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Dr_Anderson
Dr_Anderson, Doctor
Category: Mental Health
Satisfied Customers: 335
Experience:  Psychiatrist
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Hello, I have been taking both klonopin daily (1.5 mg)

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Hello,

I have been taking both klonopin daily (1.5 mg) and started viibryd 4 weeks ago and am currently at the 20mg daily dose of viibryd. I am being treated for anxiety disorder. The reason I started the viibryd was because my anxiety was not being controlled effectively by the klonopin alone, and I believe I was building a tolerance (4 months klonopoin started at 1 mg per day). My anxiety is much better now probably due to the addition of viibryd. I would like to taper off klonopin eventually because it is not meant for long term use. How long should I wait before I begin to taper off? Also, can my anxiety be treated effectively by the viibryd alone? My plan is to be on a medication safe for long term use and will eventually like to taper off viibryd as well. thanks.

Dr_Anderson :

Greetings, and welcome back! The answer to your first question is, you can begin to taper any time that you want. BUT, since the Klonopin was being used to treat the anxiety, I would wait to taper it once you feel the Viibryd is working. How will you know? Well, the easiest way to tell is to take a little less of the Klonopin once. If your anxiety remains steady or absent, the Vibryd is working, doing its job. Another way to check on the effectiveness of the Viibryd is to start the Klonopin taper. As you go down and off, monitor your anxiety, whether or not it resurges.

Dr_Anderson :

The answer to your second question is, yes! The Viibryd alone can do the job to control your anxiety.

Dr_Anderson :

Now, as for the taper off the Klonopin, we chatted about that a while back, but do you have a tapering plan?

Customer:

Thanks, doc. That sounds like a reasonable approach. I must say that my anxiety is currently a lot more under control since the introduction of viibryd.

Customer:

It is a much more subtle effect than the klonopin in terms of anxiety reduction

Customer:

I don't really "feel" the viibrd but my anxiety is lower

Dr_Anderson :

Yes, that is what it and meds like it are supposed to do - kind of like how a virus and trojan horse program OUGHT to work on your computer - there, strong and present enough to know it is there, but silent enough to be in the background and non-intrusive.

Customer:

i'm currently on twice daily doses of 0.75mg klonopin, once in the morning and once at night. My pdoc suggested we take 0.25mg off and hold at the dosage for 2 weeks and then continue reducing 0.25mg every 2 weeks. for example, I would start with:

Customer:

day: 0.5mg

Customer:

night 0.75mg

Customer:

after two weeks:

Customer:

0.5mg day, 0.5mg night and then continue on

Customer:

perhaps leaving the last stage of taper on the night dose to combat any possible major insomnia

Dr_Anderson :

Yes, that looks like a very solid plan. And if you start to get significant withdrawal symptoms (insomnia, shakes, rebound anxiety, etc.) any time during the taper, you can slow the taper down at that dose.

Customer:

yes, I've tapered off of klonopin back in 2009.

Customer:

I remember drinking alcohol during the taper made it a lot harder, so i intend to stay as dry as possible this time around

Customer:

the SSRI should help with the anxiety increase of klonopin withdrawal right?

Customer:

I will take it slow and listen to my body and avoid alcohol bc it is cross tolerant

Dr_Anderson :

To a degree, yes. It will not help with any withdrawal symptoms you have, as listed above, but it will help with any anxiety associated with the withdrawal. It's a double-edged sword - withdrawal can lead to anxiety, and removal of the Klonopin can also lead to anxiety if the Viibryd is not fully functional yet. But, it is hard to flesh apart which is the culprit. Going slowly, if the anxiety kicks in and goes away, it is most consistent with withdrawal. If it kicks in and persists, it is likely the actual anxiety disorder itself.

Customer:

Okay that makes sense. I've been on 20mg of viibryd for only one week now and will postpone my klonopin taper for at least a few more weeks.

Customer:

I want to wait until I get the full effect of the SSRI before tapering. My pdoc suggested that there is room to increase the SSRI dose to 30 or 40 mg per day if needed also

Dr_Anderson :

Yes, that would be my advice. This way if you get rebound anxiety, you'll know that an increase in the dose of Viibryd may be called for, up to 40 mg.

Dr_Anderson :

All in all, a very solid plan, and calculated to go slowly/evenly. Please let me know if you have additional questions, and I'm glad you are getting relief with the Viibryd!

Dr_Anderson :

Regards,

Dr_Anderson :

Dr. Anderson

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