Klonopin Withdrawal – 2 Weeks In

I’ve had to take a step back in my titration off klonopin. I was supposed to be off of it in 4 weeks, now it’s 6 weeks. The change was just too sudden and the complications were too many.

At first, it was the usual physical symptoms of shakiness and anxiety. Those I could deal with. I even had some mild paranoia, again, that’s fine with me. It might sound strange to some readers that having a constant feeling of an impending panic attack is manageable, but it is. There’s something about cycling several times in a day that makes anxiety seem more of an afterthought than as a present danger. I obviously took breaks and kept a relatively stress free lifestyle to manage these symptoms. I’m relatively lucky as a student to have this summer vacation where I can relax. But I also think that being bipolar (or schizophrenic or other serious mental illness) has a hardening power. Where two years ago, anxiety was high on my list of problems, but now psychosis has replaced it and anxiety just seems like something I’d rather not do. It’s like going to work an 8 hour shift while sick. Unpleasant, yes, but no longer in the “worst things to go through” file.

Part of it also comes with the shift in psychologists. I’ve gone from mindfulness to social rhythm therapy and cognitive behavioral therapy. That change has produce massive results. The rhythms set up by SRT helps keep my moods in check and alerts me to any changes. And the CBT has me constantly challenging my thoughts. So rather than just letting the anxiety pass as an afterthought, I assault it, question it, and it often dies down to a certain level. But even if I don’t use CBT, the anxiety just no longer bothers me as a symptom that I really care about. I’d rather be off klonopin.

What’s getting to me is the pain. For a while I was very uncomfortable in general. My skin crawled and was hypersensitive, so everything was painful. I was shaky and weak like I hadn’t eating in two days. And then on top of it came the migraines and the leg pain.

When I was younger, I had chronic migraines. As in, I would have a migraine about 5 times a week and an underlying low grade headache 24/7. I no longer vomit or dry heave with migraines, I just go comatose. I lay without moving and my eyes are fixed in a position where they cause me the least amount of pain. That’s when it’s bad. If I really need to do something though, I can still get it done. 10 years of experience with them has increased my immunity to them. Still, they are horrific and feels like someone is drilling into my eye with a blazing hot drill. And that is not an exaggeration. While a bike mechanic, I had the unfortunate experience of a bike chainring (the large gear in the middle of the bike) stab into my back and then rip a 4 inch gash down my back. I’ll take that any day over a migraine. Migraines also make me into a very un-chummy person. I don’t snap at people, I don’t have the energy to do that. I just bitch and everything annoys me. I also look like a drug addict since hot or cold showers (and in between), feel horrible. So my appearance is pretty bad. I can’t exactly look for jobs looking like that.

The other thing that it’s brought back is my old leg pain. I’ve had it since high school and it went away. But it’s incredibly painful. I had a little bit of it before withdrawal, but I’ve noticed that the frequency has increased. It’s not pressure sensitive, so walking or relaxing doesn’t change the pain level. It’s just insane swelling that puts pressure on my nerves causing them to fire constantly. And the swelling used to be immense, I have stretch marks on my knees where my knees swelled up to the size of grapefruits. Now it’s not so prominent, but the pain still is. The only thing that I can imagine that would hurt more is if someone was using bolt cutters to take off my leg. And withdrawal has magnified that to an unbelievable level.

There are also cognitive deficiencies. It’s a problem that philosophers call updating a belief. I’ll believe that it is tuesday, when in fact it is wednesday. And even using my phone to remind me of the day, and even doing things in sequence that are supposed to happen on that day. I will remain surprised that it is in fact wednesday and not tuesday. I have a belief that it is tuesday, and no matter how much data is thrown at it, I won’t update the belief to the belief that is wednesday. As such, I’ve had to rely heavily on my phone to get basic things done on time. The problem is also not something that happened on klonopin. While on it, I would become confused about the day or time, but if I concentrated, I could update my belief. That doesn’t happen anymore. The information comes in and goes out.

