# Clonazepam (Klonopin)



## fhoadv (Oct 3, 2009)

Hi everyone!

I have been using clonazepam to help me to cope with SA since 1996. It worked great in the beginning then it lost its "power" due to tolerance but always seemed to help a little. I tried to stop many time but I would get severe anxiety and withdrawal symptoms. However, after reading about the "dangers" of long term use of benzos I decided to stop. So in July of 2008 I started my taper (substituting clon. for equivalent diazepam) and finished it in July of 2009. Since then my life is been a nightmare! My social anxiety is back (sometimes I manage to cope), I also have depression since I stopped clonazepam (I'm currently on 45mg of mirtazapine but it's not really helping). I'm participating of a online group for people coming off benzos and they said that all these will pass but I'm not that hopeful as it has been 2 months since I had my last pill and the symptom of SA and depression don't improve.
I will see a doc on Monday and I'm thinking of asking for Nardil and Tiagabine to help with my symptoms.

Anyway....

Please leave your comments, opinions and suggestions.

Thanks,

Fabian


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## euphoria (Jan 21, 2009)

Have you tried adding an SSRI with mirtazapine? I would try that before moving on to the MAOIs, it can be very effective, comparable to the MAOI Parnate without as many side-effects:

http://ajp.psychiatryonline.org/cgi/content/abstract/163/9/1531

An SSRI would be better than an SNRI in benzo withdrawal, you don't need the increase in adrenaline.


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## meyaj (Sep 5, 2009)

Sounds like something called PAWS (post-acute withdrawal syndrome.)

If you were dependent on benzos for 12 years it's going to take a while. One of the really compelling reasons to not get hooked in the first place is that you can be suffering from stuff like this for months (sometimes even years ) after going completely off the drug.

The good news is that in all likelihood this is not your new baseline. PAWS will pass, and even though it's not as severe as acute withdrawal, it's harder to deal with for a lot of people because of the sheer length of time involved.

I REALLY want to commend you for toughing it out and looking for a better long-term solution, rather than just do the easy thing and get back on the benzos. Many, if not most, don't have that kind of strength.

Unfortunately, given how long you were on clonazepam, still feeling crappy after two months is not really a surprise at all. So don't worry that this is how you're going to feel like for the rest of the life.

Now there are people on this board with a better knowledge of psychopharmacology than I, but I feel that switching to other GABAergic drugs (Nardil and Tiagabine) is not all that different than using a benzo to deal with the PAWS. It seems really counter-productive. Maybe somebody with much deeper knowledge on the matter can chime in and disagree.


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## Drew (Jan 23, 2006)

As I'm currently taking clonazepam and considering tapering off, I've taken notes on what some others have said on the forum about how to make the process easier (to talk to my psychiatrist about).

Most of the posts are from the user medline. I hope he doesn't mind that I repost them. 



> Everyone who is moderately-severe physically dependent on benzodiazepines should consider the method of substituting the benzo with an ~ equivalent dose of phenobarbital / primidone and then tapering the dose of that drug down without feeling withdrawal symptoms nor sedation for about 3-4 weeks...
> 
> ---
> 
> ...


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## meyaj (Sep 5, 2009)

Drew, (s)he's already tapered off completely for 2 months now, none of that stuff is really going to help her.


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## Drew (Jan 23, 2006)

meyaj said:


> Drew, (s)he's already tapered off completely for 2 months now, none of that stuff is really going to help her.


Ah, ok, thanks for the correction! I wasn't sure if it would still help at this point.


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## meyaj (Sep 5, 2009)

lol, I just re-read my post and to me it seems like it may have been a bit blunt and rude... sorry if it was


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## Drew (Jan 23, 2006)

meyaj said:


> lol, I just re-read my post and to me it seems like it may have been a bit blunt and rude... sorry if it was


No apology needed! I didn't take it that way at all. I'm well aware that most of you guys who post regularly in the Medication forum know a lot more than I do.


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## Medline (Sep 23, 2008)

Drew said:


> Most of the posts are from the user medline. I hope he doesn't mind that I repost them.


