21 replies to this topic

[Jgfergie]

Hi all,

 

I have been on 120 mg of Cymbalta , in addition to 3 doses of .5 mg of clonapin a day for 8 months.  About 6 weeks ago I started weaning the cymbalta first and recently the clonapin too.  Went from 120 to 100 to 80 and now 60 with about 2-2.5 weeks in between each drop.  I also went on 100mg and then 150mg of Wellbutrin concurrently and didn't have any real issues, just some increased anxiety and depression for a day or so usually about a week after a drop. I attributed that mostly to the cymbalta drop.  Overall I have felt much better.   Last week my Dr. upped my Wellbutrin to 300 (from 150) while dropping my Cymbalta to 60.  I have also started to cut the clonapin very slowly from a .5mg dose 3x a day to a .25mg dose in the am, a .5 mg. dose in the afternoon and .25mg dose in the pm each day.  For this last adjustment, I started to feel really jittery and slightly manic so called my doctor yesterday and we adjusted my dose of wellbutrin back down to 150 today, as I felt really good there.  But my anxiety and depression is really acute today and I am thinking it is the follow-on from the Cymbalta drop.  Does that sound right?  Should I push through for another day or two and see how I feel after the WellButrin stabilizes back at 150?  Its been a week since I cut the Cymbalta from 80-60.  Our plan is for me to stabilize here at 60 with teh 150 of Wellbutrin and get off the clonapin before attacking the rest of the cymbalta.  Would love any feedback/support.  Thank you.

 

Steve

[fishinghat]

It has been a while Steve.
 
Most drs do NOT recommend doing a benzo withdrawal (Klonipin) at the same time as an antidepressant withdrawal or cross over. You are just asking for trouble. The Wellbutrin will take the place of Cymbalta with only moderate withdrawal effects for a few weeks. The early signs of Cymbalta withdrawal are dizziness, nausea and digestive issues. Your symptoms are more indicative of benzo withdrawal and your rate of drop I would consider too fast. Most drs recommend a type of water titration for coming off a benzo.
 
If you look at the conversation I have been having with Gardenlady ...

https://www.cymbalta...d-during-taper/

 

You will see a lot of information on using water taper to come off the Klonopin. By the way, I have been told by drs that Klonopin has the worse withdrawal of all the benzos so don't take it lightly. Titrating slow enough to be bearable can take a year or two. I did a Klonopin wean and it took 2 years but I went slow enough to avoid any significant withdrawal symptoms. Going back up to your previous dose on Klonopin rarely helps stabilize  a person but you can try it. Also most drs where I am at do not prescribe benzos any more as they are very addictive with a wicked withdrawal. Most use hydroxyzine which is neither addictive nor does it have a withdrawal. If you want to come off the Klonopin you need to change to Valium ( a much longer half life) and then water titrate. 

 

Also I noticed you have been on Klonipin for 8 months. The FDA and the manufacturer both recommend that benzos do not be used for more than 4 to 8 weeks and no longer than 4 months in severe cases. Your dr should have been aware of this as the info came out a little over 2 years ago.

 

If you wish to see any info on the items I mentioned I have an extensive library on medical research and such for your review if you need it. I am sure you have questions so please feel free to come back and ask.

[gail]

Hello Steve,

Welcome to the forum. Weening from two meds and starting another. Wow, what's doing what?

My advice is to ween cymbalta first. I would forget the Klonopin weening for sure. I would return to your usual dosage of Klonopin.

Cymbalta is powerful stuff. As for the Wellbutrin, a soft one. I doubt that this is the culprit here. I would stay a 60 cymbalta till you stabilize. My opinion.

Fishinghat will be in soon, he will help you. See you !ater!

[Jgfergie]

Thanks Fishinghat.  I did come back down to 200 Welbutrin and it has helped.  In terms of the wean, my doc (and I) would like to come off the Klonapin first.  I am pretty stable on the cymbalta (60) and Welbutrin (200) and didn't have major withdrawal effects from the Cymbalta so far (I came down from 120, doing 20 mg down every 2 weeks).  We intend to keep me here for the foreseeable future while I get off the Klonapin.  So are you advocating a water titration for the Klonapin?  Or are you saying I have to swap the Klonapin for Valium and then titrate the Valium?  If you have any additional info on either, I would love to see.  I am currently on 1 mg a day (.25, .50, .25 3X a day).  And do you have a Psych in NYC that you recommend?  I just switched and am happy for the most part because he sees the errors the last one made, but I don't think he is operating with this level of information (or experience?).  Thank you.

