Psychiatrist Retiring / Just Began my Titration from 6 mg. of daily Clonazepam

[[Ge...]]

Hello All,

I hope you all are doing well...

I was only eleven days into my titration schedule from 6 mg. of Clonazepam per day and my psychiatrist that was allowing me to titrate per my own schedule announced that she is retiring on 12/31/23. My titration schedule is going to take between 1 year and 9 months to 2 years because I am on such a high dosage and have been taking benzos for 15 years. I am 62 years old and want to titrate very slowly because of my age and high dosage. Also, I want to reduce the chances of any Protracted Withdrawal Symptoms.

I have a little over 4 months to find a psychiatrist that will allow me to follow my schedule in the Los Angeles area.

Does anyone have any referrals? Any help will be greatly appreciated. 

Thank you.

Sincerely, George

 

[[Pa...]]

Hello George, welcome to BenzoBuddies,

I’m sorry you’re facing this uncertainty, stress isn’t good for us, it seems to intensify our symptoms, speaking of that, are you dealing with many?  Also, can you provide us with your taper rate?  The reason I ask is because typically high dose users can get away with making fairly large reductions in the beginning but of course, need to slow down the lower they get.

I don’t ascribe to the belief that a fast taper or cold turkey will lead to protracted symptoms, mostly because I quit cold turkey and recovered in the typical time frame but I haven’t really seen evidence of that here either.  Our situations are too different to be able to say with certainty what will happen, so please don’t worry about that.

If you can get your dose down to more typical dose, you’ll probably have better luck finding a new prescriber, not many will want to take on someone with a high dose, that sends red flags into the system making them unwilling to have the light shown on them.  Nurse practitioners seem to be a good resource, some of our members say they’re a bit more understanding and willing to work with us.

This group tries to keep a record of benzo savvy medical professionals, you might try them. https://www.benzoinfo.com/doctors/

We’re glad you found us and hope we can help.

Pamster

[[Ge...]]

Hi Pamster,

Thank you for the reply! Right now, I am not feeling any serious symptoms. However, I still get anxiety when it has been several hours after taking a dose. I am tapering 5% every two weeks from the current dose. When you mentioned typical dose, how many mgs. per day would that be for Clonazepam?

Also, thank you for the tip regarding nurse practitioners and the website.

I really appreciate you taking the time to reply with the eye-opening information. I never gave thought to a new prescriber being afraid to prescribe a high dosage to a new patient. It totally makes sense.

Thanks again...

Glenn

 

[[Pa...]]

Typical doses of Klonopin I see here are around 1.5 mgs of Klonopin, so yes, you are on a very high dose and given your circumstances, my suggestion would be to try to go a bit faster, unless symptoms become unbearable leaving you unable to function. 

How many times a day do you dose, if only once, you might consider dosing twice a day, this may eliminate the interdose withdrawal you seem to be dealing with.  If you do decide to split your doses, I would suggest holding any reductions until your body gets used to the new schedule.  

[[Ge...]]

Hi Pamster,

I dose three times per day. 2 mg. (Morning), 2 mg. (Afternoon) and my shaved tablet (titrating amount) in the evening of Clonazepam. My anxiety is getting worse with the thought of finding a new psychiatrist that will help me. Also, I lost (Benzo Brain) a bottle of 28 mgs. that I set aside for titration, which mean that I will need to skip some doses in order to not have to go 'cold turkey' before my next refill.

By the way, do you happen to know the maximum number of refills that a psychiatrist can order for benzos? The more the psychiatrist can order before she retires will extend the time that I have to find one that will help me.

Thank you. I am so glad that I found this Benzo Buddies forum. Also, I am wondering how BB is funded. If it through donations, I would definitely like to contribute.

George

[[Pa...]]

Hi @[Ge...], thanks for sharing more of your story, I’m sorry to hear you lost so many pills, thats distressing and added to your concerns about finding a new doctor, I’m sure your symptoms have ticked up a bit.  Stress in my opinion is the greatest contributor to increased symptom severity. 

When you get some time, could you add your medication history into your profile, it will help us see your situation at a glance making it easier to make suggestions without having to go back through your posts.   Here are the instructions. 

I don’t have any knowledge about prescribing limitations but I would imagine insurance company policy comes into the picture as well.

Thank you for your kind offer but the owner of BenzoBuddies has never asked for or accepted donations in the nearly 20 years he’s kept this going and the team are all volunteers so come cheap. 

[[Ge...]]

Hi Pamster,

I have completed the medication history. However, I forgot (Benzo Brain) to enter my taper history. I am only two weeks into my taper. I am shaving 5% from each pill using a gram scale and file. Last night, as I was shaving the 5% off of my new current dose, I am realizing how much anxiety this process creates. I spoke to friend (Pharmacist) and he agreed with you that my taper plan is too slow. Therefore, tonight I am going to use a pill splitter and take off a 1/2 mg. of my 2 mg. evening dose and see how I feel.

