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changing doctors again - advice needed from benzo gurus!


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hi all -

well, i had an appointment with a new doctor that went relatively well, but she said during our initial meeting that she wanted to pull me off clonazepam after five years of daily use at 3mgs (prior to using clonazepam daily i was on diazepam on a near-daily basis for a good four years - i'm 27 now) - i know i've mentioned this before, but after giving it some thought, i really don't think that it's a good idea.

my rationale:

1. i went through a gabaergic withdrawal about six months ago (a slow pregabalin taper) and it was the most horrible experience that i've ever been through in my entire life. i'm still not back on my feet and can only imagine the inferno a benzo taper will throw me into - i'll be in dante's ninth circle with satan himself.

2. clonazepam doesn't seem to be causing me any problems.

3. i don't think that i can handle another gabaergic withdrawal within a one year period. i think i'll die. numerous emergency room and urgent care visits during and after the pregabalin withdrawal, in addition to a short hospital stay in order to bring body weight back up, as i was unable to eat, have me terrified of reliving such an experience. my experience coming off of pregabalin had a lot of similarities to benzodiazepine withdrawal anecdotes i've read on the internet, e.g. trouble regulating body temperature, fever, chills, cold sweats, intense and extreme rebound anxiety, loss of appetite, vomiting, diarrhea, severe weight loss, acute and diffuse body and scalp hair loss, and so on and so forth.

4. when the benzodiazepine is removed/lowered, as my body has become accustomed to it, i will no doubt relapse and what is to take its place as an anxiolytic? i asked her. her answer? lamotrigine. HA! (i recently failed that drug, but that experience is embedded in another thread somewhere).

5. a lot of anecdotal reports read online indicate the reinstitution of a benzodiazepine after a taper in cases where the benzodiazepine was being used to treat severe anxiety as opposed to, say, recreational drug abusers who have found themselves physically dependent upon the class of drugs but without an underlying anxiety disorder.

her rationale (with counter-arguments):

1. she the longer one takes a benzodiazepine the worse anxiety will become. (perhaps? - but i will surely have intense rebound anxiety just like i did when pregabalin was removed and my body, not used to the absence of the substance, will go into shock and i fear relapse even with the slowest of tapers).

2. she claims depression will set in. (i'm not depressed).

3. cognitive decline. (i'm pretty sharp).

anyhow, i made an appointment with a new psychiatrist and the initial consult is this thursday. i'm nervous, my anxiety is still not well-controlled as i still haven't pulled myself out of the hellish hole the pregabalin withdrawal has left me in, and i'm trying to mentally prepare myself to tell my whole life story, yet again, to another stranger.

am i being foolish? i suppose i can try to taper clonazepam with the help of a physician when i am very stable, but i just don't feel like now is the right time to do it.

thoughts?

xo

pardon the grammatical/syntactical/punctuactional errors - i didn't proofread! oops.

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I'd be honest with her. You aren't ready to give this a try as it is coming too soon after your last fiasco. You are stable now. Why rock the boat? If what you are doing is working and you don't appear to need an increase in clonazepam, then leaving things alone makes sense. There are lots of people that have stayed on it for years with little to no ill effects. If you aren't experience any adverse side effects then at least, see if she will let you remain in the stable state you are in now for at least another six months and then you can re-evaluate. Also, you might want to point out that the reason you are doing so well is because you are on medications that help.

I'm not sure I follow her logic on any of her claims. Just because something might happen doesn't mean that it will happen. If/when any of those things occur, you can deal with it then.

My $0.02 worth.

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thanks, sylvan! i agree with you - i was completely honest with her and when i mentioned that i was not ready/willing to come off of the drug she dismissed it and thus i need to see another physician or start a benzo taper this month. some psychiatrists are not at all benzo friendly.

that, and i'm currently not stable because i'm still rebounding from the pregabalin withdrawal. i'm getting there, but i'm definitely not solid and i feel as though if she were to start the weaning process now i'd be thrown back several steps yet again.

:sigh:

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What would she do if you asked for six months? Think she'd at least consider? Six months won't make much of a difference for any of the concerns she expressed and it might find you in a much better space. A space where you are able to consider a slow taper of clonazepam.

My pdoc and I work together as a team. We have the same goals. We compromise. We defer to each other when the other has a very strong opinion on something. IMO, this is what you should be doing with your pdoc. If you aren't then maybe you do need to consider getting a new one. If I were you, I would make sure that in shopping for a new pdoc, you make it clear that you are looking for a pdoc that you can partner with, not someone that will just hand out pills.

