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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 4 of 4. This is the beginning of the thread.
Posted by Laurie1041 on April 16, 2011, at 1:27:05
History of Anxiety Disorder x 1 year, age 19 in 1979.
Started on Klonopin 1 mg. (for panic attacks induced by start-up of Effexor XR for depression) at age 40 in 2000 (bad marriage, stress at work).
Started Provigil for Shift Work Sleep Disorder (night shift) in 2007.Hospitalized at age 47 for supposed BP I, Mixed, after a huge spending spree and ensuing depression. Note that I had been started on Provigil. I had to leave my profession as a RN and have not worked since 2007.
Hospitalized x 2 at age 49 in 2009 for severe depression after death of my husband. I was in a manic state for 4 months after being discharged on Adderral XR 30 mg. BID.
Hospitalized x 3 at age 50 in 2010 for severe depression.
Started Cognitive Behavioral Therapy in 2010 and continuing.
All SSRI's/SNRI's do not work.
Lithium - well tolerated, no side effects. It has lost it's punch.
All atypical anti-psychotics give me EPS, with the exception of Seroquel. However, my pdoc is hesitant to keep me on Seroquel due to metabolic syndrome. Plus Seroquel XR 150 mg. BID makes me dumb as a rock.
Wellbutrin - major anxiety and mood lability
Nortryptaline- 50 mg. major oversedation
Tegretol - somnolence
Trileptal - depression
Current Meds:
Pristiq 100 mg. QD
Levothyroxine 0.112 mg. QD
Adderrall XR 30 mg. QAM
Lithium 900 mg. QHS
Klonopin 2 mg. QHS
Seroquel 25 mg. QHSMy theory is that I may be suffering from "Tolerance Withdrawals" from long-term "medically-dose" stable clonazepam use (11 years).
From what I have read "Tolerance Withdrawal" can result from a stable dose of benzodiazepines and can cause paradoxical symptoms of withdrawal, including, severe depression, suicidal ideation, anxiety, and panic, to name a few. I have had and continue to have all of these symptoms.My benzo use (1 mg. x 10 years, 2 mg. x 1 year) has never been addressed by the multitude of professionals I have consulted with. My pdoc listened very politely to my theory regarding my treatment resistant depression and said I could reduce my dose of clonazepam from 2 mg. to 1.75 mg. each night. I went into withdrawals after 5 days of tapering and after 3 weeks of hell, my pdoc instructed me to go back to 2 mg. at night. I can only assume that my pdoc does not agree with my benzo "tolerance withdrawal" theory and does not exude confidence when it comes to getting off long term benzodiazpines.
I consulted with a Internist who specializes in chemical dependency and he said he would have no problem in helping me to undergo a very slow taper except for the fact that I have a psych history. (?)
I consulted with a recommended pdoc today and brought my sister and step-mom with me for the consultation and he glided over getting off of clonazepam and said that his first goal for me would be to treat my depression. What a novel idea!! I said I had been on every class of meds and he recommended that I taper off of my SNRI, wait for 7 days and start on the Ensam patch. But what he really thought would be best would be to taper down to 1 mg. of clonazepam and then start rTMS (repetitive Transcranial Magnetic Stimulation) therapy at $8500.00 for 4 weeks and then $450.00 per session thereafter for a total of 6 weeks. This sounds like junk science to me.
Any suggestions? I need some hope!
Posted by Christ_empowered on April 16, 2011, at 7:58:02
In reply to Clonazepam (Klonopin) 'Tolerance Withdrawals'?, posted by Laurie1041 on April 16, 2011, at 1:27:05
I'm so sorry you've been through all this. Sometimes the mental health industry just adds more misery to the mix, doesn't it?
I personally wouldn't do rTMS. From what little I've read, its really not that impressive.
I don't know what to tell you in terms of your meds. All I can think of (and this is going to sound terrible) would be switching from Klonopin to an equivalent, possibly higher, dose of Xanax (maybe the CR version?) since xanax, at the very least, is less likely to worsen your depression and might even help improve it. Once you're emotionally stable, then you can start tapering off the benzo, maybe by switching to valium first and doing a gradual taper that way.
As or the EMSAM patch...I mean, it could work, but so could adding in a TCA or Remeron. Remeron+Effexor= "california rocketfuel" (I didn't choose the name, trust me). Its apparently one of the better studied combos out there. The Remeron could help with sleep and anxiety, so maybe you could cut out the seroquel. With an amphetamine on board during the day, you wouldn't have to worry so much about lingering sedation from the remeron, especially if you could ramp it up to 30-60mgs. But, hey--I'm not a doc, that's just what I'd try before tapering something that seems at least somewhat useful.
I know this sounds new age-y or whatever, but if I were you, I'd look into supplements. mainstream medicine doesn't seem to be helping you all that much, so it might be time find yourself an alternative (I'd personally recommend Orthomolecular) doctor and see about addressing your depression/mood issues through nutrients.
Posted by Lou Pilder on April 16, 2011, at 8:42:05
In reply to Clonazepam (Klonopin) 'Tolerance Withdrawals'?, posted by Laurie1041 on April 16, 2011, at 1:27:05
> History of Anxiety Disorder x 1 year, age 19 in 1979.
