Question: Dr. Shipko, I have been off .5 mg./day of Klonopin for 8 months now. I had been on Klonopin (various doses) since 1995, weaned off with great difficulty and stayed off for 20 months before reinstating. I have been experiencing anxiety and in particular stomach problems (no ulcer) that just haven't quit over the past 8+ months. I would be happy to be reassured that this withdrawal process just takes time and that over time I will be feeling more back to normal. I am 65 now and recently retired. Can't find an understanding GP or psychiatrist but do see a therapist every so often.

Dr. Stuart Shipko Says...:

Anxiety and GI problems are common symptoms related to benzodiazepine withdrawal, but you need to have good medical evaluations to make sure that there isn't some other problem causing both the anxiety and the GI distress.  Sometimes the withdrawal symptoms persist longer than usual. Up to a year is not all that uncommon.  When the withdrawal symptoms are intense and persistent, some patients choose to reinstate  and consider stopping it again at a later date.  It is a tough choice, because most people want to be off the medication.  However, if your discomfort is too high, it might be worth at least a test dose of Klonopin to see if it will give you relief.

Persistent problems related to discontinuation of prescription psychiatric medications is a very new area of interest in psychiatry.  The drugs have been around now for decades, so there are a lot more people like yourself who have used medications long term and are having protracted problems when they stop. Protracted withdrawal has never been formally studied.  In that regard, it is understandably difficult to find a sympathetic doctor.

Question: There is a history of early onset Alzheimer’s in my family. I have anxiety problems and am prescribed clonazepam to take as needed when I feel panic but I am concerned about how this could have a long term impact on my memory. Will this drug increase my risks for Alzheimer’s in any way shape or form?

Dr. Stuart Shipko Says...:

It is not definitive, but it looks like benzodiazepines might increase the risk of dementia.  The short term effects of Klonopin and other benzodiazepines are well known, and memory impairment is a common side effect of this category of drug.  The studies which look at whether benzodiazepines are associated with a higher risk of Alzheimer's have been performed in elderly populations and are not definitive.  In one prospective study that looked at patients with an average age of 78, it was found that the patients who started benzodiazepines had a higher risk of developing Alzheimer's, but the authors also questioned whether the reason that the patients were put on the drugs related to early symptoms of dementia.  In another study, individuals over 65 were studied and it was found that the risk of dementia was higher in patients who had previously taken benzodiazepines, but that it was not higher in current users.  Your question is whether there is any information that supports this possibility, and the answer is yes, but the association has not been definitively proven.

Question: trying to find a rehab that is long term. I take klonopin for anxiety daily at a low dose and do not abuse it, however I cannot get off of it. I have tried many times and failed. i tapered over 3 months got down to .0625mg (which is 1/8 of a .5mg) once in the morning... stabilized there for 4 weeks and then stopped taking it.. I lasted two days before the anxiety came flooding back and had to updose to stabilize at .5mg twice a day.

Dr. Stuart Shipko Says...:

Unfortunately, I am not sure that what you want can be found in a drug rehabilitation program.  Unfortunately they do not have the sort of time you need and typically no hospital is required for this sort of problem.  As I write in my eBook 'Xanax Withdrawal' flexibility in tapering is important.  I wonder how you would have done if, two days after stopping you took .5 mg or 1 mg only once and then continued off the Klonopin.  It is possible that you could have taken some extra for just a day and would have been OK on subsequent days.  This is just an example of an alternative strategy to full reinstatement.  The anxiety you mentioned, 48 hours after the last dose, is actually uncommon, and it may have had more of a psychological than physiological cause.  For this reason it is a good idea to be in therapy while stopping Klonopin or other benzodiazepines.  Working with a professional who has had experience in helping people to stop Klonopin would be reassuring. You did a good job tapering and stopping Klonopin.  When you are comfortable, give it another try.  You might want to read 'Xanax Withdrawal' to get some further tips on stopping.

