Side-effects of Clonazepam

[AmZ]

Hi everyone,

I started taking Clonazepam last night due to my situation getting a little worse and not being able to control it.

I have anxiety and mild-depression. Symptoms I have: Sleep OK until 5am and wake up every day at this time with my stomach doing somersaults (gas and wind) and feeling nauseous. No appetite to eat until usually 4pm or in the afternoon, not panic attacks but general fluttery feeling in my body in the morning and feeling disconnected from my body, not knowing what to do with myself. Hair falling out due to being stressed, aching body sometimes such as pain in my arms, cloudy head feeling. Until the afternoon, most of the time my vision is blurry and I feel faint and light headed. Once 4pm usually comes, bang, I feel 'normal' again, and I get an appetite and eat. After this time I most of the time feel OK for the rest of the day and night.

I hope that the Clonazepam is something that will help me, but I do wonder if I need to be 'brought down' or 'brought up' - This is obviously to bring me down, but is there any element of it that will help the 'up' part?

I looked at the side-effects of Clonazepam, and some of them are the problems that I already have that I need to fix! Such as drowsiness, impaired balance and dizziness, nervousness, trouble in sleeping and, well, "Benzodiazepines can cause or worsen depression". I didn't see any mention about if it can change your appetite, but this is a big problem now that I don't want to eat and can't before the afternoon so I am left feeling very weak physically. The faint/blurry eyed thing I have also once I have eaten sometimes, but of course, if I have the faint feelings before eating in the afternoon, then I feel even more faint from feeling weak due to not eating.

Soooo... I hope this will be OK for me!

I know that Clonazepam can be very addictive, so I really only want to take them as a short term thing (as I haven't been able to function properly the last couple of days) - I heard that they can be addictive if you use them for even more than 3-4 weeks. So that, I hope will be my max usage. I know the things that I need to fix the reasons why I am anxious but they are not quick fixes so this is why I have decided it's best to take the meds (even though my psychologist recommended not - well, I recommended not to myself also, but I can't control it and it's gotten too bad already).

V difficult situation.

Any tips or anyone's opinion is much appreciated.

 

[David Baxter PhD]

Based on all of your posts here, I suspect that most if not all of your symptoms may be anxiety related -- you've already ruled out viral and it's not very likely they are medication side-effects -- and that they are continuing because you are taking such a tiny amount of your prescribed medication. Talk to your doctor or psychologist about this.

If you continue to feel drowsy on clonazepam, talk to your doctor about an alternative like lorazepam or Xanax which have a shorter halflife. Alternatively, ask your doctor about one of the SSRI medications used to treat anxiety.

 

[AmZ]

Thanks for the reply Dr.

Just to clarify here. I only started taking the Clonazepam last night and am on 0.5mg a day, so am splitting that up 0.25mg in the morning and 0.25mg at night.

My post before was basically saying that in some of the physical symptoms I already have due to the anxiety and mild depression, it seems that the side-effects of the Clonazepam could make them worse. (Such as drowsiness, impaired balance and dizziness, nervousness, trouble in sleeping and "Benzodiazepines can cause or worsen depression").

 

[David Baxter PhD]

See Making sense of medication side-effects | Psychlinks Psychology & Mental Health Blog for how to interpret real risk for side-effects with psychotropic medications.

At .25 mg, the side-effects you're worrying about are unlikely, except as mild and transient adaptation effects, as your body gets used to the medication. The other symptoms have been there since the beginning. It's not likely, in my opinion, that clonazepam you're taking is making anything worse.

Rather than alarming yourself by looking at internet sites, go talk to your doctor and/or psychologist about this. I think you are upsetting yourself unnecessarily.

 

[AmZ]

Thanks for the link.

I will speak to my psychologist etc about this. I was just asking in the meantime because I was only given 10 Clonazepam pills when I had gone to the hospital and was sent to the psychiatrist there. He said that I need to go back to my medical doctor and be referred to a full time psychiatrist who will then need to prescribe me for the future.

When he'd given me the Clonazepam in the hospital, I got just the pills and not even a leaflet which explained to me about the drug etc, so I'm not worrying myself, was just asking for general advice and get to know what to expect.

 

[David Baxter PhD]

Thanks for the clarification. I do find that a lot of people frighten themselves away from using prescribed medications because of internet information which is at best uninformed and at worst outright alarmist.

Any information you find about any medication that does not include a control group, usually a placebo group, where you can determine how many people with the same disorder or condition had the same symptoms in the absence of that medication is fundamentally flawed.