>
> Started on Klonopin 1 mg. (for panic attacks induced by start-up of Effexor XR for depression) at age 40 in 2000 (bad marriage, stress at work).
>
>
> Started Provigil for Shift Work Sleep Disorder (night shift) in 2007.
>
> Hospitalized at age 47 for supposed BP I, Mixed, after a huge spending spree and ensuing depression. Note that I had been started on Provigil. I had to leave my profession as a RN and have not worked since 2007.
>
> Hospitalized x 2 at age 49 in 2009 for severe depression after death of my husband. I was in a manic state for 4 months after being discharged on Adderral XR 30 mg. BID.
>
> Hospitalized x 3 at age 50 in 2010 for severe depression.
>
> Started Cognitive Behavioral Therapy in 2010 and continuing.
>
> All SSRI's/SNRI's do not work.
>
> Lithium - well tolerated, no side effects. It has lost it's punch.
>
> All atypical anti-psychotics give me EPS, with the exception of Seroquel. However, my pdoc is hesitant to keep me on Seroquel due to metabolic syndrome. Plus Seroquel XR 150 mg. BID makes me dumb as a rock.
>
> Wellbutrin - major anxiety and mood lability
>
> Nortryptaline- 50 mg. major oversedation
>
> Tegretol - somnolence
>
> Trileptal - depression
>
> Current Meds:
>
> Pristiq 100 mg. QD
> Levothyroxine 0.112 mg. QD
> Adderrall XR 30 mg. QAM
> Lithium 900 mg. QHS
> Klonopin 2 mg. QHS
> Seroquel 25 mg. QHS
>
> My theory is that I may be suffering from "Tolerance Withdrawals" from long-term "medically-dose" stable clonazepam use (11 years).
> From what I have read "Tolerance Withdrawal" can result from a stable dose of benzodiazepines and can cause paradoxical symptoms of withdrawal, including, severe depression, suicidal ideation, anxiety, and panic, to name a few. I have had and continue to have all of these symptoms.
>
> My benzo use (1 mg. x 10 years, 2 mg. x 1 year) has never been addressed by the multitude of professionals I have consulted with. My pdoc listened very politely to my theory regarding my treatment resistant depression and said I could reduce my dose of clonazepam from 2 mg. to 1.75 mg. each night. I went into withdrawals after 5 days of tapering and after 3 weeks of hell, my pdoc instructed me to go back to 2 mg. at night. I can only assume that my pdoc does not agree with my benzo "tolerance withdrawal" theory and does not exude confidence when it comes to getting off long term benzodiazpines.
>
> I consulted with a Internist who specializes in chemical dependency and he said he would have no problem in helping me to undergo a very slow taper except for the fact that I have a psych history. (?)
>
> I consulted with a recommended pdoc today and brought my sister and step-mom with me for the consultation and he glided over getting off of clonazepam and said that his first goal for me would be to treat my depression. What a novel idea!! I said I had been on every class of meds and he recommended that I taper off of my SNRI, wait for 7 days and start on the Ensam patch. But what he really thought would be best would be to taper down to 1 mg. of clonazepam and then start rTMS (repetitive Transcranial Magnetic Stimulation) therapy at $8500.00 for 4 weeks and then $450.00 per session thereafter for a total of 6 weeks. This sounds like junk science to me.
>
> Any suggestions? I need some hope!
>
>
> Laurie1071,
You wrote.[...long-term..clonazapam use...Tolerance Withdrawal..severe depression..suicidal ideation...contimue to have...3 weeks of...any suggestions..need hope...].
There is an increasing body of evidence that substantiates what you have posted concerning BZD addiction and withdrawal. In fact, there are many sites dedicated to helping those that want to rid themselves of this drug. I am not a member of those sites and know how one can be free from addiction/withdrawal from BZDs
One way to be free from this drug is by human achievement. Another is by divine accomplishment.
The valley that you find yourself in now may look as if there is no hope that you are seeking, surrounded by high walls. But be of good cheer. I have found that those in the tribulation that your are experiancing can overcome the addiction and withdrawal and sing a new song.
> I am prohibited from posting here what has been revealed to me, that I believe, as to how you could have a new life, free from drugs. I really want to help you, I really do. And there is now a new prohibition to me from the owner of this site that I can not post here where you can find this information.
Lou
>
>
>
>
Posted by Phillipa on April 16, 2011, at 10:57:45
In reply to Clonazepam (Klonopin) 'Tolerance Withdrawals'?, posted by Laurie1041 on April 16, 2011, at 1:27:05
Laurie I was also an RN and had to quit at age 50 due to excalating anxiety a mixture of hasimotos thyroiditis and thyroid doing wierd things that made me extremly anxious, menopause, find out chronic lymes disease and other medical problems. It's 41 years for me now on benzos and have tried and used most of classes of meds. I'm having problems taking normal for me doses of benzos as seem to need less but anxiety is worse. I don't feel depressed just can't get it together. Have had bad marriages didn't get me down at the time. My pdoc wants me on higher doses of benzos but I refuse. She thinks that all the accumulated crisis during life have caused me to lose my ability to cope. Don't know if true or not. I wonder if a corrolation between age, thyroid and type of work also. Although I loved nursing. Will follow your thread carefully. Phillipa
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Dr. Bob is Robert Hsiung, MD,
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