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Dr. Bob is Robert Hsiung, MD,
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Posted by Joe Schmoe on July 5, 2001, at 14:25:40
In reply to Re: One more try - Klonopin and Wellbutrin » Joe Schmoe, posted by Rick on July 5, 2001, at 3:09:44
> I am a little curious, though, about the relationship -- if any -- between your earlier addiction to Xanax and your concern over *tolerance* potential with Klonopin.Sure there is a relationship. I was told the reason that xanax was a temporary measure until the imipramine kicked in was because in the long run xanax was not practical due to the way tolerance developed; you upped and upped the dose till you hit the ceiling, and then what? When you are coming off a dose of xanax and hitting that rebound anxiety, you reach for the next dose and nothing is more scary than the idea that it might not be enough. It brings to mind images of heroin addiction.
>Regardless, as you no doubt know, Klonopin has less addiction potential than Xanax. Withdrawal symptoms (due to dependence) are certainly possible, although even that represents a minority situation, especially where the dose is under 3.0 mg. and a slow taper is used.
What about when you are between doses? If you are out on the town or something and your last dose wears off, do you start getting the shakes? That was the problem with xanax. I have never had that problem since because I don't allow myself to take xanax very often. Handled it on an as-needed basis for over ten years now with no problem, although honestly there are many times I would have been more relaxed if I had been using it. I guess I have become somewhat puritanical about using it in order to avoid dependence. I probably suffer more than I should. I am wondering if Klonopin will allow me to feel okay all the time, or if I will have to use it sparingly to avoid dependence - and if so, how sparingly.
The problem with as-needed regimens is that they make it impossible to have a job where you have to manage people and/or have confrontations or other unpleasant situations frequently and without warning. This is impeding my career. I need 9-to-5 protection and I am afraid to try to use xanax to get it. Thus my willingness to try Klonopin.
Posted by Rick on July 6, 2001, at 1:15:21
In reply to Re: One more try - Klonopin and Wellbutrin » Rick, posted by Joe Schmoe on July 5, 2001, at 14:25:40
>
> > I am a little curious, though, about the relationship -- if any -- between your earlier addiction to Xanax and your concern over *tolerance* potential with Klonopin.
>
> Sure there is a relationship. I was told the reason that xanax was a temporary measure until the imipramine kicked in was because in the long run xanax was not practical due to the way tolerance developed; you upped and upped the dose till you hit the ceiling, and then what? When you are coming off a dose of xanax and hitting that rebound anxiety, you reach for the next dose and nothing is more scary than the idea that it might not be enough. It brings to mind images of heroin addiction.What kind of doctor told you that? Don't answer, I know -- a benzophobic one. If they told you that tolerance is a *possibility* for some people, that's fine. But suggesting it's the typical course of events is irresponsible, and just plain wrong in cases where the drug is being used responsibly by someone who is experiencing theraputic benefit for a chronic anxiety disorder. Conversely, dependence (real or perceived need to continue the drug to avoid distress, NOT the addictive desire to take more and more) is a much more common possibility. But potential dependence is certainly no reason to avoid the med that helps most. Just ask any insulin-dependent diabetic. If the med is subsequently discontinued, there could quite possibly be withdrawal distress -- the same kind lots of folks experience when trying to get off of Paxil or Effexor. But a gradual taper usually minimizes the severity of that distress.
There are certainly a minority of people who fall outside the typical pattern. It's generally been felt -- even by non-benzophobic docs -- that benzos should be "used cautiously if at all" for individuals with a history of substance abuse or addiction. But some very recent studies are demonstrating that even this caution has been overstated in many cases.
> What about when you are between doses? If you are out on the town or something and your last dose wears off, do you start getting the shakes? That was the problem with xanax. I have never had that problem since because I don't allow myself to take xanax very often. Handled it on an as-needed basis for over ten years now with no problem, although honestly there are many times I would have been more relaxed if I had been using it. I guess I have become somewhat puritanical about using it in order to avoid dependence. I probably suffer more than I should. I am wondering if Klonopin will allow me to feel okay all the time, or if I will have to use it sparingly to avoid dependence - and if so, how sparingly.Can't you make sure you have at least a little Klonopin on you at all times, say in a little pillbox? (CVS has a great unobtrusive little round one. I taped some cotton to the bottom of the lid to keep the pills from rattling around as I walk.) Even if you took Klonopin regularly, missing a day probably wouldn't be too awful because of the long half-life. If you had problems because you had no access to Klonopin, they'd probably creep up fairly slowly. I don't know where you travel, but in towns of any significant size, you should normally be able to get an emergency supply before all the med in your system wears out. You know -- call doctor (their emergency # if nec) and have a prescription faxed to a local drugstore, etc. If it does start wearing off before you can get some, go to the emergency room. They certainly know that problems can occur if a patient goes cold turkey on a benzo. But the need for these kinds of measures should occur very rarely, if at all. Hey, there's always a possibility that I'll get hit and killed by a drunken driver when I'm on the road (a lot worse than even horrible withdrawal symptoms, no?), but I won't give up the benefits of driving because of it. Did you run out of Xanax a lot? How distressful were the shakes? How much were you using at the time, and on what schedule?
>
> The problem with as-needed regimens is that they make it impossible to have a job where you have to manage people and/or have confrontations or other unpleasant situations frequently and without warning. This is impeding my career. I need 9-to-5 protection and I am afraid to try to use xanax to get it. Thus my willingness to try Klonopin.Perhaps it's because I'm already in a long-lasting, strong relationship, but my biggest ongoing benefit from Klonopin has been been for my career. It's made a world of difference. I still don't like getting a sudden performance request thrown my way (and not just for reasons related to anxiety), but it's so refreshing not to suddenly panic. (On the other hand, I sometimes perversely enjoy watching myself calmly but firmly speak my mind during the confrontations that would freak me out in the past. Certainly not all at work!) It would seem that popping even a fast-acting pill after a swirl of anticipatory anxiety begins would be less beneficial than passively holding that anxiety at bay from the start.
BTW, how are things going so far with the new meds? I know it may be a little early to talk about theraputic benefits, but is everything going OK side-effect-wise?
Since I referred to "studies" several times,I feel compelled to include one small study abstract. This relates to both the mental and physical (withdrawal) effects of Klonopin discontinuation after 6-11 months of regular use.
