Up and Down Dosing of Benzo

[dale]

Has anyone had any experience with problems with up and down dosing of Benzos? I've been instructed to "Take as Needed", therefore taking some one day, reducing the dose the next day and then having to increase again the next 2 days or so. Could this possible have been a reason why my depression has never lifted?

[Lotty]

Hi Dale,

I'm sure people who have been hit hard by benzos (and there are quite a few) will chime in here and say it certainly may be so. It's so hard to be sure with more than 1 drug in the mix, isn't it?

However, I will say that I too use them the same way you are describing. I don't think I could have kept my job without them. It became a choice between taking one when I felt I needed it (and I mean, when symptoms are REALLY bad, which they often are for me, believe me) or take me to A&E (ER). I don't want to go to A&E.
Recently I went for about a month without a single one until this episode I am currently having (long story - switch to generic paxil).
I NEVER use them "just in case" I feel bad, if you know what I mean.

[Mixter]

I am glad that I never used any benzos after my CT in summer 2008. I have used Lyrica though, and it never helped anything. CT off Lyrica, no prob. Benzos can cause depression (on them) and rebound anxiety (off them), and also tolerance if used daily for more than 10 days (really fast), esp when dealing with SSRI withdrawal. I have heard from some people who said that benzos didn't help anything. Better to use antihistamine for sleep, and benzos very rarely for emergencies. 3 days max, then off for min 1-2 weeks. Benzos slow down neurotransmitter activity, but when on SSRI, poop out, or off they are already low and becomes even lower when using benzo and cause depression and tolerance.

[texgirl]

You can get into trouble with benzos if you interpret "as needed" to mean "every day." If you're taking any benzo daily and have done so for 10-14 days, up and down dosing is going to affect you. The fact that you feel the need to increase your dose the day after a drop demonstrates this.

If both depression and benzos are present, you must consider benzos as a possible (even likely) cause. What benzo are you taking and at what dose(s)?

[Pat Shields]

The times I have been prescribed them, it was within a specific limitation, but "as needed." For example, "Take x mg every x hrs as needed, not to exceed x mg in 24 hrs." I was trusted to be an adult about it, not to take "as wanted for entertainment."

[dale]

Originally Posted by texgirl

You can get into trouble with benzos if you interpret "as needed" to mean "every day." If you're taking any benzo daily and have done so for 10-14 days, up and down dosing is going to affect you. The fact that you feel the need to increase your dose the day after a drop demonstrates this.

If both depression and benzos are present, you must consider benzos as a possible (even likely) cause. What benzo are you taking and at what dose(s)?

Klonopin, usually fluctuating between .25mg and .5 mg pr day

[TryingtoGetWell]

Originally Posted by dale

Klonopin, usually fluctuating between .25mg and .5 mg pr day

Dale, taking benzos (or any psychotropic medication as far as I know) every day or virtually every day, but in different doses, causes chaos in the brain and nervous system.

"prn" refers to occasional use of the med at the prescribed dose; i.e., if the prescribed dose is .5 mg., that would mean occasional use of 0.5 mg tablet, like for situations of extreme stress. Even this is not a good idea, but when used rarely, benzos are not a problem for most people.

But daily is another situation - benzos can be physically habituating (aka "addicted") much more quickly than other meds, and with daily or almost daily use, that can happen within weeks (I heard of one case where physical habituation happened in one week). It takes longer with other people, but no way to know which a person will be, and the situation describe certainly sounds like physical habituation, as texgirl noted.

I think you need to stabilize at one dose if that is the case - if you frequently take 0.5 mg. it would probably need to be that one - then start a slow taper plan; the Ashton manual often referred to here has advice on that. Also, although this board is mainly about SSRIs, there are people like texgirl here who have had to go off benzos and can give you advice.

But taking the med on a regular basis with different doses is bound to cause you problems. The brain becomes habituated and expects that dose daily until one can taper off - and that must be done very slowly to minimize the problems withdrawal can cause.

[TryingtoGetWell]

Originally Posted by TryingtoGetWell

"prn" refers to occasional use of the med at the prescribed dose; i.e., if the prescribed dose is .5 mg., that would mean occasional use of 0.5 mg tablet, like for situations of extreme stress. Even this is not a good idea, but when used rarely, benzos are not a problem for most people.

But daily is another situation...

