, and b) being a bigger idiot for skipping my doses for nearly 2 days and effectively going cold turkey for that time, which is not just uncomfortable it can be dangerous. There’s no warning or recrimination or smackdown you can tell me that I haven’t already aimed squarely at myself. I’m an expert at delivering self-recriminating smackdowns, believe me.
Oh! Edited to add – I’ve recently (within the last four months) had a stress test, EKG and sonogram, all fine, so I’m not thinking this was a heart issue. Those tests are the only things keeping me from rushing to the ER every time this happens.
Klonopin has a very long half life for benzoes, 18-50 hours according to wiki. So you wouldnt experience full withdrawal for quite a while, and the new pills wouldnt build up to their full previous level till you’ve had a days worth or so.
So I wouldnt say that reaction is surprising, but check with your doctor etc etc.
Huh. Thanks, Otara. I hadn’t thought of it quite like that. So it’s sort of like those seven-second time delays on live TV broadcasts, or the way light from distant planets/stars takes a while to reach us?
It took Klonopin’s half-life time for the residual meds in my body to disappear, and thus the reaction was delayed… and meanwhile, though I’ve started up again, the body still has to wait to catch up with the full level (which I guess would be today, the first day I’ve been back on 3mg)?
For some reason half-lives of meds never really “clicked” in my brain before, but what you say makes sense. Hopefully since I was only off them for fewer than two days, I won’t be dealing with this for too much longer.
Lesson not to abruptly stop benzos learned, though, hoo doggies. Lesson freakin’ learned.
Pretty much with the video analogy. The benzoes that tend to cause the most trouble with panic disorder are the ones that act quick and leave quick like Xanax, so the trend these days is to prescribe longer lasting ones and to take them preventatively, to try and avoid peaks and troughs.
As in the pattern with benzoes often is that the person avoids taking them till they’re really struggling anxiety or panic wise, and then takes them. This increases dependence far more rapidly than when the anxiety is kept at more manageable levels overall. Taking them at high anxiety peaks also tends to make the person feel worse about themselves as well - ‘I dont have any willpower’ etc etc.
Hope you’re getting some other assistance. As Im sure you know, the long term risk even with these is ending up with both a substance abuse issue and panic disorder, where previously you only have panic disorder.
Yeah, when I had my first panic attacks (that I was certain were heart attacks and thus went to the ER), the docs gave me valium and ativan and boy, those worked pretty well. (Though I was also exhausted because I was at the ER for like eight hours as they ruled out any heart issues, so it could also just be that the panic subsided as the docs ruled out all the really bad stuff I’d been imagining.) Finally saw a psychiatrist and his first instinct was to give me Xanax, I believe .5mg once a day. Am now in regular therapy (social worker) and see the psych doc once every couple of months. When he saw that the Xanax wasn’t really doing much preventatively – though this was simultaneous with his experimenting with SSRIs, which just… God, no. My lovely Prozac, once so helpful to me fifteen years ago, now turned into the most awful experience in prolonged anxiety I’d had to date.
I went on Klonopin, then he tried to taper me down very slowly while switching to Zoloft for the depression, but when the attacks continued I finally went to him and said, “you know what? I can live with the misery of depression, I’ve done it all my life. But this panic disorder? I can’t handle it. I feel like I’m losing my mind and it’s destroying my quality of life. We have to address the panic first, and deal with the depression later, because I’m seriously unable to function.” So he said fine, let’s take you to 3mg of Klonopin and a tricyclic for the depression – unlike SSRIs, the tricyclic will NOT give you anxiety, I promise." And so far he’s been accurate. Also helps my insomnia, which wasn’t helping anything. (Okay, I’m now up at 4:40AM, but I’m on a wacky schedule.)
Thank you! Yes, I am getting help, but it’s been rough as I mentioned before, finding the combo of meds (and therapy) that will work for my unfortunate combo of issues. Panic disorder is horrible. It’s the closest I’ve ever come to understanding why people kill themselves, either accidentally or on purpose, via taking downers. I understand the desire to be free of the agony. Once I made that realization, that I not only understood but kinda wanted oblivion too – just not final oblivion – that’s when I knew it was time to get my ass to a doctor, because that desire for oblivion scared the shit out of me. That’s a little too close to suicidal for my liking.
As far as the substance abuse goes… I definitely know they’re supposed to be addictive, but so far I haven’t felt the need to go higher or anything since my doc bumped me up to 3. I had been feeling relatively stable until this last withdrawal issue. My therapist and I are working on the depression, stress and panic issues, so in the meantime, I’m happy to have found something, anything, that works. And the Xanax… honestly, as I said I only take that in the throes of an acute attack. I admit I keep a bottle in my purse, sort of as a talisman so I know it’s there if I need it. That bottle of 30 pills has been with me since June, which I think indicates I’m not chomping these things down like M&Ms.
Anyway, I know this is a question for a doc, but… are there any longterm problems with just using Klonopin (or whatever benzo) if one doesn’t keep increasing the doses? I mean, many people are on longterm uses of SSRIs, or Metfornin for Diabetes, or Beta Blockers for blood pressure, and they’re not warned against staying on the meds. So why is this medication different? In other words, why couldn’t this be just my regular medication? I suppose I have heard of memory problems. But I forget where I read that. (Just kidding!)
I would freakin’ love to be taking nothing – I used to balk at taking any pills when I was younger, not even aspirin or vitamins – but if this helps, and I don’t start needing more and more, what’s the downside?
Edited because I want to reiterate: thank you very much for your responses, Otara. They’ve been illuminating and helpful.
Okay, I’ll try my best not to mention all the things you already know so well about benzos…
I don’t know who BigT is, but apparently you haven’t seen my occasional benzo rants on this board. I hope you and your shrink are very carefully managing your meds, because if you’re not careful, benzos can seem so helpful AND THEN THEY SNARE YOU! Ask me how I know that. And if you really need them to get by, then you really really don’t want to let that happen because then you won’t be able to have them any more.
You wrote that your 3mg/day dose is working and you aren’t seeing a need to increase it. I hope for you sake that doesn’t get worse. I was on 0.5mg twice a day and gradually upping it, because constant dosage just kept getting less effective and I needed more just to keep the effect the same. But it was like, I was starting to get withdrawal problems each day, as the last dose began to wear off. And it got to where as the next pill time drew nigh, I would be watching my watch, counting down the minutes and the seconds until I could get my next hit. That’s when I began to realize there was a problem.
With only 0.5mg twice a day, I thought I could just quit cold turkey and be okay. (Months later, a doctor said that’s what he would have recommended too.) BIG MISTAKE.
I don’t know from your posts if you’ve ever experience an over-the-top full-bore clonazepam withdrawal. You wrote about rebound panic attacks you got. But did you ever experience the total brain-grinding massive intense insomnia, and the high-voltage electric brain torture? I did. At least I didn’t have seizures, which are known to happen.
Here’s one practical advice idea: Every time you get a refill, sit down while the bottle is still in your hand and it’s right there on your mind and note how many days it’s good for, and NOTE IT ON YOUR CALENDAR, right then and there!! Make a note on your calendar two weeks before you’ll run out, so you won’t have that happen again. That’s what I do with all my meds now. And library books. And any other future things I’ll need to remember.
Have you ever seen or heard of the web site www.benzo.org.uk ? I just took a look there, and I suddenly see that it’s been totally completely re-done and looks nothing like it did last time I looked there. But one valuable item there is the Ashton Manual by Prof. Heather Ashton, who ran a benzo rehab clinic for 11 years. The paper tells generally how benzos work, and gives suggestions for how to quit if you ever need to do that.
How long have you been using clonazepam or any other benzos? Have you been on it long-term? Benzos have a nasty habit of working well for short-term use, but badly backfiring and just making everything vastly worse for long-term use. I hope you and your doctor and discussing that danger, and developing some strategy to deal with it if that happens.
ETA: I see there is a recent supplemental update to the Ashton Manual here.
Yipe, that’s terrible. No, I definitely haven’t had clonazepam withdrawal (well, except for yesterday, but I don’t think that was over-the-top full-bore withdrawal, especially since I was back on it).
The worst panic attacks I’ve had were:
When I was withdrawing from Metropolol, a beta blocker. I’d tapered down on thaat medicine incredibly gradually, going from 150mg a day down to 12.5 a day over four months. I was only doing this because I couldn’t afford to go back to my doctor to get a prescription, so I figured I’d better start weaning off the meds. (They’re for anxiety rather than high blood pressure.) Bad mistake. I starting having intense head pressure, like a balloon was being blown up inside my skull, and my heart rate was going nuts, super-fast and thready, and my blood pressure was about 182 / 120 (when I went to the ER).
When I was on Prozac, as mentioned above. My whole body was buzzing like I was a human cell phone set on ‘vibrate’ as well as the muscle-stretchy feeling that made it seem as if a single touch would shatter me like glass. It took several hours (as usual) to subside and that was only with a valium I found left over from my previous hospital visit. (Whenever I read the description of panic attacks on various medical web pages like WebMD or whatever, which invariably say “they usually only last fifteen mintes,” I want to smack the writer. I don’t think I’ve ever had an attack that lasted less than an hour.)