 

Steve

[fishinghat]

I can't help with the pdoc in New York City but I can help with the water titration.
 
Read the posts from....
https://www.cymbalta...d-during-taper/

beginning with the 4th post. It gives a lot of information on water titration. Most agree that switching to Valium first is easier and I certainly have no problem with that I have always just done my water titration  using whatever I was on at the time. Either way works. There is a equivalency table for the switch. I will try to post it and any further info on water titrations and tips on coming off benzos in a few minutes.

[fishinghat]

Withdrawal Notes

http://www.benzosupp...ey_contents.htm
See..
http://www.benzosupp...instatement.htm
29% had to go over the ORIGINAL DOSE to stabilize or could not reach a dose high enough to stabilize.

Updosing during withdrawal
http://www.benzosupp...g/up_dosing.htm
24% said ut was unsuccessful.

Ashton, H. (1984). Benzodiazepine withdrawal: An unfinished story. British Medical Journal, 288, 1135-1140.
Ashton, H. (1987). Benzodiazepine withdrawal: Outcome in 50 patients. British Journal of Addiction, 82, 665-671.
These symptoms have often been temporarily alleviated by a moderate increase in dosage or the addition of another benzodiazepine, but eventually re-emerge during further chronic use and only disappear after the benzodiazepine is stopped.

http://www.smchealth...per08-12-13.pdf
If symptoms to bad stabilize dose or go up in dose for 1-2 weeks.

https://www.ncbi.nlm...d00117-0138.pdf
Small "extra dose" on any day they feel a special need for
extra help. This helps them to feel in control.

http://www.btpinfo.o...benzodiazepines
Never abruptly stop any benzodiazepine or Z drug. The shock caused by such an abrupt withdrawal is so severe that even after resumption of your drug at the previous dose, it may take weeks or months to "stabilise", and in some cases, you may never stabilise from a cold turkey withdrawal until after you have completed your reduction.

Z Drugs

Definition - Z-drugs are a group of nonbenzodiazepine drugs with effects similar to benzodiazepines, which are used in the treatment of insomnia, and most of whose names start with the letter "Z". Some Z-drugs may have advantages over benzodiazepines. (Wiki)
Eszopiclone (Lunesta) (Zopiclone )
Zaleplon (Sonata).
Zolpidem (Ambien)

Benzodiazepines and Z Drugs

https://www1.ghc.org...benzo-zdrug.pdf
Benzodiazepine and Z-Drug Safety Guideline
This guidance document is an excellant over view of these two drug groups. It explains how the Z-Drugs act just like benzos, a little less effective on anxiety and a little more effective on sleep. They are just as addictive, severe withdrawal and because their action is the same as benzos they should not be taken with benzos as it increases the rate of addictiveness and severity of withdrawal.

https://www.ncbi.nlm...pubmed/25474727
The risk to develop BZD/z-drugs dependence is significantly associated with psychiatric history and with the quantity of BZD/z-drugs that is taken.

https://www.ncbi.nlm...pubmed/24774720
Dependence on benzodiazepines (BZDs) or Z-drugs (zolpidem, zopicline and zaleplon) is a common clinical phenomenon.

https://www.ncbi.nlm...pubmed/18505619

[fishinghat]

The water titration system for cutting benzo dosages is as follows.
 
This is a procedure called water titration. If gives you good control of your withdrawal. I have used this the last 3 times with no withdrawal.
 
1st - Grind (in a mortar and pestal) three days dose. eg. If you take 2 mg a day  then a 3 day dose would be 6 mg.
2nd - Dissolve this in 600 ml of water and shake well. Poor in storage bottle and store in refrigerator.
3rd - Every 6 hours, take the bottle out of the refrigerator, shake well and pour out 50 mls and drink it . Usually this can be measured using a graduated shot glass (yes they do have shot glasses that are calibrated this way) and I have also seen tiny measuring cups at Wal-Mart. Some people use a large syringe from a vet supply store or farm supply store to measure the 50 mls. Do this four times per day.
 
To make a cut follow the above procedure through step 2. To make a three percent drop, make a new batch, shake well and  remove 18 ml from that 600 ml solution. Then add 18 ml of water back to the bottle. You have just removed 3% of the medicine. Still take 50 mils 4 times per day.
 