All that said, the pain, the cognitive problems, I am much more myself. My girlfriend has noticed it and I have noticed it. I’m more interesting again and interested in other things again. It’s like a veil has been lifted and I can see and think again. The powers of my cognition run into problems with the pain, but you’d be amazed at just how well you can think while unable to move lest you find an uncomfortable position. In addition to that, on good days where I’m not in pain, my powers of creativity are back in full force. I was initially afraid of taking an art metals class because I wouldn’t know what to create. But in the past week, I don’t even have to think hard about it and have 4 ideas of what I want to do, all marrying the art of metal with mathematics. It’s that wonderful world of sub-mania thinking, where there are no blank sheets of paper. Just possibilities and you have to choose one.

Hopefully, the slower progress will decrease the incidence and level of pain. I’ll give it a week. If not, I’m hunting down something and trying it. Nothing too strong, just enough to take the edge off. Surprisingly though, the pain has done nothing to impact my moods. Same with the withdrawal. I’m at a very comfortable and happy 8-9 days up with 1 day down. That’s a ratio I can get behind.

Hidden Complications of Medications

Withdrawal has not been that kind to me lately. I’ve been going through approximately a migraine a day. On top of that is leg pain. It’s an old leg pain that I’ve had since high school and it largely went away as I got older. It would flare up now and again, but it was manageable. And by pain, I mean crippling pain that shoots through all my joints from the knee and below. My toes even hurt.

Before, it wasn’t a problem. I would take prescription levels of ibuprofen and that would take the edge off of it. Granted, it would tank my stomach and I would feel sick and have a lot of heartburn. But at least I wouldn’t be in crippling pain. And after my back injury, I was introduced to another NSAID called Ketoprofen. That stuff is wonderful. It took care of severe back pain, sciatica, and my leg pain. Also, for migraines, I could take excedrin. It wasn’t perfect, but it took the edge off and I could function again. I can no longer take these drugs. Any of them.

The reason for these is lithium. I cannot take ibuprofen, aspirin, or naproxen (aleve) because they will increase the serum levels of lithium and push me toward toxicity. In fact, besides tylenol, there are no over the counter pain killers that I can take that does not mess with lithium. But it gets worse. All NSAID class drugs do this. So no COX-2 drugs either. What I’m left with are anticonvulsants and antidepressants (and opiates).

However, anticonvulsants are not a reality because of possible complications with lamotrigine (lamictal). All of them score a moderate interaction on the Drugs.com interaction checker. Worse yet, the best ones not only take a while to work, but can decrease the amount of lamictal in my system. That could have devastating mood impacts. So anticonvulsants are pretty much out because they are slow and interact with another one of my drugs.

Finally, there are tricyclic antidepressants and SNRIs (like welbutrin). There are two problems with this. SNRIs make me suicidal and a little homicidal. Even at low doses they destabilize me. So no matter how effective they are, I simply cannot take them. As for tricyclics, like amitriptyline, they too are antidepressants with a risk of mania. This effect is exacerbated by taking olanzepine.

And there’s one other. A low level opiate, tramadol, also interacts with both olanzepine and lithium causing increased risk of seizure. This is because it acts on both the D2 and D3 receptors in the brain. So even low level opiates are off the table because of the medication cocktail that I’m on. Which is disappointing because tramadol is the least likely to get me hooked on another narcotic.

This just reveals the hidden complications of medication. Drugs like lithium and olanzepine interact with nearly everything. And once you throw in lamictal, everything goes out the window. And adding in bipolar disorder helps clear away the remaining drugs. The only things left for intermittent moderate to severe pain are powerful narcotics like hydrocodone and oxycodone. To some, that might sound nice. But after withdrawing from one drug, I’d rather not do it with another. They are also sedating, which is something I desperately want to get away from after taking clonazepam for so long.

However, I don’t advocate dismissing these drugs because of the complete lack of access to no nonsense pain killers. It would seem strange to jeopardize one’s mental health because you can’t take ibuprofen anymore. And I’m definitely not going to stop taking these drugs simply because I have days of pain. Even if right now I’m very badly medicating myself with a little alcohol and tylenol. What it means, in my opinion, is that if you have severe pain that isn’t handled by tylenol, get to a general practitioner and find out a medication right away that you can take. I was stupid and didn’t set up a primary care physician and am now in the lurch for not doing so. Instead, I’ll have to rely on my psychiatrist for pain meds until I can get into my July appointment, and that’s a position that I don’t want to put her in.

