In a pickle...Don't want to increase Klonopin Dose

[Mermaid16]

Hi! To give you a bit of background information, I crashed bad in July of last year, was prescribed valium, that over months was increased to 8mg. I was then hospitalised in a psychiatric hospital for 1 month were we changed medications etc. I was then prescribed 1mg of clonazepam in the morning and 1mg at night. Everything has been going well and we were about to start looking at reducing some of my other medications, but the last few days my anxiety has skyrocketed again. I was up before 5 this morning for work and I felt like I was in withdrawal from the clonazepam until I took it at 7.00am. I usually don't take it until 8.30am. I feel like I have little brain zaps where I think I am going to have a seizure, I feel really anxious and can't concentrate. My mind runs so fast. I did some meditation after work yesterday, but just couldn't feel myself relaxing. I have a psych appointment tomorrow and I don't know what to do if she suggests increasing the dose. I take other medications, 100mg Nortriptyline, 50mg Sertraline, 15mg Mirtazapine and 2.5mg of Zyprexa. I just feel like i'm on all this medication and the anxiety has come back again. Has anyone been on Clonazepam for a long period and did they have to increase their dose. I need to be able to function as I work full time and have kids to look after. I want off all these medications, but everytime I think I'm close to being able to start reducing, the anxiety flares up again. Don't know what to do...

[panic_down_under]

I crashed bad in July of last year, was prescribed valium, that over months was increased to 8mg.

Where you taking the nortriptyline, sertraline, mirtazapine and Zyprexa at the time you crashed, or were they added later?


I just feel like i'm on all this medication and the anxiety has come back again.

Are you being treated by a GP or psychiatrist? If a GP, ask for a referral to a shrink asap. If by a psychiatrist get a new one, also asap.


I want off all these medications, but everytime I think I'm close to being able to start reducing, the anxiety flares up again. Don't know what to do.

Clearly, none of the meds is working so it is time to have a rethink. This nonsense of just adding more and more meds in the hope one of them will do something needs to stop.

I'd also be asking why Valium and the Clonazepam were added long-term when you weren't even close to taking the maximum dose of any of the other meds. Foolishness. :mad:

BTW-there is evidence that benzodiazepines significantly reduce the effectiveness of antidepressants by blocking hippocampal neurogenesis which is what produces the antidepressant therapeutic response (see: Boldrini M (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4374628/), 2014; Nochi R (https://www.ncbi.nlm.nih.gov/pubmed/23963779), 2013; Sun Y (https://www.ncbi.nlm.nih.gov/pubmed/23639432), 2013; Wu X (http://www.biologicalpsychiatryjournal.com/article/S0006-3223(09)00106-1/abstract), 2009; Stefovska VG (https://www.ncbi.nlm.nih.gov/pubmed/18991352), 2008).

IMHO, the nortriptyline and sertraline doses need to be increased, or alternatively, they, and maybe also the mirtazapine, be dumped in favour of another antidepressant. Either clomipramine (Anafranil), or if more noradrenaline/norepinephrine inhibition is desired then desipramine (Norpramin) would be good choices. Clomipramine is fairly sedating so you shouldn't need the mirtazapine, which I assume is only taken as a sleep aid. If necessary take up to the maximum dose of whichever is chosen, perhaps even a little more (but especially for desipramine demand plasma levels be checked a couple of times at the beginning to ensure they don't exceed the therapeutic range as the dose recommendations for this med may have been set too high).

[MyNameIsTerry]

Hi Tracy,

Something I have learned is not to judge with seeing a trend. A few days could just be a brief flare up that will reduce again. I've had many like this, although I've long suspected my med is to blame for it (you're not on mine).

It could even be anticipatory anxiety due to knowing you need to start withdrawing and how that could increase your anxiety. Many of us would have been through that worry, I know I have.

So, perhaps before you judge that a problem exists it might be better to monitor it for a little while longer first? If it just goes away, perhaps it's just anticipatory anxiety or something else that has spiked your anxiety for a short time and perhaps no further med adjustment is needed to tackle that? (I don't mean to comment on what Ian is recommending, just that it might not be a case of needing increases against your current dosages because your anxiety is worsening, if you see what I mean?)

[Mermaid16]

Where you taking the nortriptyline, sertraline, mirtazapine and Zyprexa at the time you crashed, or were they added later?

I was on 100mg of Sertraline when I crashed. I had been taking it for over 10 years so it pooped. I decreased from 100mg down to 50mg in about 7 days. I then was tried on Venlafaxine and dolusepin which I couldn't tolerate. The whole time this was going on I was on Valium, which was increased 2mg every month or so. I was on Mirtazapine for sleep. I was then prescribed Respiradone, that's when I decided to get a second opinion from a different psychiatrist.


Are you being treated by a GP or psychiatrist? If a GP, ask for a referral to a shrink asap. If by a psychiatrist get a new one, also asap.



Clearly, none of the meds is working so it is time to have a rethink. This nonsense of just adding more and more meds in the hope one of them will do something needs to stop.