Remember, benzos do not fully dissolve so always shake the solution before making cuts or taking a dose.

[fishinghat]

0.5 mg Klonopin equals 10 mg valium.

[Jgfergie]

Wow!  Thank you for sharing all of this.  A few questions:

To switch from Klonapin to Valium, do you have to cross-taper or do you just swap one for the other?

Does Valium essentially work the same way as Klonapin (for anxiety?) and can you still function?

With the Water taper - if taking one MG a day of Klonapin and I do you the water taper from that (not Valium), do I still do 600MG of water?  I'm sorry, I am terrible at math and can't figure out what the formula is and if its a ratio to the dose?

Similarly, if I switch to Valium to do the taper, and am taking 20mg of Valium a day, would it also be 600ml of water?

And lastly, how quicklly would you recommend tapering.  You mention taking out 3ml.  How often would you do that?  Thank you so much.  It pretty amazing to have the support and expertise here that you can't find with a doctor. 

 

steve

[fishinghat]

It is usually a cross taper but some drs do a direct switch. Usually both ways produce few problems.

 

Valium works on the same synapses in the same way and will provide essentially the same relief. Your ability to function should not change.

 

The 600 ml is not a set rule but benzos have only slight solubility in water so a fairly large volume is needed to properly dissolve it. In addition the solution should be shaken well be fore taking a dose. So if you are taking 1 mg a day of K the you will take 3 mg in 3 days. So 3 mg of Klonopin in 600 ml of water would be a 3 day supply.

 

If you take 50 mls of this solution every 6 hours that would be 200 mls a day and 600 ml in 3 days. This would provide you a stable even dose every 6 hours and little swing in blood levels of benzo. This will provide a smoother weaning process.

 

As far as how often to drop the 3 mls?.....Well I would begin with doing it each new batch of medicine you make (every 3 days). You may be able to adjust that rate up or down with time to find the point where there is no withdrawal symptoms. If you drop an additional 3 ml with each new batch of medicine stay at that rate for at least 2 weeks before increasing the drop rate. IF ANY SYMPTOMS DEVELOP THEN HOLD AT THAT DOSAGE UNTIL YOU FEE GOOD AGAIN. Start back up a little slower. In other words it takes a little playing around to find just the right rate.

 

Considering that you would be taking 20 mg of valium the amount of water should be increased to 1200 ml and you would take 100 mls every 6 hours.

 

I thank you for the compliment but I must admit I have learned much of this from pumping my drs for information and reading the medical journals. I have collected a substantial library of documents and notes along the way. I am always glad to share my knowledge with others so maybe their journey can be a little smoother.

[Jgfergie]

Hi Fishinghat,

Its been a while.  I switched over to Valium from Klonapin.  If you recall, I had been on 2 mg Klonapin per day (.5 in the am, 1 in the afternoon and .5 in the evening). My doctor prescribed me 20 mgs of valium as an alternative. He said this was a very high dose.  I have been weaning from that for the last 4-5 weeks, coming down to 10 mg last week.  I felt great.  I wasn't jumpy, it was very smooth, I felt like myself again.  (I am also still taking 60 mg of Cymbalta and 200 mg of Wellbutrin) This weekend I had a trigger for my PTSD and have been in a horrible way since then.   I feel like the world is caving in.  I can barely function, can't stop crying and shaking, feel hopeless and have tremendous anxiety.  I am now wondering if the valium dose was too low as a cross-taper.  Looking at the thread above and some additional research online, it seem like 40mgs Valium would have been equivalent to 2mg Klonapin.  is that possible?  Would it be normal for this to happen after the fact - meaning I have had 4-5 very good weeks and then to feel the effects?  I did go back up to 12 mgs Valium yesterday, but hasn't helped.  Did I come down too fast?  I am desperate for some answers and relief.  Thank you.

 

Steve

[fishinghat]

The 40 mg is correct for a conversion but it should not take 4 to 5 weeks to show up as withdrawal symptoms. Benzos aren't like most drugs, Going back up in dosage seldom provides relief. Your only choices are to ride it out (1 or 2 months) typically or get a prescription to something like hydroxyzine or clonidine to help with the symptoms. By the way a 50% drop in 5 weeks is fast. I mean like really fast. Normally you would be looking at about a 2% a week. Hang on, it will pass. You might also try some Benadryl (diphenhydramine) to help out if needed. One thing about it you have already come a long way. I came off 3 mg per day of Klonopin many years ago and it took me 13 months. Hanf in there it will get better.