Additionally, when you read a phrase like "can cause X", it needs to be accompanied by the percentage of people who experienced that side effect (in comparison with those not taking the drug who also experienced that side-effect). You also need to know what dose of the medication was being taken.

So for example, with clonazepam, you may see something like this:

Side effects may include:

• drowsiness, dizziness, spinning sensation;
• memory problems;
• tired feeling, muscle weakness, lack of balance or coordination;
• slurred speech;
• drooling or dry mouth, sore gums;
• runny or stuffy nose;
• loss of appetite, nausea, diarrhea, constipation;
• blurred vision;
• headache;
• nervousness, sleep problems (insomnia);
• skin rash; or
• weight changes.

What does that actually mean? Very little, as written. For one thing, those lists are generally based on side effects reported by 1% or more of patients. For another, the dose is unstated.

Looking further into the statistics for clonazepam, we find this:

Most Common Adverse Events ( ≥ 1%) Associated with Discontinuation of Treatment

Side Effect | Clonazepam (N=574) | Placebo (N=294)
Somnolence | 7% | 1%
Depression | 4% | 1%
Dizziness | 1% | < 1%
Nervousness | 1% | 0%

Clearly, other than sleepiness which is to be expected, none of this are high probability side effects. But even this doesn't tell us the whole story. Digging a little deeper, we see that these data are based on "doses ranging from 0.5 to 4 mg/day". So which patients were taking 0.5 mg and which were taking 4.0 mg? How many reported any of these side-effects at 0.5 mg vs. 4.0 mg?

Treatment-Emergent Adverse Event Incidence in 6- to 9- Week Placebo-Controlled Clinical Trials

Side Effect | < 1 mg | 1- < 2 mg | 2- < 3 mg | % ≥ 3 mg | All Doses | Placebo
Somnolence | 26 | 35 | 50 | 36 | 37 | 10
Fatigue | 9 | 6 | 7 | 7 | 7 | 4
Dizziness | 5 | 5 | 12 | 8 | 8 | 4
Depression | 7 | 6 | 8 | 8 | 7 | 1
Nervousness | 1 | 4 | 3 | 4 | 3 | 2
Appetite Decreased | 1 | 1 | 0 | 3 | 1 | 1
Blurred Vision | 1 | 2 | 3 | 0 | 1 | 1

So what should this tell you?

• Only a minority of people taking this medication experienced any of these side-effects.
• The most likely side-effect is sleepiness, part of which is also a symptom of anxiety itself (see Placebo = 10%).
• For most side-effects, whether or not or how frequently they occur is dose-related.
• Many of the reported side-effects occur as frequently with the placebo patients as with the clonazepam patients.

Data derived from http://www.rxlist.com/klonopin-drug.htm

 

[AmZ]

That information is great thank you. Very interesting.

I agree about how people can scare themselves away from using medication because of the internet and what is contained there.

I'm feeling too bad because of the anxiety in order to function so am not overly bothered about the side affects right now. After taking the meds at 10.30pm last night and again at 6am, I felt extremely tired after being awake this morning for an hour or so, so went back to bed for a couple of hours. Even thought I've been feeling more tired than usual, I still feel a lot more and even now in the late afternoon, I'm still feeling a bit 'drunk' if you could say. Whether it is a coincidence or not, I manged to eat breakfast this morning in the first time in 2 weeks and asides from feeling a bit 'out of it' - I had no feelings of anxiety. We'll see if it worked that quickly or as to whether I'm just telling myself it's worked and am just controlling my mind in thinking it worked!

Need to see when it's going to be best to take the meds when I speak with the psychologist/psychiatrist. I only usually have the anxiety at 6am when I wake up until 4pm latest and then I feel OK after, so not sure about taking it late at night before bed, then again early in the morning as maybe it will make me too sleepy in the morning. Even though, maybe I shouldn't complain lol... As long as I can get up and go to work, maybe I'll deal with that over the horrible feeling of anxiety and not being able to eat etc!

 

[AmZ]

Clonazepam saves the day.

Amazing.

---------- Post added June 27th, 2010 at 05:07 PM ---------- Previous post was June 26th, 2010 at 11:03 PM ----------

Quick question if I may...

Is there a certain amount of days until the Clonazepam will be constantly in my system, as it were, rather than it wearing off a bit at the end of the first dose I take of the day? Or would it mean that I need perhaps a higher dose if I'm starting to feel bad again after several hours of taking it?

