Intro - clonazepam and sertraline (Zoloft)

[[ma...]]

Greetings.

 

I am a first year graduate student.  I developed stress and anxiety around the end of the previous quarter due to the heavy work load and adjustment to living alone in a new city.  I basically melted down from the anxiety and had to take incompletes and finish my exams late.

 

I called my therapist/psychiatrist complaining about "morning dread".  Basically I was waking up an hour before my alarm went off feeling a sense of dread (It was a tight chest, pit in the stomach feeling).  This was similar to the feeling you might have after you wake up from a disturbing nightmare, only I had no recollection of dreaming before waking.  This feeling was making it difficult to get up and get out of the house in the morning.  This was back in early March.

 

I have been on 50 mg sertraline (Zoloft) for several years due to previous depression.  My doctor had me up the Zoloft to 100 mg and at the same time prescribed Xanax to take in the morning for anxiety.  I only took the Xanax for 3 days because it made me too sleepy to concentrate in class.  He then gave me clonazepam.  I started taking 1.0 mg at night hoping this would suppress the morning anxiety.  Taking the 1.0 mg at night didn't do anything for the morning anxiety, so I began taking 1.0 mg in the morning as well.  Taking 1.0 mg in the morning was making me feel a little drunk (wobbly legs), so I cut back the morning dose to 0.5 mg. 

 

This worked for about 4 weeks, but then I started getting a restless, bored, jittery feeling during the day that prevented me from getting any work done.  This feeling tended to peak in the evening.  I got scared that it was the clonazepam causing this so I tried not taking it for a few days and the feeling became much worse.  I started feeling small aches and pains all over my body and felt like there was intense pressure inside my head.  I resumed the clonazepam, but asked my doctor for 0.5 mg pills so I could spread it out evenly throughout the day.  At that time I started taking 1.0 mg spread into three doses.  This helped, but I noticed that I was getting sudden sleepy spells during the day and felt more scatterbrained than usual.  Some mornings I could not remember things I did 5 minutes ago.  I would get ready in the bathroom, then forget that I already did it and have to do it again.  I was extremely worried that the clonazepam was damaging me, so I started decreasing by 1/8 mg (a quarter of a pill) every 5 days.  I’ve been doing this since April 22.  This was 8 weeks after I started taking the clonazepam pills and upped the Zoloft to 100 mg. 

 

Now I am down to taking 0.5 mg of the clonazepam (0.25 morning, 0.25 night).  However, the restless feeling which I now recognize as akathisia has come back and is interfering with my ability to concentrate and finish my homework on time.  I have this itchy feeling in my bones, mainly in my left forearm, chest, and shins.  Sometimes there are mild aches and shooting pains that go along with the itchy feeling.  These sensations are extremely distracting to me and when they peak the only thing I can do is pace or sit with my legs tightly crossed.  I feel extremely tense during these episodes.  The head pressure also comes and goes at random now.

 

Another odd thing I recently experienced.  Two days ago I walked outside and noticed that my eyes weren’t adjusting to the brightness.  My sight tunneled in from the outside until I was practically blinded.  At the same time a strong chill or shiver ran through my entire body.  During and for about 20 seconds after the chill I got this weird “spaced out” feeling where it felt as if the ground was tilting under my feet.  As my vision returned I felt like I temporarily forgot where I was.

 

I tried describing my symptoms to my psychiatrist, but he seemed puzzled that I would have problems with clonazepam after only being on it for 9 weeks.  I’m wondering if other people have trouble with these drugs after only a short time.  I also described the disturbing restlessness and other odd sensations to him, but he seemed clueless.  I didn’t know the term akathisia at the time, so I had difficulty describing what I was experiencing.  He prescribed Risperdal for my “anxiety” though I looked it up on the internet and decided that it had the risk of prolonged side effects similar to what I am already experiencing.  I haven’t touched that stuff. 

 

I also discovered that sertraline and other SSRIs can cause restlessness and akathisia.  I’m beginning to wonder if the sertraline is a big part of my problem.  I read that benzos are sometimes used to “calm” people who have restlessness/akathisia from antipsychotic drugs.  I’m now wondering if the clonazepam was covering up the side effects of the increased sertraline so that I didn’t notice it until I started developing tolerance to the clonazepam.  I’m now thinking I can’t handle 100 mg sertraline and need to taper that back down to 50 mg.

 

I would like to hear if anyone has had similar experiences with benzo/SSRI combos.  It’s so aggravating that doctors are clueless about potential side effects.  They put you on more than one thing at once and it becomes impossible to tell what is going on.  I was aware that benzos were addictive and had no intention of taking them for more than a couple months.  I just wasn’t aware of how fast they could cause problems and I wasn’t aware of the akathisia side effect from sertraline (Zoloft).

 

Sorry for the long introduction.  Any help appreciated.

 

Marshall

[[Co...]]

Hi Marshall,

 

Welcome to BenzoBuddies.

 

You are doing the right thing by tapering off benzos now. The longer we take them, the greater the chances of side-effects, and the harder it is to withdraw.

 

I'd recommend that you taper off one medication at a time. Usually we'd recommend that it would be better to taper off benzos first, and then look at your ADs. However, if you suspect that your more worrying symptoms are being caused by another drug, then you might need to address that first. I cannot really comment further about ADs as I've never taken any. However, many of our members have taken ADs (or cintue to do so), and I'm sure you will receive some feedback about this.

 

Since you are now on a pretty small dose of Clonazapam, maybe you should continue with your taper. You seemed to have progressed well so far, so you might be able to finish the taper in a month or two. I would advise that you only make a new cut once you you feel reasonably recovered from the previous cut though. If you need to make smaller cuts than 1/4 of a pill, we can help you make up a liquid using homogenised milk.

 

Most, or all, of your symptoms could be caused by the benzos. You are correct though, taking many new medications at the same time can make it pretty much impossible to determin which drug is behind which side-effect. On top of this, there can be innumerable interactions with drugs. Withdrawing from your benzos can do you no harm (so long as you continue to follow a sensible taper plan), so it would seem sensible to get off while this is still relatively easy.

 

Take care.

[[ma...]]

Thanks.  I really do think the SSRI is interfering with my ability to quit the benzo.  Back several years ago I was put on a ridiculously high dose of Effexor, then Paxil, then Prozac, then Zoloft.  Each lasted about a week before I was forced to quit because I developed extreme restlessness.  I had that same itching crawling feeling in my bones and it was so bad I felt like I smashing my head against the wall.  Try drinking 30 cups of coffee and you'll know what I mean.  I now know the term is akathisia and that extreme cases can lead to suicide but most psychiatrists are still clueless about this side effect.  When I started Zoloft I found I could only tolerate 50 mg without restlessness.

 

When I went from 50 to 100 mg I thought maybe I could now tolerate that dose.  I think what actually happened was the benzos suppressed the restlessness caused by the SSRIs.  I think I need to get back to 50 mg sertraline before I can continue tapering.  I was going to look into beta-blockers for temporary relief, but it appears they can cause dependence as well.  I don't think there's any way I can taper off the clonazepam while taking 100 mg of sertraline.