Do I have the option of not tapering down from my 1.5mg of Klonopin?

[[4m...]]

Dear Buddies,

 

I am asking for help!

I am wondering if I have the option to not taper down on my Klonopin and if I do want to taper more, what is the recommended method?

 

My History:

- I have been on 1-4mg of Klonopin (Clonazepam) for over 20-years now. I have detailed “med cocktail” notes going back to 2007 (and now it is the end of 2023).

 

- The last 7 or so years I have been on 2mg a day.

 

- In Oct 2023 I did a scary taper, that ended badly (see below), so now I am on 1.5mg/day.

 

- I started on Klonopin back in 2006. So, I have been on 1-4mg for some 18-years. Most 1-2mg.

 

- The Clonazepam mostly served me well for decades, until it didn’t!  In Feb of 2023, I had a severe anxiety symptoms and the meds stopped helping. I didn’t dare get off them, as a withdraw (on top of my symptoms) was not something I wanted.

 

- Now I am on 1.5mg of Clonazepam + 1.25 of Abilify. I and am fragile, but stable. Sometime I can even get almost no anxiety in the AM and late PM.

 

- IMPORTANT NOTE: I would love to stay where I am! Stay on the Klonopin forever BUT due to the scare in US society of opioid overdoses and liability issues, I haven’t been able to find any new psychiatrists that prescribe any sort of benzos. My phycologist will be retiring soon, so I need somewhere to go to keep my refills coming.

 

DETAILS:

- It is an especially bad time to taper, as I have not recovered from my Feb 2023 relapse of anxiety. It lasted until mid-Nov of 2023, but I am still not the person I was in Jan of 2023. I still can only work about 4 hours a day I have gone from running marathons ever few weeks, to having a hard time walking more than 3 miles.

 

- I am (and have always been) under the care of the same experienced psychiatrist for 20+ years, but he will prob retire soon, and (as I mentioned), that scares the shit out of me as I can’t find any psychiatrist that are still willing to prescribe benzos. Not in my area (Southern CA) anyway. With it being a controlled substance now, they are telling you have to be seen in person, at least once in a while.

 

MY QUESTIONS ARE:

1 - Should I search hard for a psychiatrist that does, so I don’t need to taper further? I wonder if they exist in San Diego County, California.

 

2 - If I wanted to go ahead and taper, while I still have my existing psychiatrist, what is a recommended taper schedule?

 

Sincerely in need of help,

- 4mg of Klonopin

 

[[Co...]]

Hello @[4m...]. Welcome to BenzoBuddies.

I have only time to approve your introduction before logging out. If other have not already replied, I will respond properly when I return.

[[Co...]]

9 hours ago, [[4...] said:

Dear Buddies,

I am asking for help!

I am wondering if I have the option to not taper down on my Klonopin and if I do want to taper more, what is the recommended method?

Hi again, @[4m...]

I suggest, in the first instance, keeping it simple. Unless your experience demonstrates otherwise, regular pill-splitting likely will work for you.

9 hours ago, [[4...] said:

My History:

- I have been on 1-4mg of Klonopin (Clonazepam) for over 20-years now. I have detailed “med cocktail” notes going back to 2007 (and now it is the end of 2023).

- The last 7 or so years I have been on 2mg a day.

- In Oct 2023 I did a scary taper, that ended badly (see below), so now I am on 1.5mg/day.

- I started on Klonopin back in 2006. So, I have been on 1-4mg for some 18-years. Most 1-2mg.

- The Clonazepam mostly served me well for decades, until it didn’t!  In Feb of 2023, I had a severe anxiety symptoms and the meds stopped helping. I didn’t dare get off them, as a withdraw (on top of my symptoms) was not something I wanted.

- Now I am on 1.5mg of Clonazepam + 1.25 of Abilify. I and am fragile, but stable. Sometime I can even get almost no anxiety in the AM and late PM.

- IMPORTANT NOTE: I would love to stay where I am! Stay on the Klonopin forever BUT due to the scare in US society of opioid overdoses and liability issues, I haven’t been able to find any new psychiatrists that prescribe any sort of benzos. My phycologist will be retiring soon, so I need somewhere to go to keep my refills coming.

Yes. Some (or many) doctors are now unwilling to prescribe benzodiazepines. Some are even unwilling to renew prescriptions for their patients who have been taking them for years.

What you might do is explain that since you have been taking benzodiazepines for 18 years, you would like a prescription with the aim of gradually tapering off over, say, 12 months, as this will allow you time to develop coping strategies as your dose diminishes. They might not agree to 12 months-worth of prescriptions, but maybe they will be willing to negotiate.

