Brother in psych ward for potential klonopin withdrawal or paradoxical symptoms - being switched to ativan. advice?

[[um...]]

Hi all,

 

My brother was tapered down from 3 mg daily of klonopin, all the way to 1 mg without issue and that point he started experiencing major withdrawal symptoms. He went back up to 1.25, then 1.5, then 2 mg over a few weeks which relieved a lot of the anxiety-related symptoms, but at 1.5 mg he started complaining of this intense head pressure / tension headache that he felt could possibly be a paradoxical reaction.

 

He has been in pain for 4 years with chronic migraines and the idea that he might be stuck with another chronic head symptom has terrified him, leading him to suicidal ideation with a plan to act, so we had no choice but to bring him to the hospital the other day. Now the doctor there wants to switch him to Ativan at half the equivalent rate of his Klonopin. I'm terrified that his symptoms are about to get a whole lot worse. At this point I'm communicating with him over the phone and doing everything I can to have him convince the nurses/doctor to keep him on his regular Klonopin dosage until we get further explanation on what their thinking is with the switch to Ativan. I may have to go with my family to get him out of there and into another hospital or safer situation unless they work with us.

 

Has anyone been in a situation like this before? I appreciate any and all insight. Thank you.

[[Pa...]]

Hello umineko777,  welcome to BenzoBuddies,

We've had many members through the years whose experience matches your brothers, many in the medical field don't know how to properly taper us from these medications.  We're all so different, one size does not fit all.

Please follow your instincts and try to get the doctors to see your point, you're spot on in what you think needs to happen.  He's been tapered too quickly and the symptoms he's having will continue to worsen until he can get on a stable dose and stay there long enough for his central nervous system to calm down.

Switching to Ativan makes no sense, its shorter acting and will be more difficult to taper from. 

We recommend a slow steady reduction of about 5-10% every couple of weeks but what works better is using symptoms to guide the taper, this can hopefully keep us functional.

I doubt he's paradoxical, its simply the speed of the reductions piling up one on top of the other, holding or increasing his dose is what he needs.  Head pressure is a common withdrawal symptom and will typically leave at some point during recovery.

If you can, please show this document to his doctors.  Benzodiazepine Deprescribing Guidance (corxconsortium.org)

Pamster

[[Co...]]

I recall Professor Ashton explaining when asked, how do you tell the difference between 'withdrawal effects' and a 'paradoxical reaction', that if symptoms get worse when you increase your dose, it is a paradoxical reaction. If it gets worse when you reduce your dose, it is a withdrawal effect.

I would trust that the hospital doctors know what they are doing.

[[um...]]

Thank you for the replies! I definitely want to see what the doctors say. I want to trust them, but unfortunately I think my brother's psychiatrist got him into this situation by tapering him too quickly to begin with, so I'm not sure that the doctors at this particular psych ward are any more knowledgeable than his psychiatrist was if they are also moving so quickly.

If they're convinced it's a paradoxical reaction and he needs to be off the klonopin ASAP then that might change how I view their approach, but thank you for validating my suspicions that the head pressure is probably a withdrawal symptom and that he likely needs to hold or increase for now. 

Ultimately I need him to be safe, so if he's still suicidal I probably can't have him leave the psych ward yet anyway, so i'm just gonna do the absolute best I can to communicate with the doctors the correct information and get on the same page with how to deal with these symptoms. 

[[Co...]]

Hi @[um...] All any of here can do is off up our own perspectives. Ultimately, it is up to you, your brother and his doctors to decide what to do.

Despite shortcomings in my own treatment, I still hold doctors in high regard. Medicine is inexact by its very nature, and each patient is unique. In a serious situation, I turn to the experts, and especially with matter concerning my health.

[[um...]]

Hi all, just providing an update here.

I was able to convince the doctor to put my brother back on 2 mg klonopin after one day of only atavin. He was a total wreck on the day I saw him without his klonopin. They've prescribed him 2 doses (1 mg each) of ativan as needed in addition to the klonopin. His head pressure hasn't gotten any better and he's now dealing with severe anxiety in addition to that, which doesn't surprise me after he missed a full day of klonopin and was already in withdrawal before that, but I'm hoping that as he settles back into his 2 mg klonopin dose, his anxiety will level out to where it was before and perhaps we'll be left with just the head pressure to deal with. I saw him last night and while he was definitely still in rough shape, he was definitely improved over the first night.

I don't love the idea of adding another benzo into the mix with the ativan but in the short-term I think he just needs to be stabilized and I'm sort of just going to trust the doctor's judgment here. This facility likely won't provide the best resources for a slow taper, so I'm hoping that once he's back on his feet, at some point we can revisit the idea of a taper except next time do it very slowly instead of how quickly his psychiatrist was going this year.

