Please slap some sense into me...or tap it gently, either way I'd be grateful.

[iamthelizardqueen]

Hey all,

so, i've been living with my wonderful new dxs for a grand total of about seven weeks- for about eight I've been taking Klonopin every day (given to me first at a psych ER because, well, I was shaking like a nervous Chiuaua, couldn't sleep, couldn't eat, couldn't stop moving, couldn't stop talking, wanted to die, all that fun stuff (mixed is understatement. more 'tossed' like a freaking fruit salad.) need for it was agreed upon by the pdoc who did the in-depth work up on me in the partial hospitalization program that followed.

anyway, I keep getting the idea in my head that it's bad to be on this med for more than a couple weeks or 'as needed' (as I'd taken it briefly in the past with my old mis-dx of MDD/OCD/Panic disorder.) bad because it's got the risk of addiction (though I'm not addicted to anything else and never have been). Bad too because i really want to move out of the country (this is not a manic idea and it's a long story) and the country i want to move to has national healthcare and since i wouldn't qualify for that i worry about availability of my meds there (no, i haven't quite accepted that wherever i go in the world i'm still going to be bipolar. i'm still wishing i could outrun it if i just go far away enough

So, since I keep thinking i'm 'bad' for taking a 'tranquilizer', twice since i've been on a steady daily dose of .5 twice a day morning and evening, with a third dose allowed as needed (which I've only used twice and not for weeks) i've tried to cut it back and try to taper off.

Now, my pdoc said he wanted me on this three months before we talked about that and that i'm on a really low dose and shouldn't worry- but i worry. And I'm not seeing him until December (his idea not mine).

I keep hating myself for 'needing' it (i feel weak, like willpower over panic/ocd/etc should be enough. go ahead, laugh you know you want to...)

First time i went down to .25 twice a day and after two days I was back to being all freaked out. Went back to .5 and felt better but still foggy in the brain (hate that. some days it's worse than others).

This week- went three days at .37.5 (or three quarters of a .5 tablet, if you will) twice a day and I was up most of the night last night- really manic and panicky. Today even after regretfully taking the whole damn pill I am still trembling, wired, and feeling really basically cruddy.

So tell me (this is the part where you slap me if needed) is it really bad for you to go up and down on a benzo like this even in such small increments or are we talking about amounts too small to matter?

some days it makes me so tired I feel like I've still got too much of it in my system and that is also a time when I wish I could take like half a pill instead. Other days like today I am still shaking like said little dog even with the full dose.

I've asked for another appointment to see pdoc before December and i'm on the cancellation list and it's not looking good (he's gone the whole month of November apparently...) tdoc and i are still getting to know each other with mixed results. i've asked for more group therapy but there's no money for it (i'm on medicare. if i was on medicaid that would be different apparently...)

Sorry to ramble on so. I really worry about the med thing. If I could ask, what is it like for you taking one? if you've been on a benzo a long time, how long? is it really so bad to realize that you are likely going to be on this for a long time? how long is 'too long' generally, is it known?

And above all else and as a total aside- does anyone have a clue if a non-citizen has any prayer of getting this med (or other psych meds) in Australia if they go to a pdoc there (paying out of pocket for it and the med) and get a script? If anybody from Oz has any experience or info on that I'd greatly appreciate hearing it.

thanks for listening.

lizzie

[notfred]

Lets clean up your use of the word addiction. There is a big difference between dependence, tolerance and addiction. Only addiction carries negative consequences. While this passage talks about opioids the same concepts carry over to benzos:

JL: What is the difference between physical dependence, tolerance, and addiction?

Dr. Schneider: There’s a huge difference. Physical dependence is a property of many different classes of drugs, not just drugs that can be abused. Physical dependence is a property of steroids, for example. What it means is that if a person stops that drug suddenly, there is a predictable physiologic response by the body.

For example, when you are physically dependent on exogenous steroids, meaning steroids that are outside the body in medication form like prednisone, your brain stops putting out chemicals that cause your body to release endogenous steroids, the steroids produced within your body. The pituitary gland normally puts out a hormone that stimulates the adrenal gland to produce epinephrine, which is adrenalin. When you’re on the steroid medication, the body stops producing it. What happens is, if you stop taking prednisone suddenly, your body is left without the endogenous steroids, the steroids your body usually produces. Clearly, the person has become physically dependent on the prescribed steroids and the solution to it, if they don’t need the medication any more is to taper it slowly so that the body gets a chance to reverse those changes. Opioids also can, and usually do, cause physical dependence. The body makes changes to adapt to the opioids and if you stop suddenly, you get this unpleasant withdrawal syndrome.

That’s what physical dependence is — it has nothing to do with addiction. Addiction is not necessarily a physical thing. Addiction is a psychological phenomenon consisting of three elements. One is loss of control, which means you intend to use only so much but when you have access you keep taking the substance. The second is continuation despite significant adverse consequences, which means even if the substance – let’s say alcohol -- is causing liver damage, you’re arrested for a DUI, or are fired from your job, you still take it. In fact, one of the major differences between chronic pain patients and addicts is that the opioids expand the life of the pain patient. They make things better — they improve the patient’s functioning and pain whereas with the addict, their life constricts and they become more and more focused on the drug that they are misusing. So you have the opposite effect, and that’s what I’m talking about when I say addicts continue to use it despite adverse consequences. Pain patients on prescribed opioids don’t have adverse consequences — they may have side effects from opioids but they don’t have these types of adverse consequences (eg, loss of a job, organ damage). The third element of addiction is the preoccupation or obsession with obtaining, using, and recovering from the effects of the drug.

