Tapering quickly off Klonopin . . . or . . . how to drive yourself crazy and feel like crap

Dawn writes in . . . actually . . . shouts in . . . 

HI I WAS ON KLONOPIN FOR ABOUT 15 YEARS NOW AND I AM TRYIGN TO WEAN MYSELF OFF. I AM NOTICING I HAVE THE SHAKES, I CANNOT THINK STRAIGHT AT ALL, I CANNOT RETAIN MUCH OF ANYTHING, MY FACE GETS ALL TINGLY AND IT GOES NUMB.ALSO, MY MIND SEEMS OT FOCUS MUCH MORE ON OBSESSIVE THOUGHTS. SOMETIMES I EVEN FEEL LIEK IM GONNA LOSE MY MIND.I DONT FEEL LIKE MYSELF AT ALL AND I CAN DEFINATELY TEL LTHE DIFFERENCE BETWEEN A PANIC ATTACK, WHICH I GET EVEN ON THIS KLONOPIN, AND THESE OTHER ODD SIDE EFECTS. SEE, I AM DOIGN THIS MYSELF. I WAS ON 3 MILS A DAY AND NOW I WENT DOWN TO 1 MIL A DAY AND ITS BEEN ABOUT 3 WEEKS. I AM FREAKIGN OUT. BUT I DINT THINK IT WOUDL BE THIS BAD. MY DOCTOR HAD SAID GO DOWN FROM 3 TO 2. MAYBE I SHOULDA DONE THAT? I DUNNO.I JUST FEEL COMPLETELY NUTTY. I WISH IT WOULD GO AWAY :0(

Yyyyiiiikkkkeeessss!!!!

Dawn . . . get back on the klonopin . . . NOW.

As you all know by now, Klonopin is one agent in that wonderful class of medicines called benzodiazepines . . . the antianxiety tranquilizers.  They work well.   They work quickly.   And are dangerously seductive for people who tend toward the anxious.  While not the first line agent for anxiety in most cases, 15 years ago they were.  Since then, we have modified our approach as we discovered how effective the SSRIs can be in managing anxiety for most people.  But even tho’ the benzos are highly effective, they are far from the perfect solution for anxiety.  As Dawn describes so eloquently above, they don’t necessarily take care of all the anxiety (she has breakthrough panic) and they can be very addictive.  Once you are on these for years, you will have trouble getting off.  And 15 years on 3 mg is a long time . . . a verrrryyyy long time.

You mention that your doctor recommended that you go down to 2 mg and you decided to go to 1 mg on your on.  Well, Dr. Dawn, seems like you made a mistake.  I would urge you to listen to your doctor’s advice and increase your dose.  Call him ASAP and let him know what you did and how you feel.  Going down too fast on Klonopin after all that time is physically and psychologically dangerous.  You sound like you feel horrible.

How would I approach this if I was your doctor?

First off, I would explain that the likelihood of your anxiety getting worse is very, very high.  If you are on 3 mg of Klonopin and getting breakthrough  anxiety anyway, you are likely to have more breakthrough anxiety on less.  You better be prepared for it.  If possible, I would get you on an SSRI to manage your anxiety before we started down.  My guess is that either you are on one or they have been tried before (15 years on Klonopin is a long time).  Tapering down off Klonopin after being on it that long just takes time.  A long time. I would go down no faster than 0.5 mg every month.  If there were any withdrawal symptoms (and what you are experiencing are potentially dangerous withdrawal symptoms) I would slow it down even more, decreasing by 0.25 mg every month . . . or even slower.  If you experienced uncomfortable panic symptoms, I might also slow down the rate of taper.  

If the ultimate goal is to get off, it is best to go slow.  As a general rule of thumb, the higher the dose and the longer you are on it, the slower you must go in a taper of Klonopin.  Going too fast increases the chance that you will be uncomfortable and eventually give up on the taper and go back to the higher dose.  If you do, you may not have any interest in decreasing the dose again . . . and you risk feeling defeated because of it.  I think it is an admirable goal to try to be on less medicine.  But it is not always possible.  To do it correctly requires careful thought and planning, a great deal of patience, and is best done under the careful supervision of a doctor that you trust.  If you are getting advice from a doc you trust . . . take the advice.  If you don’t trust the doc . . . get a new doc.  Don’t take this matter into your own hands, however.  Getting off Klonopin can be tricky and dangerous and is best not done on your own.

–Dan Hartman, MD