On Klonopin 4.5 weeks now and need help & advice

[[Ra...]]

I will try to condense this. I have been on benzos twice before, for short periods of time (< 3 months total including taper), both times Xanax. First 2015 after an anxiety disorder hit me out of nowhere. Ultimately got through it and ended up on 7.5 mg mirtazapine for maybe 3 years then stopped. 2nd time was after a softball sized benign meningioma was removed from my right frontal region in 2020, almost certainly the source of my anxiety disorder. I had to go on cocktail of anxiety meds because of wicked anxiety from withdrawal of the huge doses of steroids they had me on for the surgery. Again, got off, medication free for 2.5 amazing years.

 

Unfortunately my unresolved heal anxiety disorder led to a chain of terrible decisions that wrecked my health and collapsed my sleep (again). Been on klonopin for 4.5 weeks now for insomnia, Xanax 0.5mg a few times before that.

 

The psychiatrist prescribed 0.5mg K 2X daily "as needed for anxiety", even though he knew it was for insomnia and I would be using it daily. For about 3 weeks I stuck to 0.5mg at bedtime and was getting ~5 hours of sleep at most, waking at ~3am give or take. What was waking me was GI problems, at about 6 hours after my last sucralfate (a GI coating med) dose. FYI there was 1 day where I took one around lunchtime but it did not really help with my main source of woe, which was GI issues and sleep deprivation, so I did not repeat.

 

Because I know how addictive benzos can be, and it was the timing of the GI drug that I was taking, I experimented with reducing the dose to 0.375mg with a pill cutter (again, this was 3 weeks in). I had no change in sleep for 2 nights, so I reduced again to 0.25mg. I did not understand the very long half life of klonopin and that it could take days for withdrawal symptoms to show up. That night I only slept 2 or 3 hours.

 

At that point I made a big mistake. After taking to the pharmacist at my insurance company the next day, she suggested that sleep was paramount and that since I was prescribed 2X daily, I should go ahead and take one then (5pm) and then take another at bed time. I did so. Because of the long half life, this was essentially like just taking 1mg. I slept great that night. But I did not want to keep repeating that, so I returned to 0.5mg the next night. I awoke at 4:30 am. The next night, 3:30 am, the next night, no sleep at all.

 

After speaking with my psychiatrist, he suggested I try 0.75mg. I did so. I woke at 5am and immediately developed burning skin sensations and had increasing anxiety for about 6 hours until it suddenly passed.

 

That brings me to last night, when I again took 0.75mg. I did not sleep, or if I did, it was brief and I am not aware of it. Today I again have had burning skin sensations and anxiety on and off throughout the day.

 

That brings me to my current dilemma. I have been on Xanax and then Klonopin now for 5 weeks. Certainly long enough to become dependent. I monkeyed with the dosing, fluctuating it up and down and now it is not working at 0.75mg, I am having what seem to me to be side effects or inter-dose withdrawals. I have also apparently become sensitive to other, complementary meds that helped me in the past and helped keep my Xanax doses low, Trazodone and hydroxyzine. Both of these now give me burning skin sensations, the Trazodone about 2 hours after administration, the hydroxyzine about 30 minutes, persisting for hours. The med is not working for it's intended purpose at the current dose, yet I am terrified of upping the dose. I have been on benzos twice before, have apparently become sensitive to previously used medications, apparent side effects or inter-dose withdrawal symptoms (burning skin, thick head, headache, etc) are going UP with increased dose, not down. The last 2 nights when the meds have kicked in my skin sensations have gone UP, not down. I am concerned now about a phenomenon called "kindling."

 

I do not want to be on this medication. It terrifies me. My GI symptoms are resolving, but it is now apparently klonopin and/or the anxiety associated with being on it that prevents me from sleeping. I have no alternative strategy for sleep or anxiety control now that I apparently can't use Trazodone or hydroxyzine. For all I know I may have also become sensitive to the 7.5 mg of mirtazapine I am also on. I will probably skip it tonight and try to see if there is a difference.

 

I don't know what to do at this point.

 

What would you do? And why? My psychiatrist would have me just up the dose to 1mg, since I slept well on that (once). But after upping from 0.5mg to 0.75mg, after one night of half decent sleep I am worse than where I was on 0.5mg.

 

My wife wants me to return to 0.5 mg since I was only on 0.75mg 2 nights. But the half life is so long, 2 nights at 0.75mg seems like an eternity.

 

It seems like I became tolerant to 0.75mg in a single night.

 

I sent a text today to my psychiatrist requesting a callback, but so far nothing.

 

Help.

 

 

 

 

 

 

[[Po...]]

Hi Raleigh Dad,

 

Have you considered taking a larger dose of mirtazapine? Is that an option?

 

It sounds like Klonopin is not working and you don’t want to be on it anyway.

 

I have been taking 30mg of mirtazapine for years and it has never lost its effectiveness in putting me to sleep. I have been on it twice for long durations and have taken as much as 45mg a night. During my benzo taper, I have had some breakthrough insomnia, but I am sure it would be worse without the mirtazapine. The only drawback I have experienced is getting munchies after taking it. Sometimes I manage to fall asleep without satiating the craving. It’s the only reason I don’t advocate mirtazapine to friends and family who struggle with weight gain.

 

Having some experience with it already, I hope this is an option for you. If it is, I would increase the mirtazapine and taper off the Klonopin.

 

All the best,

Pop Soda