Another Klonopin Horror Story . . . why do I prescribe this stuff anyway???

I have had such an overwhelming number of negative comments about Klonopin lately, I thought I would feature it in another blarticle again.  I thought I would use the following comment sent in not long ago . . .

I started Klonopin 8 years ago for “Nocturnal Myoclonus”. I had heard they were difficult to get off but not to the extent I found.

Here goes:

Changing my life. Getting healthy. Lost a LOT of weight. Now time to get rid of the chemicals poisoning my body. Started on a Monday Cold Turkey. I know, STUPID. Hit some rough patches of trembing, anxiety and did research to take Benadryl, Clonodine (which I had for my BP), drank a lot of water. Long story short….went into a full blown “PSYCHOSIS”. It was early in the morning about the 8th day. My husband got up for work. I had a bad cold and felt awful. I have heard by some the “cold symptoms” could be part of W/D. After my husband left, I felt nervous and peeked out our blinds. To my horror, there was 4 people laughing and talking by my garage. I gasped and went to another room and looked on thefront porch only to find some ghastly looking people looking at me. I called my husband screaming and crying like a 2 y/o. He tried to talk me down to no avail. He stayed on the phone telling me he was on his way back and I just kept looking…NOT Believing my eyes!!! Everywhere were people.Not like monsters but some laughing and talking. Finally my husband got back home and I was telling him “watch out, they are waiting for you to kill you”. He opening the door and grabbed me, hugging me so tight and said I was trembing in horror. NO ONE IS THERE he promised. He gently took me outside as the sun was coming up….there was no one there. The type of hallucinations you get I found out later are “Light” based. Under sources of light images form in your brain and appear distorted. They came back the next night. Inside the house. I felt a horror, and a fear like none other I have known. I was actually relieved to research by googling “Hallucinations Klonopin”. The British study is excellent.

Needless to say. I am back on my medicine and will taper very slowly over months. I was also fearful of having a seizure (that is mentioned in the literature). I had huge twitches circling from my ankles, calves, thighs, and all the way back around. Please get back on them and see someone ASAP. I also developed severe tinnitus. Everything in my house seemed to make a buzzing or horn like sound. This is supposed to be caused by the hyper sensitive hearing while in W/D. And, from what I am learning , Most people never get rid of it. i sit here now hearing a slight sound of a car horn in my ears. I will pray for you. I see it has been a while and I hope you are ok.

Yikes!!!  This story is about as bad as it gets.  It reminds me of a book that came out in the 60’s or 70’s about a poor woman who came off Xanax cold turkey and went just bonkers (10 points to whoever can tell me the name of the book . . . I’m drawing a blank).  As if the issues of addiction, sedation, impaired memory, etc are not bad enough, coming off this stuff can be a nightmare.  

So why do I prescribe it???

Because it works.  

But lets be reasonable about this.  Like all medicine, it is not for everyone.  While most tolerate the medicine with minimal side effects, some have great difficulty even with the lower doses.  As with all benzodiazepines, there is a percentage that will develop tachyphylaxis (tolerance to the medicine).  These people require higher and higher doses of the medicine to maintain there level of benefit.  I have learned over time to abandon this tactic early rather than later when the dose of the medicine concerningly high.  When folks come in who looking for their 2nd or 3rd increase in the dose of Klonopin in as many visits, I start thinking about taking them off it completely (the patient is usually quite unhappy with me!!!).  It is way better to start the weaning process early, however, rather than to wait till the patient is on high doses for a long period of time.

But, as mentioned in many of the letters sent in, it is getting off the stuff that is the greatest difficulty.  This is especially true if you have been on higher doses for longer periods of time, but it can be difficult even if you have only been on the medicine for months (as opposed to years).  The biggest error in getting off is going too fast.  We live in an impatient world and people want change NOW.  Our biological system does not work that way.  Slow changes are accommodated much easier and the psychological burden of a slow change is much less.  As mentioned many times before, there is a difference between withdrawal effects and return of anxiety . . . and that difference can be difficult to tell in some people.  But always, always, always, the risk of difficulty is minimized when doses are changed in very small increments with lots of time in between the change.  Don’t get impatient.  Keep your eye on the goal of getting med free.  Make sure you are doing all the other things that are good for you (good food, exercise, therapy, etc).  When done right, the chances of getting off the medicine can be much higher and still leave you feeling good in the process.

–Dan Hartman, MD