Dancing With The Devil . . . or . . . How Did I Allow Klonopin (or Ativan . . . or Xanax . . . ) To Rule My Life

I have been taken aback with the number of severe comments I have gotten from people who have had such a difficult time with Klonopin and other benzodiazepines over the years.  In my practice, it has a central role in symptoms relief for many people with generalized and panic anxiety.  When starting them, they always get the list of warnings about the medicine, including the addictive potential.  In all my years I have had very few horror stories about Klonopin addiction in my office.  There are clearly some people (very small minority) who are benzo-sponges.  People for whom there is never enough Klonopin or Xanax or Ativan or what-have-you.  The vast, VAST majority of people who I put on these medicines stay at a reasonable dose and tend to minimize their dose over time . . . either with my direction or on their own.  So what’s with the few who can’t get enough???

It is important to remember that, just because they have difficulty with a medicine, they are NOT bad people.  The spin on benzos is that they are BAD and people on them are BAD.  It is like alcohol and narcotic pain meds.  The drugs are not bad . . . the people are not bad . . . but there are clearly some people who should not drink and there are some who should not take pain meds or benzos. Some people’s biology leads them to be especially prone to anxiety and also prone to the development of tolerance.  Since the subjective experience of fear . . . panic . . . is intolerable to us all, the drive to take more of what did stop it in the past is huge.  Depression feeds panic and panic feeds depression.  The rate of suicide in patients with both is tremendously high.  Severe, unbridled anxiety MUST be aggressively addressed and managed.  That said, there are clearly patients who should not be put on benzodiazepines.  It is difficult to spot them until they start their pattern of misuse of the medicine . . . but once spotted, they need to be detoxed and not given another chance to be on the medicines without the presence of carefully crafted supports and checks on misuse.

It is painful for me to watch someone who clearly needs and benefits from judicious use of benzos continually refuse to take them as prescribed.  I had a wonderful lady recently who decided that she was going into rehab to stop using the Ativan that I had been prescribing and the alcohol she had been drinking (. . .that I didn’t know she was drinking . . . not a lot, but still a big no-no).  She got out of rehab a nervous anxious mess.  Off the benzos and alcohol (yipeee!!!), but a nervous, anxious and non-functional mess.  Not what I would call an improvement.  She has had an excellent track record of doing all the right things.  She goes to therapy, works to keep her stress level down as best as she can, has been stable on a solid dose of an SSRI . . . but is still an anxious mess.  Having failed all standard and non-standard pharmaceutical interventions for anxiety, I did the obvious.  I put her back on the dose of Ativan that has worked for her in the past.  With a very modest dose of the meds (Ativan 0.5-1 mg 3x daily) she does GREAT.  As long as she doesn’t beat herself up about it.

It concerns me that certain classes of psychiatric medicine and the people who take them get demonized and judged.  What does that say about us as a people and as a society?

–Dan Hartman, MD

10 comments to Dancing With The Devil . . . or . . . How Did I Allow Klonopin (or Ativan . . . or Xanax . . . ) To Rule My Life

  • Denise

    thank you for your post. there are so many things out there on the Internet where people say that benzos are terrible. I tried weaning off of Klonopin (.5mg) a few weeks ago, partly b/c of this stigma and for some other reasons, and I was able to be off of it for 1 week and then when downhill from there. I went back on .5mg of Klonopin for the past 2 weeks and it’s still been a struggle. I’ve heard the effects of trying to wean off can last for awhile, so I’ve just been trying to be patient.

  • Robert

    I could not agree more with this. I take a benzo daily for panic/GAD. I also take serotonin drug with it. It is the only combination that has kept me even and functional for 4 years now. My dose is low, and I only take them precisely as describe by my doc. I still have moments of fear when I question if I should approach my doc of going off of them. I’ve read all of the horror stories online, and I do not doubt that there are people who have very awful experiences with them. That’s not me though. What it boils down to is seeing what works for you, and finding a doc who knows how to work with them… That can be the challenge…

  • Elizabeth

    Thank you Doctor for your clear and unbiased information
    I have also been on Benzos for many years.Do not up the dose or get addicted.
    Have tried weaning off them and using Therapy etc,hopeless results!If any
    People are wired differently and if something works and is used responsibly there is no problem.Am monitored by a Psychiatrist.
    All the Best

  • for sure, all our brains are wired differently. i’d been on klonopin, .5 mg, for 17 yrs and wanted to go off. knowing the hardships of many i’d read about online, i was prepared for a long wean. to my shock it took all of 5 weeks, w/the help of a psychiatrist. don’t give up!