No problem with that.  When I see all my positive posts about (desoxy)phenobarbital for benzo withdrawal listed here it nearly seems I'm the guy who has the exclusive rights to sell Pheno worldwide.  But my experiences with Pheno for (acute) benzo withdrawal were really all positive.

I think i read once that in case of protracted benzodiazepine withdrawal (PBW) going on low-dose phenobarbital for some time and then tapering it down helps, but I can't find that article right now and I really can't say if Pheno helps with PBW.

Some controlled studies show that the benzo antagonist flumazenil helps with PBW, but receiving this intravenous drug treatment will be very hard.


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## fhoadv (Oct 3, 2009)

Thank you all guys for your replies!

Medline is right, flumazenil would help but I don't think I could get a doctor to prescribe me that. They don't take withdrawal that serious and think that what I'm having is my baseline anxiety accompanied by its symptoms (I know it's not).
I'm desperate because I started my second year at Uni and I am having a hell of a time and was thinking of putting it on hold (what I can't really afford to do) until I am completely free of symptoms.

I have been reading some replies and other threads and realised that some of you guys are quiet well versed on this subject (pharmacology in general), so I would appreciate more advice in what to do.

What should I get to help with my _severe_ SA, depression, anxiety and withdrawal symptoms?

I thought of tiagabine because it's used to help people coming off of alcohol and it's not addictive and doesn't seem to develop tolerance.

What about baclofen?

Maybe take 1 clonazepam pill now and again with d-cycloserine (I looked online to get it and it's quiet expensive) to help with the "extinction" of my SA?

Anyway, thanks once again and please leave more opinions, advice, comments, experiences .... anything.


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## Medline (Sep 23, 2008)

Baclofen works on GABA-B, but your long-term benzo use has probably "messed up" you're GABA-A system. I think you could try Lyrica (Pregabalin). It is approved in the EU for generalized anxiety disorder and has shown to be an effective and well tolerated treatment for social phobia in a multicenter, double-blind, randomized, placebo-controlled study @600mg / day (http://cat.inist.fr/?aModele=afficheN&cpsidt=15707506). It can be combined with antidepressants if neccessary.


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## euphoria (Jan 21, 2009)

I tried pregabalin on withdrawal from about 2-4mg clonazepam, it helped anxiety a bit but made me so depressed it wasn't worth it. Truly horrible feeling. I was still shaking like a leaf, and had to sit an exam... I failed.

OP, for 'resetting' your GABA receptors, flumazenil one of the best methods in PAWS. Or, as suggested, phenobarbital may work. I don't think GABA(B) agonists will target the right receptors.


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## fhoadv (Oct 3, 2009)

Another thing guys: is there anything that I could use to up-regulate (even temporary) my GABA system? Or something that I could use for my anxiety (and or) GABA that doesn't develop tolerance (at least not as fast as benzos). I have heard of Vigabatrin, Tiagabine others similar.

Any ideas and suggestions are welcomed!

Thanks.


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## Medline (Sep 23, 2008)

You can forget about Vigabatrin because of toxicity.


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## fhoadv (Oct 3, 2009)

I tried pregabalin and it did work reasonably for SA but I had restless legs syndrome while on it so I had to stop. Besides, withdrawal from it is somewhat similar to benzo w/d.


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## fhoadv (Oct 3, 2009)

Medline said:


> You can forget about Vigabatrin because of toxicity.


Ok, I won't mention this one to my doctor.

I have been waiting to see him for so long that during the appointment I have on Monday I need to know the best path to suggest to him otherwise he will just switch the antidepressant or increase the dose.

Thanks for your advices!


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## euphoria (Jan 21, 2009)

> Maybe take 1 clonazepam pill now and again with d-cycloserine (I looked online to get it and it's quiet expensive) to help with the "extinction" of my SA?


I wouldn't take cycloserine at all really, but definitely not on benzo withdrawal. As an NMDA agonist it could cause excitotoxicity.

I stick by my recommendation of an SSRI with your mirtazapine. Tiagabine could probably work for the GABA, yeah. Also, if you don't already, take magnesium supplements. This should help depression & anxiety in benzo w/d, and act as a general neuroprotective. Don't take too much though.