YMMV, YMMV, YMMV!Rick
====
J Clin Psychopharmacol 1998 Oct;18(5):373-8 Related Articles, Books, LinkOut
Discontinuation of clonazepam in the treatment of social phobia.Connor KM, Davidson JR, Potts NL, Tupler LA, Miner CM, Malik ML, Book SW, Colket JT, Ferrell F.
Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina 27710, USA.
Patients with social phobia who responded well to 6 months of open-label treatment with clonazepam were assigned to receive either continuation treatment (CT) with clonazepam for another 5 months, or to undergo discontinuation treatment (DT) using a clonazepam taper at the rate of 0.25 mg every 2 weeks, with double-blind placebo substitution. Clinical efficacy was compared between the CT and DT groups using three different social phobia scales. Benzodiazepine withdrawal symptoms were also measured. Relapse rates were 0 and 21.1% in the CT and DT groups, respectively. Subjects in the CT group generally showed a more favorable clinical response at midpoint and/or endpoint, although even in the DT group clinical response remained good. With respect to withdrawal symptoms, the rates were low in both groups (12.5% for CT and 27.7% for DT) with no real evidence suggesting significant withdrawal difficulties. At the end of 11 months of treatment with clonazepam, however, a more rapid withdrawal rate was associated with greater distress. This study offers preliminary evidence to suggest that continuation therapy with clonazepam in the treatment of social phobia is safe and effective, producing a somewhat greater clinical benefit than a slow-taper discontinuation regime. However, even in the DT group, withdrawal symptoms were not found to be a major problem. The study can be taken as supportive of benefit for longterm clonazepam treatment in social phobia, as well as being compatible with a reasonably good outcome after short-term treatment and slow taper.
Posted by Joe Schmoe on July 8, 2001, at 19:38:55
In reply to Re: One more try - Klonopin and Wellbutrin » Joe Schmoe, posted by Rick on July 6, 2001, at 1:15:21
> There are certainly a minority of people who fall outside the typical pattern. It's generally been felt -- even by non-benzophobic docs -- that benzos should be "used cautiously if at all" for individuals with a history of substance abuse or addiction. But some very recent studies are demonstrating that even this caution has been overstated in many cases.I wonder how "substance abuse" is defined. Are we talking people who smoked pot in college, or hardcore crack users trying to quit their habit?
What do these people do? Just take higher and higher doses of Klonopin to try to get high?
> Can't you make sure you have at least a little Klonopin on you at all times, say in a little pillbox? (CVS has a great unobtrusive little round one. I taped some cotton to the bottom of the lid to keep the pills from rattling around as I walk.)How similar our lives are. I have a little round gold pillbox that I pad with tissue paper so the pills don't rattle around, that I keep Xanax and Inderal in. I am always afraid of someone finding it - when sitting in deep chairs I find sometimes it slips out of my pocket (women have an advantage with purses!) and I have left it behind on chairs before. Of course when I realized it, there was a frantic search to go find it before someone else did. The big problem is not the convenience, it is trying to hide this stuff all the time. I usually keep it in my locked messy desk drawer at work now to avoid this problem. It also keeps my body heat from breaking down the medicine as it would if it was sitting in my pocket all the time. I am tempted to put it in some kind of prescription bottle, say a Claritin one or something, and just not make an effort to hide my taking it. I am tired of sneaking around. There must be a way for men without purses to work these things into their lives conveniently.
>Even if you took Klonopin regularly, missing a day probably wouldn't be too awful because of the long half-life.
I was more worried about missing a few hours than a day. If you are on an all-day assignment somewhere for example, it would be a catastrophe if your xanax ran out halfway through the day!
>Did you run out of Xanax a lot?
More of a case that I could really tell when a dose was wearing off. The anxiety would shoot upwards. Was it just my normal anxiety returning, or was it benzo-caused rebound anxiety? It is hard to tell, but it was a nasty effect, especially since it might take 30 or 45 minutes for the next dose to kick in. People would see you go from jumpy and nervous to dopey in the course of an hour. It must raise suspicions. And then you start taking the second dose earlier to avoid the anxious period between doses, and pretty soon you are taking more per day than you are supposed to because you don't wait the full time period between each dose...
> How distressful were the shakes? How much were you using at the time, and on what schedule?
I am an excellent responder to Xanax. My "mild relaxation" dose is .25 mg Xanax, and my "get ready to stand up and talk" dose is .5 mg. I have never taken more than that. .5 really knocks me out. If I take it around noon, it works for anxiety for maybe three hours, wears off, and then I start to get real tired, so by the time I get home I collapse on the couch and sleep for three hours in the evening. I am taking about occasional use mind you, not the "rebound" jumpiness that occurs with regular use. I have never taken xanax often enough to get a rebound reaction/shakes when a dose wore off, except that one month when I was tapering onto the imipramine long ago. I did not develop tolerance to Xanax in that time but I was addicted. When a dose started to wear off I was reaching for that bottle pretty quick, and when I came off it at the end of that month, for withdrawal I had overwhelming anxiety, muscle rigidity (neck would turn in little jerks, like a Parkinson's patient) and so on. That was over a decade ago and it was under bad circumstances (I had to do all this while working in a fairly stressful environment in a new job, and hide everything I was going through) so I have blotted much of this memory out. Suffice to say I have never been tempted to abuse xanax in the decade since, despite always having a bottle of it within reach. I get nervous if I take two or three Xanax doses in the same week, even though I know ratonally I would have to take it for weeks to get addicted.
> Perhaps it's because I'm already in a long-lasting, strong relationship,
I am too.
>but my biggest ongoing benefit from Klonopin has been been for my career. It's made a world of difference. I still don't like getting a sudden performance request thrown my way
who does?
>(and not just for reasons related to anxiety), but it's so refreshing not to suddenly panic. (On the other hand, I sometimes perversely enjoy watching myself calmly but firmly speak my mind during the confrontations that would freak me out in the past.
Man that is my dream scenario. Right now my throat tightens up and I get the feeling that I will lose muscular control of my neck (shivering and shaking) if I do not break eye contact.
> BTW, how are things going so far with the new meds? I know it may be a little early to talk about theraputic benefits, but is everything going OK side-effect-wise?
Very well. The first few days on the Wellbutrin I felt very upbeat (probably a little mania, I got this when starting Serzone as well) and high/euphoric (I assume this is the dopamine effects of Wellbutrin kicking in). I felt like I had taken a happiness pill. I mean it felt great. Since upping the dose to 300 mg I feel more normal. I went sparingly on the Klonopin at first but now I am taking it several times a day to get used to it. It is very subtle, doesn't make me continuously yawn like the xanax would.