If he's still suffering from the head pressure and severe anxiety by Monday (no prescription changes on the weekend since the doctors aren't in), I'm suggesting he ask for a slight increase in his klonopin (perhaps up to 2.25 mg to start) and see if that improves things at all, and maybe that will also reduce his need for the Ativan doses and prevent him developing a dependency on that additional Benzo.

Definitely appreciate any continued insight. 

[[ia...]]

 

So incredibly sorry to hear about what your brother is going through. He is so fortunate to have you as an advocate. 

 I think there's a really good chance, that the head pressure your brother is experiencing, is caused from the cessation of the Klonopin (I see that it's been reinstated - grateful to hear this). Some of the worst migraines I have ever had in my life, came from benzo WDs. I've had some terrible migraines in my life, and I can say emphatically, the migraines/pain from WDs are worse than any 'food sensitivity' headache/migraine etc. Your brother’s head pressure/pain is VERY consistent with the terrible WD symptoms that many of us have experienced.

There are a couple things that have helped me with these intense headaches.  I cannot speak for others – I’m simply speaking from my personal experience.

-I've been taking Niacin (vasodilator). When we take benzos, our blood vessels relax/open. When we're going through WD, they constrict... BIG time. Everything in the body tightens up. 

-Grapeseed Extract has also helped; more studies need to be conducted but this has helped ‘relax’ my blood vessels a bit when things start to get ‘tight’ in my head.

-No idea why this works, but eating lots of green veggies has also helped when I start to get a benzo WD headache. Especially spinach/salmon helps too. I have NO clue what it is about these foods, but there's something that helps.

Glad to hear your brother is getting somewhat ‘stable’ and the Dr. is amicable to some alternative thoughts.  Getting him to another physician who understands and specializes in benzodiazepine tapering/WD is a good idea. Not all, but most of us on this forum subscribe to a ‘low and slow’ mentality – cutting about 5-10% of our dose, then holding for anywhere between 2-6 weeks depending on symptoms. Finding a physician who is amicable to this, will be key. Sending so much love and positive energy to you and your family.

 

[[um...]]

@[ia...] thank you so much for your support, it means so much. I'm so sorry you also suffered from migraines/head pain during WD. I'll definitely take note of those recommendations for dealing with WD headaches and pass them along to my brother - not sure how much he'll be able to use them while in the hospital, but whenever he's out, if he's still dealing with the head pressure in some capacity, these will be good to know.

I am definitely encouraged that his physician was so receptive to my and his input. She admitted she's never heard of the Ashton manual but said she's fascinated by it now and is planning to read it, so that's a great start. 

I saw my brother last night again - his head pressure and anxiety were in full force, but I think at that point in the day he was suffering from major interdose withdrawal since his next Klonopin dose was only a couple of hours away. One thing that's really tough for him is he feels his short-term memory and even cognitive ability have been majorly reduced during this whole ordeal. He gets a lot more confused than he did prior to the taper. I think I've read anecdotally that these are also withdrawal symptoms. I really hope those symptoms heal in time, he's an incredibly smart person when he's stable.

[[Pa...]]

Our cognitive function is seriously impacted by this process so please reassure your brother that what he's feeling is normal and he'll return to himself as he recovers.  

I'm so pleased his doctor is listening. 

[[um...]]

My brother decided to stop taking the as-needed Ativan - he thought it wasn't helping and he knows that he'd rather not be dependent on another benzo in addition to the Klonopin. 

Today his doctor is going to let him increase his daily Klonopin dose by .5 mg, so I'm hoping that will help. I can't say for sure that it will work, but in the short-term it's the best thing to try since doing a slow taper in this facility would be very difficult. If it turns out he just needs to continue the taper then we'll cross that bridge when we get there. 

[[um...]]

Hi all, I did want to provide an update here and see if anyone has any further thoughts. My brother is home from the hospital. During his time at the hospital and while being home for about 2 weeks he has developed new withdrawal symptoms and feels like he is getting worse.

In addition to the head pressure he started dealing with crippling anxiety, hypersensitivity to noises, tingly-feeling arms and legs, "swirly" vision where he has trouble focusing on objects or words, short-term memory loss, GI symptoms like constipation and feeling bloated, and disrupted sleep/naps where he is waking up in a panic with heart racing and severe anxiety. He is also convinced that the head pressure has gotten worse each time he increased his dose after his initial taper.

I have read through many posts on here about updosing and learned that sometimes it can actually make symptoms worse or introduce new ones before actually making things better. At this point I'm encouraging him to hold on his dose for a while longer (at least a month) before making any further moves - it feels like any increase in dosage is inadvisable and a cut would also disrupt his brain/body even further right now after all the dosage changes in the last couple of months.

Does anyone have any thoughts on whether the updose could've caused these new symptoms? And if so, would continuing to hold be the best idea, or would it be recommended to start thinking about tapering again?