Tolerance is the need for more to get the same effect. Tolerance is a big issue in prescribing opioids. Everyone knows that drug addicts have to keep increasing their dose to get a high. What most people don’t know is that tolerance to the different effects of opioids differs What I’m saying is there are generally four effects of opioids on the body. Three of them we call side effects and these are sedation, nausea and constipation. The fourth effect is the desired one -- pain relief. So opioids have four effects. It turns out that tolerance, meaning that you get less effect as you continue the same dose or that you need more medication to get the same effect, tolerance develops to two out of those four effects — sedation and nausea. Doctors realize you don’t develop much tolerance to constipation and that patients taking opioids have to be on a bowel program. But, what most doctors and patients do not realize is that you don’t develop much tolerance to the pain-relieving effects of opioids. What happens — when it comes to pain relief — is that most patients, once they’ve reached an effective dose, stay on the same dose for a long time. Sometimes they need a little upward increase but it’s not a significant thing. The usual reasons that a chronic pain patient needs a dose increase is either that they’re doing more physical activities, or that their disease has progressed.

So why is it that heroin addicts need more and more? The reason is because tolerance develops very, very quickly to the euphoria-producing effects of the drug. What causes a buzz from a drug is not the concentration in the blood stream. For example, you can have pain patients who have a little bit of the drug in their body and other pain patients who have a very high level in their blood in order to get pain relief, but neither of these people are likely to experience a buzz. What causes a buzz is the rate of increase — rate of change — in the brain. People develop a tolerance very rapidly to this. So anytime somebody says, “Isn’t true that people become tolerant to opioids?” the answer has got to be, “What do you mean by tolerance? What specific effect of the opioids are you asking about?” That’s a really important point. You don’t just develop tolerance or not develop tolerance. It’s a widespread misunderstanding.

http://www.jenniferschneider.com/articles/addiction-tolerance-dependence.html

[jt07]

I took 1 mg of Klonopin 3 times per day for over 3 years. I did not become addicted. In the end, I think I developed a tolerance to it. I would forget to take a pill, and I didn't notice any difference. So I just decided to go off it completely by going off it slowly (took 1 pill a day which meant 1 refill = 3 months). I didn't have any problems coming off of it.

When I needed it, it helped me tremendously. By the time I developed a tolerance, I didn't need it any longer. If I were you, I wouldn't worry so much about it.

[Guest]

Are you receiving any therapy for this anxiety and panic? I only ask because that could be something you could rely on as well as benzos.

[Thomas]

I've been on Klonopin for eight years now (currently at 4 mg. to 6 mg. a day) and haven't experienced anything like addiction. If I very occassionally forget to take one of my 2 mg. tablets I hardly notice. I also have PRNs for noon and dinnertime (1 mg), but I rarely take them. I always take my 2 mg. at bedtime though.

Tommy

[iamthelizardqueen]

Thanks notfred for the clarification there- I hope i didn't offend anyone with my (mis)use of the word if I did it wasn't intentional (I don't remember using it but after my nighttime meds I barely remember my name so i'm sure I must have. sorry about that. (went back and checked and yes indeedy I did- 'risk of addiction' was the comment- again, apologies.)

thank you jt07 for sharing your experience- it's good to know that somebody has taken it longer than just a few months and then didn't have problems discontinuing it (comforting thought, thank you.)

Titania, thank you for asking- yes I am seeing my tdoc once a week right now and i asked for more support (begging to get into group somehow but again- insurance issues there-- been trying some online group in the meantime when i can and chat here too has been helpful to me several times) working on all that mindfulness stuff and everything- so am trying to do what they're telling me in addition to the meds. it's just with the combination of the panic/ocd and the bipolar i just can't seem to reason my way out of this with myself (if that makes any sense) i am trying though and i am finding the ideas in the Bipolar survival guide book to be very interesting and helpful. so i'm working this from every angle i can (with the mixed state where it's at right now it's difficult but i am fighting for progress no matter how small...)

Tommy, thanks for telling me about your experience. I have a lot of health issues too (sounds like you've been through a lot...) and i know my pain is undertreated and i wonder if alleviating my chronic pain would help with my anxiety at all (my depression gets worse when the pain just gets too much to take.) huh. there's a thought. Maybe i need more than just psych meds to manage all this stuff more than i thought.

thanks everybody- very helpful stuff.

lizzie

[saveyoursanity]

I've taken klonopin off and on for six and a half years. (Maybe longer. My memory is shit.) I have no problem putting it down & picking it back up again.

I would encourage you to look into other medications with your pdoc's approval. Benzos are great for sudden emerging anxiety but if you feel anxious all/most of the time, you may want to look into an AAP (atypical antipsychotic). I know it can sound scary to be taking an antipsychotic but I've had great results with a fairly low dose of abilify. My anxiety is 90% totally gone, and it's amazing.

[chimpmaster]

Ive been on valium (diazepam) fort least 6 years (xanax/alprazolam before that). Ive been on as little as 1-2 weekly and as often as 6-7 times per week, which is how often I use it now (1 dose 10mg a day).

Valium & Klonopin are long acting benzos and generally safer (in terms of tolerance and defence) than shorter acting drugs like xanax. With xanax you tend to build up tolerance fast and can become dependent quickly as the half life is so short and decreases with repeated use.