It’s also a very good reminder to double check every interaction with every drug because even common and safe drugs like ibuprofen can have relatively devastating effects. Drugs.com has a good one that lists the severity of the interactions and what it does. Also, talk with your pharmacist about these things. I’ve found several good ones and they know off the cuff what can’t be done or what little tricks can be taken to work around complications. It’s their job, and my psychologist informed me that there is a strong movement amongst pharmacists to demonstrate that they are more knowledgable than doctors about medication. Ask questions, they are more than happy to inform you about the latest research that they have read. Plus, and this is just me speculating, I think that they like the sexier drug cocktails that pose complex interactions. It’s a stretch to figure it all out. It’s like my experience with the university health clinic, where my doctor was more than willing to act as primary care after finding out that I had a herniated disk. I think it’s a break from the norm, which is always more interesting to intelligent educated individuals.

New To Bipolar? – My Ever Changing Views on Meds

The longer that I’m on medications and the more that I’ve had to experiment with them, the less straightforward it appears. It should be a normal course for anyone, that experience heightens the nuance of someone’s view on a particular subject. It’s good, it’s healthy, and it’s natural.

Earlier this morning I was thinking about whether I would recommend trying medication to new people or even to my old self given all that I’ve been through. I’ve had a rough year and a half with about 6 months of it in complete sedation and obliteration. These drugs are powerful and going slightly overboard with them can be devastating. It’s enough to make one think that the cure is worse than the disease at times. But that’s a snap judgment about the short term.

One the one hand, without knowing that zyprexa is such an effective medication, I would have stayed in a mental ward for a long time during my severe winter depression. And while it initially stripped me of emotions at a higher dose, it led to the discovery that a very small dose can control even my most severe psychotic states. It’s a long term realization from a short term loss.

Same thing goes for klonopin. I’ve been on it twice, and I should have learned from the first time on it to get off of it fast. But I didn’t. And now I know. It clearly works for controlling depression, anxiety, and mania and is cheap and effective. Granted, it took a while to find out all that it does, but it’s part of my armament against dangerously extreme moods and anxiety.

Then there are all the other psych meds that I’ve been on. The horrific experience of going on abilify, the failures of seroquel and risperidone. They all cost me time, money, and energy. One would think that after a while I should just give up. Or if you’re starting out, that the energy that it takes to try all these meds is worse than the energy it takes to manage the moods on their own.

I reject those ideas. I’ve always been on the side of finding a minimum level of dosing to help stabilize me and then allow psychology to help with managing the rest of the ups and downs. And that takes a lot of energy even with the meds. But the energy that I invested in finding the meds that work for me will pay off. One can think of it in terms of net gains. While in the short term I might have spent a lot of energy finding the correct medication, that energy will be saved in managing the severity of my moods. It’s restoring me to a functional level. It might have taken a bad year to figure it out, but I’m talking about the rest of my life as well. And that life will likely be longer because of drugs like zyprexa helping me out during severe depressions that will ultimately crop up a few times in my future.

I’ve also written about mood cycling before (though I cannot remember the post’s name) where as time goes on, they become easier to trigger and grow in how extreme they are. I might have been functional at one point in my life with the mood swings, but as time went on, the highs went higher and the lows went deeper, landing me in a psychiatrist’s office with suicidal thoughts. And when I went off of medication in a drug holiday, I went from a psychiatrist’s office to a mental ward. It’s best to think of bipolar disorder as a progressive disease. It doesn’t stand still and stay the same. It gets worse. It’s similar to epilepsy in many ways. So locking it down and controlling it quickly is for the best. This bad year has ultimately succeeded in getting my moods in a safe confined range where I still go up and down, but never reach anything dangerous.

