How to taper (or discontinue) a paradoxical benzodiazepine ? (clonazepam)

[Mary]

I'm wondering which of the supps you are taking are helping the receptors that have down-regulated?

I am very interested in your list. I do take melatonin and sometimes some RelaxMax by Xymogen which I think has the l-theanine, taurine...not sure what else. I do get some of the niacin, niacinamide, choline/inositol etc in my multi but should consider how much.

Hi @Oci - Niacin and niacinamide both stimulate GABA receptors. I discovered niacin a couple of years ago and it made a big difference in my sleep, it made the l-theanine etc more effective (this was before I started the lorazepam taper). It (the niacin) also lowered my cholesterol, just a side unintended benefit.

Since starting the lorazepam taper, I've read that niacinamide is more effective than plain niacin in stimulating the GABA receptors; however, the niacin definitely has an effect, so now I take both niacinamide and niacin (as well as everything else). I'd already been taking a choline/inositol supplement for sleep for several years, but added in extra inositol after the taper and it has helped a lot too with sleep. Inositol also enhances GABA's effect.

So I highly recommend adding niacin, and/or niacinamide (probably will take some experimenting to see what works best for you, maybe both of them) and inositol to any GABA supps like l-theanine. Here's one product which has niacinamide, inositol and GABA - I haven't tried it but it gets good reviews: http://www.iherb.com/Twinlab-GABA-Plus-with-Inositol-Niacinamide-100-Capsules/2363

If you do take niacin, get the plain kind which causes flushing. The non-flush kind doesn't work. Also, don't get extended release niacin, it has been linked to liver damage.

Niacinamide does not cause flushing.

Hmmm. @Mary How much of these various things are you taking and are they in separate caps or have you found a good combo?

I just take everything separately because I stumbled across each of these things one at a time. Here's what I take:

An hour before bed:
150 mg. 5-htp
200 mg. l-theanine
1 tablet Theanine Serene by Source Naturals
500 mg. niacin
500 mg. niacinamide
1 capsule choline/inositol (250 mg. each)
500 mg. inositol
3 mg. melatonin (Natrol sublingual)

And then I repeat it all, except for the 5-htp, when I wake up in the middle of the night. I don't take any more 5-htp.

Sometime (if ever! ) when my sleep is more stable I'll probably a try a combo like I linked above, but this is working for me now so I don't want to mess with success --

Good luck!

 

[Oci]

Wow @Mary What a wonderful resource you are!!! I will certainly follow up on these. For awhile there, I was not waking up in the night but since the last reduction of Zopiclone, I'm again waking in the night and finding it very difficult to get back to sleep....if I even do. Eating a bunch of carbs in the night is certainly not a good idea for my weight! So I am glad to try as you suggest.

Adding one thing at a time seems like a good idea. I don't always follow my own advice! Most of what you listed I already in single amounts. I have used over the years for insomnia but stopped during the taper as it was strongly recommended on benzobuddies to not take supplements. I greatly reduced what I was taking for sleep.

BTW, my Integrative doc has suggested amino acids during withdrawal. Have you tried? Any opinion?

Many thanks again for all your help! Oci

 

[Mary]

Hi @Oci - I'm really glad to hear this info may be helpful for you. I recently discovered the same thing as you about carbs in the middle of the night. I've been eating low carb for years and hardly any with dinner ... and have had middle of the night insomnia for years too. I had heard about blood sugar drops causing insomnia but didn't pay attention. But low blood sugar does seem to be a factor also so I have some very low calorie crackers and I've tried just one in the middle of the night and I think it helps. My sister swears by eating some potato (not a lot) before bed, which I think can help also, but it is a very delicate balancing act because I gain weight at the drop of a hat! argghh! And like you no way can I eat a lot of carbs in the middle of the night. But I am more mindful of carbs now and will eat some potato with dinner and have the cracker in the middle of the night if I feel hungry.

I forgot to mention the amino acid glycine above. This can be very helpful for sleep, I've been taking it for several years and take 2000 mg before bed and 2000 mg more in the middle of the night. Here's one article: http://www.naturopathiccurrents.com/articles/glycine-improving-sleep-quality

When I first started taking glycine about 2 years ago, it caused a major detox reaction for me - I was detoxing a lot then, so many things made me detox, so I had to go very slowly with it. I later found it is involved in Phase II liver detoxification, so it might be wise to go slow with it until you see how you react. I no longer detox on it, I think it helped normalize my detox pathways. Inositol also caused a mild detox reaction when I first started it, but it no longer does either.

