Clonazepam advice

[[Al...]]

10 weeks ago I was prescribed clonazepam to treat insomnia and agitation caused by an increase in my Prozac dose. For the first few weeks I only took 0.5mg every few days when the symptoms were unbearable. As an alternative, I did a lot of exercise to wear myself out. In the last two weeks, however, I reached a point where I couldn't take any more exercise. I'd lost so much weight and exercising for 4 or 5 hours a day to get some relief seemed unsustainable, so I gave in and started taking clonazepam daily to treat the insomnia and agitation.  For the past week I've been taking between 0.25mg and 0.75mg daily. I know it's not a good idea, but the symptoms can be so unbearable at times that I feel I have no choice. I've reduced the dose of the Prozac and hope that the insomnia and agitation will subside soon so that I can stop taking the clonazepam. Does anyone have any advice on what I should do in the meantime? If I have to continue taking clonazepam for a while, what is the safest way to do this? Should I only take it when things get unbearable and try to exercise and use other coping strategies as much as possible, or should I stick to a low, steady dose taken at the same time every day to avoid inter-dose withdrawals? I would really appreciate some advice as I feel trapped between the insomnia and agitation on the one hand and developing clonazepam dependence on the other.

[[Re...]]

Hello @[Al...], Welcome to BenzoBuddies,

I hope I am understanding your post correctly, the Prozac (and increase in Prozac dose) actually increased your insomnia and and agitation, you were prescribed clonazepam to treat this? You have been on clonazepam for 10 weeks altogether and having issues reducing? 

Reducing the Prozac to the original dose where you experienced more stability might be a good idea, or good goal. I would personally take a "lower", steady dose from clonazepam, wait until stabilisation than taper off (as you are mentioning). I am positive stabilization comes sooner rather than later. Learning new coping mechanisms and exercising in the meantime is a great approach I believe.

Please read about correct tapering methods here. We usually recommend reducing 5-10% of the previous dose every 2-3 weeks, but generally following your symptoms. You might be able to do this faster, given you are not on clonazepam for such a long period. 

I am positive others will share their ideas as well. 

I am happy you found us!

RR

 

[[Al...]]

Hi @[Re...]

 

Thanks for the reply. Just to clarify, here is the timeline.

• About 13 weeks ago I increased my dose of Prozac. At that time I was free of agitation and insomnia.
• About 10 weeks ago, the agitation and insomnia hit me (due to the delayed effect of the increase in Prozac started 3 weeks earlier).
• I was prescribed clonazepam for the agitation and insomnia, but I used it sparingly (0.5 mg every 3 or 4 days) because I didn't want to become dependent on it.
• Instead of taking clonazepam every day, I did a lot of exercise to treat the agitation and insomnia, taking the clonazepam only as a last resort. 
• However, I lost a lot of weight and about a week ago I reached a point where I felt I couldn't continue exercising so intensely.
• At this point I started taking the clonazepam daily to treat the agitation and insomnia. I have been taking it daily for about a week now.

My question is: what should I do now? Is it better to stay on a low and regular dose of clonazepam and then slowly taper off once the agitation and insomnia have stabilised? Or, if possible, is it better to try to take it only when needed? Initially I thought it would be better to take it only as needed, but I feel I may be going through withdrawal between doses and wonder if taking a low dose regularly is actually the safer, more stable option. I was also wondering about the best way to take it. If I take 0.5mg daily, what is the best time of day to take it? Or is it better to split the pill and take half in the morning and half in the evening to even out the dose? It would be really helpful to hear what you and others would recommend in this situation. Thanks!

 

Edited April 17 by [Al...]

[[Re...]]

Thank you for the details @[Al...].   It may take a while for this hyper-agitated state to normalize, for your reduction from the AD to take effect and for your body to find balance again. I would like to make it clear, that I have no experience when it comes to Prozac. Depending on your symptoms, if these are truly unbearable*, and you discussed this with your doctor, you might want to stick to a "low" dose and taper that down after reaching stability. This may be your safest option. You can try splitting the dose to morning and evening doses to see if it has a better effect on you, but our bodies are different, there is no precise rule to fit everyone. 

*Your experience is only yours, it is hard - and to be honest - impossible for us to precisely know and feel what the other person is going through. One should consider many factors here, are you able to fulfill your daily duties, why you were prescribed prozac, etc.. I, after taking benzodiazepines for a long time and going through difficult times would do many things to go back and avoid being dependent again, I would keep away from these meds as much as possible - but, this is a "biased" opinion of a person whose viewpoint is very much distorted by the state he is in after high dose, long time use and very improper tapering.