The chemistry is complicated here. I am not sure if .5 mg per dose will be enough Klonopin; and if it isn't, I am not sure if that is because of the Wellbutrin; and if it is because of the Wellbutrin, I am not sure if that is because I have to get used to the Wellbutrin, or whether the Wellbutrin will always be activating and require more Klonopin even after the initial three weeks. In time I will get it sorted out. I suspect I may have to take more Klonopin for the first few weeks till the Wellbutrin settles down, and then cut back on the Klonopin. But that is assuming the Wellbutrin will settle down. It has not really made me anxious yet, except for occasional tightness in the chest which the Klonopin seems to relieve, but the effect of the Wellbutrin could well be simply negating some of the benefits of the Klonopin. I wonder if Wellbutrin becomes less activating after two or three weeks? I am definitely enjoying the reduced appetite (I am somewhat overweight) - wonder how long that will last!
> Since I referred to "studies" several times,I feel compelled to include one small study abstract.Thanks for all the information. The data on Konopin sounds very positive. My question is this: what is your dosing regimen? Do you take it three times a day? It sounds like that would be, say, 7 AM, 3 PM, 11 PM. But what is the point of taking a social anxiety drug at 11 PM at night? Is it to avoid a withdrawal reaction, or is there some therapeutic benefit to maintaining steady-state of this stuff?
Thanks again. So far I have been taking Klonopin once a day (first several days) and then twice a day (the last several days). Have not taken one late at night yet.
Posted by Rick on July 9, 2001, at 4:15:13
In reply to Re: One more try - Klonopin and Wellbutrin, posted by Joe Schmoe on July 8, 2001, at 19:38:55
>
> > There are certainly a minority of people who fall outside the typical pattern. It's generally been felt -- even by non-benzophobic docs -- that benzos should be "used cautiously if at all" for individuals with a history of substance abuse or addiction. But some very recent studies are demonstrating that even this caution has been overstated in many cases.
>
> I wonder how "substance abuse" is defined. Are we talking people who smoked pot in college, or hardcore crack users trying to quit their habit?I'm just paraphrasing what I've read, but I'm sure it's much more the latter.
> What do these people do? Just take higher and higher doses of Klonopin to try to get high?
Maybe. I know that some of my newsgroup searches on Klonopin have come up with posts in the recreational drug newsgroups. I think it's sold on the street for to be used in some kind of combo. I'm no expert here. Also, as I noted, recent studies are suggesting that past episodes of alcohol/drug addiction or heavy recreational drug use shouldn't necessarily raise a red flag for benzo-based treatments. That conclusion makes intuitive sense to me. Everyone's situation is different; these things aren't black and white.
>
> > Can't you make sure you have at least a little Klonopin on you at all times, say in a little pillbox? (CVS has a great unobtrusive little round one. I taped some cotton to the bottom of the lid to keep the pills from rattling around as I walk.)
>
> How similar our lives are. I have a little round gold pillbox that I pad with tissue paper so the pills don't rattle around, that I keep Xanax and Inderal in. I am always afraid of someone finding it - when sitting in deep chairs I find sometimes it slips out of my pocket (women have an advantage with purses!) and I have left it behind on chairs before. Of course when I realized it, there was a frantic search to go find it before someone else did. The big problem is not the convenience, it is trying to hide this stuff all the time. I usually keep it in my locked messy desk drawer at work now to avoid this problem. It also keeps my body heat from breaking down the medicine as it would if it was sitting in my pocket all the time. I am tempted to put it in some kind of prescription bottle, say a Claritin one or something, and just not make an effort to hide my taking it. I am tired of sneaking around. There must be a way for men without purses to work these things into their lives conveniently.Yes, this all sounds REAL familiar to me! Things constantly fall out of my pockets. But the pillbox has only fallen out a couple of times, and I've always been fortunate enough to notice it -- say when I open the car door and see it lying by the seat. I think somehow the fact that I keep it in the same pocket as my comb helps. Maybe the comb keeps it from falling out. I do know that I find myself reflexively pushing it deep into my pocket when I sit down or get up.
At least once or twice a month I forget to take the pillbox with me. That's created a little bit of worry and social anxiety on a few occasions (especially the first few times), but nothing too significant. My early-to-mid afternoon doses of Klonopin and Serzone are beneficial but seem a lot less essential than the larger doses I take first thing in the morning. In fact, I often forget to take the afternoon dose. Even with somewhat decreased benefit in a few cases, I'm stil SOOOO much better off than pre-Klonopin. Those really seem to provide the bulk of the "steady state feel".
I've sometimes dropped a pill on the floor in my office, hoping that no one walking by sees me scavenging around looking for it. While I'm still as discreet as possible (especially when I'm at the client's office, where I'll usually go into a bathroom stall to take a pill), I'm no longer as concerned about someone seeing me pop my afternoon regimen. I seem to be seeing more people, including my boss, openly downing pills from a pillbox. The Claritin bottle idea is a good one,.
I found your comment about degredation from heat interesting. I've never thought about it in terms of pocket heat, but I've had a lot of situations where I will, say, pick up a prescriotion at lunchtime and then have to decide whether I should leave it in the hot car for four hours (shaded whenever possible), or take it inside and try to keep it hidden away while also remembering to take it with me when I leave. I've done both. I've often wondered how much I should be concerned with the med breaking down in sit-in-the-car-in the hot sun situations.
> >Even if you took Klonopin regularly, missing a day probably wouldn't be too awful because of the long half-life.
>
> I was more worried about missing a few hours than a day. If you are on an all-day assignment somewhere for example, it would be a catastrophe if your xanax ran out halfway through the day!I highly doubt that will be as much of an issue with Klonopin, especially if you do take some every morning, as I believe you said you were doing or considering. I would think that ths would keep you well above "catastrophe" level at minumum -- especially if the Wellbutrin turns out to be helpful for your SP. BTW, I assume that you've checked out your caffeine sensitivity, if you're a coffee, tea or Coke drinker. I never would have believed that largely avoiding caffeine (during the week, anyway) would make a noticeable difference in social anxiety for me, but it really does. I think cutting back on caffeine is one reason I've been able to reduce the Klonopin dosage several times.
> >Did you run out of Xanax a lot?
