THIS IS ONLY MY OPINION, but Id keep clear of it. Its the most potent of all the benzos. Benzos are well known for their tolerance producing, addictive qualities. This class of drug, initially works well anxiety(so it helps with dp/dr), but it can come at a great price. It worsens depressive states and it will more than likely eventually aggravate an anxiety disorder which will make your dp/dr much worse.
This class of drug should be reserved for very short term use only. Id use it sparingly only during times of SEVERE anxiety/panic.
Even after short-term use of clonazepam, there is evidence of physiological
dependence and consequent adverse withdrawal symptoms. Abrupt discontinuation of benzodiazepine therapy has been reported to cause withdrawal symptoms including irritability, nervousness, and insomnia. Benzodiazepine withdrawal is more likely to occur following abrupt cessation of excessive or prolonged doses, but it can occur following the discontinuance of therapeutic doses that have been administered for as few as 1?2 weeks. Abdominal cramps, confusion, depression, perceptual disturbances, sweating, nausea/vomiting, paresthesias, photophobia, hyperacusis5 , tachycardia, and trembling also occur during benzodiazepine withdrawal, but these reactions are less frequent. Convulsions, hallucinations, delirium, and paranoia also can occur. Benzodiazepines should be withdrawn cautiously and gradually, using a very gradual dosage-tapering schedule
Well...I quickly tapered klonopin and almost killed myself so Im probably not the best person to ask. This is my experience. I had been on it for 9 months at 2 mg. By month 3, I was already in severe tolerance and I was very sick. I decided to taper very quickly. When I withdrew, I had SEVERE anxiety/panic, depersonalization, derealization, seizures,delusions, horrific irrational fear, auditory and visual hallucinations, a feeling like my entire body was on fire, vomiting, twitching and spasming and many more symtoms. It was terrible.
I spent the first 12 days in and out of a emergency room because of life threateing blood pressure. I also spent 24 hours in a locked psychiatric ward. I had to get injected with narcotic pain killers to try to dull the burning I had all over my body. It was the worst experience of my life and the bad stuff lasted for 2 months.
Im not sure when the actual withdrawal ended because the severe stress I was put thru Im sure was enough to wreak havoc on my body and mind. I do know at 1 year off I still felt pretty bad.
Take some good advice. This class of drug is physically and psychologically addictive and Im sure if you do a little reasearch you will find out what Im talking about . If you are in bad shape and need instant relief than use it very sparingly. Do not take it on a regular basis. This stuff is very potent and has a long half life so it can cause a severe addiction in as little as 2 weeks. In my opinion the last thing a person with mental issues needs is to add the stress of addiction and withdrawal.
OH WOW! Gonna do my best to stay away from the xanax now. I think I am addicted to it already. I have been on it 2 months. What about Buspar for anxiety. My dr. wants to add it to Celexa because my anxiety is seriously out of control. She also mentioned neurontin? Any info or advice.
Well, thanks for scaring the shit out of me. I have been taking klonopin for about 4 weeks(?) and I have made ten tablets last that long, showing how much I actually take them. (At .5 mgs.) About 1-2 weeks ago I stopped taking them. Are chances of withdrawl symptoms high? I do get twiches and stuff... I'm just worried about other problems that you stated.
P.S. I have 4 tabs left - so I really haven't used many... does this matter?
Dont scare yourself. What I went thru was due to a very abrupt withdrawal. I had a very ignorant doctor that knew nothing about benzodiazapene addiction and withdrawal. If you taper very slowly, the severe symptoms can be largely avoided. I still stick to my beliefs tho that this class of drug should be reserved for occaisional severe periods of anxiety and panic.
The buspar works primarily on serotonin so once you get stabilized on an ssri, It may help to potentiate the effects of the AD. In my case, solo it did nothing but it had great anxiolytic effect in combo with Celexa.
Ive never tried Neurontin. Ive read its very weak. It works on gaba like benzos but doesnt have the addictive qualities.
Thats a very small dose and you havent been on long. My guess is you should be fine quitting without a taper. You shouldnt experience any withdrawal. Im guessing your doctor will tell you the same thing.
The thing about benzo addiction is most people start out the same as you. Unfortunately they reach tolerance and need more and more. Before they know it they are a long term, high dose user and withdrawal is very difficult.
Shit can the Klonopin and find a different drug that has anxiolytic properties without the risks of severe addiction. Feel good that you probably dodged a bullet.
I always like to mention there is one person here I know very well who had excellent results on Neurontin and remains on it.