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## fhoadv (Oct 3, 2009)

euphoria said:


> I wouldn't take cycloserine at all really, but definitely not on benzo withdrawal. As an NMDA agonist it could cause excitotoxicity.
> 
> I stick by my recommendation of an SSRI with your mirtazapine. Tiagabine could probably work for the GABA, yeah. Also, if you don't already, take magnesium supplements. This should help depression & anxiety in benzo w/d, and act as a general neuroprotective. Don't take too much though.


Thanks Euphoria!

What kinds of magnesium supplements do you suggest (reliable sources) and other supplements?

Thanks.


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## meyaj (Sep 5, 2009)

I take KAL magnesium glycinate supplements, 400mg/day... my doctor recommended that specific form, much more absorbable and doesn't act like a laxative like other forms of magnesium. It does help.

Again, I would urge staying away from any GABAergic drug to lessen symptoms. Benzodiazepines have a particularly bad reputation, but going on Lyrica or other GABAergic drug to deal with PAWS is going to be like giving a recovering heroin addict some oxycodone. It's only going to serve to keep your GABA receptors downregulated, and rather than helping get you through this uncomfortable period, it's really just going to delay it, possibly making you start back from step one.

You've been strong for 2 months now which is more than most can say, and although the GABAergic drugs may seem like an easy and enticing way to make things more comfortable for you, it's not going to let your body get back to its own homeostatic balance. I promise you'll get through this with a little patience, and there are many drugs that can help mitigate the PAWS that have no gaba activity... it just takes a bit of work finding the right one.


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## Medline (Sep 23, 2008)

meyaj said:


> I take KAL magnesium glycinate supplements, 400mg/day... my doctor recommended that specific form, much more absorbable and doesn't act like a laxative like other forms of magnesium. It does help.
> 
> Again, I would urge staying away from any GABAergic drug to lessen symptoms. Benzodiazepines have a particularly bad reputation, but going on Lyrica or other GABAergic drug to deal with PAWS is going to be like giving a recovering heroin addict some oxycodone. It's only going to serve to keep your GABA receptors downregulated, and rather than helping get you through this uncomfortable period, it's really just going to delay it, possibly making you start back from step one.
> 
> You've been strong for 2 months now which is more than most can say, and although the GABAergic drugs may seem like an easy and enticing way to make things more comfortable for you, it's not going to let your body get back to its own homeostatic balance. I promise you'll get through this with a little patience, and there are many drugs that can help mitigate the PAWS that have no gaba activity... it just takes a bit of work finding the right one.


That's probably the best form of magnesium, yeah. His benzodiazepine (BDZ)/GABA-A receptor complex is "messed up", so I agree that going on benzos again is very likely a bad idea. But other GABAergic drugs like Nardil (which metabolite acts as an GABA-transaminase inhibitor) or Tiagabine (which acts as a selective GABA reuptake inhibitor) might effectively lessen his anxiety (Nardil his depression too) without being counterproductive, because they act on the GABA system completely different than benzos.

Phenobarbital is a strong GABAergic, but useful for at least acute benzodiazepine withdrawal because it allows the (BDZ)/GABA-A receptor complex to normalize while lessening or eliminating the withdrawal symptoms at the same time because it acts completely different than benzos on the GABA system.


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## fhoadv (Oct 3, 2009)

Thanks for the information Medline! 

I was thinking about trying to use flumazenil. I don't think my doctor will prescribe that, so I was thinking of getting a hold of it online and try it myself to see if my GABA receptor can be "fixed" that way. (I know it is not a excellent idea but I'm quiet desperate)


Again, opinions, comments and suggestions are welcomed.


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## meyaj (Sep 5, 2009)

Medline said:


> That's probably the best form of magnesium, yeah. His benzodiazepine (BDZ)/GABA-A receptor complex is "messed up", so I agree that going on benzos again is very likely a bad idea. But other GABAergic drugs like Nardil (which metabolite acts as an GABA-transaminase inhibitor) or Tiagabine (which acts as a selective GABA reuptake inhibitor) might effectively lessen his anxiety (Nardil his depression too) without being counterproductive, because they act on the GABA system completely different than benzos.


Yes, these drugs do have very different mechanisms of action, but I think the assumption that they won't be pushing his body's homeostatic response in the same direction is kind of wishful thinking. He's dealing with post-acute withdrawal... what he needs is time for his GABA receptors to upregulate back to a normal level. Taking other GABAergic drugs are certainly going to be counter-productive to this.