I hope others will share their experiences soon.   

[[he...]]

Hi @[Al...]. If it were me, and I were not dependent yet on the clonazepam, I would get off it as quickly as possible before dependency sets in and you get in trouble, but be warned that dependence has been reported in as few as nine days of daily use. So if I were going to come off, I might try a 25% drop in dose and just see if your body handles it well. If it did, I would try come off as quickly as possible. If not, I'd know I was already dependent and would have to come off more slowly, cutting 5 to 10% of the current dose every two to four weeks.

I hope you can get off it and find something else to help with the insomnia and agitation. Perhaps you don't actually need Prozac either? It is a very activating SSRI, so those side effects don't surprise me. Why are you taking Prozac (fluoxetine)?

[[Al...]]

Hi @[he...]

Thank you so much for the reply.

I agree that I should get off the clonazepam as quickly as possible if I'm not dependent. I've been taking it twice a week for two months, but have only been taking it daily for one week. My doses over the past 7 days are as follows:

Day 1: 0.75 mg

Day 2: 0.75 mg

Day 3: 0.25 mg

Day 4: 0.25 mg

Day 5: 0.5 mg

Day 6: 0.75 mg

Day 7: 0.25 mg

That's an average of 0.5 mg per day. What do you think I should do next? A 25% drop from those levels would be 0.375 mg, but I'm wondering if it might be possible to drop straight down to 0.25 mg. If I was to do that, how long would I need to stay on 0.25 mg to see if my body handles it well? And if it did handle it well, what would be the next step? Could I then drop down to zero? The tricky thing is not knowing whether I'm dependent and also the delay in feeling the effects of a cut due to the fairly long half-life of the drug.

PS I'm taking Prozac for OCD and depression. I would like to stop taking that too, but I've been on it a long time and would need to taper very carefully.

 

 

    

[[Fe...]]

I was just writing about clonidine in another thread. You might look into that. 

[[Re...]]

@[Al...] Glad you are here getting clarity to make an informed decision about your health.

Anything you take can complicate an already complicated situation and you can end up on a polydrugged merry-go-round. Frankly, this is how it starts. With a drug to treat another drug-induced side effect and then another drug to treat that.

Do you notice a difference when you take the different daily amounts? Did your doctor take you back down in Prozac to the dose where you did not feel agitation or have insomnia? How would you describe the agitation? Does it come with pain in your chest electrical sensations in your body in addition to the need to move?

Edited April 18 by [Re...]

[[Al...]]

@[Re...]

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

Do you notice a difference when you take the different daily amounts? Did your doctor take you back down in Prozac to the dose where you did not feel agitation or have insomnia? How would you describe the agitation? Does it come with pain in your chest electrical sensations in your body in addition to the need to move?

I would say sleep is better on the higher daily amounts of clonazepam. The Prozac dose is complicated. I was very gradually increasing my dose up to 30 mg when the agitation and insomnia hit. The previous dose before 30 mg was about 28 mg. However, I've now dropped down to 20 mg because I felt like I was sensitized and needed to go lower than the previous dose to deal with the symptoms. Do you think I may have dropped too low at 20 mg?Judging the best dose in this situation is really difficult and my doctor hasn't been much help. The agitation doesn't come with chest pain or electrical sensations in my body.

[[Re...]]

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

If I was to do that, how long would I need to stay on 0.25 mg to see if my body handles it well? And if it did handle it well, what would be the next step? Could I then drop down to zero? The tricky thing is not knowing whether I'm dependent and also the delay in feeling the effects of a cut due to the fairly long half-life of the drug.

Some level of dependency can form after shorter use as well. You most certainly should not drop down to zero after you tolerate 0,25mg. These are really potent medications on "lower" doses.These "lower doses" are rather a misconception. The time needed to stabilize and the amount of time needed to taper depend on your symptoms and personal experience. If you can tolerate the symptoms well, feel encouraged to carefully continue on this taper rate. If you can not tolerate them, that is a sign you should slow down. 

[[Al...]]

@[Re...]

Thanks for the heads up. It's really hard for me to know what to do because I don't know if I'm dependent or not after two months of sporadic use and one week of daily use. If I'm dependent, then I need to taper slowly and carefully, and shouldn't drop from 0.25mg to zero. But if I'm not yet dependent, the best option might be to get off the meds as soon as possible as suggested by @[he...]