Question: I have been on benzodiazepines since about 2007. I started with 2.5 mg of Xanax a day then that got switched to 2mg of clonazepam and 4 mg of lorazepam a day. that got switched to just 2mg of clonazepam a day and I got off of the clonazepam once about 2 years later and my doctor tapered me off in a week. I was in hell. I begged her to help me and she began prescribing it again. 2mg of clonazepam a day. I could sleep and function again. That was the only time (about 3 weeks) that I have not been on benzos. Now I am on 5mg of nitrazepam and 3mg of clonazepam a day and its been like this for at least 4 years and Im so thin I cant gain weight, food tastes different I don't like foods that I used to like.. I get nauseous and get sick very often. I found out I have severe GI disease and Im terrified. Im only 25. Im also on methadone and Im tapering off that at the moment. I know Im addicted to these pills but I don't know what to do about it. I know the right thing is to probably get off of them but I have school and work and coming off methadone is difficult as it is. My doctors refuse to talk to me about changing my benzo doses because Im on methadone. what should I do?

Dr. Stuart Shipko Says...:

You have indicated that you are tapering off of methadone at the present time.  I agree with your doctors in this case.  You need to taper off just one drug at a time.  The benzodiazepines and the opiates (like methadone) both act as antagonists to a major stress/anxiety hormone and neurotransmitter called cholecystokinin (CCK).  If you were to taper the benzodiazepines down at the same time that you are tapering the methadone, the results would be unpredictable and possibly very uncomfortable.  Your doctor would not know whether the discomfort related to the methadone or the benzodiazepines.  It is doubtful that your GI problems relate to your use of benzodiazepines, as this would be quite uncommon.  You should focus on the methadone for now, and after stopping it you can then address the benzodiazepines.  Good luck to you.

Question: I have been using 10 mg of valium per day for the past 3 weeks as a tool to keep my anxiety under control while I try to get a handle on a serious drinking problem. I think I originally developed an alcohol problem in part because I self medicate social anxiety with a few drinks – and then it grew into something much more from that starting point. I do understand that valium is a very addictive drug but right now my focus is firmly on just trying to stay sober. This is my first real period of sobriety after a decade or so of hard drinking. I understand that I should not stop using the valium very suddenly. How long do you think I should continue to use the valium for before it is safe enough for me to start tapering off it without causing undue risk of an alcohol relapse?

Dr. Stuart Shipko Says...:

There is not a good answer to your questions.    It is conceivable that if you lack sober living skills that whenever you taper the Valium you will start drinking again.  Where are you getting the Valium?  You should be under the care of a physician who has a plan that addresses your question.  Depending on the severity of the drinking problem, and the success in stopping drinking while taking Valium, some patients are better off taking Valium indefinitely.  In my experience, it is more common for a patient with a drinking problem to start drinking again even while taking Valium, and for that reason I tend to avoid this treatment strategy - even for patients who may have originally been using the alcohol to self medicate anxiety.   Also, you may be underestimating the difficulty of tapering and stopping Valium once you are dependent on it.  For many people, stopping alcohol is a lot easier than stopping Valium.  Even at 3 weeks, Valium can be difficult to stop, but it is certain that it will be easier to stop taking the Valium now than it will be in 6 months or a year from now.  My advice to you is that you should get professional chemical dependency help right away for assistance in stopping the Valium right away while you are actively engaged in treatment for alcohol abuse.

Question: Whenever I am I a social situation it feels like I am an actor playing a script of me...I don't know how better to explain it, but its almost like I am looking at things from an outside perspective (not really, but I am always thinking about how everyone around me is perceiving everything I am doing) and the instead of just being able to act naturally and enjoy myself I feel like I am in a spotlight all the time or like I am on stage in a play and that everyone is watching me and judging me on everything I do. I don't know why, but I feel this especially when I am out with my kids and I am talking to them in public. Whenever we are at home and alone it's just very natural and fun but as soon as there is an 'audience' I start feeling really self conscious about everything I say and I am always feeling like people are constantly judging me on my parenting skills. Why am I like this and how can I stop being like this?