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If I were you, I would make sure that in shopping for a new pdoc, you make it clear that you are looking for a pdoc that you can partner with, not someone that will just hand out pills.

this is what i want, rather than someone who blindly hands out pills or acts as an authoratative figure. i suppose we'll see how the appointment with the new doctor goes on thursday as the old clinician is extremely adament about getting me off of klonopin as soon as possible.

another red flag - i asked her if she used the ashton manual, or referenced it when tapering her patients. her response? 'ashton what?' 'what's the ashton manual?'

edit: i'd like to add that people on this site have been very kind and have offered very honest, insightful, and helpful advice. i'm grateful that e-communities like this exist and that people take the time to help one another out! thanks, sylvan!

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I am 27 yo male, who's been taking Klonopin at 3 mg t.i.d. and am now down to 1mg by request of the doctor (She doesnt like the mix with BPD), on my way to being off. I've come to realize that the entirely tedious task of tapering off this med might be worth it, given the difficulty of doing it and the fact that it is a short term med in the first place. As a result more anxiety, insomnia, lability and stress related Borderline crap. I guess if you trust your doctor try it. I wish you the best.

wanted to add, my doc waited till i was "stable".

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thanks for the insight, liquid - suppose i'll consider when i'm in a much more stable place.

i'm a bit confused by what you mean when you state, "...as a result more anxiety, insomnia, lability and stress related Borderline crap." are you attributing this to klonopin? klonopin withdrawal? or your bipolar disorder/boderline personality disorder?

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thanks for the insight, liquid - suppose i'll consider when i'm in a much more stable place.

i'm a bit confused by what you mean when you state, "...as a result more anxiety, insomnia, lability and stress related Borderline crap." are you attributing this to klonopin? klonopin withdrawal? or your bipolar disorder/boderline personality disorder?

I'm sorry for the confusion, kinda not all here or there? depersonalizing . What I initally meant was that the Klonopin was causing withdrawl/rebound effects. I also seem to have ibs sometimes (diarrhea, constipation), fine tremor(Lithium), cold sweats and some weight gain. Though Borderline is killing me right now, i've had worse anxiety while on kp at times.

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I'm sorry for the confusion, kinda not all here or there? depersonalizing . What I initally meant was that the Klonopin was causing withdrawl/rebound effects. I also seem to have ibs sometimes (diarrhea, constipation), fine tremor(Lithium), cold sweats and some weight gain. Though Borderline is killing me right now, i've had worse anxiety while on kp at times.

oh, that's okay. thanks for your input. it's interesting that you had withdrawal/rebound effects on klonopin given its long half-life and that the medication made your anxiety worse.

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Ya when I was withdrawaling from gabapentin. The withdrawals are the same with Lyrica. But I had Klonopin to help with that even tho I had the most worse nightmares withdrawaling from gabapentin. But, gabapentin can ease your withdrawals from benzo use but there's not enough research to back up my claim. Also Why? is she just against benzo's. If you need it you need it. Thats the way I look at it and I hope you get the right treatment so some doc doesn't screw your mind up. Because when I was first taking Klonopin. I would run out early due to having bad nightmares and they would calm me down. So when I ran out they where just as bad as the gabapentin withdrawals. I understand your concern and I'll keep you in my thought as you go thru this lengthy process.

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thanks, sonic! i hope not to go through benzodiazepine withdrawal and thus the change to the new doctor.

i really have no idea why she is extremely adament about removing klonopin from my medication cocktail.

gapapentin and pregabalin are chemical cousins. i've been on both, but have only withdrawn from pregabalin as i was switched from gabapentin directly to pregabalin. pure hell!

thank you for keeping me in your thoughts! i hope that all goes well on thursday with the new doc!

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I honestly do not crave my missing Klonopin doses. I kinda feel like a curtain is being lifted which is good, but I'm not handling what I see very well because of BPD. I took gabapentin 1200mg for a long time with no withdrawls, even after abusing it and its cousin pregabalin (more abusable to me than benzos oddly enough). Ranting about me sorry... I guess what im getting at is be careful if you have ever had bad benzo wd, but klonopin (& all benzos,z-drugs), work differntly then gabapentin and pregabalin which i think work on voltage dependent calcium channels. Bzd's are all GABAa agonists and do not have direct interaction.