>
> More of a case that I could really tell when a dose was wearing off. The anxiety would shoot upwards. Was it just my normal anxiety returning, or was it benzo-caused rebound anxiety? It is hard to tell, but it was a nasty effect, especially since it might take 30 or 45 minutes for the next dose to kick in. People would see you go from jumpy and nervous to dopey in the course of an hour. It must raise suspicions. And then you start taking the second dose earlier to avoid the anxious period between doses, and pretty soon you are taking more per day than you are supposed to because you don't wait the full time period between each dose...
Hope the Klonopin helps smooth that out. I bet it does.> > How distressful were the shakes? How much were you using at the time, and on what schedule?
>
> I am an excellent responder to Xanax. My "mild relaxation" dose is .25 mg Xanax, and my "get ready to stand up and talk" dose is .5 mg. I have never taken more than that. .5 really knocks me out. If I take it around noon, it works for anxiety for maybe three hours, wears off, and then I start to get real tired, so by the time I get home I collapse on the couch and sleep for three hours in the evening. I am taking about occasional use mind you, not the "rebound" jumpiness that occurs with regular use. I have never taken xanax often enough to get a rebound reaction/shakes when a dose wore off, except that one month when I was tapering onto the imipramine long ago. I did not develop tolerance to Xanax in that time but I was addicted. When a dose started to wear off I was reaching for that bottle pretty quick, and when I came off it at the end of that month, for withdrawal I had overwhelming anxiety, muscle rigidity (neck would turn in little jerks, like a Parkinson's patient) and so on. That was over a decade ago and it was under bad circumstances (I had to do all this while working in a fairly stressful environment in a new job, and hide everything I was going through) so I have blotted much of this memory out. Suffice to say I have never been tempted to abuse xanax in the decade since, despite always having a bottle of it within reach. I get nervous if I take two or three Xanax doses in the same week, even though I know ratonally I would have to take it for weeks to get addicted.I know Xanax has a shorther half life than Klonopin, but I'm surprised that the effects would wear out in three hours. Or now that I think back to my own experience with Xanax, maybe I’m not *too* surprised...I know when I took as-needed Xanax (my first-ever med for Social Phobia, in tandem with Nardil), it relaxed me to some degree by making me feel a little doped-up. I didn't really like the feeling, at least not in a work setting. It was as if I was drinking but without much cognitive degredation. (Is it the same for you by any chance?..or is the pre-crash impact strictly mental?...or would you describe your acute reaction in a completely different way?)
Xanax would make me feel exhausted hours later, usually as soon as I got home. I never had any craving for more except when I couldn't sleep. That was one hell of a sleeping pill for me when I was keyed up! Oddly, it quickly seemed to become less effective even for this. Whereas one .5 mg would zap me into dreamland for awhile, I got to the point where even 1.5 mg wouldn't do it if I was really keyed up. Since starting daily Klonopin, rarely taken after 4 p.m., I have trouble getting to sleep only about one night every month or two. And even then, I nod off in not much more than 30 minutes. I still have about fifteen Xanax's left from my original, 4/99 prescription of 90 .5 mg tabs (30 times three refills), since insomnia is no longer an issue.
One more thought...I wonder if your body metabolizes Xanax quickly. If so, the same might happen for Klonopin. But it should still exert an effect lasting at least twice as long as Xanax's, probably even longer.
> > BTW, how are things going so far with the new meds? I know it may be a little early to talk about theraputic benefits, but is everything going OK side-effect-wise?
>
> Very well. The first few days on the Wellbutrin I felt very upbeat (probably a little mania, I got this when starting Serzone as well) and high/euphoric (I assume this is the dopamine effects of Wellbutrin kicking in). I felt like I had taken a happiness pill. I mean it felt great. Since upping the dose to 300 mg I feel more normal. I went sparingly on the Klonopin at first but now I am taking it several times a day to get used to it. It is very subtle, doesn't make me continuously yawn like the xanax would.Sounds like an auspicious start.
I forgot about the yawning! I was afraid people would think they were boring me. Celexa also had that effect on me big-time, as did some of the other meds I tried, to a lesser degree. I still get into that mode about once every week or two.
> The chemistry is complicated here. I am not sure if .5 mg per dose will be enough Klonopin; and if it isn't, I am not sure if that is because of the Wellbutrin; and if it is because of the Wellbutrin, I am not sure if that is because I have to get used to the Wellbutrin, or whether the Wellbutrin will always be activating and require more Klonopin even after the initial three weeks. In time I will get it sorted out. I suspect I may have to take more Klonopin for the first few weeks till the Wellbutrin settles down, and then cut back on the Klonopin. But that is assuming the Wellbutrin will settle down. It has not really made me anxious yet, except for occasional tightness in the chest which the Klonopin seems to relieve, but the effect of the Wellbutrin could well be simply negating some of the benefits of the Klonopin. I wonder if Wellbutrin becomes less activating after two or three weeks? I am definitely enjoying the reduced appetite (I am somewhat overweight) - wonder how long that will last!
Yeah, it's hard sorting these things out when you have to start both meds at once (even though that's what most pdocs want you to do, since they typically view the benzo as a temporary augmentation or adjustment aid to the AD). All of the possible scenarios you presented are plausible, and it sounds like you’ve already got some good “contingencies” in mind. There are a lot of current and past Wellbutrin users on this board, likely including some with both Social Phobia and some shade of depression. Would be interesting to see what they have to say about adjustment to Wellbutrin activation.
> Thanks for all the information. The data on Konopin sounds very positive. My question is this: what is your dosing regimen? Do you take it three times a day? It sounds like that would be, say, 7 AM, 3 PM, 11 PM. But what is the point of taking a social anxiety drug at 11 PM at night? Is it to avoid a withdrawal reaction, or is there some therapeutic benefit to maintaining steady-state of this stuff?
Frankly I don't think there *is* much benefit to taking it at bedtime, and I don't. I initially avoided bedtime dosing because I had sleep apnea (since gone away since I shed quite a few pounds), which can be exacerbated by benzos. So I inadvertently learned that I didn’t need a bedtime dose. (The logic of an 11 p.m. dose seemed strange to me, too.) The aforementioned fact that Klonopin helps me sleep, even though I often take my final dose as early as 1 p.m., should be testament that -- at least for me -- 3-time dosing is unnecessary to maintain consistent benefit.
