Depression maxed out during taper. What to do?

[[Ha...]]

Hi All-

To give a super abbreviated version of my history. I was put on klonopin during a bout of severe, prolonged panic ~4 months ago. .5mg to start. That climbed to 1mg after 5 weeks. Psych had me cold turkey to gabapentin, i reinstated klonopin after less than 2 days. Klonopin jumped to 1.5mg in order to stabilize. Seroquel was added to the mix to help me sleep. My lifelong paxil dose of 20mg was gradually increased to 50mg during all of this.

I started my taper in earnest about 9-10 weeks ago. Dropped from 1.5mg to .75mg in 3 weeks. That was much too fast. Depression, anxiety, crying fits, fearing for my life and my future lasted for maybe a week before i stabilized. I then dropped to .625mg. Again, too rapid. More doom, depression, anxiety, daily crying fits, believing my life was truly over. 

After stabilizing, and even feeling quite good for a couple of days, i dropped to .5625mg. After 8-9 days at .5625, i dropped to .5mg. I felt OKish for 8-9 days. And then hell broke loose. For the past 3 weeks, i have almost every day, felt as bad as i can imagine someone feeling. Flu like symptoms in the mornings, a depression so severe it transcends my articulation, persistent anxiety about the state I have found myself in, totally trapped and not improving one bit, and feeling like this is truly it for me. 

I have recently found a benzo wise doc who told me i could try updosing to .75mg, which he believes may not be antithetical given the length of my use and rapidity of my taper, or continue to try to hold at .5mg. Since it has been 3 weeks with no sign of improvement, I feel frozen and helpless. An unsuccessful updose would be devastating, adding that much more time to my taper with no relief in sight. But, as it stands, i feel like I cannot take many more days of this level of suffering.

Is it abnormal for someone to experience such a deep, dark, bone rattling depression at this stage of the game?

And a more uncomfortable question -- for buddies who simply cannot take it anymore, what is the best course of action? I figure an ER visit (or god forbid, a psych hold) would simply result in a cold turkey or being filled with a massive updose in benzos. And accordingly, putting me in an even worse position. Some people in my support system have encouraged inpatient treatment, but i can't find any buddies saying that was of help during (or after) a taper. And I know that it can be extremely counterproductive if the impatient/residential treatment facility elects to CT or rapid taper or hastily manipulate meds.

For what it's worth, i have a long history of GAD (generally well managed with Paxil) and about a decade of dealing with panic attacks (often the result of a little too much acohol, yay). So yes, some underlying issues that make tapering even more of nightmare. However, i have not dealt with much depression in my life. Only mild spells I would say. This level of depression i have been hit with is a completely different level.

Appreciate any advice from other buddies. I could really use it. ;-(

-Hagibis

[[Th...]]

You are correct regarding ER visits and psych wards.  ERs are for stabilizing care, not to treat Benzo WD.  I found out the hard way as I visited 4 ERs over a 6 week period and all they wanted to do was give me more psych drugs including Benzos.  As you already know, psych wards can give you whatever drugs they believe are necessary to "stabilize" you including Benzos.  IMO, it is NOT abnormal to experience deep dark depression at this point as everyone is different and each person seems to have that one "worst" symptom.  I had severe anxiety and depression that I never had prior to coming off of Benzos.  I learned to expect the unexpected.  There is no rhyme or reason to anything during WD.  Healing and recovery are completely nonlinear and play out differently for everyone.  IMO, inpatient treatment is almost identical to doing a cold turkey or a rapid taper.  I did a CT at the recommendation of my PCP, which is not recommended for the reasons you listed.  A slow taper is typically best, but you have to do what is best for you.  If you have a Benzo-wise doctor, he/she should be able to have a treatment plan with "options" in case things go south.  Good luck.

Edited November 8, 2023 by [Th...]

[[Ha...]]

5 hours ago, [[T...] said:

You are correct regarding ER visits and psych wards.  ERs are for stabilizing care, not to treat Benzo WD.  I found out the hard way as I visited 4 ERs over a 6 week period and all they wanted to do was give me more psych drugs including Benzos.  As you already know, psych wards can give you whatever drugs they believe are necessary to "stabilize" you including Benzos.  IMO, it is NOT abnormal to experience deep dark depression at this point as everyone is different and each person seems to have that one "worst" symptom.  I had severe anxiety and depression that I never had prior to coming off of Benzos.  I learned to expect the unexpected.  There is no rhyme or reason to anything during WD.  Healing and recovery are completely nonlinear and play out differently for everyone.  IMO, inpatient treatment is almost identical to doing a cold turkey or a rapid taper.  I did a CT at the recommendation of my PCP, which is not recommended for the reasons you listed.  A slow taper is typically best, but you have to do what is best for you.  If you have a Benzo-wise doctor, he/she should be able to have a treatment plan with "options" in case things go south.  Good luck.