Furthermore, it might be strange to think of it this way, but trying drugs that failed is a learning experience beyond just learning that drug X didn’t work. These drugs push your mood and brain around in ways that you never experience in ordinary life except for extreme circumstances. As a result of being over medicated and the feelings attached to that, I have developed a hyper sensitivity to where my mood is at any given time. Seeing what it is like to not have manic or depressed thoughts, and be rather normal, has shown me what sort of dialogue I should expect with each one. And just based upon a quick categorization of desires, motivations, and a few minutes of internal dialogue, I can tell exactly where I am and how severe my mood is. All these failures have taught me more about my mind by showing me alternative states of mind.

It’s kind of like when I had migraines every few days. The triggers were plentiful and over time I learned to avoid them. They were mainly food triggers and smells. Getting the meds right was on par with finding all the triggers for my migraines. It’s a lot of trial and error and with error comes horrific pain or zombie like states. But it pays off in the end. And in terms of migraines, I developed a sort of six sense for triggers. From just smelling something, I can accurately predict whether it’s a trigger. Took 10 years to get that, but it’s saved me from a lot of migraines. What it took was a lot of sniffing and letting my brain correlate the smell with what I ate. Just like now I have an intuition about what is going on inside my mind at any given moment. I just naturally catalog what is important and I constantly check it.

I’m never going to say to anyone that finding the right medications is easy, fun, or quick. I was lucky and did it relatively quickly and I don’t know how people go on for longer. But it’s not only worth it in terms of getting the stabilization and the energy saved from that, it’s also worth it in terms of learning more about one’s mind and how it operates.

Driving During Withdrawal And Other Things

First of all, don’t unless you have to. It is a very very bad idea. I had to make the journey up to my parents, which is usually around a two hour trip. I’ve done it many times and I know the route to the point that I don’t even need to read the signs any more to find my way onto the correct back roads to cut 20 miles off the google maps suggestion. There’s some construction here and there, but it’s pretty easy driving. But this time I started to have withdrawal while driving.

The reason is rather simple, I didn’t want to be comatose while driving, so I took my klonopin early in the day, quite early. I had to wake up early anyways, so it wasn’t a major task. But that put my dosing time at 7am, and withdrawal sets in about 9 hours after that. I left at 3pm. Didn’t time that one very well, but I had packing to do and a strong lack of motivation. So my agitation set in half way through, just when it started to get hairy anyways. I was stuck behind a slow driver. And by slow, he was on a two lane high way and was going about 10 mph under the speed limit. And there were 3 cars ahead of me that weren’t passing him. During the passing lanes, it just got jammed with lazy drivers and nothing happened for about 30 miles. I’m not prone to road rage, but I desperately wanted to ram everyone ahead of me. Even savoring the images of the car wrecks. I was not in a good mood.

Then I hit the main highway again, and it was backed up and not going anywhere. I got within 1000 feet of the off ramp and I took my chance and used the shoulder to get to it. A lot of people had that idea. Just get off the highway and take the residential roads until you connect in another 10 miles and see how the traffic is up there. The idea paid off in the end, but in the mean time I was tailgated for a few miles. That usually irks me, but this time I stopped my car and started screaming at the gal for tailgating me in a residential neighborhood. I could have easily snapped and started a fight. The other driver, thankfully, went pale and drove off leaving me alone. But the adrenaline was high, I was shaking with it. I decided that it would be a good idea to pull over and have a cigarette before heading on. It worked and the rest of the journey was uneventful.

That’s the thing that I’ve noticed about the withdrawal and the agitation associated with it. There is both a violent nature to it and an explosive one. Violent thoughts come very naturally and I don’t have the natural impulse to push them aside. And that’s coupled with sudden fits of adrenaline that just surge through me and I lose it. There isn’t much warning either, it happens in minutes at most, sometimes within seconds. So I might be mildly annoyed at one moment, which will often pass, and the next I’ll erupt. And it’s not for lack of trying to stop it. Obviously, the best idea is to challenge any ideas and talk myself down, ultimately just removing myself from the situation. But when driving, it’s harder to do that. In addition to that, when annoyed, my thoughts tend to narrow and I don’t think straight enough to step back and challenge anything.