I find it *very* important to make the first dose the biggest one - 2/3 to 3/4 of the daily total. I usually take the rest of the daily amount 5-7 hours later. If there's a difficult challenge coming up (e.g. a big presentation) I might change the timing a little so that I get some an hour ahead of the event. Once in awhile I'll take an extra .25 (or even .5), especially if I'm facing a whole day of social. business-social and/or performance situations, say at an out-of-town convention. But I find the "extras" less and less necessary as time goes on. I do have two rules that I've learned I need to follow consistently: 1) Never take more than 1.0 mg at a time, and 2) Don’t take doses of any size less than 4, preferably 5, hours apart. If I violate either of these the result can be sedation/dopey feeling and some loss of effectiveness.
But, again, the worst that happens with some variation in the routine is a temporary, modest degradation in effectiveness, not an “Oh, shit, I’m f**d” situation. I obviously can’t guarantee the same will apply for you, but I’d be surprised if you don’t see significant movement in that direction vs. your experience with as-needed Xanax...especially after the gradual experimenation and fine-tuning.
>
> Thanks again. So far I have been taking Klonopin once a day (first several days) and then twice a day (the last several days). Have not taken one late at night yet.I'd suggest you don't. The few times I gave that a try, I just woke up groggy.
Posted by Pattisun on July 9, 2001, at 6:16:18
In reply to Re: One more try - Klonopin and Wellbutrin » Joe Schmoe, posted by Rick on July 9, 2001, at 4:15:13
The psychiatrist that the family practice doctor insisted I go to told me that Klonopin was NOT a drug that you can get a high from, so he was not concerned about me being on it. And, that Klonopin was not a drug his 'recreational drug user patients' tried to get.
He wrote a report back to my doctor that said my anxiety disorder was "moderately well controlled and my use of Klonopin should not be interrupted"
And, as far as Klonopin and recreational drug use--well, back in the 80s I used to get Klonopin from my girlfriend because they were the perfect soother after a bout of cocaine use. {{that's that period of life when I briefly lost all control of myself and used cocaine for a while}}--that's hard to admit to.
I leave Klonopin at work on a prescription bottle OR in a Motrin bottle, just in case ((I've rushed to work in the mornings, forgetting to bring it with me)) . And, I've never discussed Klonopin with anyone, just told them it's meds I have to take every day. Never take my Klonopin bottle with me (just because I always kept that one at home with the refill # so I can call the pharmacy). And, of course I do have a purse, but I also keep Klonopin in my fanny pack, or in my husband's fanny pack (if I am not carrying one). I've ridden big roller coasters and it's set off a panic attack, or I work out too hard.
I take my Klonopin at 11:00 and 2:00 (or close to it). And, on a really bad night or during a bad panic attack I'll take another one (.5 mg). They no longer make me sleepy at all--it's been six years for me. And, I have a pretty functional life THANKS to Klonopin (and cognitive therapy).
Good luck to both of you. Never met anyone else besides me that took it until I just found this board.
Posted by Mark H. on July 9, 2001, at 20:19:07
In reply to AD-provoked hypomania - is it diagnostic?, posted by Zo on July 9, 2001, at 14:39:44
> The literature seems about evenly divided.. ..
Hi Zo,
My reading suggests the literature is divided on(but leaning toward) the hypothesis that when STARTING an anti-depressant the occurrence of a hypomanic episode may indicate bipolar disorder, but I haven't seen any references that hypomanic activity as a rebound effect from STOPPING anti-depressants has diagnostic significance. However, other respondents to your post will be better informed than I am and may recall citations regarding withdrawal and diagnosis.
As a person with Bipolar II, I can tell you that when I quit taking Effexor the first time, all of my bodily, emotional and mental systems that had been suppressed by the medication rebounded wildly. I had to put out a memo to my colleagues asking them to cut me some slack while my systems regained some equilibrium. It was far more intense than any hypomania I had experienced.
If you're wondering whether you're Bipolar II, the main things to look at are the cyclicity of your depressive episodes (for instance, my two deep troughs usually come at roughly the same two times each year), the occurrence of one or more hypomanic episodes (that are NOT attributable to withdrawal or other external stimuli), and -- by the book -- the absence of psychotic mania or mixed states (highly agitated depression).
Absent those criteria, I would guess that a hypomanic-like state caused by abrupt withdrawal would not be diagnostic, but hopefully others will have more information.
Best wishes,
Mark H.
Posted by xraytech on July 9, 2001, at 20:21:04
In reply to regular Klonopin users, posted by Pattisun on July 9, 2001, at 6:16:18
i was on klonopin for nine years for headaches and anxiety. i became physically addicted to not only klonopin, but also oxycontin, and soma a muscle relaxer that is "non-addictive". let me tell you, after a 5 day detox, it took MONTHS to get that klonopin out of my system. it literally was in my bones. my doc said that it was in my fat and as i lost weight, it got released a little here and there. what a nightmare.
i never actually abused klonopin, well maybe once or twice, to fall asleep faster, i might have taken more than the usual does a coupla times.. but thats how youcan get into trouble.
be careful!
just letting you know what can happen sometimes, not what will happen, what can or might happen.
KNOWLEDGE IS POWER.good luck
robin:)
Posted by Rick on July 10, 2001, at 19:53:41
In reply to regular Klonopin users, posted by Pattisun on July 9, 2001, at 6:16:18
Thanks for sharing your own Klonopin "story" + "tips and tricks", Pattisun. It was great that your psych intervened to make sure you got the med that really helps keep panic at bay!
Now, stay off those rollercoasters!
Rick
Posted by Rick on July 10, 2001, at 20:09:00
In reply to Re: regular Klonopin users, posted by xraytech on July 9, 2001, at 20:21:04
Sounds like a pretty awful experience! You must have had some unbearable pain to need all three of those meds. How are you doing now? If you still need meds, what are you using?
I learned about Klonopin's pain-relieving properties inadvertently. When I began taking it for social anxiety I was surprised to find that my frequent jaw/facial pain (sometimes morphing into headaches) unexpectedly disappeared. I had just been getting ready to start checking into whether I had TMJ or some related syndrome. (My sister got it from nighttime bruxism, but has been doing well since she began wearing a splint at bedtime that prevents her from grinding her teeth.)
I'm not sure I'd want to take Klonopin soley for pain (never researched it), but that's a moot point for the forseeable future since I'm definitely sticking with it for the Social Phobia.