I've only been taking it since Thursday, but for example - I took it this morning (I am on 0.5mg a day, so 0.25mg twice daily) at 7am. Now it's 5pm, I am starting to feel a lot of anxiety and fluttery feeling in my body again. I was going to take the next dose at 7pm and keep it regular like that but for the last hour I've started to feel pretty bad.

So yeah, a higher dose possibly could be needed OR does the body take a few days to build up and keep the Clonazepam in my system more so this shouldn't happen?

I'm not asking this as a 100% answer, just as advice. I will of course ask the psychiatrist and speak with my psychologist about it.

Thanks in advance.

 

[David Baxter PhD]

SSRIs like Prozac or Celexa or Effexor have a gardual and cumulative effect.

Clonazepam doesn't really work that way so it doesn't "build up" in the way you describe. The amount you are taking is very small. If you think more would be helpful, talk to your doctor about it.

 

[AmZ]

Thanks DR.

I will check. I am going tomorrow to a psychiatrist to get a prescription but will need to ask obviously before just getting that - It's not a proper appointment yet as they have a waiting list. Problem is, I only have 5 or so pills left so that's why I need to go on emergency tomorrow. (They had only given me a few when I had gone to the hospital originally). But will need to check that this is the right thing for me.

For now, it's doing pretty good to be honest. I have hardly any feelings of anxiety and all the physical symptoms I was having, asides from the couple of hours in between doses.

They said the dose is a regular dose for someone with mild(ish) anxiety and mild-depression like I have so will see what the new psychiatrist says tomorrow.

Thanks.

 

[David Baxter PhD]

The standard starting dose is 0.5 mg either once a day or 1-3 times per day as required.

However, especially if you are exhibiting signs of depression as well as anxiety, your doctors will almost certainly only authorize clonazepam for the short term and will probably prescribe one of the SSRI medications like Celexa or SSRI/SNRI medications like Effexor, if only because of the addiction concerns with benzodiazepines.

 

[AmZ]

I just double checked and on the label it says 0.5mg 1 x daily - But at least when I got them from the psychiatrist he said to take half a tablet to start with. But maybe I should just take 0.5mg (1 pill) when I get up in the morning instead of splitting them up? I guess if it's the morning until afternoon which is only the time I have the anxiety pretty much, I shouldn't be splitting them up. I was just concerned that if I don't take anything at night, then by the time I wake up in the morning I will automatically be feeling bad and if I only took the pill once awake in the morning, it will take a little time to kick in and I want to be able to get up straight away and function. Know what I mean?

Up until now, the depression side is really quite mild and to be honest, without sounding like I am trying to cover something up, I feel unhappy at times, but it's not depression. I don't really have any symptoms of depression.

For sure more on the anxiety side.

 

[David Baxter PhD]

If it makes you sleepy taken in the morning, take it at night. The benefits will carry over until the next day and it will help you sleep more soundly.

 

[AmZ]

But if I take 0.5mg at night, I'm concerned that it's still not going to be good for me up until 4pm or whatever the next day.

But maybe you're right and it would be better like that. A higher dose before I go to sleep, will be good for the worst time of the day (morning and lunchtime) and hopefully be enough to cover me until the afternoon.

---------- Post added at 10:59 PM ---------- Previous post was at 06:03 PM ----------

Silly sounding question, but here I go....

I genuinely feel that my current anxiety is temporary. I've had it for 3 and a bit weeks now. I treated it as a virus for 2 weeks due to thinking it was a physical problem but turned out to be all from anxiety. Those 2 weeks obviously made things 10 times worse, and now, since a couple of days ago, along with going on meds, I have gone back to work, the gym, etc and my normal life.

Now I've been taking the meds for just 3 days, I don't feel any feelings really of the anxiety physically and mentally I can't say that I do either so much. I know things that bother me from my past a bit and from the last couple of months being tough for me. I also know some of the 'fixes' I can make over the next couple of months hopefully which will lessen my anxiety greatly. But the fixes are neither instant, nor can I really say it will take 'x' amount of time to solve (i.e. increasing my social life etc).

Now that the meds have stopped the physical feelings, I can't really know when I am feeling better or not, as silly as it sounds. How am I going to know when to come off of the meds so as to not take them for longer than needed nor to take them not long enough and for the physical feelings of anxiety to come back?

Maybe I can continue feeling anxious about things for the rest of my life, like we all can, but to which level is it I won't know because of being on the Clonazepam.

I can't see there being a straight answer here.... But maybe there is?