Benzodiazepines are a class of drugs that act as central nervous system depressants, or sedatives and tranquilizers.
Clonazepam, with a trade name of Klonopin, is an anxiolytic drug prescribed to manage seizure disorders and also panic disorders by slowing down some of the bodily and brain functions related to anxiety and stress. Clonazepam is thought to increase the presence of gamma amino-butyric acid (GABA) in the brain, which helps to slow down heart rate and blood pressure, and calmemotional disturbances.
The U.S. Food and Drug Administration, or FDA, warns that taking Klonopin can be habit-forming and that users may become physically and psychologically dependent to the drug. Users should therefore not stop taking clonazepam suddenly without medical supervision due to the dangerous side effects, or withdrawal symptoms that may occur after the discontinuation of the drug. Side effects and withdrawal may occur in users who take the drug only as prescribed.
Klonopin and other benzodiazepines are commonly abused and even taken with other drugs and/or alcohol, which may increase the withdrawal side effects. The Drug Abuse Warning Network (DAWN) reported that over 61,000 people sought emergency department treatment for a negative reaction involving the recreational, or nonmedical use, of clonazepam in 2011.
Clonazepam, when taken or abused for any length of time, can create chemical changes in the brain. Parts of the brain that are normally suppressed by the drug may become accustomed to the interaction of the drug and stop performing normally without it. This is when a dependence on the drug has been formed. When clonazepam is then removed, these functions that were being dampened are suddenly not, and a kind of rebound may occur. The symptoms that Klonopin may have been managing, such as anxiety, panic, seizures, and insomnia, may then be magnified.
The drug should not be stopped suddenly or without the direct supervision and guidance of a medical professional. Potentially fatal seizures or a coma may occur with the sudden cessation of Klonopin.
Catatonia is also a rare, but documented, side effect of clonazepam withdrawal, as reported by the journal Psychosomatics. Vital signs such as blood pressure, heart rate, respiration levels, and body temperature may need to be monitored during withdrawal, as they can jump to unhealthy levels rather quickly as the brain and body attempt to restore order without clonazepam. Physical symptoms of clonazepam withdrawal may include:
Withdrawal from clonazepam can be dangerous and even potentially life-threatening.
Benzodiazepine withdrawal is also known for the debilitating psychological side effects that may occur after a drug such as clonazepam is stopped. Perhaps one of the most serious emotional side effects of Klonopin usage is the increased risk for suicidal thoughts and behaviors, as the FDA even made a point to add warnings about the potential for increased suicidal ideation to Klonopin labels in 2009. Psychological symptoms of withdrawal from clonazepam may also include:
The emotional benzodiazepine withdrawal symptoms will usually subside with time and psychological support.
There are generally three main phases of benzodiazepine withdrawal: early withdrawal, acute withdrawal, and protracted, or late withdrawal. Since Klonopin is a benzo with a long half-life of 18-50 hours, as published by the journal Case Reports in Psychiatry, withdrawal will not usually start until about 1-3 days after the last dose, or when the drug stops being effective.
Early withdrawal usually lasts about 2-4 days and is likely to include “rebound” symptoms, such as anxiety and insomnia. Acute withdrawal usually peaks around two weeks after stopping clonazepam and may last anywhere from a week to a month, according to information published in the Center for Substance Abuse Treatment’s Substance Abuse Treatment Advisory. The bulk of the withdrawal side effects will likely occur during acute withdrawal. Protracted withdrawal may include a continuation of psychological symptoms and drug cravings that may appear without warning at any time for several months or even years after the cessation of Klonopin.
Not everyone will experience all three phases of withdrawal as addiction and withdrawal are unique to each individual. For instance, protracted withdrawal is considered fairly rare; however, it may be more likely to occur in someone taking clonazepam than someone taking a shorter-acting benzo such as alprazolam (Xanax). Protracted withdrawal may be able to be avoided or controlled with therapy and mental health treatment.
Some of the factors that may influence the number of symptoms and the length of withdrawal may include:
Generally speaking, the more dependent the brain is on Klonopin, the longer and more uncomfortable withdrawal may be.