And of course there's l-theanine.

5-htp I guess is not technically an amino acid but it is derived or produced by the amino acid tryptophan, and it also has been very helpful for me with sleep.

I don't know of any other amino acids which are helpful for sleep. Did your integrative doc name any of them?

 

[Oci]

Hi @Mary, Interesting about the low carb diet. It is well known that low carb diets produce insomnia. It is highly recommended by many that we eat practically no carbs early in the day (makes us more hyper to be active) and all the carb load late in the day. I have found this helps.

When I carb load in the night, I assure you it is not just a low calorie cracker! That would not work for me. I think the secret may be to keep blood sugar on an even keel throughout the day and then it is not as likely to tank in the night. I think I likely need to be having more "slow" carbs although perhaps we need some higher glycemic carbs to do the trick....ie trigger tryptophan to crossover.

I also think I have not been eating enough in the daytime as I've been busy.

Recently I tuned in briefly to a podcast by Chris Kresser. He has to balance his carbs very carefully or he suffers insomnia. He says...
"Try eating more carbs at dinner
Melatonin is synthesized in the brain by the pineal gland, along with serotonin, which is a neurotransmitter that is also involved in sleep regulation. An important raw material for this synthesis is the amino acid tryptophan, and carbohydrates increase the amount of tryptophan available to the pineal gland. Studies have shown that eating a carb-rich meal a few hours before bed can shorten sleep onset, and higher-glycemic carbs in particular seem to have the greatest effect. (13, 14, 15) If you have insomnia, and particularly if you’re on a low-carb diet, adding some carbs at dinner could be an easy and effective way to improve your sleep.

On the other hand, high-protein meals can decrease the availability of tryptophan because other amino acids compete for transport across the blood-brain barrier and into the pineal gland. (16) However, the glycine-rich proteins found in skin and gelatinous cuts of meat don’t have this effect, and studies have shown that gelatin consumption before bedtime (say, a mug of bone broth) can improve sleep quality."

Yes, I gain weight easily too but really believe that we should not have to be on a very low carb diet indefinitely. There are other downsides to low carb too ie gut health. There are lots of references but here is one.
http://fixyourgut.com/low-carb-diets-and-the-gut/

Thanks for the advice re glycine. I will give it a try. And perhaps 5-htp again although...

I am getting close to the end of my Zopiclone taper now and think my body will adjust. I have had periods of good sleep even while tapering. I think the latest struggle is because I have been striving to meet some goals...trying to produce a lot of work in a short time. Feeling somewhat uncertain in what I am doing even though work is generally enjoyable. This always makes me more intense and therefore sleep more elusive. This will be over after this weekend. I expect I will sleep much better next week!

I also realize that I am not preparing for sleep. I've been happily working away until after 11 and then expecting to just drop off to sleep. It took me a long time to get to sleep last night. But then I slept through to 6:45. Still it was only @6 hours and that is not enough for me.

Lots of dreaming though. What does that say about sleep quality? Or my state?

Anyway, thanks again for all your sharing of information. Oci

 

[Braz]

@Oci,
I get that. Supposedly Lyrica and gabapentin also help with GABA synthesis .. I once asked the doc for it and he refused !

I'm worse off now ... about that Cheney and prescribing Klonopin for central sensitization ... I feel pretty sensitized now and I have to get off !

 

[caledonia]

@Braz This article just came to my email and I thought of you. Tapering with CBD oil.

http://www.everywomanover29.com/blog/cbd-organic-hemp-anxiety-benzodiazepine-tapering/

 

[Mary]

@Oci - I'm sure you're right about carbs, especially as being important for sleep. I am eating potatoes at dinner now for the first time in years (!) I love potatoes ... well, good luck with your Zopiclone taper, it sounds like you're doing well. Lots of dreaming sounds nice to me, I don't do it that often or at least remember them that often --

BTW, gelatin is high in glycine. When I first started using glycine, it was in the form of gelatin (which caused a major detox reaction, I think I wrote about the detox reaction above). Eventually I switched to just plain glycine although I may go back to gelatin as it has other nutrients as well. We're going to know so much at the end of it all! (when we're cured, of course! )

 

[Mary]

@Braz This article just came to my email and I thought of you. Tapering with CBD oil.

http://www.everywomanover29.com/blog/cbd-organic-hemp-anxiety-benzodiazepine-tapering/

@caledonia - are you using CBD oil for a taper? How do you use it, when do you take it, how much etc.? And does it have any psychoactive effects?

