Switching from Klonopin to Xanax

[springvillefd]

Hey guys got a question or two for you if anyone can relate...


My doc has put me on Prozac 60mg each morning with 0.5mg klonopin each morning and night. This worked really well for a few years and I talked to my doctor about coming off the medication as im only 22years old and I dont want to be taking meds unless I have to. My doc agreed to taper me off the drugs and I have been off of them for a few months. The tapering took about 3 weeks. For the next several weeks after that I felt fine but slowly I started getting jitters and then back with anxiety. I still had klonopin left so I took 0.25mg as needed on my own discretion. At first it wasnt that bad so I didnt think much of it. So it kept getting worse and I finally decided to go back to my doc and get back on medicine but the doc wanted me to try diff drugs. He put me on Zoloft 100mg once each morning with 0.25mg Xanax as needed. He said if I needed I can take more Xanax and titrate to effect. So far I keep having constant anxiety with it being the worst each morning. I have taken Xanax and upped it and I havent felt anything really. Internally im still very shaky, weak, nervous ect.
The anxiety goes away during the day and gets much better in the PM hours however, i keep having these tremors internally and it feels like I could just start shaking a lot. I am wondering if this is withdraw from the klonopin still??? (this feels just like when I had forgotten to take a klonopin back when I was on it). I have an apt scheduled tomorrow at 11:30 am and am requesting to just go back to klonopin because I know how I tolerate it and it works well.

Thanks guy!

[insights]

Internally im still very shaky, weak, nervous ect.
The anxiety goes away during the day and gets much better in the PM hours however, i keep having these tremors internally and it feels like I could just start shaking a lot. I am wondering if this is withdraw from the klonopin still???

No.

The tremors and shakes are common initial side-effects of Zoloft, not helped by you being started on probably too high a dose. 50mg would have been better, 25mg ideal. Switching to Klonopin won't do much to ease these side-effects as they aren't anxiety symptoms but a drug effect. They should diminish after a few weeks. But Klonopin might be more effective in controlling the heightened anxiety antidepressants trigger in the beginning. Xanax is actually the more potent benzodiazepine, however, it is a short acting one and you may be of those that does better with the smoother ride of the longer acting Klonopin.

Ian

[springvillefd]

So I have been on zoloft for a few weeks maybe two-ish and so far I am still having these tremors and internal shakiness esp in the morning. When Im active (usually standing) I notice it the most but when I like lay on the couch or bed I feel fine but my muscles are tired. My doctor says to just watch it and if it gets worse come back in. I have felt like this pretty much ever since I started zoloft. I am assuming this is the zoloft but am worried its something else. I am wondering how many others on here have felt this way after starting zoloft??

[2sungo]

I'm not on zoloft, but am on lexapro (again) and klonopin, and I notice the same cycle of feeling worse in the am and better in the pm.  I suspect this is the actual anxiety itself, when you wake up cortisol and adrenaline are at their highest I beleive, and they contribute to anxious feelings when our nerves are sensitized.  At night, just before sleep, one can feel almost normal.  Before this third episode in 25 years (they seem to come about a decade plus apart), I just drank tea or coffee to wake up in the am, but right now I just drink a small green tea, caffeine seems too stimulating in any serious quantity when I am in this state.  Odd how that is not the case in between episodes, though I have usually been on a low dose of some kind of AD inbetween episodes and carry klonopin "just in case" (though I have not used it often in between espisodes).  Seems depression comes after the anxiety as well, maybe that is in response to the anxiety or panics, but it gets better with time and treatment too.  I did not like Xanax when I tried it (which was when I had my first panic attacks years ago) b/c when it wore off the generalized anxiety would come back and I would feel as bad as before.  Klonopin gives longer protection against anxiety/panic and is easier to taper off of when one is ready to do so (assuming the AD is working and one is stable for a while,no need to rush in my opinion).

[insights]

Odd how that is not the case in between episodes, though I have usually been on a low dose of some kind of AD inbetween episodes

I'm not sure that this is a good idea. If you're taking an antidepressants than it should be at the therapeutic dose all the time. The danger of reducing the dose when anxiety or depression are waning is that this may lead to the buildup of tolerance. However, discontinuing treatment between episodes may also do so with growing evidence that antidepressants tend not to work as well as before each time they are discontinued and restarted.

Ian

[springvillefd]

I may just go back to my doctor and request to go back to Prozac 60mg x1 a day and stay on the Klonopin at the same dose, which would take things back to the way they were last year when I felt fine. All of this mess is just because I wanted to see if I could come off the drugs and be okay but apparently not and then being placed back on different SSRI and Benzo was a bad idea. I have been taking Zoloft since the 13th of March and I do not like the side effects. Tremors/muscle tightness/fatigue and severe lack of sexual desires. I had none of this with Prozac. I am a 22 year old male. These side effects of Zoloft are not welcome. 

[2sungo]

Ian, definitely agree with you that the long term AD dose should be enough to be effective as I am finding out from experience, though I don't see why it cant be lowered if things are good and it remains in the therapeutic range and no problems appear.  Going off is probably a bad idea as you said and I have found out,  unless they come up with some miracle of magnetic stimulation or other treatment that can replace the ADs (unlikely in our lifetimes, but one can hope....) or outright cure these conditions (gene therapy--maybe for the next generation).

[insights]

unless they come up with some miracle of magnetic stimulation or other treatment that can replace the ADs (unlikely in our lifetimes, but one can hope....)

I get the sense that research into anxiety disorders and depression has been put on the back burner. Certainly, the pharmaceutical industry is nowhere as interested as it was. Too many lawsuits and too many failed candidate drugs.

So short of a fortuitous breakthrough, I think we're pretty much stuck with what we have. And what we have is diminishing by the minute too. Benzodiazepines are now problematic in much of the world and definitely no longer a first-line treatment for anxiety and the tide may also to be turning against antidepressants with the British NHS promoting therapy, especially online based therapy as the treatment of choice. Which might not be a bad thing provided that those like me who don't respond are given alternatives. The problem is that if much of the world follows suit the alternatives may begin to dry up as the smaller potential market reduces investment in R&D.

Ian

[springvillefd]

So I finally went to see a psychiatrist this past Thursday and he advised me to go back to the 60 of Prozac and stay on the Klonopin .5 x2.
He is tapering me off of zoloft by telling me to stop 50mg and add 20 of prozac for 3-4 days then drop another 50mg of zoloft and add a total of 40 of prozac for about 3-4 days then stop the remaining zoloft and go up to 60 of prozac.

I start a new job this Monday. I am hoping I will not have any withdraw effects while tapering this way. Has anyone tapered like this before? I hear several stop cold turkey on zoloft. 

[insights]

I hear several stop cold turkey on zoloft.

Don't! Prozac has a very long half-life, over 9 days, so it takes a while to build up in your blood-stream taking up to 5 weeks for plasma levels to settle to a steady state.

Ian