I'd also be asking why Valium and the Clonazepam were added long-term when you weren't even close to taking the maximum dose of any of the other meds. Foolishness. :mad:

The second psychiatrist changed me to Clonazepam, upped the Sertraline to 200mg and the Mirtazapine to 45mg and I was climbing the walls with anxiety, I couldn't tolerate it. So a tapered back down. I then had 5 sessions of ECT while in hospital for a month which did seem to help. So now I am on 15mg Mirtazapine, 50mg Sertraline, we did try to taper right off the Sertraline but I started having early morning waking and panic attacks, so we went back up to 50mg. 100mg Nortriptyline. 2.5mg Olanzapine (I think this is because I have OCD thoughts) and 1mg twice daily of Clonazepam.

BTW-there is evidence that benzodiazepines significantly reduce the effectiveness of antidepressants by blocking hippocampal neurogenesis which is what produces the antidepressant therapeutic response (see: Boldrini M (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4374628/), 2014; Nochi R (https://www.ncbi.nlm.nih.gov/pubmed/23963779), 2013; Sun Y (https://www.ncbi.nlm.nih.gov/pubmed/23639432), 2013; Wu X (http://www.biologicalpsychiatryjournal.com/article/S0006-3223(09)00106-1/abstract), 2009; Stefovska VG (https://www.ncbi.nlm.nih.gov/pubmed/18991352), 2008).

IMHO, the nortriptyline and sertraline doses need to be increased, or alternatively, they, and maybe also the mirtazapine, be dumped in favour of another antidepressant. Either clomipramine (Anafranil), or if more noradrenaline/norepinephrine inhibition is desired then desipramine (Norpramin) would be good choices. Clomipramine is fairly sedating so you shouldn't need the mirtazapine, which I assume is only taken as a sleep aid. If necessary take up to the maximum dose of whichever is chosen, perhaps even a little more (but especially for desipramine demand plasma levels be checked a couple of times at the beginning to ensure they don't exceed the therapeutic range as the dose recommendations for this med may have been set too high).

It is a bit messy, but this is the way it has happened. I'm okay with the meds as long as they work. As Terry suggested, I will see if this is just a hiccup. Thank you for all of your advice. Would you mind if I ask what medication you take. It is a TCA also isnt it?

---------- Post added at 18:38 ---------- Previous post was at 18:32 ----------


Hi Tracy,

Something I have learned is not to judge with seeing a trend. A few days could just be a brief flare up that will reduce again. I've had many like this, although I've long suspected my med is to blame for it (you're not on mine).

It could even be anticipatory anxiety due to knowing you need to start withdrawing and how that could increase your anxiety. Many of us would have been through that worry, I know I have.

So, perhaps before you judge that a problem exists it might be better to monitor it for a little while longer first? If it just goes away, perhaps it's just anticipatory anxiety or something else that has spiked your anxiety for a short time and perhaps no further med adjustment is needed to tackle that? (I don't mean to comment on what Ian is recommending, just that it might not be a case of needing increases against your current dosages because your anxiety is worsening, if you see what I mean?)

Thanks for your advice Terry. I will wait and see what happens. By nature I jump to the worst possible scenario. When I thought about it, there were a few things I thought I could attribute it to. I have been working long hours and it also could be hormonal as I was having hot flushes the last two days. In any case, sometimes you just have to take a deep breath and stop you mind from running a thousand miles a minute. I will see what the psych thinks tomorrow. I might ask to get my Nortriptyline levels tested again. I am also a little worried about cholesterol and diabetes as I have stacked on weight. I will stop rambling now. Thanks Terry x

[panic_down_under]

Would you mind if I ask what medication you take. It is a TCA also isnt it?

Yes, dosulepin, aka dothiepin. But probably not a good choice anymore because it is very cardio-toxic. Amitriptyline would be the closest in action.

[bdale1234]

Hi! To give you a bit of background information, I crashed bad in July of last year, was prescribed valium, that over months was increased to 8mg. I was then hospitalised in a psychiatric hospital for 1 month were we changed medications etc. I was then prescribed 1mg of clonazepam in the morning and 1mg at night. Everything has been going well and we were about to start looking at reducing some of my other medications, but the last few days my anxiety has skyrocketed again. I was up before 5 this morning for work and I felt like I was in withdrawal from the clonazepam until I took it at 7.00am. I usually don't take it until 8.30am. I feel like I have little brain zaps where I think I am going to have a seizure, I feel really anxious and can't concentrate. My mind runs so fast. I did some meditation after work yesterday, but just couldn't feel myself relaxing. I have a psych appointment tomorrow and I don't know what to do if she suggests increasing the dose. I take other medications, 100mg Nortriptyline, 50mg Sertraline, 15mg Mirtazapine and 2.5mg of Zyprexa. I just feel like i'm on all this medication and the anxiety has come back again. Has anyone been on Clonazepam for a long period and did they have to increase their dose. I need to be able to function as I work full time and have kids to look after. I want off all these medications, but everytime I think I'm close to being able to start reducing, the anxiety flares up again. Don't know what to do...

I hope you feel better.:bighug1: