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Dr-A-Greene
Dr-A-Greene, Doctor
Category: Mental Health
Satisfied Customers: 190
Experience:  Clinical and Forensic Psychologist
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I currently take 1.5 mg of clonazepam per day for anxiety,

Customer Question

I currently take 1.5 mg of clonazepam per day for anxiety, but recently, I feel like I've built up a resistance to it and I'm starting to feel withdrawal symptoms (anxiety, EXTREME lethargy, headaches and overall just feeling like crap, for lack of a better word.) I'm also feeling more depressed than I was when I initially started the clonazepam about 6 months ago to the point where both the anxiety and depression are becoming quite overwhelming. I have about a seven year history with anxiety/depression that tends to come and go. My GP gave me a prescription for Zoloft, but I'm afraid to begin taking it as the clonazepam seems to be fading and I *hate* the idea of upping my dose of that. Should I try the Zoloft (25 mg starting dose per day)? I'm afraid that it will make my anxiety worse, or, make me feel like a lethargic zombie. Please help.
Submitted: 2 years ago.
Category: Mental Health
Expert:  Dr-A-Greene replied 2 years ago.

Hi there - I would like to assist you if I can. Basically I think that you're right on target with the clonazepam. It sounds like you're probably addicted to it and are suffering withdrawals during the downtime between doses. There is always a high risk of this occurring with benzodiazepines and it is usually recommended that they are only taken sporadically, as needed. 1.5mg is a fairly substantial amount to be taking every day. My guess is that this is factoring heavily into the increase of depressive symptoms as well.

My recommendation would be to go ahead and start the zoloft. I think it's unlikely that it will make your anxiety worse (unless this is something that you experienced as a side effect before). I would then give it some time to get into your system (a couple of weeks) before systematically decreasing the clonazepam. The zoloft should eventually combat the anxiety too, which will eliminate the need for benzodiazepines.

Let me know your thoughts

Thanks,

Dr. G.

Customer: replied 2 years ago.
Can you recommend some sort of tapering schedule for the clonazepam? I started at 1mg (2x a day) and moved up to another .5mg a few months ago. My GP doesn't seem to think that taking it every day is that big of a deal, though she's just a general doctor, not a specialist. I just don't know how I'm going to continue dealing with the withdrawal feelings that I already feel. It's making work increasingly difficult to get through (I'm a SLP and work with kids, which is quite demanding) and I guess I just feel like I'm at my wits' end.
Expert:  Dr-A-Greene replied 2 years ago.

Wow - it sounds like you have some stress with work (I admire your profession!) and the med withdrawal can't be helping. I'm sorry to hear you're in this situation. It happens a lot, especially with general practitioners it seems. I hate to say that, as it's a generalization (and some are excellent!), but I tend to see it a lot.

So, if you want to discontinue, I will try to recommend a schedule that isn't too demanding.

As suggested above, I would begin the zoloft and stay on it for a few weeks first if you can. This will give it some time to build up and counteract some of the mood symptoms. It's not recommended to taper down off a benzo and taper up on an SSRI at the same time.

Then, after several weeks, you can begin a slow taper. I would suggest getting a pill splitter to be able to decrease in smaller doses. In general, try to decrease by around 10% every 10-14 days. So, if you're taking 2.5mg a day, go down to 2.25 for 10 days, etc. Clonazepam has a long half-life, so it will take a long time for a non-disruptive taper (for example, if you quit cold turkey, it would take 5-7 days for the worst withdrawal symptoms to hit). However, I think the schedule above should be alright.

If you experience severe withdrawal symptoms, you could supplement the withdrawal with diazepam. Some people have to do this, as it lessens the withdrawal symptoms. Of course, then you need to discontinue the diazepam after that, so it can be messy.

My guess is that if you get the SSRI into your system for a while and go down very gradually you should be doing great in a couple of months. I know it's not fast, but it's safe, which is more important.

I truly hope this helps...

Thank you!

Dr. G.

Dr-A-Greene, Doctor
Category: Mental Health
Satisfied Customers: 190
Experience: Clinical and Forensic Psychologist
Dr-A-Greene and other Mental Health Specialists are ready to help you
Customer: replied 2 years ago.
Thanks so much for your advice. I truly appreciate it. I'm actively trying to find a psychiatrist and/or psychologist in my area, but I live in a small town and options (including seemingly competent doctors) are limited.
Expert:  Dr-A-Greene replied 2 years ago.

I completely understand. The old school of prescribing didn't take into account the addiction potential of benzos with long half-lives (like Valium and Klonopin). Luckily the new school of thought is to only prescribe small doses of shorter-acting meds like Ativan (which may be an acceptable option for you in the future). I truly hope you're able to find someone who is more in touch with that. I'll keep my fingers crossed... However, you sound like a very proactive and intelligent woman - I have no doubt that you'll get through this and come out the other side a stronger person who continues to advocate for herself!

Best wishes,

Dr. G.

Expert:  Dr-A-Greene replied 2 years ago.
Hi - it's Dr. Greene. I was just emailing you to find out how it was going with the medication (if you've started the zoloft, etc). I've been thinking about you and just wanted to check in.
Take care,
Dr. G.
Customer: replied 2 years ago.
Hi Dr. Greene,

I started the Zoloft (25mg) this past Friday evening and so far so good - some typical side effects, but they are minimal and I'm able to deal with them. My mood has lifted a tiny bit, but I spoke with my GP a few days ago and she mentioned it could be PMDD, but I don't really know. I'm still taking 1.5 mg of clonazepam a day and just trying to be positive - fake it til you make it, right? I'm not going to start tapering the dosage of clonazepam until I feel steady on the Zoloft. I'm also going to see a psychologist next week, so we'll see how that goes. Anyway, that's the plan for now. I really appreciate you checking in with me. You've been more helpful and caring over the internet than doctors that I've sat face to face with, so I sincerely XXXXX XXX for that.

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