Dr. Stuart Shipko Says...:

It is not possible to tell you why you feel this way, as the cause of this behavior is likely complex.  As far as changing your behavior, it would seem that by continued socializing that you should get more comfortable with it.  If not, you might benefit from cognitive therapy which would help teach you to be more comfortable in these situations.

Question: Hello Dr. Shipko, I apologize that this message is so long. But I will try to summarize the best I can. I have a 24 yr old son, who we've been trying to help for the last 10 years with his mental health issues and addiction problem. My husband and I have never had drug/alcohol addiction, however my dad and my grandfather have been alcoholics. My son's problem started when his older brother (who had an opiate addiction) relapsed and tragically died of an overdose at the young age of 20. Our remaining son who at the time was 14 spiraled into a deep depression and debilitating anxiety kicked in shortly after (prior to this, we did notice that he had anxiety issues, but exaserbated). He isolated himself and threw himself into an online game that he used to cope. He would stay up all through the night playing and would have little communication with anyone. Despite our efforts of counseling, drug therapy prescribed by a psychiatrist, SPECT scan by the Amen Clinic, (which showed that he had anxiety disorder and mood disorder) etc. nothing seemed to work. He would have out of control rage and take it out on my husband and I. After a 1 1/2 years of this he went back to school, but when he did he started using alcohol first and then it turned into other drugs. He eventually was arrested at the age of 18 for posession of ecstasy and stolen property. He was ordered to a 6 month program, which he did and seemed to be doing better once he was out. Unfortunately, he soon got back into the drug scene and started using opiates. He has been on suboxone, which he has weaned himself off of just recently. He is sober now, but his addictive behavior goes into other areas of his life. Prior to giving notice, he worked in Las Vegas for a well known magician. After 8 months he decided to leave because of addiction to gambling and anxiety issues. He's now home with us (in California) and needs help to get his life on track. My husband and I have depleted all our savings, retirement, etc. to try to help our boys. My husband left his lucrative position when Aaron was 16 because we felt that we were losing him, too. Now we are at a point where we both are without work and financial means to help him. If you have any suggestions of low cost group home for young men who have mental health issues along with addiction issues to get some life coaching and possibly medication to help with debilitating anxiety would be so much appreciated. Or if you have any other suggestions? We are at a point where we know there's not more we can do, but want to try to reach out to other experts in this matter. Thank you so much - CC

Dr. Stuart Shipko Says...:

I do not have any direct knowledge of facilities that might suit your needs.  I have heard that the 10 Acre Ranch in Riverside, CA has a low cost group home that might suit your needs.

Question: I have GAD and panic disorder and I am addicted to lortabs and somas. I would like to try to wean myself off by tapering because I do not think i could handle a full on detox.  My question is concerning controlling my anxiety while I reduce my daily dosage. The opiates work well to control my anxiety and when I take less my anxiety goes up quite badly. Is there anyway I can reduce the anxiety that comes with tapering? My friend recommended xanax but I think it is going to take me at least a month to taper and the last thing I want it to get addicted again to any kind of benzo. I have been through that before and I will never do that again.

Dr. Stuart Shipko Says...:

In this circumstance, tapering would be very difficult, since Lortab and Soma are both agents that reduce anxiety.  You are correct to be concerned about heightened anxiety during tapering as this is going to be a significant barrier to stopping these drugs.  Xanax is not a good choice of substitute drug for the reasons you have noted.  I do not know whether or not you require detox, but you are going to require professional help if you are serious about trying to stop these drugs.  There are outpatient treatments that taper the drugs where your anxiety can also be monitored and treated if necessary.  In the face of an underlying anxiety problem, it is particularly difficult to stop Lortab and Soma - a common addiction in people with panic anxiety.