But if you wish to remain on the medication, you will need to keep trying different psychiatrists until you find one willing to prescribe for you.

9 hours ago, [[4...] said:

DETAILS:

- It is an especially bad time to taper, as I have not recovered from my Feb 2023 relapse of anxiety. It lasted until mid-Nov of 2023, but I am still not the person I was in Jan of 2023. I still can only work about 4 hours a day I have gone from running marathons ever few weeks, to having a hard time walking more than 3 miles.

I suggest that you explain this to the prescribing doctor.

9 hours ago, [[4...] said:

- I am (and have always been) under the care of the same experienced psychiatrist for 20+ years, but he will prob retire soon, and (as I mentioned), that scares the shit out of me as I can’t find any psychiatrist that are still willing to prescribe benzos. Not in my area (Southern CA) anyway. With it being a controlled substance now, they are telling you have to be seen in person, at least once in a while.

Then this is what you should do. I expect most doctor will expect to see you from time to time.

9 hours ago, [[4...] said:

MY QUESTIONS ARE:

1 - Should I search hard for a psychiatrist that does, so I don’t need to taper further? I wonder if they exist in San Diego County, California.

2 - If I wanted to go ahead and taper, while I still have my existing psychiatrist, what is a recommended taper schedule?

Sincerely in need of help,

- 4mg of Klonopin

1. From what you have written, if you wish to continue taking Klonopin, it seems that you will need to continue your search. You might ask your existing psychiatrist for a recommendation/referral.

2. After long-term use, it is usual (around here at least) to taper off over a number (or many) months from a dose of 1.5mg/day. What would be fairly typical for our members in a similar situation to you is to reduce their dose by 0.125mg (a quarter of 0.5mg pill) every couple of weeks. Some can taper more quickly, and some will take longer. Our usual advice is to suggest 'a symptom-based taper'. That is, make new cuts according to how you react and feel reasonably able to make new ones.

The plan I just outlined would take 24 weeks to complete. Again, though, many can taper more quickly than this (and some need to taper more slowly). But I think it is reasonable starting point for your initial cuts so that you can assess how you react.

[[Li...]]

17 hours ago, [[4...] said:

I have not recovered from my Feb 2023 relapse of anxiety. It lasted until mid-Nov of 2023, but I am still not the person I was in Jan of 2023. I still can only work about 4 hours a day I have gone from running marathons ever few weeks, to having a hard time walking more than 3 miles.

Hello, @[4m...].  

Are you familiar with the concept of drug tolerance?  If not, I’ve included links to two articles from the Benzodiazepine Information Coalition you might find of interest.  I wonder if this paragraph from the second article might apply to you?

“Long-term benzodiazepine use may even aggravate anxiety disorders. Many patients find that anxiety symptoms gradually increase over the years despite continuous benzodiazepine use, and panic attacks and agoraphobia may appear for the first time after chronic use. Development of or worsening symptoms during long-term benzodiazepine use is probably due to the development of tolerance to the anxiolytic effects.”

Benzodiazepine Tolerance: Why Are My Symptoms Getting Worse on My Medication?
https://www.benzoinfo.com/2016/09/08/benzodiazepine-tolerance-why-are-my-symptoms-getting-worse-on-my-medication/

Tolerance
https://www.benzoinfo.com/tolerance/

 

[[Re...]]

/Sidenote: Thank you for this @[Li...], I realize now many issues I had on BZDs. Of course having many issues without them, too... So there's a catch /

[[4m...]]

12 hours ago, [[C...] said:

Hello @[4m...]. Welcome to BenzoBuddies.

I have only time to approve your introduction before logging out. If other have not already replied, I will respond properly when I return.

 

Hi Colin,

Thanks for your detailed reply.

I have started a search for a “backup” psychiatrist, as I don’t know when my existing one will retire.

I talked to my existing psychiatrist, but he didn’t have any recommendations/referrals, as all the doctors of his era have already retired.

I am going through a list on the psychology today website and will be calling one by one.

In addition, after reading your post and talking to my psychiatrist, I did decide it was probably a good idea to ALSO start a very slowly taper to get to a lower dose. My plan is to start on Jan 1 2024, and go slow.

I like your idea of “a symptom-based taper”, but I would like to take way longer than 24 weeks. I like the 1-year idea.

Maybe the next step it just to get to 1mg....

Thx so much for taking the time to reply!!!