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yes, gabapentin and pregabalin work via a completely different mechanism than the benzodiazepines. they are gaba analogues and seemingly increase the density of gaba transporters.

i've never abused any of my prescribed drugs, or any drug for that matter.

you may have had an easier time coming off gabapentin and pregabalin because you don't have an underlying anxiety disorder that the drugs were treating. same for the benzodiazepines, i suppose. as such, my situation is a bit different than yours.

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I took high doses of benzos (mainly Xanax) for about seven years. I went cold turkey off Xanax twice, and it wasn't fun (one was my idea, one was forced in the phospital). I don't blame you for not wanting to Rick the boat that's working for you right now. If its not causing rebound anxiety or depression, then you need to have a discussion about this with the pdoc. Also, the pdoc's personal preference of not wanting to use benzos may be seeping into her treatment plan.

I would say that if you have uncontrollably anxiety off the klonopin and this pdoc doesn't want to discuss a compromise, then it might be time for a new pdoc.

Btw, tapering off benzos slowly or through stepping down to less-strong benzos isn't as scary as you would think. Two years ago, I voluntarily gave up Xanax (I had misuse issues). My pdoc and I gradually used different benzos to curb my anxiety, but step down in strength. I now sporadically use Librium, which is old school and very mild. I hardly need them any more, but I have them for when the anxiety is through the roof (I took two yesterday, the first time I've done that in almost a year).

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thanks for your advice, gizmo. encouraging to hear that you are doing well without the use of a daily benzo!

i think when i'm very solid i'll consider tapering, but now is definitely not the time and as klonopin doesn't seem to be causing any problems, i can't see the need to remove it in the immediate.

so, i hope all goes well for me with my new pdoc on thursday!

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-I think it is a reasonable and wise goal to work toward getting off benzos after seven continuous years.

-Comparing Klopopin withdrawal to pregabapentin/gabapentin is like comparing apples to peanuts. Nothing in common.(except that elephants like both).

-Benzos are like bandaids that shield you from overly strong emotions. Unfortunately, they only have short term effect. They don't help the brain repair itself. Other drugs like AP's and mood stabilizers are shown to help the brain regrow neurons, thereby repairing itself to a degree. Eventually it is important to minimize or discontinue benzo use, so that drop that shield and get accustomed to handling the bluster of the world.

-There should not be any reason to go through some arduous withdrawal. Being planned you should be able to work out a schedule with your doctor. Benzos are easy to work with in that they come in many small doses, they can be split and can be dissolved in water for even smaller dose handling. Remember, there is no race to the bottom.

I know the anxious feelings of getting through the day without my Xanax. Successfuly reducing the benzos will mean having a clearer more alert head, and a brighter day. That doesn't mean that you will be left without med support at critical times!

regards, a.m.

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Thanks for your input, AirMarshall.

I suppose that many of the medications that anxiety sufferers take in order to quell anxiety are more akin to "band-aids" than "cures". The problem with benzodiazepines (for me) is the reduced efficacy over time. That said, I've given it a whole lot of thought and think that I can successfully taper off clonazepam, although, contrary to the doctor's opinion, I don't feel as though right now is the most opportune time to do so, and so I'm off to another physician. Her extreme anti-benzodiazepine viewpoint was offputting, and the immediacy of her short tapering schedule was disconcerting - she stated she'd be able to get me off clonazepam within a month's time. That, combined with her plan to "stabilize" me on lamotrigine, a drug which she touted as being "highly gabaergic" (I'm not quite sure if she is just gravely misinformed or was just trying to get some sort of placebo effect to work on the dumb kid), along with her lack of knowledge of Dr. Ashton's tapering manual, left me with a sour taste in my mouth. Lamotrigine is not known for being a very effective anxiolytic, and my diagnoses are GAD and PD. I went along with it, though, and took it for a week only to find it greatly exacerbated my anxiety, and so that was the end of that.

After much reflection, all of the aforementioned sounds more and more like she was setting me up for a monumental relapse, or rather further reduced functioning, as I'm not currently stabilized, not having quite recovered completely from the pregabalin withdrawal.

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Successfuly reducing the benzos will mean having a clearer more alert head, and a brighter day. That doesn't mean that you will be left without med support at critical times!

I am quite alert at all times and clonazepam, as far as I am able to discern, has not impaired cognition or mood. Although, it is refreshing to know that I won't be left without benzodiazepine support at critical times. Unfortunately (or fortunately), clonazepam has been a saving grace as I am struggling in day-to-day functioning and, thus, critical times are my immediate reality.