Rick
Posted by AMenz on July 14, 2001, at 0:04:51
In reply to regular Klonopin users, posted by Pattisun on July 9, 2001, at 6:16:18
I'm on lorezapam which I can't get off of. It makes me groggy, gives me memory lapses, and is overly sedating even at only 1 mg a day.
How is Klonopin on these issues. Is it a benzo?
> The psychiatrist that the family practice doctor insisted I go to told me that Klonopin was NOT a drug that you can get a high from, so he was not concerned about me being on it. And, that Klonopin was not a drug his 'recreational drug user patients' tried to get.
>
> He wrote a report back to my doctor that said my anxiety disorder was "moderately well controlled and my use of Klonopin should not be interrupted"
>
> And, as far as Klonopin and recreational drug use--well, back in the 80s I used to get Klonopin from my girlfriend because they were the perfect soother after a bout of cocaine use. {{that's that period of life when I briefly lost all control of myself and used cocaine for a while}}--that's hard to admit to.
>
> I leave Klonopin at work on a prescription bottle OR in a Motrin bottle, just in case ((I've rushed to work in the mornings, forgetting to bring it with me)) . And, I've never discussed Klonopin with anyone, just told them it's meds I have to take every day. Never take my Klonopin bottle with me (just because I always kept that one at home with the refill # so I can call the pharmacy). And, of course I do have a purse, but I also keep Klonopin in my fanny pack, or in my husband's fanny pack (if I am not carrying one). I've ridden big roller coasters and it's set off a panic attack, or I work out too hard.
>
> I take my Klonopin at 11:00 and 2:00 (or close to it). And, on a really bad night or during a bad panic attack I'll take another one (.5 mg). They no longer make me sleepy at all--it's been six years for me. And, I have a pretty functional life THANKS to Klonopin (and cognitive therapy).
>
> Good luck to both of you. Never met anyone else besides me that took it until I just found this board.
Posted by Else on July 14, 2001, at 5:09:35
In reply to Re: regular Klonopin users: Does it impair memory, posted by AMenz on July 14, 2001, at 0:04:51
Klonopin and lorazepam (Ativan), are both benzos but Ativan is short-acting which means in comes along with a lot of nasty withdrawal symptoms. I can take it at 2mg/day for one week and get terrible rebound anxiety after 10-12 hours, and withdrawal symptoms at the end of the week. MY doctor once told me Ativan produced the worst withdrawal symptoms of all benzos. My experience with Klonopin, which is long-acting, has been much more positive although I have never been on it for very long periods (years). I assume there are withdrawal symptoms but since doctors use other long-acting benzos like Valium and Librium (which are a bit longer acting than Klonopin) to do progressive detox, the detox from Klonopin shouldn't be as bad as with some other drugs. I personnaly find it's much easier on the body than Ativan or even Xanax.
> I'm on lorezapam which I can't get off of. It makes me groggy, gives me memory lapses, and is overly sedating even at only 1 mg a day.
>
> How is Klonopin on these issues. Is it a benzo?
>
Posted by JahL on July 14, 2001, at 10:06:05
In reply to Re: regular Klonopin users: Does it impair memory, posted by AMenz on July 14, 2001, at 0:04:51
> I'm on lorezapam which I can't get off of. It makes me groggy, gives me memory lapses, and is overly sedating even at only 1 mg a day.
>
> How is Klonopin on these issues. Is it a benzo?Klonopin has a reputation for not being entirely helpful with memory. Prozac antagonises Klonopin, the dose of which I have just doubled, having just re-started Prozac. My memory is shot & I spend an ave. of an hour a day looking for my car keys.
Low doses don't make me groggy but help with sleep/night-waking etc. Above 2mg & I sleep for 24hrs.
J.
Posted by Janelle on July 14, 2001, at 16:02:45
In reply to Re: regular Klonopin users: Does it impair memory, posted by Else on July 14, 2001, at 5:09:35
As a long-term Klonopin user (1 - 1.5 mg/day, depending on conditions), I didn't think about it impairing memory until you raised the question, and now I'm wondering because my long-term memory ain't what it used to be. However, I think that this is due to there being years now of incredible stress in my life, so much to deal with and think about that my brain can only "hold" so much. I've never heard anything about Klonopin impairing memory. Hmmmm ...
If it has impaired my l-t memory, I'd rather have that than live with the anxiety that Klonopin helps me with.
As far as Klonopin being addictive and having withdrawal if you go off it, it's "less" addictive than the short acting benzo's and is said to be the LEAST addictive, but IS nonetheless addictive and should be tapered off GRADUALLY.
Posted by Zo on July 14, 2001, at 16:57:28
In reply to Re: regular Klonopin users: Does it impair memory, posted by Else on July 14, 2001, at 5:09:35
That is so interesting. I never had any problem getting off *any* benzo, even Xanax, and most *especially* not Ativan/lorazepam. We are all so different!
Zo
Posted by Janelle on July 14, 2001, at 18:19:50
In reply to Re: regular Klonopin users: Does it impair memory » Else, posted by Zo on July 14, 2001, at 16:57:28
You said that you never had any problem getting off *any* benzo - did you just stop (cold turkey) taking them?
I ask you because I think I'll probably be going off Klonopin soon, and wonder if I should taper or just stop cold turkey? (I'll ask the doc too of course!)
I have found that if I forget to take Klonopin, even for a few days, NOTHING "bad" happens, whereas if I skipped Paxil for even one day - woo boy, I'd get that "electric head" and have a nightmare.
Posted by Else on July 14, 2001, at 20:54:06
In reply to Re: regular Klonopin users: Does it impair memory » Else, posted by Janelle on July 14, 2001, at 16:02:45
There is no doubt in my mind that Klonopin impairs memory but I'm not entirely sure that this is a bad thing. I have always had this exceptional memory. I made it through high school without studying, simply because I could vaguely overhear what the teacher said and store this information somehow, whithout even trying. Every drug I've taken that was effective against anxiety caused me some level of memory impairment ( this includes most benzos and SSRIs.) It's a price I'm willing to pay considering I can probably spare the lost learning skills. Something tells me memory and anxiety are closely related. Aren't the most embarassing moments in your life those you can remember the most vividly? In any event, this has led me to believe that benzos just make me "normal". Most people are not as anxious as me and they clearly do not possess the memory I possess. I, for example, am the only person I know who can remember a phone number the first time I hear it without even writing it down. Well, I can't do that anymore but really, so what.
