I think I have a Benzo dependency.

[[Be...]]

My doctor raised my dosage to 1mg a day. So I’m down 33%. I had to put it in writing which I guess helped. 

[[Be...]]

I think I’m at baseline right now. I still have occasional anxiety, memory and concentration issues. 

[[Li...]]

Good to hear from you @[Be...].  That’s wonderful you are back to baseline! 

Yes, you (or rather your doctor) made a 33% reduction in your dose from 1.5mg to 1mg.  It sounds like you are tolerating it ok but I hope your doctor will be willing to let you stay at this dose for a while to make sure you’re fully recovered from the 66% reduction she made initially.  I also hope she’ll support you in implementing a symptom-based, gradual taper moving forward.  (I suspect you already know this, but anxiety, memory, and concentration issues are all common withdrawal symptoms.)

[[Co...]]

On 08/04/2024 at 13:35, [[B...] said:

I want to thank you all for your support! I appreciate being able to communicate with people who really now what I’m going through. I find this very therapeutical and educational. 

You are most welcome.

On 09/04/2024 at 02:04, [[B...] said:

My doctor raised my dosage to 1mg a day. So I’m down 33%. I had to put it in writing which I guess helped. 

This is encouraging news.

[[Be...]]

Well I’m starting with the shakes again. This in between doses. 😔 

[[Li...]]

Hello @[Be...].  Good to hear from you.

Am I correct that today is Day 5 since you updosed from 0.5mg to 1mg after the drastic 1.5mg to 0.5mg reduction imposed by your “I don’t believe in slow tapers” doctor?

The shakes you are experiencing could be withdrawal symptoms hitting from the 33% reduction in dose (from 1.5mg to 1mg) or interdose withdrawal (due to the change from 3x a day dosing to 2x) or a combination thereof.

Have you reported this to your doctor?  I wonder if she would be willing to add a 0.25mg midday dose to see if that would stabilize you?  This would bring your reduction to approximately 17% (from 1.5mg to 1.25mg) which is more in line with our guideline of keeping reductions in the range of 5-10%.

Now might also be a good time for you to ask your doctor if she knows about the recently published Maudsley Deprescribing Guidelines (MDG) for benzodiazepines (as well as other psychiatric meds).  Using the risk criteria for withdrawal set forth in MDG (pp. 350-352), you are a candidate for the slower taper regimen for clonazepam (pp. 393-394).  

Note: the slower regimen in MDG switches to a liquid dosage form at a total daily dose of 1.2mg.  However, you could begin by using a combination of regular tablets and liquid as I outlined earlier.

 

 

[[Be...]]

@[Li...] I did request to up dose to 1mg per day. I will bring this up to my doctor. I did developed a tolerance at 1.5mg per day and the shakes started about 6 months ago. I thought it was due to some other medication. I didn’t now it was due to benzodiazepines withdrawal. So if I were to understand correctly, I should expect withdrawal symptoms to occur during my whole withdrawal process since it started while I was @ 1.5mg. I don’t mean to whine. I am strong and will do whatever it takes to get off benzos. I’m fully committed. 

Edited April 11 by [Be...]

[[PE...]]

29 minutes ago, [[B...] said:

@[Li...] I did request to up dose to 1mg per day. I will bring this up to my doctor. I did develop a tolerance at 1.5mg per day and the shakes started about 6 months ago. I thought it was due to some other medication. I didn’t now it was due to benzodiazepines withdrawal. So if I were to understand correctly, I should expect withdrawal symptoms to occur during my whole withdrawal process since it started while I 

 

 

 

Edited April 10 by [PE...]
Wrong thread. Tired

[[Li...]]

Rest assured, I am aware that you asked your doctor to increase your dose back to 1mg, @[be...].  I’ve been keeping a close eye on your case. 

Is the list of medications you’re taking up to date?  Here’s what you indicated in a previous post:

Fluoxetine, Aripiprazole, Prazosin, Benztropine Mesylate, Clonazepam, Enalapril, Trazadone, Rosuvastatin, Metformin, Pantoprazole, Naproxen, Famotidine  

This is quite a cocktail so it will be challenging to determine what might be causing or contributing to the shaking (or the other symptoms you’ve reported).  For example, one of the adverse effects of apriprazole (Abilify) is tardive dyskinesia (movement disorder).  

If you have not already done so, I encourage you to identify the adverse reactions and drug interactions for each of the medications you’re taking.  (You can find this information in the official FDA drug labels at DailyMed.)

This will give you a sense of which symptoms might be due to adverse reactions or interactions versus which ones might be due to clonazepam withdrawal.  If you don’t feel up to this task, I wonder if there are resources at the VA or the pharmacy you use that can assist you with a medication review?

If you did indeed become tolerant to the clonazepam at 1.5mg then your options were to increase your dose or taper off.   You elected to taper off so our first challenge is to discover a dose where you can stabilize (in this community, stabilize does not mean the absence of symptoms but rather symptoms are not changing in nature or number).  

