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

[[de...]]

It sounds like he is having inter-dose withdrawal; meaning his body is starting to need the drug before the time of his next dose.    He  probably needs to taper off the Klonopin as the inter-dose withdrawal will only worsen with time.       I know you mentioned in one of your earlier posts, that he did not do well on a prior Klonopin taper.      How fast was he tapering before? 

[[um...]]

thanks for the reply @[de...].

I was fearful this might be interdose withdrawal. My brother's prior taper was much too fast. His psychiatrist was dropping his dose .5 mg every two weeks. This was long before we knew about Benzo Buddies, the Ashton Manual, and all the risks with overly rapid tapers.

The tricky thing is that he was prescribed Klonopin for HPPD and we're not aware of any other treatment for the disorder, so he's terrified of coming off of klonopin completely.

I've been in communication with another person on this forum who is also on Klonopin for HPPD and also went through an overly rapid taper like my brother. They were able to stabilize their symptoms with gabapentin, then taper off the gabapentin, and are now proceeding with their Klonopin taper at a snail's pace and are so far having success in decreasing their dose while remaining stable.

My hope is that my brother could take a similar path, but the introduction of interdose withdrawal symptoms already is making me nervous that he won't have enough time to stabilize before being forced to continue his taper.

[[Pa...]]

I’m sorry to hear he’s dealing with increased symptoms, I wonder if he’s becoming tolerant to his current dose?  How often is he dosing? 

[[um...]]

@[Pa...] thank you for the reply. He could be becoming tolerant, it's possible. Currently he's taking 1 mg in the morning, and 1 mg at bedtime. 

[[Co...]]

@[um...] You probably should talk to the prescribing doctor about this. But their likely response will be to increase the dose. How would you and your brother feel about this?

The problem is, though, he likely will become tolerant of the new dose after a while.

[[um...]]

thanks for the response @[Co...]. my brother's anxiety has gotten a little bit better now in the last few days. we did mention this increased anxiety to his psychiatrist who suggested it could've been because of the clock changes for daylight savings time in the United States a few weeks ago - apparently it can really throw off the body's rhythm and cause increased anxiety/depression for people who suffer from those afflictions. if this continues to be an issue though we will mention it again. My brother had also increased his gabapentin dose last week per his neurologist's recommendation - it's possible that gave him some relief from the anxiety, but I'm not sure.

The topic of potentially increasing his klonopin dose is a complicated one. From everything I've learned now, there are many risks to increasing benzos over the longterm. So if we can find an alternative treatment for his HPPD, then it'd be much better to go with that treatment and slowly taper off of klonopin. But that's a big 'if' since HPPD isn't widely understood. I think for now we'll stay focused on him getting through his remaining head pain symptoms and tackle this later if we can. In the meantime, we're actively looking for a more specialized provider who could help him with all of this, since his current provider has said my brother's situation is a complicated case. 

[[Co...]]

@[um...] I just read a little about HPPD.  The pain your brother experiences seems unusual. The Wiki page does not mention benzodiazepines as a possible treatment, but I did find a study about treating HPPD with clonazepam  and is quite encouraging (you've probably read it):

https://pubmed.ncbi.nlm.nih.gov/11475916/

Given the seriousness of your brother's condition, try not to worry about potential long-term problems associated with use of benzodiazepines. For some conditions, benzodiazepines are the best or only viable long-term therapy. And just as with any other medication, it is about balancing potential risks against potential benefits.

[[um...]]

this is excellent feedback @[Co...]. There is a lot to my brother's history that I haven't really encapsulated in these posts because I wanted to stay focused on the present situation, but to just to give a bit more context:

Klonopin has been a very effective treatment for my brother's HPPD since he started taking it in 2019. It's not a stretch to say that it saved his life, as he had been hospitalized for suicidal ideation back then due to the HPPD symptoms that were so tough to live with. For four years he has taken Klonopin without any issues and the HPPD symptoms have been almost invisible.

He agreed to try tapering this year because the provider had encouraged it, likely due to the longterm risk of benzos though also possibly due to regulatory scrutiny on benzos (the provider has mentioned being "audited" multiple times due to prescribing a high dose of a "controlled substance"). We mistakenly believed it would be easy enough to increase his dose again if he started to experience HPPD symptoms again. Sadly we didn't understand how complicated and unpredictable benzo tapering can be, how severe the withdrawal symptoms can be, and how increasing your dose during a taper doesn't always fix things. I wish I had done all the research I've done now before he ever started his taper.

His HPPD symptoms are still seemingly being treated by the Klonopin, but now my brother has had these horrible head pain benzo withdrawal symptoms to deal with instead. 

For now we're just gonna see if we can get him relief for those symptoms in the short-term, and then carefully figure out a long-term plan later.

[[Co...]]

@[um...] I hope your brother finds relief for the head pain soon. And since your brother is now relatively stable and well after much effort, I suggest making changes only after careful consideration and in consultation with his doctors.

Our aim should be to as well as possible. And sometimes, this involves the use benzodiazepines. In this respect, benzos are exactly the same as any other medicine.