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One other tidbit. From what I can tell you don't have any inappropriate or addictive use of benzos.

There are people who are addicted or horribly overprescribed and can't seem to kick them.

There is an element on the web who demonize benzos and scare people. There is one British professor who specializes in benzos and (think I recall) developed some rather over complex detox/discontinuation schedules. (don't expect any particular doctor to follow this sort of stuff. They rely on their own medical training).

Bottom line: Don't let this sort of stuff cause you to build up med changes into some fearsome obstacle. Med changes aren't usually fun, but usuall not terrible either. Possible side effects are just 'possible' until they occur. Take it as it comes.

best.

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Thanks, A.M., I really appreciate all of your advice/input. Very kind of you to take the time to write.

Best,

David

edit: I think you are referring to Dr. Ashton and her convoluted Ashton Manual on benzodiazepine discontinuance.

And you are absolutely right, I have never abused any medication prescribed or any medication/drug for that matter, nor do I have an addictive personality - I don't crave more Klonopin at all.

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well, the new doctor was very empathetic and has kept me on the medication combination that i am on for now whilst he is going to do some research (and i really hope he does) to try to figure out a way to alleviate sexual dysfunction caused by the serotonergic agents i'm taking. i have a follow-up appointment in three weeks. we'll see if he has actually done any research or asked for additional opinions from his colleagues. if not, i have no idea what to do. give up on life.

my introduction was something along the lines of 'anxiety and sexual dysfunction due to psychotropics are ruining my life, can you help?' we'll see - but he said flat out that he didn't have any solutions to offer at present which was really disheartening, but i've heard it before. i've tried augmenting with buspar (did nothing), wellbutrin (panic central), yohimbine (panic central), various herbal concoctions (waste of money), ropinirole/requip - a dopamine agonist (did nothing). i proposed cyproheptadine but he was not willing to prescribe it right now - he stated he had to look into it and other potential options (i don't know what other options there are as i seem to have exhausted them all).

:sigh:

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About the sexual dysfunction issues: I know that they are oh-so-common with mental meds, but have you had your thyroid and hormone levels checked? Some meds mess with these, and if one is out of whack, it can really mess things up sexually.

I have a very difficult time with a loss of libido. It's Sonething I've struggled with for years. Thankfully I've been married for a really long time, and we are able to do things in addition to sex to maintain an intimate relationship, things that perhaps aren't so easy to do when single and in the dating scene.

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hi gizmo!

thanks for all the advice. lyrica, while on it, really screwed with my endocrine system, and my sex hormone levels were all over the place. since withdrawing from lyrica they've all stabilized within normal range.

my thyroid is another issue - i have pretty high (out of normal range) thyroperoxidase antibodies and low thyroid stimulating hormone levels (but within normal range), my T4 and T3 levels were within normal range. So, the endocrinologist stated that I have roughly a 50 percent chance of developing hyperthyroidism at some point in my life and has recommended thyroid testing every six months.

i also had a 24-hour cortisol and metanephrine test and the results came back normal.

i'm sorry to hear that you're suffering from the same sort of issues - i sympathize greatly. it's just been completely and absolutely devastating as it doesn't allow me to date and so the fear that i've had for years of growing older alone is becoming more of a reality and suicidal ideation is becoming more of a problem as of late. i suppose that's an understatement - i wish i could tell my psychiatrist that i'm severely suicidal after so many years of sexual dysfunction and failed attempts at trying to date only to find that yes, humans are sexual beings with sexual needs and i'm effectively a chemical castrate and i'm incredibly lonely - i want a romantic partner. but i can't tell my psychiatrist the truth, lest i be willing to be involuntarily committed and that won't help in the least.

anyhow, sorry to vent, but i really appreciate your help.

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Trust me, tell your pdoc exactly how you feel and why. They have heard everything and, after all, are physicians first.

I understand the embarrassment. I am a woman with a male pdoc. I recently had to swallow my embarrassment and tell him that my mental meds stopped my period for the past 2+ years. I mean, that's the kind of stuff you discuss with an OB/GYN. But it was important he needed to know, because it's possible that my mental meds (namely risperdal) may have to be chsnged because of this issue.

If your sexual well-being is this important to you, then it's important to your pdoc as well.

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i told him but stopped short of telling him about suicidal ideation. he said he'd do research and get back to me at our next appointment and i'm really hoping he does.

thanks, giz. i'm trying to pull through an incredibly difficult life.

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