Basically, driving when in withdrawal is a bad idea in a number of ways.

However, there is some good news on the withdrawal front. I was taking klonopin every 12 hours, which meant mornings and nights were not pleasant. I went to the pharmacist to finally refill my prescription and she noticed that it took me a while to get it in. But also noticed that I was not in very good shape because I hadn’t taken my klonopin yet. So I talked to her a little bit about it, how I have problems in the morning and at night, but also early afternoon, when I get knocked out by the klonopin. It’s a lose-lose-lose way of taking the drug. She told me to take the drug first thing in the morning and an hour or so before bed so I could sleep. And then for those few hours that I would be in withdrawal, have a single beer or a single glass of wine. Sip it, not guzzle it. Apparently the alcohol, since it too is a CNS depressant, will take the edge off if it looks like it’s going to be too much. But I’m not drinking enough or for long enough to form any dependency on it. It worked last night. I didn’t feel great, but I felt more like myself. And that was something that I usually did before going off of klonopin. I like my microbrew beer in madison, and would often enjoy one with dinner or sitting down for a movie. Never getting drunk or even close to being buzzed, just as something to drink. I won’t do it all the time, just as needed.

Today, so far, I can see that the shift is working well. I have my afternoons back, and I’m groggy before noon no matter what time I wake up. I honestly feel much more like my old self. I’ve spent the past 5 hours just listening to music and doing various things around the house. I’m also looking up new artists to listen to. It’s been fun, and I feel like I’m having fun. I’m ultimately not afraid of trying something and not liking it or failing, I’m adventurous again. I can’t wait until I’m completely off klonopin and start my summer fresh and ready (and mildly manic).

Benzo Withdrawal and Contentment

Going off klonopin is a beast. It’s going to take 4 weeks to ease me off of it, and that’s a rather moderate addiction to it. Benzodiazepines are a class of drug that is powerful, wonderful for what it can do, and over long stretches of time, quite dangerous in terms of addiction. The speed of which I’m being taken off of it is relatively fast too. If I can’t handle the withdrawal, then it’ll take somewhere around 6 to 8 weeks. It is a drug that you never want to stop cold turkey. Not only could it be destabilizing, but the withdrawal would be horrific.

I’ve already written about how my first day off of it produced some major aggressive thoughts and a general seething hatred for people. And it’s just hate, unlike mania, where you despise people or see them as beneath you and therefore dislike their existence. This was just hatred.

But that’s just the change in mood that comes from it. There’s also everything else that has come along. For starters, as much as I do not like the drug, I now have times that I crave taking it, especially at night where I’m approaching my next dose. And it’s not just desiring to have it, it’s the bare thought “I need it” that comes up. This is likely because the withdrawal symptoms are things that I would usually take the drug for. So the addiction is not only chemical dependency, but psychological dependency. And the symptoms are not very pleasant. I have much higher anxiety than usual after 10pm. I feel anxious for no reason and have a lot of tightness in my chest. It feels like I’m going to have a panic attack in the near future. But that never comes, so I’m stuck in the waiting room expecting the worst and resisting the urge to take the drug. There are also skin sensations associated with this. I feel everything and can experience pain very quickly. Pricking my finger on a knife goes from a silly mishap to a lightning bolt traveling up my arm. If I didn’t have the baby dose to take every night, I would be in hell after a few days. They say quitting cigarettes is hard, that’s not even close to this. With cigarettes, you have cravings that can become intense and you can get moody. You don’t want to scream and shout at random people or feel like you’ve just watched the scariest movie in your entire life and now can’t sit in a room alone.

Thankfully, klonopin acts rather fast, so after my nightly dose, it all goes away and I can sleep. Still, the only thing I can do in those times is watch TV since I don’t have the attention span to really appreciate a movie. But the kind of TV that I watch can help. Sitcoms are a no go unless they’re absolutely surreal, like Spaced. Sitcoms are also very loud and fast. And by loud I literally mean the way that they are mixed. It’s a normalized and compressed sound to make everything sound even and easy to hear. But it lacks realism in that voices don’t wander in and out of volume levels. It’s quite unnatural and more like commercials than like real sound. The best choice I’ve found is Wire In The Blood, which is a british crime show. The darkness of it soothes my aggression and the slower pace over 90 minutes keeps me on track. It’s very much like The Wire and Prime Suspect in its involvement and development.