I know it has to be my decision on what action to take, but is there any way to know if I'm dependent or not, so I can make a more informed decision?

 

[[Re...]]

I don't think dependence is a clear "yes" and "no" question, I believe there are different levels to it. Being on the medication for a longer time deepens dependence, that is for sure. This does not mean that you can not do a relatively short but nore comfortable, gradual taper within a course of a few weeks (2-3). That is what I mean only. You also changed your antidepressant and are symptomatic, that is why I would be personally a bit more cautious. But, this is not more than a personal opinion. 

[[Al...]]

@[Re...] Thanks again, I really appreciate your thoughts on this. Could you give me an idea of what a relatively short but more comfortable taper would look like in practice? For example, what would be a suitable starting dose bearing in mind the following doses taken over the past 7 days?

 

Day 1: 0.75 mg

Day 2: 0.75 mg

Day 3: 0.25 mg

Day 4: 0.25 mg

Day 5: 0.5 mg

Day 6: 0.75 mg

Day 7: 0.25 mg

 

[[Re...]]

 @[Al...] You have been taking clonazepam for 7 days, prior to that you have taken it twice weekly for about two months, if I am understanding it correctly. You currently have issues after raising the dose of your antidepressant, and you restored your original dose recently. You might try bigger cuts, as you mention yourself, holding 2-3 days. You might try to cut 25% from 0.5, the math is self explanatory, cutting the right dose might be a bit more difficult depending on what tablets you have). You will see what doses and cuts your body can tolerate if you go under 0.25 mg. If you have no issues with this reduction rate even under reductions under 0.25 mg, that is fantastic news, hopefully this will be the case due to mainly sporadic use for a relatively short time. But if you do encounter them, you might want to slow down and hold your dose, and reevaluate your speed. 

[[Al...]]

@[Re...] Thanks, just to make sure we are on the same page, am I correct in understanding that it would be a hyperbolic rather than a linear taper and the first five steps of the taper would be as follows?

Step 1: 0.375 mg (three quarters of a 0.5 mg pill) hold for 2-3 days

Step 2: 0.281 mg (roughly half of a 0.5 mg pill) hold for 2-3 days

Step 3: 0.210 mg (*need to figure out how to measure) hold for 2-3 days

Step 4: 0.158 mg (*need to figure out how to measure) hold for 2-3 days

Step 5: 0.119 mg (*need to figure out how to measure) hold for 2-3 days

Also, what would be a good target for the final (lowest) dose in the taper?

 

 

 

 

 

 

[[Re...]]

@[Al...], this looks great! I hope this matches what you had in mind, too. Hopefully you won't face much difficulties during your reduction and you will be fine with less precise doses, keeping the numbers above as a guideline (reducing by one third of a half, for example, a file or a blade might help you). If you encounter issues on lower doses - and I think that is unlikely - that situation is a bit different. 

The recommended jumping dose is lower, it is 0.025-0.05 mg, but that is after long time use. You will see how your body reacts to the changes, and then reevaluate your steps and methods again, if necessary. I am really hopeful that won't be needed and you can jump from a higher dose, like the one above. 

 

 

[[Re...]]

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

@[Re...]

I would say sleep is better on the higher daily amounts of clonazepam. The Prozac dose is complicated. I was very gradually increasing my dose up to 30 mg when the agitation and insomnia hit. The previous dose before 30 mg was about 28 mg. However, I've now dropped down to 20 mg because I felt like I was sensitized and needed to go lower than the previous dose to deal with the symptoms. Do you think I may have dropped too low at 20 mg?Judging the best dose in this situation is really difficult and my doctor hasn't been much help. The agitation doesn't come with chest pain or electrical sensations in my body.

At this point, it is hard to say as you are making so many changes and they can have latent effects later on. Especially with the antidepressants from what I understand from patient experiences. Are you on Surviving Antidepressants the patient forum where they talk about this specifically?

I am not surprised the doctor is not much help. Most of them are useless when it comes to this, they leave patients hanging, cause more damage, and then blame it on the patient.

Dr. Witt-Doerring is known in this community for helping patients taper as well as Dr. Mark Horowitz so you could always contact them. Angela Peacock psych med consultant also knows a lot about tapering and she can be an advocate for you and help with information and perspective on this.

 

[[he...]]

