Crossing over from Clonazepam to diazepam -- good or bad? Please let me know

[[mo...]]

I finally found a nurse practitioner who is willing to help me taper off Clonazepam.  I was originally on 4mg.  I started tapering before I knew anything and reduced to 3mg.  I then learned more about tapering and I have always used dry cut with a scale.  I went slowly, 5% maybe once every 2 weeks to a month.  In 2019, I became so severely depressed, it scared me - so I went back up to 3mg.  Then lots of family tragedies had me starting and stopping my taper.  Then, I started tapering slowly from 3mg end of 2023.  I was down to 2.7mg.  When the nurse practitioner started working with me, she used a liquid compound of Clonazepam. She started me a little higher and I am now down to 2.7mg.  By the way, that severe depression from 2019 never left.  But I deal with it the best I can. Anyway, I just had an online meeting with her on Monday.  She wants me to cross over to diazepam because she says that I am in tolerance with clonazepam and have interdose withdrawals. I have heard that this does not work for many people.  I am a caregiver to two family members and cannot have any more severe problems than I have already.  I told her I am very nervous about it and a doctor that I follow on YouTube warns against doing this cross over to diazepam.  He says to just space out the clonazepam more times throughout the day and to finish the taper with clonazepam.  Tomorrow I am to pick up the diazepam capsules from the compounding pharmacy.  She says there are no fillers this way.  I do not know they that is any better.  But I am very nervous.  Currently taking:  AM: 0.9mg Clonazepam, afternoon 0.7mg C, PM 1.1mg C.  A total of 2.7mg clonazepam.  Tomorrow she wants me to take:  AM: 0.9mg Clonazepam, afternoon 0.7mg C, PM 0.5mg Clonazepam with 10mg diazepam.  Seems like a big jump!!  Has anyone had experience with this???

[[...]]

@[mo...], hi again)  Your taper seem quite reasonable and, guess, had all the tragedies not happened you would be doing well now.

I'm not good at the tapering but i somehow did my own and read some information on it. Have you ever tried Aston Manual? There are good recommendations on tapering in general and crossing to diazepam in particular, some tables too.

Good for you you can handle the depression without updosing now. Just great! As far as i know depression can be caused exactly by benzo. The drug inhibits our activity. Perhaps, no good updosing it.

Good luck to you with all my heart!)

Edited April 10 by [...]

[[Id...]]

Hi @[mo...],

 I’m happy you were able to manage your taper so sensibly, unfortunately it’s no so immediate nor a so spread knowledge to get things right to begin with. I am also happy you have someone following you in doing this slowly even if it is not perfect as per your post. 
 

I understand you are so disoriented as say in your previous post, I’d like to assure you that this is really really common and we totally get it (I was in a lot worse state when I found this place). There’s good support here, let it be for you or from other posts you can learn from.

Kate’s advice is really good, and I mean really, when you are not oriented reading Ashton manual and benzoinfo might really make the difference, even just to alleviate the horrible confusion that is a symptom of its own. You don’t need to understand it all or “find a solution in there”, it might just help to ground you and help your mental state with this.

I totally understand you are scared. And also I am far from a good taper expert but I had to learn some lessons. Clonazepam in some cases seems to be the worse to taper from but please don’t let this discourage you, it doesn’t have to be like this for you.

Severe depression happened to me without any doubt with diazepam, I also dealt with it but the med in se hit me to a point I had to stop the switching (I am not saying it will be the same for you, but I’m validating the fact that it can come from the meds).

Yes, it could be an approach to space out doses if you are in intra dose wd but nothing is a guarantee unfortunately. 
 

What I would like to suggest you is what helped me most to orientate in a technically worse situation… take notes of your symptoms every hour if necessary and rate the severity of them (don’t worry if it won’t be perfect) this helps understand how you react within doses if you are in intra doses wd and to help your prescriber to better understand (thanks to that for example I understood that spacing out diazepam doses was a big fat “no” for me, even if I did really slowly and carefully). It will also give you a better way to advocate for yourself if a symptom gets really worse. None practicer would want to give you something that is unbearably worse. 
 

Also as Kate said the table examples that you can find in the manual are really helpful to help you understand what a sensible switch might work, of course there’s no need to follow them, they are a real example, but they can give you an instrument to talk with your prescriber if you think it will be useful. 
 

