Unsure Where to Go From Here

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Hi Everyone - I wanted to join the community to get some advice on how to proceed with my medication situation. A little backstory I developed some fairly severe anxiety (primarily health related) around the start of COVID 2020. I was prescribed Lorazepam as needed and took it on and off for a couple of weeks. I then had a span of about 8 months where I was free of medication. Things then took a turn in March of 2021 and I started medication again. Below is my history of Benzo usage along with other medication. I'm not seeing any improvement in anxiety and my physical symptoms seem to be worse even though I'm on a low dose Gabapentin as well (200mg twice daily). I'm wondering if my Benzo usage could be making this worse and how someone would go about stabalizing and withdrawing this type of usage since it isn't daily. I've spoken to my doctors and they don't seem concerned but I am:

 

April 2021: 0.5mg Ativan daily while getting onto Escitalopram

June 2021: single dose of 0.5mg Ativan

August 2021: single dose of 0.5mg Ativan

September 2021: single dose of 1mg Ativan

October 2021: 4mg of Ativan (4 seperate days of dosing 1mg)

November 2021: 0.5mg daliy for 6 days while upping dose of Escitalopram

December 2021 / January 2022: 1 mg day for 8/12 days

February 2022: 5 days of 0.5mg Ativan

March 2022: 2 days of 1mg of Ativan

April 2022: Nothing

May 2022: 0.5mg 1 day

June 2022: Nothing

July 2022: Nothing

August 2022: 0.5mg of Clonazepam 1 day

September 2022: Nothing

October 2022: 3.5mg of Clonazepam over the course of 5 days throughout the month

November 2022: 3.5mg of Clonazepam over 6 days throughout the month

December 2022: 0.75mg Clonazepam 1 day

January 2023: 0.75mg of Clonazepam 1 day

February 2023: 8 days of 0.5mg of Clonazepam throughout the month

March 2023: 3 days of 0.5mg of Clonazepam throughout the month

 

As you can see sporadic usage often with large gaps in between - most recently the clonazepam has been taken primarily due to sleep issues but my anxiety has been extremely high the past month to 5 weeks.

 

Any thoughts / help would be so greatly appreciated - there isn't much help out there for either tapering or dealing with sporadic Benzo use. Thank you in advance from the bottom of my heart!

 

 

[[Pa...]]

Hello MK83, welcome to BenzoBuddies,

 

Once our body becomes dependent on the drug it begins to create problems, such as anxiety, panic and insomnia to name a few, your sporadic use of benzodiazepines has led your body to become dependent.  May I ask why you switched from Ativan to Clonazepam?

 

We suggest reducing your dose by about 5-10% every couple of weeks or whatever your symptoms will allow, we've found this can hopefully keep us functional.  If it's your desire to taper from this drug, I would advise finding a dose you can take daily, this would help reduce gaps in blood serum levels that may cause you to experience symptoms.  Once you stabilize on that, you can begin your taper.

 

I'll post some links to help you get started but please keep talking to us, we want to help.

 

Pamster

 

Colorado  Consortium Benzodiazepine Deprescribing Guidance

 

Planning  Your Withdrawal (Taper)

 

Withdrawal  Support (during your taper)

 

Ashton  Manual symptom list

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Thanks for the reply! The switch was per my psychiatrists recommendation. Regarding the tapering the question I would have is because I go through such long gaps without taking the medication I’m unsure how to approach that. That would mean getting on a daily dose I assume and then beginning a taper. I’ve never been a daily user of the drug so this would be new to me.

[[Pa...]]

Clonazepam is actually the better drug to taper from since it has a longer half life, but yes, taking it daily is what we suggest in order to taper.  I know it seems counterintuitive to take it every day and members have tried to taper their sporadic doses but it doesn't usually work.

 

Can you tell me what prompts you to take a dose when you do, and when you say you took it for 6 days during the month, are those days continual?