As with any benzodiazepine, medical detox is necessary for those withdrawing from clonazepam.
Medical detox ensures that trained professionals are on hand to monitor progress 24 hours a day, seven days a week, and medical detox will often utilize medications to help control the more difficult withdrawal symptoms. Since it may be dangerous to stop taking clonazepam “cold turkey” due to the range of withdrawal symptoms, detox will often include a tapering schedule. This is a way to slowly lower the dosage over a safe period of time, which can minimize potential physical and emotional side effects. The Journal of Clinical Pharmacology reports that major withdrawal symptoms can be largely avoided with a gradual weaning, or tapering, of clonazepam. Medical detox will usually last about 5-7 days until the peak of withdrawal symptoms has passed, and body is 100% clear of Klonopin. There is no specific medication currently approved to treat benzodiazepine dependence directly; however, there are several medications that may be useful during medical detox. Antidepressants may be helpful to manage depression and suicidal behaviors that may occur during detox and clonazepam withdrawal, and other medications that work to influence GABA levels, such as gabapentin, are also being studied.
Klonopin (clonazepam) is a benzodiazepine drug that has a number of therapeutic uses.
It is used to assist in the control of seizure disorders, assist in the control of anxiety disorders, and may be used as a muscle relaxant or sleep aid. Klonopin’s primary action, like all benzodiazepines, facilitates the effects of the inhibitory neurotransmitter gamma aminobutyric acid (often abbreviated as GABA) in the brain and spinal cord. This action results in a decrease in the firing rates and excitation levels of all other neurons, resulting in sedation, relaxation, and a sense of overall calmness. These effects are therapeutic at lower levels of the drug. Benzodiazepines such as Klonopin also produce feelings of mild euphoria and wellbeing. They are classified as controlled substances by the United States Drug Enforcement Administration ( Schedule IV controlled substances). Klonopin and other Schedule IV substances have a potential for abuse and the development of physical dependence. They can only be legally obtained with a prescription from a physician.
Because Klonopin is a high-potency benzodiazepine with a relatively short onset of action, it is used in the treatment of serious anxiety disorders, such as panic disorder.
However, these properties also leave open the potential for the development of a serious physical dependence on Klonopin. The syndrome of physical dependence occurs as an individual’s system adjusts to the presence of a drug in the system and in a sense learns to operate efficiently only when the drug is present in the system at certain levels. Other system functions compensate for the presence of the drug, and the release and maintenance of freestanding levels of neurotransmitters, hormones, and the functioning levels of all systems in the body are adjusted according to the presence of the drug.
When an individual stops taking the drug or reduces the dosage of the drug significantly, and these freestanding levels of the drug in the system decline, the individual’s system is thrown out of balance, resulting in a reaction that leads to the release or inhibition of neurotransmitters, hormones, etc. This situation results in the physical withdrawal symptoms that occur when one stops taking Klonopin. The physical withdrawal symptoms are accompanied by emotional and behavioral symptoms that are very uncomfortable for the person.
Several variables affect the individual presentation of withdrawal from Klonopin in individuals who abuse the drug.
It is important to note that benzodiazepines like Klonopin are more often secondary drugs of abuse that are used in conjunction with some other primary drug, such as alcohol or narcotic medications.
When there is polydrug abuse of substances that also carry a high risk for physical dependence, the withdrawal process is much more complicated.
Variance in human physiology and psychological makeup can affect the intensity and length of withdrawal symptoms. The length of time the individual abused Klonopin will influence the length and intensity of withdrawal symptoms. The frequency of use and dosage used also affect the withdrawal process.The most often cited depiction of withdrawal from Klonopin (or any benzodiazepine) indicates that withdrawal really occurs in two major steps. Some sources will increase this to three steps or even more to account for very acute feelings of withdrawal and/or for a post-acute withdrawal syndrome. That being said, benzodiazepine withdrawal is generally considered to occur in two stages:
This period occurs within a period of 1-4 days following last use, depending on the half-life of the benzodiazepine. Benzodiazepines with longer half-lives will result in the appearance of acute withdrawal systems later than benzodiazepines with shorter half-lives. Klonopin has a half-life elimination of 30- 40 hours, so individuals may not begin to feel serious acute withdrawal symptoms for a day or two following discontinuation.