Thanks, @[Th...]. 

Unfortunately for me, anxiety/panic disorder preceded my use of benzos. I had a severe, prolonged bout of panic that led to me taking benzos 4 months ago. Accordingly, family and friends are pushing me to get a "higher level of care," ie inpatient/residential/intensive outpatient. What they can't seem to wrap their heads around is the fact that in addition to the anxiety that led me to benzos, i am now very much contending with the benzos themselves. And i cannot convince them that an inpatient/residential option is unsuitable for someone trying to taper off of benzos.

I'd say things have certainly gone south already. My life is pure agony. Unfortunately my new benzo wise doc is out of town until next week and not very reachable until then. So i'm a position of not knowing what the heck to do. Stuck in a position of mental torture with no options. And i feel like even if i somehow stabilize and taper further, my history of panic disorder and (moderate) alcohol abuse make me a grave case. I'm feeling immense pressure to take action (again, inpatient or residential treatment, more consistent therapy), but i've been given no reason to believe any action steps will alleviate the pain and put me on a likelier path to recovery.

[[Th...]]

Unfortunately there are no quick fixes, shortcuts, immediate cures or ways around, under or over WD and related symptoms. Inpatient or residential treatment cannot shorten any of the torture you are currently experiencing and most likely will only make it worse?  One option I see is another Rx drug (non-Benzo) that might be able to alleviate some of your symptom intensity?  I worked with a Benzo-wise psychiatrist that was going to try Gabapentin if I didn't improve in a timeframe that he had laid out for me.  Fortunately it never came to introducing Gabapentin for me.  There is no shame in taking a non-Benzo Rx drug to get some relief...if possible?  People that have never gone through withdrawal cannot wrap their minds around what you are experiencing and believe it is a "simple fix" by trying another Rx drug, Inpatient or residential care treatment options.  I am sorry you are in the predicament you are in, but it does get better with time after you are completely off.  The unknown is how much time and how intense will the symptoms be.  Please get the help you need to do what is best for you!  Peace!

[[Ko...]]

I am sorry that you are feeling so horribly. My history is a bit similar to yours in that I was on klonopin 0.5 mg for 3 months and then tried to taper off by 50% and found myself with miserable symptoms by the next week. I went back to the 0.5 mg after that and gradually became a bit more stable. I ended up switching to valium and felt somewhat more stable- tapering from that now. I also have found depression and intrusive suicidal thoughts to be some of my main symptoms. 

I do think that since you are feeling so desperate and you made such large drops in dosage initially, that it may make sense to do what your doc suggested and updose to the .75 so you can stabilize before you try to taper again.

I agree that the ER and psych inpatient would just complicate things as you would lose control over your klonopin dosage and be subjected to a potentially big updose, rapid taper, with potentially a lot of other medications added on.

 

[[Ha...]]

22 hours ago, [[K...] said:

I am sorry that you are feeling so horribly. My history is a bit similar to yours in that I was on klonopin 0.5 mg for 3 months and then tried to taper off by 50% and found myself with miserable symptoms by the next week. I went back to the 0.5 mg after that and gradually became a bit more stable. I ended up switching to valium and felt somewhat more stable- tapering from that now. I also have found depression and intrusive suicidal thoughts to be some of my main symptoms. 

I do think that since you are feeling so desperate and you made such large drops in dosage initially, that it may make sense to do what your doc suggested and updose to the .75 so you can stabilize before you try to taper again.

I agree that the ER and psych inpatient would just complicate things as you would lose control over your klonopin dosage and be subjected to a potentially big updose, rapid taper, with potentially a lot of other medications added on.

@[Ko...] You made the switch from .5mg klonopin to valium? Curious to hear more about that experience as that is what my pscyh is leaning toward. Since i'm dealing primarily with intense anxiety/panic and depression, i'm worried these could both be worse on Valium. I've heard depression in particular can be exacerbated by Valium, and my understanding is that klonopin tends to do a better job masking anxiety/panic. Not sure how true that is.