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I typically take a dose when I’ve found I can’t calm down. Often this happens very late at night. Especially the past few months I’ve had issues sleeping so if I can’t get to sleep I will sometimes panic and take a pill at say 3AM. I know this isn’t a great way of doing things. My intentions are not to take them at all or very little but sometimes I get so worked up I feel it’s the only thing I have in my arsenal to get some sleep.

 

Regarding the dosage question below in terms of consecutive days very few times are they daily doses. More often than not once per week lately with a few exceptions over the past few years.

 

Thanks again for chatting! It’s greatly appreciated!

 

[[Pa...]]

How do you feel in between doses, are you struggling with anxiety or sleep, is it typically sleep that prompts you to take the medication?

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I'm definitely struggling with Anxiety - I will typically wait it out and try to see if it passes before taking a pill (typically a last resort for me) which often ends up meaning its very late at night. The sleep issues are there but largely bc of the anxiety.

[[Pa...]]

I believe your use of Clonazepam is exacerbating your anxiety and insomnia and I can see your use has increased according to your timeline so getting off the drug would be a good move but how to taper when you don't take every day?  I've seen members attempt to taper taking it like you do and it doesn't typically work for them so they go on a daily dose, are you against doing that?

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I’m not opposed to doing anything that will help me. I am nervous about making things worse. I’m just at a bit of a loss as to how to go about doing that from a relatively small dose. The doctors I’ve spoken with don’t generally believe the Clonazepam usage is what’s causing or exacerbating the anxiety so tapering hasn’t really been discussed. I’m open to any and all suggestions. This is all new to me.

[[Pa...]]

I understand your doctors don't acknowledge the Clonazepam to be the problem, we see this a lot, but do you?  Its quite common to become dependent on these drugs even while not taking them every day so I just want to make sure you agree some of your problems might be due to your use of benzodiazepines.  I guess I'm asking you if you agree because this will require you to have confidence you're going the right thing for you, even if your doctors don't agree.  If you're not convinced, I understand but I've seen this too many times to doubt it.

 

How would you feel about cutting a .5 mg tablet into quarters and taking .125 for a couple of weeks? 

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It's hard to know for sure especially with all of the different advice floating around out there but I tend to agree with you that certainly they aren't helping at the very least. I'm not opposed to what you suggested. Any more specific suggestion on the taper? What time would you suggest I dose given the sporadic nature of my dosing? Would I simply run with the 0.125mg for a couple of weeks and then stop? Thanks again for taking the time to chat with me!

[[Pa...]]

I just had a thought, before you commit to taking the drug every day, would you be interested in figuring out a taper for the way you currently take it?  I don't really know what that would look like but if you're not comfortable taking it daily, its a consideration. 

 

However, if you do decide to take it daily, that would be to establish a baseline of daily use and once stable, you'd begin your taper.  There could be some experimentation while you do this, .125 may prove to be too little or too much of the drug so you might have to adjust that.  Tapering is all about experimentation and you're the subject which is unpleasant because those adjustments typically come with discomfort.

 

 

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I'd be open to both - obviously its kind of complicated given the sporadic use so I'd like to explore both types of taper and I will chat with my doctor on both sides Friday - while she may not believe it is necessary she is alway open to my ideas and just wants to help so I don't think I'll get any pushback either way.

 

In the meantime and for the tapers are there any supplements or things that you've found that really help the physical and mental symptoms of withdrawal or interdose withdrawal? I am in counselling bi-weekly for the anxiety.

[[Pa...]]

I'm glad to hear you're going to consider all of your options and you have a doctor who hears you.  Supplements as well as other medications are tricky, there is no consensus on what helps and what hurts because we're all so different and because our central nervous system is so sensitive we don't react the way we normally might.  I hesitate to name any but there have been many discussions about supplements here: Alternative  Therapies & Supplements

 

As for interdose, the simplest answer to that is to dose more often.