Klonopin withdrawal or re-emergence of anxiety???
Erin writes in with a very common question:
I am coming off Klonopin. I am currently at .25mg. and have been for three nights. Does the withdrawal symptoms have a peak and then they get better? I really want to stick it out but I am feeling pretty crappy.
There are a number of factors that go into the answer for this question. First (and sometimes easiest) issue is this–do the current symptoms that you have feel like the anxiety that you used to have before the Klonopin (or other anxiety medicine) was started? Klonopin, like other benzodiazepines, is no cure. It helps to alleviate symptoms while it is present, but, once removed, previously experienced symptoms may return. If what you feel is that old demon anxiety . . . it has little to do with ‘withdrawal’ from Klonopin. It just isn’t there to work anymore. The solution may be to restart the Klonopin at the last effective dose, and/or try an antidepressant that has antianxiety efficacy, and/or do some hard work with a cognitive behavioral therapist. It is certainly possible that what you are experiencing is true withdrawal symptoms from the absence of the Klonopin. That would depend on several factors including: (1)how high a dose you were on (if you were on really high doses you might have more difficulty getting off), (2) how fast you are getting off (more likely to have anxiety and withdrawal with a quick taper) and (3) your own biological sensitivity (cannot measure that but you know yourself better than anyone else).
Regardless of the reason for the difficulty, what I typically do if someone is having a difficult time coming off the medicine is to go back to the last dose that was effective and then slow down the taper schedule. Unless you are in a particular hurry (eg, getting pregnant soon), it may be better to make the taper schedule very long and slow. The duration of withdrawal symptoms can be anywhere from a few days to a few weeks. Typically, 7-14 days is sufficient to wait out withdrawal symptoms . . . but who says you are typical! But seriously, if you did the standard taper of 0.5 mg Klonopin for a few weeks and then go down to 0.25 mg for a few weeks you are unlikely to be experiencing “withdrawal” unless you have a particular biological sensitivity. Again, that would be addressed by a more gentle taper. Talk to your psychiatrist about going down by 1/4 tablets rather than 1/2 tablets every few weeks or so.
The following url will get you to the website for the American Academy of Family Physicians. Once there, type in Klonopin withdrawal and you will get a good overview of benzodiazepine withdrawal symptoms and the management of it.
Hope you feel better soon.
–Dan Hartman, MD