I just want to clarify for everyone that when I described prn dosing as being occasional use at the prescribed dose, that doesn't mean that when used occasionally (once in a while) one can't use a lower dose if that suffices - which it often dose.

My concern is that when used regularly, taking different doses each day (when one has become physically habituated/addicted) causes chaos in the brain.

Consistent daily dosing is needed when physically habituated to the med. True prn use ("as needed" - occasionally only) does not, and taking lower dose is fine and minimizes side effects.

Two very different situations.

[vestabula]

I was taking Lexapro(for fibromyalgia) and Valium(for RLS) together for two years. I did a very hasty taper off Lexapro and really suffered....and probably still am a year later. Then decided to get off Valium as I was given an 'as needed' prescription also and after reading about the drug realized I was putting my body and brain through chaos with different dosages every day...sometimes missing days at a time. Benzo w/d, at least for me has been a worse Hell than the SSRI...if that is possible. The symptoms of w/d for both class of drugs are very similar but for me the Benzo experience is more intense and frightening...especially feeling like I am going to black out in the mornings. My suggestion is to never try to wean of both of these drugs at the same time. I was off Lexapro for only a few months before I started the Benzo taper. Make sure you are stable before tackling your next drug.

[dale]

Originally Posted by TryingtoGetWell

Dale, taking benzos (or any psychotropic medication as far as I know) every day or virtually every day, but in different doses, causes chaos in the brain and nervous system.

"prn" refers to occasional use of the med at the prescribed dose; i.e., if the prescribed dose is .5 mg., that would mean occasional use of 0.5 mg tablet, like for situations of extreme stress. Even this is not a good idea, but when used rarely, benzos are not a problem for most people.

But daily is another situation - benzos can be physically habituating (aka "addicted") much more quickly than other meds, and with daily or almost daily use, that can happen within weeks (I heard of one case where physical habituation happened in one week). It takes longer with other people, but no way to know which a person will be, and the situation describe certainly sounds like physical habituation, as texgirl noted.



I think you need to stabilize at one dose if that is the case - if you frequently take 0.5 mg. it would probably need to be that one - then start a slow taper plan; the Ashton manual often referred to here has advice on that. Also, although this board is mainly about SSRIs, there are people like texgirl here who have had to go off benzos and can give you advice.

But taking the med on a regular basis with different doses is bound to cause you problems. The brain becomes habituated and expects that dose daily until one can taper off - and that must be done very slowly to minimize the problems withdrawal can cause.

Thanks, hearing this gives me some relief as to what I may have been keeping me in an anxiety and depressd state since I restarted them. And also gives me a plan to correct. It's crazy though that my P Doc did'nt mention anything about this.

[texgirl]

Originally Posted by dale

It's crazy though that my P Doc did'nt mention anything about this.

The same thing happened to me, Dale. It's unforgiveable when you consider that the addictive properties of benzos have been recognized and well-documented (unlike SSRIs) for 30+ years.

I want to add one suggestion to the good advice that TTGW gave above. If you're currently fluctuating between .25mg and .5mg, I would first try stablizing at .25mg instead of .5mg. Give yourself two or three days to feel the effects. If you find you're really jumping out of your skin at the lower dose, you can go up to .5mg. But if you can manage on .25mg every day, you'll have that much less of the drug to wean off of eventually. .25mg may not seem like much, but as you've seen, small amounts of Klonopin are very powerful.

[dale]

Originally Posted by texgirl

The same thing happened to me, Dale. It's unforgiveable when you consider that the addictive properties of benzos have been recognized and well-documented (unlike SSRIs) for 30+ years.

I want to add one suggestion to the good advice that TTGW gave above. If you're currently fluctuating between .25mg and .5mg, I would first try stablizing at .25mg instead of .5mg. Give yourself two or three days to feel the effects. If you find you're really jumping out of your skin at the lower dose, you can go up to .5mg. But if you can manage on .25mg every day, you'll have that much less of the drug to wean off of eventually. .25mg may not seem like much, but as you've seen, small amounts of Klonopin are very powerful.

Thanks for your input, I'm in the middle of a bad w/drawl I think from stopping Paxil so quickly. I just reinstated Last Friday, after being off for 1 month, is it normal to be feeling so out of it and depressed or should I have already stabilized. I'm very confused and scared so I don't want to touch a thing for now.