That’s a great idea. It’s a pain in the ass that my insurance is extremely strict (though I understand why) about the dates when I can get refills. If it’s less than a month they won’t allow it. So I’m always cutting it fine and have to wait until I have like two pills left before I’m able to refill. My doctor suggested that he might write me a larger prescription than I need just so I’ll have extra, but I wasn’t keen on that idea because as annoying as it is, at least I don’t have any more temptation to take more than necessary.
I think I did come close to that “counting down the seconds” deal with Xanax. But that’s notoriously short-acting, which is why it was a bad choice for me over the long term.
Once I started on these meds I began getting worried that I wouldn’t remember how many doses I’d taken each day, which is when I got myself one of those little pill dispensers with the days marked on them, so I’m able to count ahead and keep track of things. (I think this is when I first realized “holy crap, I’ve become my grandmother.” But whatever works, y’know.) But your idea is a better one for keeping track of things monthly. I think I’ll set up a reminder on my computer to warn me when I’m two weeks away from needing a refill, and then a second reminder a week later. So far, to my doctor’s credit, he’s always scheduled our appointments about a week before I run out. The problem this past weekend was due to my losing my prescription slip and forgetting to call my doctor for a new one. Brilliant.
Yes, I’ve absolutely been there! When my doctor wanted me to lower my Klonopin originally (from 1.5 a day to 1 a day), he had no suggestions for me how to do it. I found that manual and saw that the recommendation was to use valium as a substitute and very slowly start switching over from Klonopin to valium, which apparently is easier to wean off from than Klonopin. Of course my doctor hadn’t bothered mentioning that method. But yes, I think that site’s a godsend. Once I feel stable, if ever that happy time comes, I’ll wait a few months to make sure I am stable and will probably try to slowly, like over a year, taper down. My experience with tapering off of Metoprolol was enough to teach me that even a couple of months wasn’t a slow enough process.
How long have I been using any benzos: well, my first-ever benzo was Lorazepam (Ativan) but only was on that for a week back in 2008. Next was Diazepam (Valium), ditto, in um 2010, I think? Then my current psych doc put me on Xanax I believe it was 1mg a day, and that’s when I began the Prozac, so that would be… hmm, since last September, I think? He realized I’d need something longer-acting so we switched to Klonopin in October. So about six months on that one.
I’m lucky to get 15 minutes with him and no, we haven’t discussed what the longterm plan is; I think the idea is just to see me stabilized for a decent amount of time before we discuss the future. But I’ll bring it up at my next appointment (at the end of April).
BigT hates benzos like you do, btw. But I do think I’ve seen your warnings before as well, I just forgot your screenname. Sorry about that! I will definitely take your words to heart. I read an interesting discussion on some mailing list just for doctors (should’ve bookmarked it) talking about how clonazepam longterm use hasn’t been a problem for their patients, though a couple disagreed. It was an interesting debate… I’d never read or heard a conversation among doctors talking among themselves about whether they should be prescribing various meds, so it was quite enlightening. I think it was from 1995 or so, or maybe it was 2005.
As I mentioned, my end goal, or hope, is to find the panic attacks decreasing in frequency, which I’m seeing happen gradually… it’s definitely not happening as often, as I said above, and they’re getting more managable for two reasons, I think: 1) the medication, and 2) I’m gaining some more control and ability to tell myself as they start, “okay, you recognize this feeling, it’s not new, it’s not a heart attack, relax, ride it out, you’re not going to die from a panic attack,” etc. Only when this doesn’t work do I move to the nuclear option (Xanax) or if that doesn’t work, calling 911, because if the Xanax isn’t helping I worry that it is a heart issue and I don’t want to waste time trying to decide “hmm, is this numbness along my left side of my body due to panic, or a heart attack?” (So far it’s always been panic. But it’s not something I plan on fooling around. I even asked the ER doctors, embarrassed about wasting resources on a stupid panic attack, “should I have come here?” and they said “yes, that’s why we’re here, better safe than sorry – too many people wait hours to see if the problem goes away and unfortunately it does, permanently.”
Whew. Too much writing for this early in the morning. Also I really try not to think about panic attacks too much, because that sometimes makes me more aware of my heart rate, which is almost always what starts triggering me into the vicious circle of noticing my heart rate, which makes me nervous if it’s slightly elevated, which then makes me more nervous, my heart rate increases again, and so on and so on.
So I’d best shut up now! But thank you very very much for your post. I do appreciate your advice.
But thank you very very much for your post. I do appreciate your advice.