> As a long-term Klonopin user (1 - 1.5 mg/day, depending on conditions), I didn't think about it impairing memory until you raised the question, and now I'm wondering because my long-term memory ain't what it used to be. However, I think that this is due to there being years now of incredible stress in my life, so much to deal with and think about that my brain can only "hold" so much. I've never heard anything about Klonopin impairing memory. Hmmmm ...
>
> If it has impaired my l-t memory, I'd rather have that than live with the anxiety that Klonopin helps me with.
>
> As far as Klonopin being addictive and having withdrawal if you go off it, it's "less" addictive than the short acting benzo's and is said to be the LEAST addictive, but IS nonetheless addictive and should be tapered off GRADUALLY.
Posted by Else on July 14, 2001, at 20:59:26
In reply to Re: regular Klonopin users: Does it impair memory » Else, posted by Zo on July 14, 2001, at 16:57:28
Really? Ativan was the benzo from hell for me. It's probably because at some point I was taking 6 mg daily (a hefty dose) and was cut off with no tapering. That was a horrible but thankfully brief withdrawal. Ever since, I can't take Ativan without these withdrawal symptoms showing up again, even at low doses. I don't know what happenned but I stay away from short-acting benzos now just in case.
> That is so interesting. I never had any problem getting off *any* benzo, even Xanax, and most *especially* not Ativan/lorazepam. We are all so different!
>
> Zo
Posted by Rick on July 15, 2001, at 17:37:23
In reply to Re: Giving up/Klonopin ENHANCED Cognitive Function » Joe Schmoe, posted by Rick on July 1, 2001, at 17:41:28
I've been taking Klonopin daily for two years, and for about six months I've been having some memory lapses beyond what was normal for me pre-meds. (However, the overall cognitive *enhancement* that comes from focusing on things besides anxiety strongly outweighs the recall annoyances.)
I'd say the memory lapse is probably NOT due to Konopin per se, but rather due to any one or more of:
A) Serzone, which I started about a year ago
B) Combining Serzone and Klonopin (although
I'm taking less Klonopin than I did pre-
Serzone)
C) Getting older
D) Insufficient sleep (not insomnia, just staying
up too late because I'm busy or I'm spending
too much time on the net...oops)Not long ago I experimented with cutting back on each med (1.25 to .5 mg Klonopin, and 450 mg to zero Serzone), and there was a very clear improvement in the memory situation when the Serzone got to a low dose. Unfortunately, but not unexpectedly, my strong Social Anxiety cocktail wasn't quite as effective without the Sezone. The Klonopin decrease (with Serzone still at 450) didn't seem to improve the situation at all. OTOH, I may not have let the experiment go on long enough to draw the best conclusions. And maybe I should've tried cutting down on my third med as well (Provigil), but I'd be very surprised if that one was contributing to memory lapses.
I know Klonopin causes memory problems for some people, especially at higher doses. It certainly has a reputation for having that potential. I know many people also complain of memory deficits with Serzone, Effexor, and other AD's as well. I have a friend who is taking Serzone solo, and she's ecstatic with how it's helped her GAD, but she's now having memory lapses as well.
But for myself, especially after that little test, I have a feeling Klonopin is NOT the main culprit.
*****Which leads me to a question: Does anyone -- especialy Klonopin users who have had memory problems -- know if it can take a whole year before the lapses start to occur? Even if the dose has been titrated down instead of remaining stable or increasing?*****
Fyi, the long-term memory lapses are annoying, but the short-term ones are most problematic. "Rick, I have a question about that report you're pulling together for tomorrow." "Oh...yeah...THAT report...uh, what's the question?"...as I frantically try to recall the details, with success levels ranging from all-comes-flooding-back-instantly to near-complete amnesia on some occasions. (Once in awhile I'm pretty sure it's the OTHER person who is confused.) I have been a little disorganized and overworked as of late, and I've never been one to remember details (the RELEVANT ones, that is!), but I'm sure there's more to it than that.
Rick
Posted by AMenz on July 15, 2001, at 18:37:47
In reply to Re: Klonopin memory probs? Or ADs? Or...???, posted by Rick on July 15, 2001, at 17:37:23
Thanks for all your responses. It cleared up my confusion on this topic.
> I've been taking Klonopin daily for two years, and for about six months I've been having some memory lapses beyond what was normal for me pre-meds. (However, the overall cognitive *enhancement* that comes from focusing on things besides anxiety strongly outweighs the recall annoyances.)
>
> I'd say the memory lapse is probably NOT due to Konopin per se, but rather due to any one or more of:
>
> A) Serzone, which I started about a year ago
> B) Combining Serzone and Klonopin (although
> I'm taking less Klonopin than I did pre-
> Serzone)
> C) Getting older
> D) Insufficient sleep (not insomnia, just staying
> up too late because I'm busy or I'm spending
> too much time on the net...oops)
>
> Not long ago I experimented with cutting back on each med (1.25 to .5 mg Klonopin, and 450 mg to zero Serzone), and there was a very clear improvement in the memory situation when the Serzone got to a low dose. Unfortunately, but not unexpectedly, my strong Social Anxiety cocktail wasn't quite as effective without the Sezone. The Klonopin decrease (with Serzone still at 450) didn't seem to improve the situation at all. OTOH, I may not have let the experiment go on long enough to draw the best conclusions. And maybe I should've tried cutting down on my third med as well (Provigil), but I'd be very surprised if that one was contributing to memory lapses.
>
> I know Klonopin causes memory problems for some people, especially at higher doses. It certainly has a reputation for having that potential. I know many people also complain of memory deficits with Serzone, Effexor, and other AD's as well. I have a friend who is taking Serzone solo, and she's ecstatic with how it's helped her GAD, but she's now having memory lapses as well.
>
> But for myself, especially after that little test, I have a feeling Klonopin is NOT the main culprit.
>
> *****Which leads me to a question: Does anyone -- especialy Klonopin users who have had memory problems -- know if it can take a whole year before the lapses start to occur? Even if the dose has been titrated down instead of remaining stable or increasing?*****
>
> Fyi, the long-term memory lapses are annoying, but the short-term ones are most problematic. "Rick, I have a question about that report you're pulling together for tomorrow." "Oh...yeah...THAT report...uh, what's the question?"...as I frantically try to recall the details, with success levels ranging from all-comes-flooding-back-instantly to near-complete amnesia on some occasions. (Once in awhile I'm pretty sure it's the OTHER person who is confused.) I have been a little disorganized and overworked as of late, and I've never been one to remember details (the RELEVANT ones, that is!), but I'm sure there's more to it than that.