[Jgfergie]

Thank you for replying.  I really appreciate it.  I actually just went through my calendar and notes and spoke with my wife and realize some of what i said was not correct.  Forgive me, my brain is really foggy.  

Four weeks ago I was already down to 1 mg. Klonapin and that is when my Dr. switched me to 18 mgs valium, in an effort to have an easier taper. Since then I have been weaning 2mgs each week.  The switch was seamless for me and I felt much better on the valium,  It was even, I didn't have that anxious pit in my stomach, I felt really good.  When I hit 10mgs valium (entering week 5 this past weekend), I had a trigger for my PTSD and have been in bad shape ever since - crippling anxiety panic and fear, shaking, crying, feelings of doom.  Is it possible I came down too fast?  I haven't felt like this in months - since I got the Cymbalta down over the summer, actually.  I am getting conflicting information on line in terms of what the actual conversion is.  I went back up to 12 this morning and hope that I stabilize. The other thing is my doctor was encouraging the taper and timeline.  He still thinks that 12 is too high of a dose and wants me to come down to a lower dose.  For whatever its worth, I am 6'1" and 185 lbs. thanks.

[fishinghat]

Actually I agree with that conversion rate. It makes a lot more sense. I agree with your dr that you need to come down more on the Valium BUT considering that benzos are to be used for no more than 4 to 8 weeks you need to come off it at this point. The rate you come off is not up to the dr or me or even you. It is up to whatever your body can stand. I will post the standard conversion table used by most drs but yes they do vary some.
 
The table below is from the Ashton Manual and is the standard that most drs use. In the case of Klonopin 0.5 mg of Klonopin equals 10 mg of Valium.

https://www.benzo.org.uk/bzequiv.htm

[Jgfergie]

Thanks Fishinghat.  That is comforting.  I want to get off of them too. Hence my aggressive weaning schedule. Do you agree that its possible some of these symptoms are a result of my body reacting to coming off too fast?  I guess I am just looking for validation that these feelings are more tied to a chemical reaction than to something else. 

[fishinghat]

Absolutely sounds like withdrawal from a benzo!! Stomach/GI issues and lots of unwanted emotions (crying, fear, irritability, etc). Usually restlessness as well.

[gail]

Hello JG,

Fishingbrain is right. The tapering was way too fast. I also did the switch from Ativan to Valium. 30 mg of Valium took me 48 months or so. I went really slow as I had anxiety for many years.

Fishinghat was my mentor for the tapering. And he did a good job. I tapered by 1/4 mg at a time like every 10 days or so.

Since it was a PTSD trigger, Valium or not, I think that is the culprit and a message to slow the taper. So I would say, stand still at 12mg till you stabilize. Upping the dosage doesn't help. I experienced it.

For myself, the best way for anxiety is to take the Benadryl Total in caplets, not gel because you can't split the gel. The dosage is 1 1/2 caplets and make sure that it's Benadryl Total. The others didn't work for me. It's the dyphenhidromine that makes you relaxed. I would say it's ok for 2 days in a row then skip days as it becomes less powerful.

Be patient, this situation will pass, it always does. In less than a month for sure. I'm contradicting our Fisherman, but that's ok.

[Jgfergie]

thank you both Fishing Hat and God-Like.  This is so comforting and helpful. I will get the Benedryl total and try that too.  so the dosage is 1.5 caplets every 12 hours?  And do you know it would adversely interact with my cymbalta and/or wellbutrin? again, I say a huge thank you.

[fishinghat]

It does not interact with those two but you need to check any of the other meds you are taking. By the way, it is incompatible with many sleep aides.

[Jgfergie]

I am not taking anything else but vitamins and minerals. thank you again. 

[gail]

Hello again JG,

When you feel the anxiety creeping up, yes it's one and a half caplet. I took it once a day, skipping here and there. After eating. And that for many years, a life saver. But just once a day.

Takes about 15 to 30 minutes to feel it. And since it's a PTSD case, and perhaps the Valium tapering, you will be returning to your own self soon. Just stay at 12 mg for a while.

The first time you take the caplets, don't plan on driving. By the way, in each caplets, there is 500mg of acetaminophen. Update us on this.

As our boy says, time and patience. I so love our Fisherman! I learn a lot from him.

[Jgfergie]