Do you think that a 1/2 mg. cut from a 6 mg. daily dose is okay?

You are correct. My anxiety was bad enough with the new psychiatrist search and when I lost the medication for titrating, it has gotten worse. 

I would like to thank the owner for such generosity in keeping this great website going. Also, I thank you for your volunteer work. It is greatly appreciated!

Best regards, George

[[Fa...]]

Hi, @[Ge...],

I think cutting .5mg from your total 6mg daily dose would be a good place to start.  This is an 8.3% reduction.  I would suggest holding for 2 weeks.  Keep a log of any symptoms and their severity over this period.  You do not want to skip doses.  I would recommend figuring out how many pills you have before your next refill.  Hopefully picking up a 2mg tablet every 4 days from tapering will assist.

[[Pa...]]

I agree with @[Fa...], increasing your reductions is prudent given you’re on such a high dose, this should help you in regard to your lost pills as well.  It’s good you’ve got a friend in the business, pharmacists are often more knowledgeable about medications than the doctors who prescribe them. 

Thank you George, I’ll pass along your good will to the owner. 

[[Ge...]]

Hello,

Thank you Faith Hope Love and Pamster! Yes, I was thinking the same thing (not skipping doses) regarding recovering my lost pills. However, last night I did skip a dose, just as I did two other days because of my lost pills. Each of those three times, I did not sleep well, had elevated blood pressure and increased anxiety the next morning.

Yes, this 0.5 mg. cut will be an 8.3% reduction. But, if I continue to cut 0.5 mg. each stage, the percentage reduction is going to get too high, the lower my current dose gets.

Unfortunately, if I reduce by 0.5 mg. every two weeks, I am going to get to a point where I need to break out the scale and file again to stay in the 8% to 10% reduction range.

Do you suggest that I should keep my two week (I will hold longer if necessary) reduction amount in the 8% to 10% range?

Thanks again to you both and thank you Pamster for passing along my feelings to the owner. He or She is a godsend to the benzo community!

George

 

[[Fa...]]

Hello again, @[Ge...].  We will be more than happy to work with you throughout your taper, however, we need to first address the issue of skipping doses.

How many doses are you planning to skip before your next refill?

[[Ge...]]

Hi Faith Hope Love,

Thank you so much for your support! I have 17 days until my next refill. Since I will be cutting 0.5 mgs. for the next 14 days, I do not believe that I will have to skip more doses. Unfortunately, I'm so busy right now trying to find a new psychiatrist among other things, I am unable to count pills and make calculations.

So, it sounds like you believe that skipping doses is a 'no no'.

Are you an administrator for Benzo Buddies also?

[[Fa...]]

Hi, @[Ge...].  That is good news you won't be forced to skip any more doses.  It is fine if you miss a few doses here and there, but I would try not to do so if possible.  Especially when you begin tapering it is best to keep daily doses and blood levels steady and consistent.

Does your current psychiatrist have a referral for you (and her other patients) for when she retires?  What about a referral from your GP or your pharmacist friend?  The good news is that you have 4 months which should be ample time, so try not fret. 

In regards to your taper, I would try not look too far ahead.  The goal is to remain functional while getting off your benzo which means a symptom based taper is ideal.  You should gather your first crucial piece of information with your taper when you cut .5mg and hold for 2 weeks.  You very well may feel just fine and can proceed with another .5mg cut.  Try not to seek out symptoms.  Wish you the best and keep us posted!

[[Ge...]]

Hi @[Fa...],

I will try not to skip too many doses unless it is to avoid a cold turkey situation.

Yes, my current psychiatrist did give me a referral and I have an appointment with him in October. However, he is part of a large network of psychiatrists and he has bad reviews online. Even my insurance company, told me about his bad reviews when I was trying to find out if he is In-Network. Also, while filling out his extensive online paperwork, it stated that if you have substance abuse issues their protocol must be used. I need to be in control of my taper or be given a slow titration schedule. So, I do not have high hopes with him.

My GP is the one that cut me off of 1 mg. of Xanax per day and sent me to the psychiatrist and my benzo doses skyrocketed. I will ask him at my next appointment. Unfortunately, my pharmacist friend did not have any referrals since he works in the cancer field.

Your last paragraph was very informative and encouraging. I made appointments with two more new 'benzo friendly' psychiatrists today and I have a consultation with Dr. Lepp from SafeTaper tomorrow. However, SafeTaper does not take insurance, so that route will be very costly. He does use a variation of the Ashton Method. So, that is along the lines of what I am looking for.

Thank you so much for your kind words and encouragement. I am shedding tears right now. It blows me away that someone online that knows nothing about me is trying to help.

Best regards, George

 

[[ia...]]

 

Hi @[Ge...], 

I wanted to say 'hi' and welcome you to benzo buddies. You are in the right place and among those who understand. I read story – thank you so much for sharing. There's something that I want to share with you, in an effort to empathize and relate to what you're going through.. I read your story - and want you to know, I TRULY understand (most of) what you're going through. 

I was seeing a psychiatrist for 7 years. I had established a great relationship with this physician who specializes in chemical dependency. In June of 2020 a few major life events rocked my world and I was struggling to sleep and cope emotionally. He prescribed me Diazepam and Alprazolam. Long story short, over the course of just a few days, I developed a dependency. Fast forward to the fall of 2022, that psychiatrist (who I knew and trusted) retired and I was passed to a new psychiatrist - who on our first appointment told me he wanted to 'get me off the benzos'. There was no actual discussion about it - he just STOPPED prescribing them. (Horrible). It caught me off guard -and I didn’t have the chance nor the courage to say: “Hey can we talk about this, I need to taper.” Fortunately... I was only taking a SMALL amount of what I was actually prescribed and had squirreled away quite a bit of both medications. I began my taper immediately (and on my own). I tapered off two medications concurrently for ten months. I jumped off both in the last two months and I’ve felt the best I have in months.

You will find a good Dr – that will be empathetic to your situation. We’ll be here to support you on your journey. All will be ok…

 

[[Ge...]]

Hi @[ia...],

Thank you so much for welcoming me into this unbelievable community.

I appreciate that you have shared your story with me and I am so happy that you are feeling great! 

It is quite scary that so many psychiatrists and physicians do not know the dangers of overprescribing and making a patient go cold turkey off the benzos. Jeez, I did not even know the dangers until I saw some You Tube videos a couple of years ago. I was also on two different benzos (Clonazepam and Alprazolam) at the same time for a few years until the pharmacist refused no longer fill my Alprazolam. I was freaking out until I called my psychiatrist and she raised my Clonazepam dosage.

I am also trying to spread the word about the dangers of benzos by word of mouth. In fact, I was getting a tattoo related to my benzo titration last week and I told my artist that if an MD ever offers to prescribe a benzo to you. DO NOT TAKE IT!!!

Thank you for your words of encouragement and positivity. I am deeply grateful...

[[or...]]

20 hours ago, [[G...] said:

Hi Faith Hope Love,

Thank you so much for your support! I have 17 days until my next refill. Since I will be cutting 0.5 mgs. for the next 14 days, I do not believe that I will have to skip more doses. Unfortunately, I'm so busy right now trying to find a new psychiatrist among other things, I am unable to count pills and make calculations.

So, it sounds like you believe that skipping doses is a 'no no'.

Are you an administrator for Benzo Buddies also?

I didn't read the whole thread @[Ge...] but when I saw you were so busy you couldn't, or didn't think you had time to count you pills & calculate. I had to chime in.  This is, imo, one the most serious things, top priority, in keeping you able to function well each day, so that you are stable enough to do your "business".  I have a bad tremor, but it takes me about 5 minutes to cut my dose every morning.  I don't taper down every morning, I hold for about 2 weeks.  I hope you will reconsider your thoughts on "not" being able to cut, or just break your tablets into two, .5 mg or whatever you are dealing with mg-wise.  Again I am just saying that keeping my priorities straight has helped me get 5 months into my taper successfully, not totally without wd sxs, but better than I would have been if I'd put anything before my taper, DenisePS you can do this.

 

[[Fa...]]

Hi, @[Ge...],

It sounds like you are taking all the proper steps in finding a new prescriber.  Again, you have plenty of time.  You are looking for a prescriber whom will allow you to taper at your own speed and to write your prescriptions.  I ended up with a gentleman who does not take insurance.  He allows once a month tele-health visits and charges me $140.  I felt most comfortable with him as he allows me to completely control my taper speed and writes my prescriptions as needed. 

I am optimistic your first step in your experiment/taper will be a success.  Please do check-in and ask questions as needed.  

[[Fa...]]

@[Ge...] Here are a couple references you may choose to show to your potential (de)prescribers.  One is the drug label for your clonazepam tablets.  Boxed warning, bullet point number 3, is a reference they should find credible.  Another is the attached deprescribing guidance for patients and prescribers.  Some are able to move faster than this guidance recommends, and you may mention that you will certainly do so if your body and your symptoms allow it.

https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=8069b1a0-7c06-4252-b44e-e2eef065d9b8

https://corxconsortium.org/wp-content/uploads/Benzo-Deprescribing.pdf

[[Ge...]]

Hi @[or...],

I will take your advice regarding counting my pills. Yes, you are right. If I get caught in a cold turkey situation, I'm in big trouble. 

I am taking Faith Hope Love's advice and cutting 0.5 mg. and holding for two weeks. Last night, was my first time using this approach. I only got 4.5 hours of sleep and had AM anxiety that lasted for a couple of hours, then went away. This anxiety did go away on its own (refrained from taking my taking my first dose to help). Holding out left me with a good feeling...

Hi @[Fa...],

I had a free consultation with the doctor from SafeTaper today. He also does monthly tele-visits and does not accept insurance. However, he charges a whopping $275/per month. He has agreed to take me as his patient after my psychiatrist retires.

I am going to keep the three appointments that I have setup with the potential new psychiatrists. But, the stress involved in this process does not help my titration efforts.

Thanks for the useful websites and I wish to thank you both for your encouragement.

By the way... Since I am brand new here, is there a way to reply to multiple replies separately or do I have to reply to multiple people in one reply?

[[or...]]

Glad it helped you George and I don't know that I welcomed you, but I am always glad to see folks find the site.  It's helped me so much, especially not to feel alone in this journey   

Yes you can do separate "quotes" to each person if you like, you just click the person's "quote" option under their reply only, then the next etc. You can try it out by clicking on the plus-sign under reply at bottom of reply, and it will show the one quote at bottom of page, and you can reply and then go back to next reply you want to quote etc.  Hope that makes sense, it's pretty early for me, but I did get about 6 hours sleep, maybe 5.  Not as many as I'd like but better than way less, Denise

[[Fa...]]

@[Ge...] That's great news you have a potential new psychiatrist that will allow you to control your taper!  I agree regarding keeping your other appointments as you may find one that suits you better, takes insurance etc...  I know it's easier said than done, but try not to stress as you now have a good "worst' case scenario in place and it will not help your symptoms.  You still have over 3 months to complete the process.  

I would suggest not skipping any doses and taking your doses at the same times each day.  Your body will want consistency.  If sleep is an ongoing issue, you may consider cutting the .5mg from your afternoon dose (ie. 2mg morning, 1.5mg afternoon, 2mg evening) and hold for 2 weeks.

[[Ge...]]

2 hours ago, [[o...] said:

Glad it helped you George and I don't know that I welcomed you, but I am always glad to see folks find the site.  It's helped me so much, especially not to feel alone in this journey   

Yes you can do separate "quotes" to each person if you like, you just click the person's "quote" option under their reply only, then the next etc. You can try it out by clicking on the plus-sign under reply at bottom of reply, and it will show the one quote at bottom of page, and you can reply and then go back to next reply you want to quote etc.  Hope that makes sense, it's pretty early for me, but I did get about 6 hours sleep, maybe 5.  Not as many as I'd like but better than way less, Denise

Hi @[or...],

Thanks for welcoming me in. Yes, I agree. It has helped me tremendously. Prior to this, I was fumbling around, making giant spreadsheets, weighing and filing pills and losing pills. It is so nice to meet such wonderful people 'in the same boat' as you. When I talk to other people that know nothing about benzos and explain what I am attempting, they do not quite understand the seriousness of the problem. Also, thanks for the reply tip!

I am in Cali, so I am up early also and got about 6 hours of sleep too. This morning, my anxiety is not a bad as yesterday, so that's great.

All the best, George 

P.S. Replying to you nice folks reduces my anxiety!!!

[[Ge...]]

31 minutes ago, [[F...] said:

@[Ge...] That's great news you have a potential new psychiatrist that will allow you to control your taper!  I agree regarding keeping your other appointments as you may find one that suits you better, takes insurance etc...  I know it's easier said than done, but try not to stress as you now have a good "worst' case scenario in place and it will not help your symptoms.  You still have over 3 months to complete the process.  

I would suggest not skipping any doses and taking your doses at the same times each day.  Your body will want consistency.  If sleep is an ongoing issue, you may consider cutting the .5mg from your afternoon dose (ie. 2mg morning, 1.5mg afternoon, 2mg evening) and hold for 2 weeks.

Hi @[Fa...],

Yes, I was so happy after my consultation. This MD knows benzos and believes in slow tapers. Not taking insurance is the only problem.

Thanks for the afternoon dose tip. I will definitely do that on the days that I go to the gym. After I leave the gym, my anxiety is low. On my 'off days', anxiety is much higher in the afternoons. 

Not sure if changing my titration dose times is a good idea, though.

[[Fa...]]

@[Ge...] Dose as you feel best.  You are correct though...keep it consistent.  Don't change dosage times and amounts outside of your scheduled reductions.