After you get as stable as possible, our next challenge will be to initiate the taper process. I don’t know what branch of the military you served in but the taper process is quite similar to the OODA cycle (Observe, Orient, Decide, Act), which is a variation of the Deming/Shewhart cycle (Plan, Do, Monitor, Adjust).  

Our goal will be to keep your withdrawal symptoms as tolerable as possible while maintaining whatever level of functionality you require to perform essential daily activities.

 

 

 

[[Be...]]

@[Li...] Thank you very much for your support. I am a disabled Army veteran with PTSD, Anxiety disorder, Severe Depression, MST, and GERDS. I cut out the apriprazole for two months but the symptoms didn’t get better. I am back on it now. I go through medication review every 3 months. I thank you for your advice because it helps me to better communicate with my doctor. That’s how she increased my dose to 1mg per day. I have easy access to my doctor and she said she is willing to adjust my dosage as needed but right now we’re at a we’’ll see how it goes for now. It does seem to me that the problem is due to inter dose. That is when I feel the symptoms flare up. 

[[Li...]]

Hello @[be...].  Thank you for your service!  

I’m glad you get regular medication reviews.  Monitoring for and recognizing adverse drug reactions is key in cases of polypharmacy.

Re: the shaking … 

19 hours ago, [[L...] said:

Have you reported this to your doctor?  I wonder if she would be willing to add a 0.25mg midday dose to see if that would stabilize you?  This would bring your reduction to approximately 17% (from 1.5mg to 1.25mg) which is more in line with our guideline of keeping reductions in the range of 5-10%.

Re: discontinuing then reinstating the aripiprazole  …

Are you familiar with the concept of neurological sensitization? Changes in your medication regimen can be destabilizing.  Examples of such changes include starting, stopping, and/or restarting CNS-active meds, dose changes, and dosing schedule changes.  

Lastly, have you given any thought to contacting Angie Peacock about her experiences in the military and with VA healthcare and polypharmacy?  To learn more:

 

 

 

[[Li...]]

@[Be...] We haven’t heard from you for a while.  How are you doing?

[[Be...]]

@[Li...] I’m doing as well as can be expected. Shakes are still there and short term memory is still affected. Anxiety is still present mostly between doses. I did watch the video. I would never have made it with a 66% reduction. Because of your advice I am at a 33% reduction. I now have to monitor my blood pressure due to fluctuations. 

Edited April 25 by [Be...]

[[Li...]]

Hello @[Be...].  Thank you so much for giving us an update!  It sounds like you are beginning to stabilize at your new dose of 1mg but may be experiencing interdose withdrawal.  

Have you considered dosing more frequently while holding your dose constant at 1mg (e.g. 3x a day instead of 2x a day)?

Is your doctor now willing to support you in an individualized, gradual, symptom-guided taper as suggested in The Maudsley Deprescribing Guidelines (Horowitz & Taylor, 2024)?  I hope so.

PS Did you mean to write you would NOT have made it with a 66% reduction in your post above?  As you know, our general guideline is to keep reductions in the range of 5-10%.

[[Be...]]

@[Li...] I meant I would not had made it with a 66% cut. It seems like my doctor is willing to be flexible with my tapering. She did acknowledge my tapering would be on an individual basis. I’ll also be going in for a brain scan to rule out any changes. 

[[Li...]]

Thank you for the clarification, @[Be...].  That’s encouraging news your doctor has acknowledged your taper should be individualized!  

If you have not already done so, I suggest you ask your doctor to take a look at The Maudsley Deprescribing Guidelines (Horowitz & Taylor, 2024).  Call her attention to the section on how to estimate the risk of withdrawal and the corresponding size of reductions (pp. 350-352) as well as the section on deprescribing clonazepam (pp. 388-395).

To give you a sense of the size of your next reduction …

The faster tapering regimen for clonazepam suggests a 0.125mg reduction from 1mg to 0.875mg. The moderate tapering regimen suggests a 0.05mg reduction from 1mg to 0.95mg.  The slower tapering regimen suggests a 0.025mg reduction from 1mg to 0.975mg.  

However, perhaps the key takeaway from MDG is that taper rate should be determined by the individual’s response to reductions. 

I hope all goes well with the brain scan.  Please keep us posted.

[[Bu...]]

On 11/04/2024 at 07:00, [[B...] said:

@[Li...] Thank you very much for your support. I am a disabled Army veteran with PTSD, Anxiety disorder, Severe Depression, MST, and GERDS. I cut out the apriprazole for two months but the symptoms didn’t get better. I am back on it now. I go through medication review every 3 months. I thank you for your advice because it helps me to better communicate with my doctor. That’s how she increased my dose to 1mg per day. I have easy access to my doctor and she said she is willing to adjust my dosage as needed but right now we’re at a we’’ll see how it goes for now. It does seem to me that the problem is due to inter dose. That is when I feel the symptoms flare up. 

BB,  My first posted to this forum was a week ago, it appears we're traveling down the same road Benzo wise. It's all new to me. I'm doing my 'taper' this thru the VA. Just wanted to say Hello Brother, God Bless    

[[Be...]]

Likewise. We can do this!

Edited April 26 by [Be...]