@[Al...] This is tough, because if you're not dependent, you don't want to start daily at a too-high dose and keep yourself on this stuff any longer than you have to, but at the same time, you don't want to be hit with a big response from your body by cutting too much. If you were to drop to .25 mg, which doesn't seem too outlandish given that you didn't take it more than a couple times a week for most of this, you could always add more if things get hairy. It's a decision you'll have to make for yourself and not one any of us can definitively point you in one direction or the other. If it were me, I would try to get to as low as a dose as possible to start tapering from, and hopefully you'll just be dealing with pure withdrawal and not any BIND (neuro injury).

[[Al...]]

@[Re...] and @[he...]

I was going to taper as discussed in this thread, but I've noticed that after taking a dose in the morning, I feel agitated during the day until the agitation wears off in the evening. Then, if I skip a dose, the agitation seems to go away for a while. Do you have any idea what might be happening here? Could it be a paradoxical reaction, or is it something else that might settle down if I reinstate the daily taper and try to ride it out? 

Also, I feel quite bad lately. My stomach, chest and neck feel tight, I have no appetite, and I've lost some feeling in my hands and feet. Do you think these are withdrawal symptoms from skipping doses, or side effects of the medication?

[[Re...]]

Hello @[Al...], I am not sure I understand, you have been skipping doses to see how your body reacts? Paradoxical reactions are uncommon as I read here, but they do happen.

Withdrawal symptoms might very well occur between doses if you skip them. 

If your current taper does not work, I suggest you post to the Taper Strategies section of the Forum, or if you wish I can move this thread there. You might be able to get better insight there. 

I am really sorry you are experiencing issues, @[Al...]. 

[[Al...]]

Hi @[Re...]

Thanks for the quick reply. I've been skipping doses because the clonazepam appears to be making me more agitated and I wanted to see what happened if I did not take it.  Over the past two days, when I skipped doses, the agitation calmed down, but when I took another dose today, it came back. On the other hand, I think I might be suffering from withdrawals. I'm trying to understand what I should do in this situation. It seems like I'm stuck between a rock and a hard place.

[[Re...]]

Hello @[Al...],

I am sorry to hear you are having such difficulties and I really understand your issues. It might be the case that the change in the antidepressant sensitized your nervous system, at least that is what it seems to me.

I would nevertheless cut my story short with benzodiazepines. Dealing with psychotropic medication often seems to be the process of finding out how our bodies react to the changes we apply in the levels of medications.

If you feel better without the benzo, I would probably follow the more rapid taper schedule and watch for withdrawals. It is also important, I believe, not to shock our CNS with sudden, complete withdrawal or let withdrawal symptoms amp up to a severe level. If going through this you remain functional, and are able to fulfill your daily duties, that is a really good sign altogether.

Most importantly, you will be the one who feels the limits and preferences of your own body. 

I would be interested what others think about this, this is my opinion only. I hope members will read and post to your thread soon. 

Take care @[Al...],

RR

[[so...]]

Alpha , if your dead set on tapering , go slow . Maybe try the orally disintegrating 0.125 tablets ? Combine half a 0.5 and one ODT 0.125 … once daily . See if you do well for say , 4 weeks … minimum. . Just an idea . I’m about to try that myself as i climb down from 1 mg daily . But I have 15+ years use behind me at 3 mg ! So I’ve made progress . Let me know how things are going ! be well . 

[[Al...]]

Hi @[Re...]

I'm really confused by what is happening now. Sunday night (on a day I skipped a dose) I had terrible insomnia, and then yesterday (Monday) when I got up I had really bad symptoms (agitation, strongly beating heart etc). It got so bad that I had to take 0.5 mg clonazepam in the afternoon. At first the clonazepam didn't seem to have any effect, but after about 2 hours it started to calm me and I was able to sleep well last night. I'm now wondering if I'm dependent and putting myself through damaging cyclical withdrawals by skipping doses and only taking the clonazepam as a last resort.

Sunday night and Monday before I took the clonazepam were truly unbearable, so do you think it might be better to take a regular daily dose and see if I can achieve some stability before starting a slow taper? As you mention, the change in antidepressant dose has already destabilized my nervous system, so I think I might be adding to the instability by taking the clonazepam irregularly.

Also, when taking a regular dose, are there any recommendations on what time of day to take the dose (morning, afternoon, evening, or divided doses)? I know everyone is different, but it would be helpful to hear your opinion on any factors that should be taken into account when choosing dose timing. Sleep is a big issue for me at the moment, so I'm wondering if it might be better to take an evening dose.

[[Al...]]

Thanks @[so...]

I really appreciate the suggestion and kind words. Wishing you all the best with your taper!