Why do all my psych-docs recommend a 0.5/week step down?

[[wi...]]

I'm in the process of weaning off a 2-3 mg,. per day dose of klonopin which I have been on for the past 10 years for Panic Disorder, GAD and SAD. I have always varied the dosage from day to day and taken klonopin on an "as needed" basis rather than taking a set amount every day. I estimate that my average daily dosage over the past year has been about 2 mgs.

 

My immediate need to get off the klonopin is that I have suffered from drug-resistant depression for five years and after trying virtually every SSRI on the market, several TCAs, one MAOI and various augmentation agents from Wellbutrin to Lithium to thyroid hormone to  atypical antipsychotics (Resperidol, Seroquil, Lamictal, etc), no combination of meds has resulted in any substantial or lasting relief from the depression. (Been seeing several psychologists over these years as well in conjunction with the meds. Several forms of talk therapy have yielded no better results than the meds--both totally ineffective!) As a last resort, I am preparing for a course of ECT at Weill Cornell in NYC. This was my choice and I suggested it to my psychiatrist. ECT has a good track record with treatment-resistant depression. To prepare for it I have to be off the klonopin for a specified period of time.

 

However, regardless of what I hope will be a successful course of ECT, I have been reading a lot about the benzos and feel that it is time to get off them completely and for good! So there will be no going back after the course of ECT is over. 

 

The doctor who will be administering the ECT suggested that I step down from my average daily dose of 2.0 mgs by 0.5 mgs/week. My local psychiatrist agrees that this is a reasonable schedule. Yet on the web I have come across dozens of withdrawal schedules and they are all much slower than the recommended 0.5/week that seems to be the standard formula used by most doctors. This is disturbing to me and I am wondering why most psychiatrists, in my experience, recommend the 0.5 per week schedule when the Ashton method and most other schedules discussed online and in forums like this one suggest much much slower withdrawal schedules?

 

I have weaned off klonopin several times over the years for various purposes and in all cases I dropped from 2-3 mgs/day to zero within 4-6 weeks without any major withdrawal effects. So I'm wondering if some people even after a decade of benzo use are able to successfully get of klonopin in 4-6 weeks? Are there two groups of benzo users: those who are able to cut the dosage rather quickly without problems and those whose body chemistry causes them to be more physically addicted and therefore require a much slower taper? Or is a 0.5 drop per week potentially unsafe and unreasonably quick for all klonopin users?

 

I know it's better to be safe than sorry, but I am also anxious to begin the ECT treatments ASAP because every day for the past five years has been a total waste of my life and it is getting no better! The 0.5/week reduction will have me off klonopin in three more weeks assuming I do not suffer any major withdrawal symptoms which necessitate changing the schedule. Going by the 10% reduction every 7-14 days which is recommended here under the direct taper method I would be postponing the ECT treatments by an additional 12 weeks which is quite a difference.

 

I am trying to understand whose right--the various forums and articles which recommend withdrawal schedules that take months or even years, or the psychiatrists and doctors I've encountered who seem to think 0.5 less per week is just fine! Or are both right for different people?

 

From past experience I feel I can come off klonopin by a 0.5 mg reduction every 7 days with minimal difficulties--mainly some increase in anxiety and a modest degree of muscle stiffness maybe, but these have always been manageable during past step-downs. The question is: Even though I have been able to get off klonopin for as long as 4 months several times in the past with this schedule, is it intrinsically an unsafe schedule and would I be better off going slower? Is redcuing the dosage for a ong-time user at this rate going to increase my chances of experiencing seizures? This is of particular concern sinse, of course, the ETC treament will be intentionally causing short controlled seizures. I would hate to start this treatment if I am already more prone to seizures than the averge person!

 

Although I've started the weaning off and am currently taking 1.5 for this week, I am considering talking to my psychiatrist and telling him that I would like to reduce the dose by 0.25 mgs/week instead of 0.5 mgs/week--basically taking twice the amount of time to wean off than the current schedule. In the experience of those of you who have successfully gotten off klonopin from a dosage of about 2.0 mg/day, is the 0.25 mg/week schedule any safer than a 0.5 reduction, or are both too fast for most people in your experiences?