Also, the irony of life. I seem to be developing an "essential tremor" -- I inherited this from my father who had to stop performing surgery in his late 60's I believe. The tremor in his hands was rather bad, but he lived until 84, and it was a bad heart that did him in.
I have calmed down a bit about this, though I am not thrilled. I see a neurologist in June.
Thing is, what is used to treat essential tremor? Inderal (which is one drug that was one of the worst meds I've ever taken -- gave me heart problems that were not permanent and didn't help my anxiety), and BENZOS! Well, I'm already on 6mg Klonopin and have been for many years. I just like to counter Joe's experience with a tad more positive one for me.
Everyone is different.
Also, it is recommended for people with essential tremor who avoid social situations because of shaking hands have a DRINK OR TWO, LOL. Seriously.
I can't drink!!!! It makes the DP/DR much worse!
There is one other med that is a possiblity. I don't need something like that now, but this tremor REALLY has gotten bad suddenly. Due to a LOT of stress. I'm going to hold off on any more meds, however:
1. I have never grown tolerant to Klonopin (6mg/day) since 1987. I'm now on the generic clonazepam.
2. It is recommended (actually various benzos) for a large number of the population with tremors. (This increases over age 40, though not every older person gets tremors).
My point ... we're all unique, and Joe I'm not posting this to bug you. I had to laugh when I found out the treatment for this essential tremor, which I have apparently inherited from my father, is treated with benzos and alcohol, LOL.
Cheers folks ... hic 8)
At least I can laugh at this this week. I was a disaster over this since I got the pretty clear Dx. Final Dx in June by the neurologist. My father's tremor made the GP say, "Oh, yeah, essential tremor" as he made my hands shake more with various neurological tests. SIGH.
How do you know you arent tolerant to the klonopin? You take the equivalent of 120mg of valium daily. You still experience anxiety at a dose that would put most people in a coma or coffin. Thats not a good sign that the klonopin is doing much good.
You now have a tremor? You talked about having tinnitus? Both of these are signs of tolerance withdrawal. I remember specifically that my hands started to shake nonstop when I reached tolerance. It went away once I got thru the severe withdrawal. It occurs when adrenaline starts running unchecked.
In my opinion, booze and benzos are a ridiculous treatment plan for any problem. Im guessing neither would have any effect on you any more.
Sometimes a cigar is just a cigar, and sometimes a physical illness is just a physical illness. You need to be informed.
See this excellent link to essential tremor. My father had it. He was never on a psychotropic med in his life. He was born in 1906 for God's sake, LOL. Never believed in psychiatry. He self medicated his tremor with alcohol, NOT in excess!
Also, my tinnitus was caused by an ear infection. It's gone. I have a bad sinus which I had surgery for back in 1993. Also had my tonsils out. Infections ceased as did tinnitus. When infections return with FAR less frequency, I occasionally get tinnitus. No connection with Klonopin. A course of antibiotics eliminated it. I don't have tinnitus!!!!
Joe, you have to READ reputable sources. And I have seen not only my shrink, but my GP, a medical resident, and will be seeing a neurologist in June. The GP diagnosed "essential tremor"!
Here's stuff on essential tremor. Also, I recently have had 4 vials of blood drawn which is being analyzed for differential diagnosis which could be a thyroid problem, and about a million other things.
Benzos are used in medicine for many things. Try living with essential tremor. If you have something that works to improve quality of life, you use it. You have an informed decision to make, yes. I'm not going to increase my Klonopin, or add any Benzos myself, or start drinking, LOL. I will wait for my blood tests, and see the neurologist. Per 3 doctors so far this has NOTHING to do with any psychotropic med I'm on.... particularly Klonopin!
There are a lot of folks out there who can't function with essential tremor. And many who get it who've never been on psychiatric meds!!! Good grief. In rare cases, newborns have essential tremor!!!!
Ya' gotta believe me Joe, that this is MY way of treating myself. I'm not pushing it on anyone. I'm giving another view is all.
READ THIS!!!!! http://www.emedicine.com/neuro/topic129.htm
Causes: ET probably represents a syndrome; multiple etiologies can be identified. Most or all of these causes are probably genetic.
ET is familial in at least 50-70% of cases. Transmission is autosomal dominant, with incomplete penetrance. Some cases are sporadic with unknown etiology.
Variations in methodology (assessment procedures and diagnostic criteria) account for the wide variation in findings; reported studies have found that 17% to almost 100% of cases are familial.