It’s all rather unpleasant for those few hours every day, but the upside is that I’m much clearer during the day. I forget less and do more without constantly putting it off. And I think I have a theory for why that is. Klonopin makes me too content when I take it.

It’s like Brave New World in that klonopin is a mood. It’s contentment with how things are. That’s brilliant if I’m anxious, depressed, manic, any sort of heightened state where I’m no longer functioning properly. It tones things down. It makes me content. And that’s perfect for handling the extremes of moods. But in everyday life, that’s a bad thing. Being too content with things means that I don’t feel anything when I procrastinate. There’s no anxiety or anything and I don’t feel bad about doing it. I just pass it along. It also means that I don’t see as much need to get things done in general. As I said in another post, klonopin shifts me into neutral. My brain can be whirring along, but I can’t connect to it to do anything. It placates me into oblivion and I have to struggle to do anything. Not to mention the obligatory naps 2 hours after taking it.

And now that I’m cycling again, I can see the difference in starker contrast. During my ups and downs, I’m never fully content with anything. I always see room for improvement and desire to improve it. That was lost when I did not cycle. And the drive from that perception of things not being in their right place makes me do the things that I do. It makes me rework things and be creative. It’s necessary for me to do things. Klonopin took all that away and made me ok with how things are. It doesn’t make me happy with how things are, just ok. And being off of it for the past few days, I’ve noticed it more. I’m trying new things, new movies, new kinds of music, I’m adventurous again in my tastes rather than being satisfied with what I already had. So for that, I’m grateful to finally be tapering off of it. Just in time for the summer mania season to hit too.

Anger, Agression, And Going Off Klonopin

I finally did it! I’m going off of klonpin. It’s being done slowly over the next two weeks to avoid withdrawal symptoms. And I’m happy that I’m doing that. Yesterday was my first day cutting down, we halved the dose to see what would happen. Unsurprisingly, I’m mildly addicted to it. I wanted to take it while I was out at the farmers market, almost craving it. Even though I don’t like it, I know how it feels and I felt off without it.

One of the big things that I have to watch out for is a spike in my anxiety levels. It’s very common in withdrawal to have higher anxiety, and I have anxiety already while on klonopin. So it’s not like I really want any more. But there can also be some agitation and even agression that comes with it. And that’s what I experienced.

I felt like the world revolved around me and I was incredibly snippy and insistent on doing things my way. I feel rather guilty about how childish I was with my girlfriend. But there you have it. These are powerful drugs, and going on them or off of them does a number on your brain. It can’t be avoided, but it can be contained. Luckily, I spent most of the afternoon talking with my neighbors and having a few drinks. The small social setting helped tremendously and I couldn’t have asked for a better way to keep myself calm and in control.

Keeping it low key and small was alright, but the farmers market was a bad idea. Granted, it got me out of the house and doing some things, but the size of the crowd and the people that comprised parts of it made things worse. It was when I was passing the usual protesters at the market, the creationists and the 9/11 truthers that I noticed a surge of agression and irritability. Usually, I can brush those people off and just keep moving. But yesterday was different. I not only wanted to shout and yell at them for their ignorance, but I wanted to smash their signs and even start a fight. Not a good sign, and probably due to some withdrawal.

There were less dramatic thoughts too. In general, there was just a casual irritability at random people who weren’t even aware of my existence. Whether it was the clothing, or the things they were buying, I made snap judgments about them and despised them for it. It was irritability to the extreme. Again though, the crowd size didn’t help. Crowds always bring out the worst in me.

That’s about it for my first day off of klonopin. It was thankfully uneventful despite what my brain was trying to get me to do. And this morning I didn’t have the cravings for taking it, so that’s a good sign that I’m on the mend rather quickly. It’s just one of those days that one has to be vigilant about. When your brain chemistry is going awry, it’s a good idea to keep to the simpler things and let it die down.