[[Co...]]

Hello again @[um...]

To reiterate something I wrote you three weeks ago (further up the thread), if your brother is suffering from paradoxical effects, upping his dose will only make them worse. Given the serious situation in which he finds himself, do not make any changes to his dosing regimen without consulting with his doctors.

[[um...]]

Thanks so much for the reply @[Co...]. Yup, definitely going to consult with his doctors on any next steps. His symptoms and the way they evolved were really confusing while increasing from 1 mg -> 2 mg (head pressure getting worse, but anxiety getting better) so it wasn't clear if they were paradoxical. Then after that one day in the hospital where he was on Ativan instead of Klonopin is when a lot of the new symptoms were introduced, before he even went from 2 mg to 2.5 mg Klonopin (that didn't happen until about a week into his hospital stay), so we thought that missing a day of the Klonopin is what caused his symptoms to worsen/new symptoms to develop. We also thought that his increased anxiety was partially situational because he was so uncomfortable in the hospital setting. His doctors in the hospital were okay with the increased dose. I did push to keep him on Klonopin instead of Ativan mostly because they were trying to switch him over all in a single day which seemed extremely dangerous, and also based on another comment here, I thought the updose could give him some relief, but that hasn't been the case so far.

[[um...]]

I wanted to report that my brother had to be hospitalized again. I am going to follow your advice from weeks ago @[Co...] and trust the doctors in this time of crisis. I just told my brother that if he's hesitant with anything they are doing to please ask that they consult with me and my family before proceeding. To me, a cold turkey (I don't think they'd do that, but still) or rapid taper off of his klonopin dose would be dangerous, but if they have some really compelling reason to taper him off so quickly, I'd be willing to hear it. 

[[Be...]]

On 01/09/2023 at 11:46, [[u...] said:

Hi all, I did want to provide an update here and see if anyone has any further thoughts. My brother is home from the hospital. During his time at the hospital and while being home for about 2 weeks he has developed new withdrawal symptoms and feels like he is getting worse.

In addition to the head pressure he started dealing with crippling anxiety, hypersensitivity to noises, tingly-feeling arms and legs, "swirly" vision where he has trouble focusing on objects or words, short-term memory loss, GI symptoms like constipation and feeling bloated, and disrupted sleep/naps where he is waking up in a panic with heart racing and severe anxiety. He is also convinced that the head pressure has gotten worse each time he increased his dose after his initial taper.

I have read through many posts on here about updosing and learned that sometimes it can actually make symptoms worse or introduce new ones before actually making things better. At this point I'm encouraging him to hold on his dose for a while longer (at least a month) before making any further moves - it feels like any increase in dosage is inadvisable and a cut would also disrupt his brain/body even further right now after all the dosage changes in the last couple of months.

Does anyone have any thoughts on whether the updose could've caused these new symptoms? And if so, would continuing to hold be the best idea, or would it be recommended to start thinking about tapering again?

Hi, I'm so sorry to read about your brother- he has been through heck.  Updosing could definitely be the cause. The symptoms you describe are all known side effects of the drug.  I cannot stress enough how important it is to understand the effects of the drugs on the body, and strongly suggest that you research information from reliable sources on the effects of the drug.

You said, "He is also convinced that the head pressure has gotten worse each time he increased his dose after his initial taper" If he believes the symptoms stem from the dose increase, then you can draw your own conclusions.  The gut instinct doesn't lie. We all know our bodies and what they tell us.

The Ashton manual is a great source. There are also plenty of other sources listed on this site.

[[um...]]

thanks so much @[Be...]. yup, i've actually read the ashton manual in its entirety. most of the symptoms he is dealing with are indeed listed in there and the ones that I didn't find in there have been reported by others on this forum. I think what we really didn't understand were the effects of updosing, so hoping the doctors can help us get to the bottom of that and find the right path forward. I feel horrible for him, it's been so tough to watch what he's going through. appreciate your support.

[[Co...]]

8 hours ago, [[u...] said:

I wanted to report that my brother had to be hospitalized again. I am going to follow your advice from weeks ago @[Co...] and trust the doctors in this time of crisis. I just told my brother that if he's hesitant with anything they are doing to please ask that they consult with me and my family before proceeding. To me, a cold turkey (I don't think they'd do that, but still) or rapid taper off of his klonopin dose would be dangerous, but if they have some really compelling reason to taper him off so quickly, I'd be willing to hear it. 

@[um...] I am sorry to learn that your brother has had to return to hospital. I hope is well enough to be discharged soon.

Yes, in serious or emergency situations, we need to place our trust in doctors. It does not preclude you from asking some sensible questions of course, just so long as they do not significantly interfere with much needed care.

[[um...]]