 

[Oci]

@caledonia - are you using CBD oil for a taper? How do you use it, when do you take it, how much etc.? And does it have any psychoactive effects?

I have wondered about CBD oil too. One of my brothers uses it and it has had miraculous effects on him. He was in a lot of pain from various ailments, very obese and hardly able to walk. After going on CBD he has lost all the excess weight, feels good and is not out walking.
I wonder what it would do for me!!!

 

[Oci]

@Oci - I'm sure you're right about carbs, especially as being important for sleep. I am eating potatoes at dinner now for the first time in years (!) I love potatoes ... well, good luck with your Zopiclone taper, it sounds like you're doing well. Lots of dreaming sounds nice to me, I don't do it that often or at least remember them that often --

BTW, gelatin is high in glycine. When I first started using glycine, it was in the form of gelatin (which caused a major detox reaction, I think I wrote about the detox reaction above). Eventually I switched to just plain glycine although I may go back to gelatin as it has other nutrients as well. We're going to know so much at the end of it all! (when we're cured, of course! )

Good for you that you are branching out and eating potatoes! There are some good diet books out there that take into account overall health...not just weight. ie The Perfect Health diet. See http://perfecthealthdiet.com/about/ The authors are pretty amazing! They were very involved with perfecting the low carb diet for years and have now changed their opinions. I think they have a lot of good points. There are others too with interesting diets. We each have to find what works best for us as individuals.

 

[Braz]

@Mary, @Oci,

That's for that suggestion of CBD ... I take it works for 'mental anxiety', but does it also work for 'physical anxiety' (to put it that way) ? There are a lot of physiological processes that one could describe as 'physical anxiety'. For me, the mental part is much easier.

 

[caledonia]

@caledonia - are you using CBD oil for a taper? How do you use it, when do you take it, how much etc.? And does it have any psychoactive effects?

No, I'm not taking it. It was just some information I saw that I thought might help Braz.

CBD oil doesn't have THC, so it's not supposed to have psychoactive effects.

There is lots of good info in general about CBD on this page. It says the CBD oil can help reset the nervous system (about 1/3 of the way down the page).
http://mentalhealthdaily.com/2016/02/24/cbd-oil-for-anxiety-is-cannabidiol-an-effective-treatment/

I use a bit of 5htp for my taper, as needed at this point. Which, looking back, the issues I had were more due to mercury redistribution than the actual taper. But anyway, it did help.

 

[Braz]

Well, a big part of the problem is that there is no drug that is nearly as potent/strong as clonazepam (per mg).

 

[Braz]

@geraldt52, @Mary, all,

I´ve done a bit more research. I´m familiar with Nielk´s story and tried to get a bit more about Tranxene.

(http://phoenixrising.me/archives/12200)

About a certain dr. Lapp: ´Dr. Lapp’s Comments: 4. The use of Tranxene is the accepted method of withdrawal. Please note that Tranxene is SHORT acting. Thus a short-acting drug is substituted for a long acting one, and then the Tranxene must be withdrawn.´

´accepted method´ Would anyone know how to learn more about these ´methods´ or ´protocols´ for using Tranxene ? In this country, they just don´t use it for that purpose. Any idea about contacting that Dr. Lapp ?

Sorry about the bold/mess. I think my computer is acting up.

 

[Mary]

I'm familiar with diazepam, and know it's a very different drug, also shorter acting.

@Braz, I just saw what you wrote above. Actually this is incorrect. According to the Ashton Manual (http://www.benzo.org.uk/manual/bzcha01.htm#5), clonazepam has a half-life of 18-50 hours, whereas diazepam is 20-100 hours. This one of the reasons they recommend diazepam as a crossover drug for a benzo taper, it's longer-acting than many benzos and supposed to keep you on a more even keel.

According to the Ashton manual, Tranxene is very LONG acting - 36 to 200 hours. But it states the opposite below:

About a certain dr. Lapp: ´Dr. Lapp’s Comments: 4. The use of Tranxene is the accepted method of withdrawal. Please note that Tranxene is SHORT acting. Thus a short-acting drug is substituted for a long acting one, and then the Tranxene must be withdrawn.´

So this quote is confusing - it says that Tranxene is SHORT acting, but then says that a short-acting drug is substituted for a long-acting one - it makes no sense. It's the other way around - a long-acting drug (Tranxene) is substituted for a shorter-acting one.