 

And if the 0.5/week reduction is unsafe for most people, why do so many doctors (psychiatrists, no less) recommend this schedule? What am I missing here?!

 

Thanks,

Withoutascent

 

[[St...]]

 

Although I've started the weaning off and am currently taking 1.5 for this week, I am considering talking to my psychiatrist and telling him that I would like to reduce the dose by 0.25 mgs/week instead of 0.5 mgs/week--basically taking twice the amount of time to wean off than the current schedule. In the experience of those of you who have successfully gotten off klonopin from a dosage of about 2.0 mg/day, is the 0.25 mg/week schedule any safer than a 0.5 reduction, or are both too fast for most people in your experiences?

 

And if the 0.5/week reduction is unsafe for most people, why do so many doctors (psychiatrists, no less) recommend this schedule? What am I missing here?!

 

Thanks,

Withoutascent

 

 

In basing trust in Prof. Ashton's years of research of this drug, I believe the easiest way to get off is how she has scheduled in her manual. She has done the most extensive research that most doctors haven't so I would lean towards her interpretation of the best way to discontinue with the least amount of withdrawal symptoms. We use that reference here as a general guideline to the safest way.

 

Everyone metabolizes the drug differently, so some may be able to taper faster without a problem, but the .25 a week option would be a safer bet I think, though still a bit fast according to the general guide. I agree with others who have responded to your intro, that the Klonopin may actually be causing some of your depression as it's been known to have that effect on some people.

 

I don't know about ECT at all so I can't comment on that part, but I hope whatever you decide to do, you have success and an easy transition.

 

Star  

 

 

[[Mi...]]

Your story sounds very similar to mine. 

 

I had severe, debilitating depression that was resistent to every other course of treatment.  However, my depression was due to benzos.  My doctor reduced my dose of Valium prior to my 5 treatments, but did not take me off completely at the time.  Mostly, this was because they felt I needed the treatments ASAP.

 

If I were in your shoes, I would try to taper down by .25 mgs per week (.125 would be even better), even if it means delaying the ECT for a few more weeks.  The treatments are much more effective if you are no longer on benzos.

 

I'm sure you have already weighed the pros and cons of ECT, and I truly hope it helps you.  I only had 5 treatments, and it was a lifesaver for me.  It does not work for everyone and there can definitely be side effects, but it did work for me.

 

I hope you can discuss all of your options with your doctor, including your rate of taper.    

 

 

[[Be...]]

Your situation is very similar to what brought me to BenzoBuddies in the first place.  I was unsuccessfully treated for depression and then bipolar disorder for 10 years and all the while was on one benzo or another.  When I finally got to the point where ECT seemed like the only option, I came here trying to find out how to get off Ativan, Ambien and Seroquel.  If you are interested, my intial thread is here:

http://www.benzobuddies.org/forum/index.php?topic=7207.msg77295#msg77295

 

When I found out that benzos could cause or worsen depression, I decided to taper off the Ativan and Ambien as recommended here and delay the ECT.  As a result, I never ended up having to have ECT and risk the negative side effects.

 

From what I know from reading here and elsewhere, your chance of getting a seizre while tapering at .5mg/week is extremely low.  I believe that is why doctors suggest that schedule.  (Mine did as well.)  There do seem to be people who can get off benzos relatively quickly and easily.  They seldom join a support forum like this one so you are unlikely to hear from them but they are out there.  I would say that if you don't have adverse effects from that .5mg cut, you could try sticking to that schedule. Of course, reducing the subsequent cuts to .25mg would be even better if your doctors will go along with it.  You say you have quit Klonopin before rather easily and maybe that will be the case again.  I hope so. 

[[Ca...]]

What is ECT?

[Guest [Si...]]

What is ECT?

 

Electroconvulsive therapy

 

http://en.wikipedia.org/wiki/Electroconvulsive_therapy

[[Ca...]]

Thank you