I wanted to follow up here with some good and bad news. The good news is that my brother is home from the hospital - the doctors put him on lithium which completely stopped the suicidal thoughts. When he got home he also had an appointment with his neurologist who prescribed Gabapentin to help with the head pressure symptoms and that has seemed to help a lot. 

The bad news is that he met with a new provider today and she is completely against long-term klonopin prescriptions and is refusing to refill his prescription despite the fact that he's been on it for over 4 years. So we're going to have an appointment in a couple days with his old provider and hope that he can continue the prescription until we find someone else who understands his situation (this old provider had previously told my brother to go find a new provider who can manage his 'complex situation', so we're going in circles now). My brother has a little over a month left of his current Klonopin dose, so I hope we can get his prescription refilled before then, but I'm terrified that neither psychiatrist will prescribe it to him. Has anyone ended up in this situation before? I suppose the worst case is my brother would have to go to the ER if he runs out of Klonopin, but I can't imagine they'd prescribe him all that much, certainly not enough for a safe taper.

[[Pa...]]

I’m relieved to hear your brother isn’t suicidal anymore but distressed you haven’t found a provider to supply him with enough medication to taper.  Have you looked at a Nurse Practitioner, some members have said they can be a little more understanding.  

[[Co...]]

On 10/10/2023 at 00:51, [[u...] said:

I wanted to follow up here with some good and bad news. The good news is that my brother is home from the hospital - the doctors put him on lithium which completely stopped the suicidal thoughts. When he got home he also had an appointment with his neurologist who prescribed Gabapentin to help with the head pressure symptoms and that has seemed to help a lot. 

The bad news is that he met with a new provider today and she is completely against long-term klonopin prescriptions and is refusing to refill his prescription despite the fact that he's been on it for over 4 years. So we're going to have an appointment in a couple days with his old provider and hope that he can continue the prescription until we find someone else who understands his situation (this old provider had previously told my brother to go find a new provider who can manage his 'complex situation', so we're going in circles now). My brother has a little over a month left of his current Klonopin dose, so I hope we can get his prescription refilled before then, but I'm terrified that neither psychiatrist will prescribe it to him. Has anyone ended up in this situation before? I suppose the worst case is my brother would have to go to the ER if he runs out of Klonopin, but I can't imagine they'd prescribe him all that much, certainly not enough for a safe taper.

I suggest that you contact the neurologist, explain the situation, and ask if he/she will prescribe Klonopin for your brother. As an anticonvulsant, neurologists do prescribe this medication from time-to-time. It was a neurologist who prescribed me Rivotril (Klonopin/clonazepam).

[[um...]]

thank you @[Co...] and @[Pa...]. the good news is that after an appointment yesterday with his old provider, they have agreed to continue treating my brother with klonopin until he finds a new provider that he is comfortable with. your suggestions are great ideas, I will keep those in mind if we run into any issues like this in the future.

[[Pa...]]

Excellent news @[um...], you’re a good person to help your brother through this challenging experience, he’s lucky to have you. 

[[Co...]]

On 12/10/2023 at 19:57, [[u...] said:

thank you @[Co...] and @[Pa...]. the good news is that after an appointment yesterday with his old provider, they have agreed to continue treating my brother with klonopin until he finds a new provider that he is comfortable with. your suggestions are great ideas, I will keep those in mind if we run into any issues like this in the future.

Good to hear that, @[um...]. Please keep us updated with your brother's progress. He is fortunate to have such an engaged and caring sibling.

[[me...]]

On 12/10/2023 at 11:26, [[C...] said:

I suggest that you contact the neurologist, explain the situation, and ask if he/she will prescribe Klonopin for your brother. As an anticonvulsant, neurologists do prescribe this medication from time-to-time. It was a neurologist who prescribed me Rivotril (Klonopin/clonazepam).

It was a dental surgeon who prescribed my clonazapam now it's my gp and no review in 6,+years😤

[[um...]]

Just another update. My brother's symptoms had been relatively predictable for the last two months since he got out of the hospital - lots of head pressure/head pain unfortunately - but his anxiety and all other symptoms were pretty much gone. He did seem to develop tinnitus at a certain point, but it's not been severe enough to cause much of an issue for him. 

However, in the last few days he has suddenly noticed he's been feeling much more anxious leading up to the time of his scheduled klonopin doses. He is also not sleeping as well, and is even noticing some potential benzo belly/GI-related symptoms emerging, like difficulty eating large portions. These symptoms are scarily reminiscent of the symptoms he encountered during the summertime when he had been hospitalized. But for now he is still able to get through most of his day without issue, it's just that the time before his klonopin doses are quite difficult. 

He hasn't changed his klonopin dose at all in the last two months - still at 2 mg per day. I'm just hoping that these new symptoms don't start to snowball and consume more of his day and debilitate him like earlier in the year. Has anyone seen anything like this occur? Any suggestions to get ahead of potential worsening symptoms?