I don't know anything else about Tranxene or using it for a taper. So you might look into using diazepam after all because it is longer-acting than clonazepam. Or Tranxene but again I don't know anything about it and I don't know why it's not recommended instead of diazepam, because it is longer-acting (maybe too long? I don't know!)

 

[geraldt52]

[SIZE=5] Would anyone know how to learn more about these ´methods´ or ´protocols´ for using Tranxene ? ...[/SIZE]

I'm sorry, Braz, but I'm not going to be of any help. I never heard of Tanxene, and my experience with tapering using a slew of different drugs was a complete failure. I know that others have had a different experience. I quit Klonopin cold turkey...I survived it, but sometimes I wondered if I would. The worst of it was over in maybe 6 weeks, but I'm not sure I've ever completely recovered from Klonopin, now 15 years later. I don't think there are any easy answers...that's how Michael Jackson ended up where he ended up. The good news is that you may have nothing more the wrong with you than the Klonopin, and if you can get off it one way or the other you might recover completely.

 

[Braz]

@Mary, @geraldt52 ,

I'll try avoiding asking questions you can't answer.

But to explain:
Something many people don't know: 'duration of action', basically how long the drug works. 'half life'=time it takes for blood plasma levels to fall by 50 %. With most benzodiazepines there is a considerable difference between their 'duration of action' and 'half life'. Is diazepam really 'long acting' ? If I were to take 30 mg diazepam in addition to my regular clonazepam 'intake' I will feel the diazepam for at least two days after taking the dose, probably longer. But If I drop the clonazepam it won't last long ...
In a nutshell, blood plasma levels are not everything. After taking a dose, a very large fraction of a benzodiazepien is directly distributed to the brain. Another way of saying this, it is the biological activity.

As far as Tranxene is concerned: it is converted into the stomach into desmethyldiazepam, which as a half life of 50-100 hours (depending on sources). I did try it, and not only was it weaker than both clonazepam and diazepam, it was also shorter acting than both clonazepam and diazepam, requiring dosing of 3-4 times a day !
So, half life isn't everything. But clonazepam is a beast of a drug, very powerful (although I never noticed that when I was healthier ...) and lasting a full day, more or less.

I've seen at last two references to using Tranxene to come off clonazepam, one being from a doc Cheney ...
Statements about 'the protocol', 'accepted method' are just that, I don't know what to do with it. You'd have to read the protocol or talk to the doc in question. It is not used in this country for that purpose.

In the USA there is or was a 'sustained duration version' that we don't have locally. For what it's worth.

So I'm in a quandary. A CT would be so harsh. It would definitely fry my CNS. And I did try diazepam, such a godawful drug, not to mention it is 'addictive' (able to make you very ill) in its own way.
What a tragedy that a doc knew how to prescribe, but not how to discontinue.

 

[geraldt52]

@Mary, @geraldt52 ,
...What a tragedy that a doc knew how to prescribe, but not how to discontinue...

It isn't just "a doc", it is docs in general. I really don't think any of them know how to get you off when you're in trouble, and 90+% of them don't even realize it can be a problem...or in most cases care. If it were an easily solvable dilemma Michael Jackson, with access to any doctor and any thing that he needed, would not have ended up where he did.

 

[Mary]

Okay @Braz, I am out of my depth here. I strongly urge you to look into niacin and niacinamide and inositol for their effect on GABA receptors, and perhaps get some adrenal support. Good luck --

 

[pspa123]

When I was going through a taper off long-term klonopin, the almost universal advice from people who knew on what was then an amazing Yahoo support group that no longer exists was not to touch any supplements. Heather Ashton says the same thing. Other people who write books about withdrawal say the same thing. Go slowly. VERY slowly. Period.

I wouldn't listen to people trying to sell you supplement programs (there are a number of those online), or amateur advice on forums about taking this and taking that and upregulating receptors and balancing this and that and blah blah. The brain has to make a slow, gradual adjustment to a lower and lower dose of the drug. That's it. There are no gimmicks or shortcuts or bandaids.

PS Ashton sometimes crossed people to the longest-acting benzo, valium, from shorter-acting benzos like xanax. Crossing to a short-acting one makes no sense at all to me.

PPS If you have good reason to believe your "paradoxical reaction" situation mandates a different approach, you might try the Mad in America website, I believe they maintain a list of doctors who are expert in benzo withdrawal. But again, I would not be playing with supplements based on anecdotal reports of "this worked for me."

Here is the list I mentioned.
https://www.madinamerica.com/service-directory/directory-category/individual-practitioner/