Still here trying to stabilize at .5mg. Wondering if i've just hit tolerance and it's all exceedingly worse versions of hell as i try to taper and eventually jump. Fearing I could be a lifer on this stuff, and i've only been taking it for 4 months. :-(

[[Ha...]]

23 hours ago, [[T...] said:

Unfortunately there are no quick fixes, shortcuts, immediate cures or ways around, under or over WD and related symptoms. Inpatient or residential treatment cannot shorten any of the torture you are currently experiencing and most likely will only make it worse?  One option I see is another Rx drug (non-Benzo) that might be able to alleviate some of your symptom intensity?  I worked with a Benzo-wise psychiatrist that was going to try Gabapentin if I didn't improve in a timeframe that he had laid out for me.  Fortunately it never came to introducing Gabapentin for me.  There is no shame in taking a non-Benzo Rx drug to get some relief...if possible?  People that have never gone through withdrawal cannot wrap their minds around what you are experiencing and believe it is a "simple fix" by trying another Rx drug, Inpatient or residential care treatment options.  I am sorry you are in the predicament you are in, but it does get better with time after you are completely off.  The unknown is how much time and how intense will the symptoms be.  Please get the help you need to do what is best for you!  Peace!

@[Th...] thx for the reply. I do have to wonder how much of what i'm experiencing right now is withdrawal symptoms versus the panic/extreme GAD that resulted in me taking klonopin.

I am actually already on other Rx drugs. My psych tried taking my Paxil from 20 to 30, 30 to 40, and 40 to 50. No alleviation of symptoms. Seroquel (50mg) was added for sleep. So yeah, i'm polydrugged and unable to stabilize at .5mg. It is a living nightmare. If i'm struggling this badly with anxiety/depression at .5mg, i struggle to envision how I can complete a taper and push through withdrawals. 

The push for intensive outpatient from my family comes because they recognize i have serious underlying anxiety/panic. That is something that will need to be dealt with in addition to the benzo monster. And i recognize, they are somewhat inextricable at this point. I hope this is just a hellacious month in what will be a long, miraculous recovery, but it's tough to see a way out when you're in the thick of it.

[[Ko...]]

@[Ha...]

58 minutes ago, [[H...] said:

@[Ko...] You made the switch from .5mg klonopin to valium? Curious to hear more about that experience as that is what my pscyh is leaning toward. Since i'm dealing primarily with intense anxiety/panic and depression, i'm worried these could both be worse on Valium. I've heard depression in particular can be exacerbated by Valium, and my understanding is that klonopin tends to do a better job masking anxiety/panic. Not sure how true that is.

Still here trying to stabilize at .5mg. Wondering if i've just hit tolerance and it's all exceedingly worse versions of hell as i try to taper and eventually jump. Fearing I could be a lifer on this stuff, and i've only been taking it for 4 months. :-(

I made the switch gradually from 0.5 mg klonopin to 10 mg of valium a couple months ago. I started klonopin as a last resort for severe insomnia after not really sleeping at all for 3 weeks and it never even worked that well for it.  I  developed worsening depression while on the klonopin as well as other tolerance symptoms in July- burning skin, severe fatigue, total anhedonia. After I learned the situation I was in with the benzo tapering process I also developed pretty intense SI that seems to visit me every morning when I awaken and sometimes hangs around throughout the day. So, I had all that going on before crossing to valium. My provider pretty much forced me into switching to valium as she felt the only way to taper klonopin was with compounded solution.

I was very nervous to make the switch.  The switch overall wasn't bad- I did it over a few weeks. I notice that I am more tired and unmotivated.  I would say the depression is about the same -still severe- I have never in my life had such intrusive SI and anhedonia. I haven't had more anxiety other than the same amount of ruminations about this taper and withdrawal process and how it will affect my life. It did help me sleep better initially but as I have lowered the dosage gradually to 8.5 mg I started waking up in the middle of the night again.  

So I would say, don't be fearful of making the switch. I don't think it made anything worse.

I think a lot of my depression is confounded by ongoing high stress level of being a single parent and sole breadwinner, working a full time highly cognitive job.  I am going very slowly on the taper to try and stay functional but its difficult. 

I wish there was another way out of this miserable situation.  It's so unfair.  It's good to read the positive viewpoints of the others who have posted on this thread.