I don't know too much about flumazenil but THAT I could see working to speed up the process. In the meantime though, wouldn't it actually be even MORE anxiogenic? Also, I think with the current state of his GABA system, it would significantly increase the risk of seizures.



Medline said:


> Phenobarbital is a strong GABAergic, but useful for at least acute benzodiazepine withdrawal because it allows the (BDZ)/GABA-A receptor complex to normalize while lessening or eliminating the withdrawal symptoms at the same time because it acts completely different than benzos on the GABA system.


I don't know why people keep suggesting GABA agonists like phenobarbital!! Like you sort of said, it's useful for acute benzodiazepine withdrawal. He's been totally off the benzos for two months now! For the same reason as stated above, at this point, phenobarbital is DEFINITELY going to be counterproductive as it's not going to allow his GABA system to upregulate to a normal level, which is absolutely essential if he wants to get through PAWS. I'm aware that they work at different sites, but with phenobarbital it seems like you're just trading one problem for another.


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## Medline (Sep 23, 2008)

I know just of one online source for flumazenil which I won't name because of board rules. Flumazenil is normally administered intravenously, but it seems that sublinual absorbtion is also possible. Nevertheless I don't think you should do that.


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## fhoadv (Oct 3, 2009)

Do you guys know of ANY other substance that I could use that would act like flumazenil to speed up the recovery of my GABA system? 

Anything! I have already ordered magnesium as you guys suggested to help.

I am currently taking: Omega 3, Inositol, Choline, L-theanine, Vitamins and now and again I use oxytocin (not oxycontin!) to help me to relax.

Keep giving your opinion! They are helping a lot.

Thanks.


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## meyaj (Sep 5, 2009)

fhoadv said:


> Do you guys know of ANY other substance that I could use that would act like flumazenil to speed up the recovery of my GABA system?
> 
> Anything! I have already ordered magnesium as you guys suggested to help.
> 
> ...


Anything you could be taking is really just to deal with the symptoms. I really don't think you WANT something like flumazenil. You already have a hypoactive GABA system... to use an antagonist could speed up the process but it can make the experience MUCH worse for you, and possibly give you seizures.

Things I can recommend are vitamins B1, B6, and B12 in large amounts. Folic acid complements those well too. You have to be careful not too take TOO much though, especially with B6, which can cause nerve damage. B12 I get a large amount in monthly injections from my doctor.

Omega 3s are good is you're taking enough and buying the right kind. Not all Omega 3 is the same. if the principal ingredient is APA (α-linolenic acid), it's probably not a good quality product, as effectiveness of that particular Omega 3 is extremely low. You should be getting at least 800mg EPA and 400mg DHA if you want any chance of real benefits.

Depending where you live, SAM-e is an amazing OTC supplement. I use it for my liver and my mood, both of which it has been proven quite effective for. In North America you should be able to get it OTC as it is a natural supplement, although I believe in much of Europe it's a prescription anti-depressant! Of course, if you're already taking an anti-depressant, check with your pdoc first to make sure it's okay. I take it with a tricyclic just fine, and it should probably be okay with anything short of an MAOI. If you buy it, make sure they are enteric-coated, and come in a (hopefully opaque) blister pack. SAM-e is a very delicate chemical so these things are important. It's also why it's necessary to take on an empty stomach.

Other than that, I really don't know, but I strongly suggest staying away from any drug with any GABA effect. Your body needs to see the goalposts for GABA homeostasis, and I'd let it do its job.


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## Medline (Sep 23, 2008)

fhoadv said:


> I use oxytocin (not oxycontin!) to help me to relax.


You use (intrasal) oxytocin? If yes, how long do the relaxing effects last for you? Is it the prescription strength product "Syntocinon" which I doubt somewhat?


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## fhoadv (Oct 3, 2009)

Medline said:


> You use (intrasal) oxytocin? If yes, how long do the relaxing effects last for you? Is it the prescription strength product "Syntocinon" which I doubt somewhat?


