Withdrawal from clonazepam

Discontinuation during and after slow tapering has been shown to be well tolerated ( 79). A slow discontinuation of clonazepam usually results in a benign withdrawal course. Withdrawal from higher doses, particularly rapid withdrawal, however, can be associated with more severe discontinuation symptoms ( 80). 

Patterson JF. Withdrawal from alprazolam dependency using clonazepam clinical observations. J Clin Psychiatry 1990 5[Suppl 5] 47-49. 

RBD is characterized by a relative absence of the atonia characteristic of REM sleep. This lack of atonia permits the physical acting out of dream mentation, particularly dreams involving confrontation, aggression and violence. RBD is seen most frequently in older men. RBD occurs in both acute and chronic forms. Acute RBD can occur during withdrawal from alcohol or sedative-hypnotics. RBD has also been induced by the tricyclics, SSRIs and venlafaxine. The chronic form of RBD may occur as part of an identifiable underlying neurological disorder, but typically is idiopathic. RBD may also be an initial manifestation of parkinsonism. RBD is very responsive to clonazepam, although this use has not been FDA approved. 

Some patients can find it difficult to withdraw from as little as 0.5 mg clonazepam each night for sleep. Even motivated patients have sometimes developed such a fear of trying to go to sleep without BZs that they cannot undertake a serious effort. The fear is usually based on previous disturbing experiences of rebound insomnia. 

Albeck JH. Withdrawal and detoxification from benzodiazepine dependence a potential role for clonazepam. J Clin Psychiatry 1987 48[Suppl 10] 43-48. 

Severe withdrawal can occur after relatively short exposures to BZs. I have treated patients who suffered from severe withdrawal problems after only 2 weeks of low-dose exposure to prescribed alprazolam and clonazepam. Lader (1984) and the APA (1990a) task force confirmed that therapeutic doses commonly produce severe withdrawal symptoms. 

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