One study demonstrated an increase from 67.7% to 96% of cases having an affected relative after repeated and varying questioning, followed by direct interviewing of family members. MY FATHER HAD THIS! HE HAD TO STOP BEING A SURGEON BECAUSE OF IT!!!!! I am not pleased!!!!!
Genetics: Two susceptibility loci have been found.
The FET1 gene is located at 3q13 and was identified in 75 members of 16 Icelandic families.
Another locus, 2p25-22, was identified in 15 members of 4 generations of Americans. Abnormalities found in 3 additional American families have been reported to map to this locus.
In one family with levodopa-responsive, autosomal dominant, Lewy body parkinsonism, a chromosome arm 4p haplotype that segregates with the disease was identified. This haplotype also occurred in individuals in the family who did not have parkinsonism but rather a postural tremor consistent with ET. This suggests that in some cases postural tremor can be an alternative phenotype of the same mutation.
Associations between ET and Parkinson disease (PD) and ET and dystonia have been suggested.
ET has been hypothesized to be a risk factor for the development of PD. Some patients with PD report a longstanding history of bilateral upper extremity postural tremor. Without biological markers for these diseases, determining whether longstanding postural tremor is part of a PD syndrome or reflects the presence of both ET and PD is not possible.
Some patients with focal dystonia, such as torticollis, have mild bilateral upper extremity postural tremors. Without biological markers for these diseases, determining whether postural tremor is part of a focal dystonia syndrome or reflects the presence of both dystonia and ET is not possible.
Other diagnostic considerations: The Movement Disorders Society has proposed the following diagnostic criteria for classic ET:
Inclusion criteria are as follows:
Bilateral, largely symmetric postural or kinetic tremor involving hands and forearms that is visible and persistent
Possible additional or isolated tremor in head but absence of abnormal posturing Exclusion criteria are as follows:
Other abnormal neurologic signs, especially dystonia
The presence of known causes of enhanced physiologic tremor, including current or recent exposure to drugs that are known to cause tremor or a drug-withdrawal state. Per my doctors, this does NOT apply to me. My genetic propensity is the suspect.
Historic or clinical evidence of psychogenic tremor
Convincing evidence of sudden onset or evidence of stepwise deterioration
Primary orthostatic tremor
Isolated voice tremor
Isolated position-specific or task-specific tremors, including occupational tremors and primary writing tremor
Isolated tongue or chin tremor
Isolated leg tremor
DIFFERENTIALS Section 4 of 9
Author Information Introduction Clinical Differentials Workup Treatment Medication Follow-up Bibliography
Caffeine - I DON'T drink this anymore because of its worsening my DP and causing the tremor to get worse.
Multiple System Atrophy
I pray to God I don't have Parkinson's. It was suggested since my mother said my father HAD Parkinson's I could have that. God help me. But my mother was nuts. She'd say things that weren't true 87% of the time.
I'll find the treatment section.
The neurological visit and bloodwork wlll be a process of elimination. My GP was about 90% certain this is essential tremor which is YES exacerbated by anxiety and stress. I'm a MESS! What can I do? Buddhist thought, yoga, some vitamin treatments -- RADICAL ACCEPTANCE. Living every day to its fullest.
This is edited.
Treatments for Essential Tremor -- I am NOT PLEASED, but what
choices do I have, Joe?????
Medical Care: Primidone and propranolol are the cornerstones
of maintenance medical therapy for ET. These medications provide
good benefit in reducing tremor amplitude in approximately 75% of
Some patients require only intermittent tremor reduction, such
as when attending a meeting or engaging in a social activity. For
these patients, a cocktail or beer prior to the activity may be
An alternative is propranolol (10-40 mg)
approximately one half hour prior to the event. Alcohol consumption
is not an appropriate maintenance therapy for patients who seek
tremor reduction throughout the day.
The mechanism of tremor reduction by alcohol is unknown. In a
double-blind study, the 6-carbon alcohol methylpentynol did not
have any effect on tremor. This suggests that the alcohol group of
ethanol is not the element that provides antitremor activity and
that ethanol's antitremor effect is not due to sedation.
Restricted intra-arterial ethanol administration does not reduce
tremor in the perfused limb. This suggests that ethanol's effect is
Propranolol - I can't drink and I can't use Propanolol, the first logical line of treatment
Winkler first noted remarkable tremor reduction in a patient
treated with propranolol for paroxysmal atrial tachycardia.
In a double-blind crossover study, propranolol at doses from 60-240
mg/day reduced tremor in 75% of patients with ET. In a
dose-response study, 240-320 mg/day was found to be the optimal
dose range with no additional benefits above 320 mg/day.