>
>
> Rick
Posted by Willow on July 15, 2001, at 20:30:54
In reply to Re: Klonopin memory probs? Or ADs? Or...???, posted by Rick on July 15, 2001, at 17:37:23
I had a sleep test done several months ago and go see the doctor in a couple weeks regarding the results, moderate periodic limb movements resulting in some arousal from sleep. The first line of treatment for this I believe is Klonopin, hence my reason for following this thread.
Rick raised some concerns which I have. Definitely when I'm more tired I'm more easily confused, but the effexor has helped with this. Has anyone else had an AD help with memory problems and thinking problems? And taking a drug such as Klonopin, will it worsen the memory process? Recently I took one dose of lorazepam, .5mg, and the fatigue was severe for several days, had to fight to stay awake. Later I tried a second dose out of curiosity, the same thing. Is Klonopin similar to lorazepam?
Willow
Posted by Neal on July 15, 2001, at 23:40:38
In reply to To ZO: re getting off benzos:, posted by Janelle on July 14, 2001, at 18:19:50
Janelle- I wouldn't advise stopping Klonopin cold turkey. Klonopin is a long-acting benzo, so you can cut way back suddenly (like I did) and think you're home free, and then on the third or fourth day the roof caves in . . . . (YMMV of course).
Posted by Janelle on July 16, 2001, at 0:10:54
In reply to re getting off benzos: » Janelle, posted by Neal on July 15, 2001, at 23:40:38
Neal - thanks for the advice - I am NOT planning to stop Klonopin cold turkey because I've heard that even though it's a long-acting benzo, it IS addictive and I've been on it a long time. However, I think I take low dose (0.5 - 1.5 mg/day depending on circumstances; usually 1 mg/day) and I have had times when I had to go up to 2 or 3 mg/day, then cut back down to 1 mg/day with no problem.
However, if and when I'm able to get off it I sure will do so slowly and gradually (probably reduce to 0.5mg/day for a few weeks, then maybe even cut that in half for awhile!) I went through Paxil withdrawal where the roof caved in and do not want to experience anything remotely like that again. Thanks for the feedback.
-Janelle
Posted by Rick on July 16, 2001, at 2:05:14
In reply to Re: Klonopin memory probs? Or ADs? Or...???, posted by Willow on July 15, 2001, at 20:30:54
> I had a sleep test done several months ago and go see the doctor in a couple weeks regarding the results, moderate periodic limb movements resulting in some arousal from sleep. The first line of treatment for this I believe is Klonopin, hence my reason for following this thread.
>
> Rick raised some concerns which I have. Definitely when I'm more tired I'm more easily confused, but the effexor has helped with this. Has anyone else had an AD help with memory problems and thinking problems? And taking a drug such as Klonopin, will it worsen the memory process? Recently I took one dose of lorazepam, .5mg, and the fatigue was severe for several days, had to fight to stay awake. Later I tried a second dose out of curiosity, the same thing. Is Klonopin similar to lorazepam?
>
> WillowWillow -
I don't know how much Effexor you're taking, but if the dose is high enough it is often has stimulating qualities driven by norepinephrine reuptake inhibition, which could enhance alertness. This is based on what I've read and seen posted, not what I've personally experienced. I'm interested in hear more first-hand AD cogniton-enhancing experiences, too.
As for your Ativan (lorazepam) reaction, I don't think it's typical for fatigue from one dose of a benzo to last for days, even in the early stages of use. Ativan, in particular, should have about the quickest on/off effect of all of them because of its short half life. There might be some "crashing" fatigue afterward, but a good nap -- or at least a night's rest --should take care of that. I'll be interested in what others have to say on personal experiences re this situation, too. I assume you'll be discussing this with your doctor. If you are, say, a poor metabolizer of lorazepam, she may may want you to take a tiny dose or avoid it completely -- especially if you start using Klonopin.
As for Periodic Limb Movement Disorder, the same friend whose GAD responded to Serzone was diagnosed with PLMD after a sleep study over five years ago. They gave her what was then a "new anticonvulsant drug" called Neurontin, 300 mg before bedtime, which was promptly successful in treating the PLMD with no side effects.
Actually, while Klonopin is indeed often used for PLMD, the favored treatments these days seem to be dopamine agonists that are indicated primarily for Parkinson's, with Mirapex being the "hottest" at the moment. Before that it was pergolide (Permax) and bromocriptine. Of course, many still use these. My friend was seeing some return of PLMD syptoms early last year, and based on net research she tried pergolide. There was no improvement, and there were some mildly unpleasant side effects. So she went back to Neurontin, but this time 400 mg (I gave her a big supply of monster 800 mg pills from my failed trial of Neurontin for Social Phobia, and she cut them in half). This, plus avoiding booze too soon before bedtime, did the trick.
Isn't it interesting that all of the PLMD drugs I mentioned are used successfully in mood disorders, as well? (Tough evidence for psychotropic or psychotropic-augmentation benfits from bromocriptine and especially pergolide is spotty.)
Good Luck,
Rick
Posted by Else on July 17, 2001, at 6:29:53
In reply to Re: Klonopin memory probs? Or ADs? Or...???, posted by Rick on July 15, 2001, at 17:37:23
< snip >
(However, the overall cognitive *enhancement* that comes from focusing on things besides anxiety strongly outweighs the recall annoyances.)
You said it. I couldn't agree more.
Posted by Zo on July 17, 2001, at 21:00:45
In reply to To ZO: re getting off benzos:, posted by Janelle on July 14, 2001, at 18:19:50
> You said that you never had any problem getting off *any* benzo - did you just stop (cold turkey) taking them?
>
> I ask you because I think I'll probably be going off Klonopin soon, and wonder if I should taper or just stop cold turkey? (I'll ask the doc too of course!)
>
> I have found that if I forget to take Klonopin, even for a few days, NOTHING "bad" happens, whereas if I skipped Paxil for even one day - woo boy, I'd get that "electric head" and have a nightmare.I had the WORST junkie-like withdrawal of my life. . .stopping Desyrel (trazadone) cold once, on the bad advice of a bad GP.
I'd use your intuition and sense of yourself. Tapering is advisable under any circumstances, but I always went off Klonopin, Xanax, Ativan and the like in pretty big drops, over the course of a week, without much of a kickback at all. I've been more addicted to wheat - no joke.
Good Luck,
Zo
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