Also if you are a caretaker or whatever other difficult you can encounter in life you can think about holding the taper, which should ideally be guided by patient and symptoms.

I hope this somehow might help. I wish you all the best. Also I am really without energies: I hope I have expressed myself well 

[[mo...]]

Thank you for all the responses.  I have read the Ashton Manual.  I also understand that it is nothing that is set in stone.  Each person is an individual.  I have yet to meet a person who has successfully crossed over from clonazepam to diazepam.  I am having so much trouble just holding myself together right now, I do not feel I am ready to even try.  I cannot handle anything worse than what I am already suffering.  It is affecting my relationship with three of my children.  They only get angry with me and stay away because they do not understand.  My fourth child is overdrugged right now by psychiatry.  They have him completely sedated.  I am not ready, mentally, nor do I have a space in my life to "try it out" and have a disaster.  Yet, my nurse practitioner keeps insisting.  I was started on xanax back in 1997 and told I would need it for life, like a diabetic needs insulin.  That caused depression.  So, for 27 years they have me believing there is something wrong with ME!  I put myself in the hospital 4 times for horrible depression.  They have tried over 25 drugs on me.  It came to a point where a MD said I had "treatment-resistant depression" and that I should consider ECT.  That's when I quit listening to them and sought elsewhere. So, no, I am not ready to try a new drug!  I would rather just taper off Clonazepam, but she is not listening to me.  I have MD appointments for my mother with dementia I need to take her.  My daughter is coming from Cleveland on Monday for my birthday.  I don't want to be experimenting with yet another drug.  I want to try to be present for my daughter and be able to take mom to appointments without freaking out.  And tomorrow I have an appointment with the ED at her memory care to discuss her treatment.  How do I advocate without breaking off my relationship with this nurse practitioner.  In a way, I feel I am back in with the psychiatrists who think they know my body, my mind, my self better than I do!

[[mo...]]

I feel alone!!!

I HAVE NO IN-PERSON SUPPORT.  I AM HARDLY EVER ON HERE BECAUSE IT IS DIFFICULT FOR ME TO HAVE ONLINE SUPPORT.  IT DOES NOT FEEL LIKE SUPPORT.  THERE IS NO HELP AND I AM DESPARATE!!! NO ONE WANTS TO GET INVOLVED.  NO FAMILY NO FRIENDS NOBODY   IT is difficult to get through each day and difficult to have a reason to stay alive.

[[Nu...]]

21 hours ago, [[m...] said:

Currently taking:  AM: 0.9mg Clonazepam, afternoon 0.7mg C, PM 1.1mg C.  A total of 2.7mg clonazepam.  Tomorrow she wants me to take:  AM: 0.9mg Clonazepam, afternoon 0.7mg C, PM 0.5mg Clonazepam with 10mg diazepam.  Seems like a big jump!!

0.5mg of clonazepam is equivalent to 10mg of diazepam, so that dose reduction is quite close in terms of equivalency. I never crossed over -- so maybe others can weigh in. Can you share details about why your NP feels you're in interdose withdrawal? What exactly are you experiencing?

Conceptually, crossing over has merit. But that doesn't mean it's right for everyone.

It seems that your NP is actually trying to consider equivalencies and interdose withdrawal concerns, which is quite impressive compared to many providers.

[[Nu...]]

41 minutes ago, [[m...] said:

I feel alone!!!

I HAVE NO IN-PERSON SUPPORT.  I AM HARDLY EVER ON HERE BECAUSE IT IS DIFFICULT FOR ME TO HAVE ONLINE SUPPORT.  IT DOES NOT FEEL LIKE SUPPORT.  THERE IS NO HELP AND I AM DESPARATE!!! NO ONE WANTS TO GET INVOLVED.  NO FAMILY NO FRIENDS NOBODY   IT is difficult to get through each day and difficult to have a reason to stay alive.

I am sorry that you feel this way. I've felt very similar to this for a long time, which was a marked departure from pre-benzo withdrawal days. I don't have an easy solution. Education of family members is a good start. How much has your NP acknowledged your struggles and, if your NP is a benzo-wise provider, can your NP talk with your family?