The other variable that affects the onset of acute withdrawal from Klonopin is the frequency and dosage of use. The more often and higher the dose used, the sooner the withdrawal symptoms will appear. Because Klonopin has a high potential for physical dependence, it is quite possible that abusers of the drug were taking very high doses very frequently, and withdrawal symptoms can appear sooner in these individuals.
Acute withdrawal symptoms can be quite variable but most often will consist of some combination of:
A rebound effect refers to the return of symptoms that were controlled when one took a specific medication. Since benzodiazepines like Klonopin are used in the control of anxiety, rebound, anxiety is a common acute effect of stopping the drug. Some sources may recognize rebound anxiety as a first step in the withdrawal process from Klonopin as it often presents early in the acute withdrawal process.
This refers to the symptoms that persist after acute withdrawal ends. People who abuse Klonopin and were taking extremely high doses of the drug may experience more extended periods of withdrawal.
Individuals will experience general feelings of malaise, cravings, anxiety, depressive symptoms, and may continue to experience some somatic symptoms, such as nausea, lightheadedness, headache, mild fever or chills, and so forth. An additional period of rebound anxiety may also occur near the end of this stage.
There is a section of the literature regarding withdrawal from drugs in general, including Klonopin and other benzodiazepines, that describes a third phase of withdrawal that consists primarily of psychological symptoms, such as mood swings, periods of irritability, periods of anhedonia (difficulty experiencing pleasure), and depressive symptoms that continue to present themselves on an intermittent basis for weeks to years following discontinuation of the drug of choice. This post-acute withdrawal syndrome (PAWS) is not universally accepted as a stage of withdrawal by many researchers, nor is it formally listed in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders; however, the syndrome is accepted by some individuals in the field of addiction as legitimate.
It is suggested that individuals who do not have the symptoms of PAWS addressed are at a higher risk for relapse
Withdrawal from a benzodiazepine such as Klonopin can be potentially fatal due to the risk for seizures (although this risk is rare).
As a result, medical detox is always necessary for benzodiazepine withdrawal. Several medications can be used to assist in the withdrawal process, including:
Any number of medications could conceivably be used to address specific symptoms during the withdrawal process. However, research indicates that using a tapering process, where the individual in withdrawal continues to receive increasingly smaller dosages of the drug until formal discontinuation, is the most effective means to manage withdrawal from benzodiazepines such as Klonopin.
After an individual is deemed physically stable, the emotional side effects of withdrawal are considered more thoroughly. Cognitive Behavioral Therapy (CBT) and Motivational Interviewing (MI) are two forms of therapy that may be used during benzodiazepine addiction treatment. Individuals usually attend both group and individual CBT sessions, which may also include homework and educational sessions that strive to uncover the cause of addiction and how to avoid potential stressors and triggers in the future. MI can aid in increasing an individual’s internal motivation level by offering incentives for clean drug tests. Peer and family support groups are also useful aspects of a comprehensive substance abuse treatment program. Levels of care may change throughout withdrawal as individual needs and circumstances change as well.
Relapse is common in individuals addicted to benzodiazepines, and it is especially hazardous after detox. Someone who has been accustomed to using drugs at a certain level, but has not used them for a period of time and then returns to previous use levels, may end up suffering a fatal overdose. The National Institute on Drug Abuse (NIDA) reported that benzodiazepine overdose deaths increased fourfold from 2001-2013, to close to 7,000 fatalities in 2013.
A relapse may occur as someone strives to self-medicate what may be uncomfortable withdrawal symptoms.
Therapy and psychological support are vitally important during benzodiazepine withdrawal in order to reduce and minimize potential relapse and avoid tragic consequences.
Clonazepam withdrawal is best managed with a combination of both pharmacological and therapeutic methods starting with medical detox.
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