Klonopin (Clonazepam)

“For years I have
said that Clonazepam is perhaps the most useful medication in chronic
fatigue syndrome “

Dr. David Bell

Klonopin is…

A benzodiazepine that calms down the brain by reducing the ‘set point’ at which it’s neurons are activated by increasing the production of GABA, a chemical that reduces neuronal activity. Klonopin has primarily been used to treat panic and seizure disorders.

Klonopin May Work in CFS Because…

Overactive neurons in patients brains may lead to ‘information overload’, oversensitivity to stimuli and exhaustion. Imagine being surrounded by a bank of TV sets and trying to concentrate on all of them – that’s what may be happening in CFS. Dr. Cheney believes this constant flood of information may cause the state of ‘sensory overload’ that requires patients to seek a place of quiet to rejuvenate themselves. Dr. Baraniuk believes the ‘gates’ that filter information into the brain may be damaged. Several studies suggest, in fact, that the brains of ME/CFS patients have difficulty turning their attention off of innocuous stimuli such as background noise.

By reducing the ‘set point’ at which the brain becomes active Klonopin and other drugs and therapies that reduce central nervous system ‘arousal’ may give the brain the chance to rest and rejuvenate itself. Dr. Bell states Klonopin is most effective in those patients who feel ‘wired but tired’.

ME/CFS Doctors Report

Klonopin’s effectiveness in ME/CFS is intriguing given that one of its side effects is fatigue. Too much Klonopin can, in fact, cause fatigue but just the right amount will increase energy levels and calmness. Physicians seek to find the ‘sweet spot’ between over and over activation of the brain.

Healing A Damaged Brain? – Dr. Cheney puts Klonopin in the ‘neuroprotector’ category. In 2000 he stated that since overactive neurons eventually burn themselves out and die that ME/CFS patients will suffer neuron loss unless this problem is brought under control. A 2001 report from Carol Sieverling stated Dr. Cheney believed high doses to battle severe relapses could make one drowsy but would not otherwise have negative effects. Dr. Podell, alluding to benzodiazepines,  reports that “a proportion of people with FMS/CFS do surprisingly well with this class of medicines, even with long term use.” He finds its sometimes useful to combine a low dose tricyclic antidepressant with Klonopin.



Other physicians are more cautious.  Dr. Klimas stated that she tries not to prescribe benzodiazepines such as Klonopin but when she does so she does at the lowest possible level.  Dr. Bateman reported  the central sensitivity sometimes found in ME/CFS can make dose reduction, once one is habituated to the drug, ‘very difficult’, causing ‘markedly amplified’ withdrawal symptoms. She prescribes the drug ‘sparingly’ and generally doesn’t exceed 1 mg at bedtime.   Dr. Lapp reported that once tolerance appears its best to taper off the drug and he generally does not exceed 2 mgs at bedtime.

Dose

Dr. Cheney most frequently prescribes a combination of Klonopin, Doxepin elixir and a magnesium supplement (Magnesium Glycinate Forte/with taurine or a magnesium (glycinate) complex.

  • Klonopin – two or more 0.5 mg. tablets at night for sleep. One quarter to half a tablet in the morning and mid afternoon to improve energy and cognition. Increase the dose until you become drowsy and then cut back. Double the dose during severe relapses. Dr. Cheney finds that very small doses (usually a quarter to a half a tablet in the morning and mid-afternoon) improve cognitive function and energy. He states that “if the daytime dose is low enough, patients will actually get a lot clearer and think better.”
  • Doxepin elixir (10 mg/ml.) –  Acts synergistically with Klonpin to assist sleep. Start with two drops at night and gradually increasing until you experience grogginess (‘morning fog’) in the morning.
  • Magnesium glycinate (200 mgs.) – at bedtime.
Dr. Bateman generally does not exceed 1 mg. at bedtime and Dr. Lapp generally does not exceed 2 mgs.

Side Effects

  • Addiction: Because Klonopin is a benzodiazepine it has the potential to be addictive but reports of addiction (drug-seeking behavior) are rare.
  • Tolerance – Tolerance occurs when a patient must increase the dose of a drug to get the same effects. Some reports suggest as many as a third of  the  patients who take Klonopin for over a month develop something called ‘benzodiazepine withdrawl syndrome’. As with any drug higher doses can have more negative effects.
  • Withdrawal: Withdrawal occurs when a patient experiences symptoms when going off the drug.  Klonopin must be withdrawn slowly. Read out how on ME/CFS patients withdrawl from 8 years of high dose Klonopin use landed her in a detoxification clinic.
  • Dr. Bateman reported  the central sensitivity sometimes found in ME/CFS can make dose reduction, once one is habituated to the drug, ‘very difficult’, causing ‘markedly amplified’ withdrawal symptoms. Wikipedia reports that  Benzodiazepine withdrawl is considered more hazardous than withdrawl from opiates and that “benzodiazepine  withdrawal syndrome” can result in anxiety, irritability, insomnia, sensory disturbances, thoughts of suicide, nausea, hypersensitivity to stimuli, headache, and even in very rare cases, seizures. Ironically some the symptoms of benzodiazepine tolerance such as anxiety and thoughts of suicide can lead uninformed doctors to increase a patients dose.

Klonopin vs. Clonzepam

Clonzepam is the generic form of Klonopin. In Dr. Cheney’s experience Clonzepam is not quite as effective as Klonopin. Dr. Bell, however, reports good success with Clonzepam.

Sleep Series on Phoenix Rising

 

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Bell Lyndonville News, Volume 4, Number 3: August 2007

Carol Sieverling. 2000. Paul Cheney, M.D on Klonopin – Protecting Your Brain. by Carol Sieverling from the CFIDS and FMS Support Group of Dallas Fort Worth

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