Average tremor reduction is 50-60%, but some patients experience
marked tremor reduction and others no benefit.
O'Brien initially observed that primidone, when administered to a
patient with epilepsy and ET, reduced tremor. In a
placebo-controlled study, primidone significantly reduced tremor in
otherwise untreated patients and patients treated with propranolol.
Doses greater than 250 mg per day did not provide additional
The mechanism of action is unknown. Active metabolites are
phenylethylmalonamide (PEMA) and phenobarbital. PEMA has no effect
on tremor, and phenobarbital has only modest effect on tremor.
Tremor reduction is not correlated with serum levels of primidone
A single dose of 12.5 mg clozapine and placebo were compared in a
randomized, double-blind, crossover study in patients with
drug-resistant ET. Tremor was reduced significantly by clozapine in
13 of 15 patients (P<0.01).
A significant reduction of tremor was reported with long-term
(open-label) clozapine therapy (39.9 mg/d).
No tolerance was observed over 15 months.
In a small, open-label case series, mirtazapine was reported to
reduce tremor in patients with ET and PD.
Currently the authors often try mirtazapine as a second-line agent.
Gabapentin: A double-blind crossover trial comparing
gabapentin (400 mg tid) to propranolol (40 mg tid) found that both
drugs demonstrated significant and comparable reductions in tremor
compared to baseline. However, a double-blind, placebo-controlled,
crossover study identified no difference between gabapentin and
Benzodiazepines: Benzodiazepines, particularly clonazepam
and alprazolam, are used commonly in the treatment of ET, but their
effectiveness is limited. They probably work to reduce anxiety that
can amplify tremor amplitude.
Botulinum toxin: Botulinum toxin has been evaluated for the
treatment of ET. Its use in the treatment of tremor of the upper
extremities is limited because it commonly causes weakness. It is
more useful in the treatment of head tremor, as it often provides
benefit without unwanted troublesome weakness.
Practical management of pharmacologic therapy
If sufficient benefit is not achieved with primidone or
propranolol, other medications are considered based on the severity
of the residual tremor.
The authors often try mirtazapine as a second-line agent.
If the tremor is mild and more of a nuisance than disabling,
benzodiazepine is considered, usually clonazepam.
If the tremor is severe or causing disability, clozapine is
introduced next. Blood monitoring is required with this drug, and
patients sign informed consent in the light of the rare risk of
For patients with head tremor, cervical injections of botulinum
toxin may be given.
Surgical Care: For patients with medically refractory,
disabling upper extremity tremor, surgery is considered.
Stereotactic thalamotomy and thalamic ventralis intermedius nucleus
deep brain stimulation (DBS) are the procedures of choice.
DEAR GOD I DON'T WANT SURGERY. BUT I'LL DO IT IF THIS
PROGRESSES. MAYBE IT'LL HELP THE DP FOR GOD'S SAKE. I have to pick my poison on this. I'm really scared.
Joe, I could really use a little emotional support here. I
appreciate that you have not been as agressive with the anti-benzo
stance which IS legitimate in many cases. NOT IN MINE
I dont know alot about essential tremor - just a little. I cant say whether any psychotropic drugs would cause it or not. I'm sure its in the side effects of almost all nervous system medicines. You might want to access a PDR, searching for tremor as a side effect to any of your meds. If it is indeed inherited, I wouldnt try Clozaril if I were you. Its far, far too strong of an antypsychotic. I would try Gabapentin. It bypasses your liver, and is really easy on the system. Some say its a little too easy, and that it does pretty much nothing, but its just a false neurotransmitter, and everyone will respond differently to it. I do know that if you are under alot of stress, you can also have a hand tremor. I've had them periodically this year, while I've been sick, and it probably was due to being over-andrenalized with whatever my condition is. Dont get a deep brain stimulator, unless it gets really, really bad. Essential tremor isnt anything serious, but a surgery into the deep brain is. I'd exhaust all other resources, even some of DakotaJoe's theories , before doing that. I really hope it gets better, but dont worry about it too much. I know its tough, but I've gotten rather stoic about this kind of stuff. Hopefully, when your move ends, the tremor will settle down. Your in my prayers.
Well...I went thru tremors during my klonopin addiction and withdrawal. I also got the morning tremors during my alcoholic daze. Ive read all over the place this can be caused by weakened gaba and unchecked adrenaline.
I dont know why you have tremors but I think you will be in denial no matter what. I guess thats what addiction is all about.
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