Hi! I believe I can be of help with this issue.
I am very glad you are weaning yourself off from Klonopin. Benzodiazepines are extremely addictive. Klonopin does not have the worst record for withdrawal symptoms and it sounds as though you are doing okay with the tapering down. Your procedure is right on target. You might want to slow it down by one day to 5 days between changes. That's a bit more traditional. But if you're tolerating it well, tapering down every 3-4 days is great.
You might also consider adding a behavioral component to your treatment for your anxiety and/or depression. I don't know if your low weight is because of an eating disorder if that is your correct body weight. So you may want to consider treatment as well for the ED if this is a problem. While behavioral treatment requires more effort from the patient than medications and is not as quick acting, it doesn't have the side effects nor withdrawal symptoms of the medications. If you would like to introduce a behavioral treatment, feel free to ask me another question about it. Just write “For Dr. Mark” at the beginning and everyone will know it’s for me.
Okay, I wish you the very best!
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And this is actually the key to my answer to you that you need to think about and consider and act on. Your symptoms are severe enough that I can recommend psychotherapy to help as well as self help efforts. Yes,you had therapy before, but I don't think you're done with the work. I will also at the end of the posting give you a technique you can use on your own as well for when you are in the throes of anxiety and fear and worries.
Let's work on five ways you can begin to build a behavioral program for yourself: diet, exercise, spiritual life, motivational reading and psychotherapy. The first four are to help you feel more involved and in control of yourself and what's going on inside. The psychotherapy can actually teach you skills and give you tools for managing your symptoms.
Diet: cut out coffee, sugar, white flour. That may be tough. But you will see results as some of the newer research shows. And lean meats only. No fast food restaurants, no fatty foods. See what I mean about getting involved in controlling what's happening? With diet changes you are treating your problem with respect: you are acknowledging you need to make changes to get your body feeling better.
Vitamins can be useful for moods. A good quality daily vitamin, for example. One of the most important supplements is Omega 3 fatty acids, either in fish oil or capsules or in flax seed oil. Buy good quality. The clinical dosage is 800 to 3,000 mg daily. Start with the middle of the range. All these things you should get at the biggest and most frequented health food store and ask them for the best brands they trust in terms of quality.
Exercise: 5 days a week moderate exercise, to include 3 days of strength training as you get more used to it. Pretty amazing isn't it? I told you it would require work, but what you put in to it you will get out of it. Your doctor will verify the research results showing the benefit.
Spiritual life: the medical literature is now rather overwhelming about the benefits to so many different areas of physical health of regular religious and spiritual practice. Going to church, meditation, etc. are all shown to produce benefits to the physical body. What about our mental health? Well, you will see that meditation is now a regular part of psychotherapy interventions. I don't know if you're a religious person or not. But if not, this may be a good time in your life to tune up your spiritual life. If you do not believe in G-d, that's not a barrier to your own spiritual life. Just thinking about the meaning of your life, of life in general, and studying spiritual texts and practices will help with the anxiety, panic, and depression.
Then along with exploring the spiritual part of life, I want you to get really into motivational videos and books. Here's a simple YouTube search I put together for you on "motivational speakers": http://www.youtube.com/results?search_query=motivational+speakers&aq=f Some like Tony Robbins are the classic big guys. Some are newer. Watch them all. Get inspired. Buy a book or two. Here are some possibilities, but they are only suggestions as there are so many good ones.
The first book is the father of all these type of books. How to Win Friends and Influence People by Dale Carnegie. There are classes in these books now! It was written in the 1930s and still has something to say to us today that is very worthwhile.
I think very highly of the second book on my list, which is a real classic: The Seven Habits of Highly Effective People by Stephen Covey. It is the book that has helped more people than probably any other. The third book is by Anthony Robbins. He's one of those speakers who fills up huge auditoriums. For a reason. He's a terrific speaker and writer. The particular book (if you like it, try his others): Awaken the Giant Within.
Which brings us to psychotherapy. You need to find a psychologist or psychotherapist to help you manage the anxiety and other symptoms. Fortunately, anxiety and panic are among the most researched disorders in terms of effective treatments. And the therapies today are very effective. The preferred form of treatment today is Cognitive Behavioral Therapy to learn skills. Here is the Amazon web page address for the classic workbook for anxiety by Edmund Bourne: http://www.amazon.com/Anxiety-Phobia-Workbook-Fourth/dp/1572244135/ref=sr_1_1?s=books&ie=UTF8&qid=1286170992&sr=1-1
If your doctor isn't able to refer to anyone, here is the web address for Psychology Today's therapist directory. You can sort by zip codes and when you see someone who seems like they might be helpful (they show you a photo of the therapist!) look at the listing and see if they list psychodynamic and CBT therapy in their orientations and depression and anxiety disorders as one of the areas they work with. http://therapists.psychologytoday.com/rms/ I think you should see someone who isn't as structured as a pure CBT therapist and recommend you consider seeing if the therapist also lists humanistic and/or psychodynamic therapy in their orientation. I think you have a lot of talking you need to do; a lot of emotions you need to express and work on. And that's best in psychodynamic therapy. But CBT is practical and you need that as well. The idea here isn't that these types of therapy are magic. It's that you may want to find a therapist who will form a strong therapeutic alliance with you and will help you look at the sources of your emotions and anxious reactions.
Okay, that should help you get working on these symptoms and get some relief. I wish you the very best!
Now, I want to give you a tool to use for when the worry and panic is overwhelming. Here are instructions on a therapeutic protocol called Progressive Muscle Relaxation (PMR). It's really quite easy to do almost anywhere. My patients suffering from depression and anxiety, when I teach them PMR at first are amazed how simple it is and that it is a psychological protocol. It was first used in the 1920s! Since then, of course, it has been refined and many studies have been done showing its effectiveness. You will practice PMR at first when you don't wake up with an attack so that you will be familiar with it. I want you to practice the PMR at least 5-6 times before an attack or feeling acute anxiety. Why? Because when you're in the throes of anxiety, you will only remember to do something you are very familiar with it. So practicing 5-6 times is really a minimum.
I want to stress the importance of breathing as well. Part of the physiology of what is happening to you in anxiety states is that your breathing is getting shallower. This reduces the oxygen in your blood to your brain. That increases the anxiety reaction. Not good. So breathing is the primary tool. I have found in my practice that learning breathing techniques can be helpful. But some of my patients are not interested in learning more than one thing at the beginning, so I have found that just reminding you to BREATHE deeply at the same time you are doing PMR is almost as good. If you are willing to take a yoga class and learn breathing techniques, that's the best. But, breathing deeply with your PMR will help. So, we're ready for learning PMR. I want you to print my instructions below my signature and have a copy in each of the rooms of your home where you may be when you have an attack. And again, you need to practice this easy technique at least 5-6 times as soon as you can. It needs to become as natural to you as breathing. Ah, remember breathing?
Quickly focusing on each group one after the other, with practice you can relax your body like ‘liquid relaxation’ poured on your head and it flowed down and completely covered you. You can use progressive muscle relaxation to quickly de-stress any time.
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