  • Kelly

    I have been on Klonopin .5 mg/day for 6 years. I was initially prescribed this benzo for post-partum anxiety I experienced with my daughter. I have tried many times over the past few years to be weened off and could not function with my anxiety level. I found a new psychiatrist recently who decided on a very slow tapering till I am completely benzo free. We’ll see how it goes…

    I would like to say that the stigma associated with klonopin is mind blowing. I also have a new GP who I told about my RX. I felt like his demeanor completely changed after I told him about being prescribed klonopin. Instead of asking if I was employed, he said “you’re not employed right?” He made me feel like I was this nutjob roaming the streets looking for my next high, when actually I am employed in law enforcement. Which my psychiatrist also made a comment about…he said he was sure my employer would not appreciate the fact I was on a controlled substance. I told him actually my employer is aware of this and has no problem with it.

    These reactions from DOCTORS make me feel like there is something so terribly wrong with me. I have NEVER EVER abused my prescription and hate that I have to take it. There is nothing worse than making someone with anxiety feel mentally ill.

  • Dottie B.

    Dr. Dan – This is a beautifully written and thoughtful article.

  • My withdrawal from klonopin ruined my life. Was on it for five years. Also was taking Darvocet for severe fibromyalgia symtoms. I went off both at the same time after a dui because of my abusive marriage. Long story short–this drug should NOT be on the market. I was addicted to prescription drugs with no idea I was. I hope no one will go through the hell I’ve been to. Am on forum for FDA to ban Klonopin. Horrible drug!!!!

  • doctordan

    Jenny–Not to minimize the difficulties you had, but is banning a medicine that helps so many people really the answer? You should have been informed about the potential difficulties with the medicine . . . and the potential difficulties in getting off the medicine . . . before you started it. Hopefully you were. Another area of concern is the use of benzodiazepines with opiates (ie, Darvocet). Coming off both at the same time undoubtedly made it quadrupally more difficult. BTW, Darvocet has been pulled off the market in both the US and in Europe because of concerns about it.

    I hope that you have been able to get your feet back on the ground and are doing well. I may not agree with your cause . . . but I am glad you are using your voice.

    –DH MD

  • […] Originally Posted by CountryFisher No there's nothing wrong with taking medication so that it helps you. Taking Paxil has helped my anxiety and depression tremendously, including my OCD. I'm glad it helped. While I personally had a bad experience with Paxil, I do realize it helps some people too. I think doctors could do a better job in informing patients of side effects and I learned as a result of my experience to do better research on prescriptions before I take them. That's what I don't get about a lot of the anti-prescription reaction, and I'm not just talking in this thread or on the site. Someone has a bad reaction to a drug, say Xanax or Paxil and they become convinced it's evil, no one should take it and it should be banned. I can say I certainly don't want to take Paxil again and I'm a bit wary of anti-depressants in general based on my experience. FOR ME. Other people respond well to Paxil/anti-depressants and if they do, good for them. I'm glad they are able to find relief from their symptoms. An interesting blog entry by a psychiatrist re: the benzo backlash: Dancing With The Devil . . . or . . . How Did I Allow Klonopin (or Ativan . . . or Xanax . . . ) To … […]

  • Jack

    Thanks you for this post. I feel that xanax is so demonized these days that people are so scared to take it and as a result have not even a temporary respite from their anxiety.

    After 6 years of therapy including Cognitive Behavioral Therapy with 3 different doctors I had no rest from my crippling anxiety. Finally I agreed to try xanax which I had avoided because of what I had heard about it.

    The result was that I was able after almost 6 years to return to work. That was 8 years ago. I’m not arguing that xanax has side effects. I openly admit that they do. What I do not hear of however and what I want to share is that xanax allowed me to have a life. I was able to work again, which allowed me to provide for my family and myself. Without xanax I was basically crippled, I could not help provide for my family or have any life. I felt like I was barely existing.

    So ultimately if I have to weigh up having a life on xanax or no life at all and no way to provide for my family I know what I would choose. Perhaps someday I will have to face the consequences of coming off xanax however I will know that at least I was able to provide for my family – something I was never able to do before.