Yes, it is the intranasal but it is not Syntocinon, I couldn't get a hold of that one. This one is called oxycalm and they say it has "similar" strength to Syntocinon (I don't believe it).

The relaxing effects don't last too long... let's say about 20min more or less but it does help to help when your are feeling too tense.


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## Medline (Sep 23, 2008)

And does it make you more "sociable" for that 20 minutes? Btw: I also don't believe that this product can be compared with Syntocinon.


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## euphoria (Jan 21, 2009)

Is there any evidence that intranasal delivery bypasses the blood-brain barrier? I'd be very wary of using BBB-impermeable drugs/supplements/meds due to the undesirable ratio of peripheral to central action, and possible side-effects.

BTW, the correct way to write *S*-*a*denosyl-*me*thionine is SAMe or SAM, not SAM-e. If any website presents it as the latter form, they very likely know nothing about it.


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## meyaj (Sep 5, 2009)

euphoria said:


> BTW, the correct way to write *S*-*a*denosyl-*me*thionine is SAMe or SAM, not SAM-e. If any website presents it as the latter form, they very likely know nothing about it.


Talk about pedantic :um

Yes, my mistake despite having a few boxes of the stuff sitting not 10 feet from me.


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## Medline (Sep 23, 2008)

euphoria said:


> Is there any evidence that intranasal delivery bypasses the blood-brain barrier? I'd be very wary of using BBB-impermeable drugs/supplements/meds due to the undesirable ratio of peripheral to central action, and possible side-effects.


Yes, intrasnasal oxytocin does pass the BBB and produces CNS effects. Just search for intranasal oxytocin on pubmed. Side effects were in general benign.

Here is also a randomized controlled trial of intranasal oxytocin as an adjunct to exposure therapy for social anxiety disorder:



> Guastella AJ, Howard AL, Dadds MR, Mitchell P, Carson DS.
> School of Psychology, University of New South Wales, Sydney, Australia. [email protected]
> In humans, oxytocin nasal administration reduces social-threat perception and improves processes involved in communication and the encoding of positive social cues. The aim of this study was to determine whether oxytocin given as an adjunct to exposure therapy improves treatment for social anxiety disorder (SAD) as indicated by a comprehensive set of symptom outcome measures. In a randomized, double-blind, placebo-controlled trial, we administered 24 IU of oxytocin or a placebo in combination with exposure therapy to twenty-five participants who met primary diagnosis for SAD. Participants administered with oxytocin showed improved positive evaluations of appearance and speech performance as exposure treatment sessions progressed. These effects did not generalize to improve overall treatment outcome from exposure therapy. Participants who received oxytocin or placebo reported similar levels of symptom reduction following treatment across symptom severity, dysfunctional cognition, and life-impairment measures. This study shows that the administration of oxytocin improves mental representations of self, following exposure therapy. These effects may be either short term or situation specific. Future research is now needed to determine whether oxytocin can enhance treatment outcomes for SAD when used with greater frequency, with a wider variety of social learning experiences, and in conjunction with interventions that more specifically target change in broader dysfunctional cognitions.


I think the short half-life / duration of action of oxytocin limits it's usefulness as a treatment for SAD. I have / had greater hope for the longer-acting intranasal carbetocin spray that is / was being tested for autism.


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## fhoadv (Oct 3, 2009)

Medline said:


> And does it make you more "sociable" for that 20 minutes? Btw: I also don't believe that this product can be compared with Syntocinon.


It doesn't make me more "sociable" but it does let me less nervous when in social situations. I'm trying to get a hold of Syntocinon to try and see if the effect is better. I don't think that Oxycalm has the same amount of oxytocin as Syntocin. The bottle doesn't show the amount (a bit dodgy).


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## fallenboy (Jan 18, 2011)

I've also been looking into Oxytocin and carbetocin for social anxiety, carbetocin is pretty easily available formulated for IV on the web, is there anything to stop me from buying this and administering it intranasaly?

Been looking to see if anybody else has tried this, or for any human studies on carbetocin delivered intranasaly and not found anything.

Any thoughts/advice.


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## planetmed (Oct 26, 2010)

Hi Fabian!

i would you like to know how you feel now? (1 year later) Did you find something helped you with your withdrawals?
Hope you are feeling better


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