Klonopin is a fairly potent benzodiazepine (benzo) medication which contains the psychoactive drug clonazepam. It is similar and roughly as potent as Xanax, a popular benzo medication for both clinical and illicit use. When compared to an equivalent dose of diazepam, the “gold standard” benzo to which all others are compared, Klonopin is roughly 15 times stronger on a milligram-per-milligram basis. Klonopin use produces sedation, relaxation, and anti-anxiety effects although in higher doses it may also produce memory and coordination impairment. This drug, like all benzos, works through increasing the brain’s sensitivity to the neurotransmitter GABA, a major inhibitory neurotransmitter. This can subsequently produce downstream effects on several other neurotransmitter systems including the serotonin, dopamine, and norepinephrine systems.
Like all benzos, Klonopin acts as an agonist, or stimulator, of the neurotransmitter GABA. It does this through a convoluted route by binding at specific benzodiazepine receptors, which are subunits of the GABA-α receptors. This action increases the affinity of GABA to GABA-α receptors, thereby increasing the inhibitory and neurological depressive effects of GABA. Repeated use of Klonopin can produce tolerance, and further use will result in physiological dependence. This occurs due to adaptive changes made by the brain in the form of downregulation and neurological remodeling. Downregulation is the process of the brain turning down its sensitivity to GABA in an attempt to maintain balance. Remodeling is the process of the brain making structural changes in an effort to operate more effectively in a GABA-downregulated environment. While downregulation is mainly responsible for the short-term, and potentially dangerous, symptoms of Klonopin withdrawal, remodeling is responsible for the long-term, mainly psychological symptoms.
When someone who has been using Klonopin in high doses or for long periods stops using the drug, the brain will be unbalanced due to both downregulation and remodeling. The adaptation made to operate in the chronic presence of Klonopin will produce a state of hyperactive arousal once the drug is suddenly stopped. This can produce a variety of symptoms, both psychological and physical. Some of these may even be dangerous or potentially fatal. The disruptions to the GABA system will become apparent within hours to days of the last time someone used Klonopin, as withdrawal symptoms emerge and intensify after abstinence. 1, 2, 3, 4
Since Klonopin is a sedative-hypnotic type drug, the symptoms of Klonopin withdrawal will exhibit opposite characteristics in the form of hyperactive disruption to a variety of systems. The changes the brain made to operate in a Klonopin-rich environment will reduce the brain’s ability to slow itself down and moderate many functions once the drug is removed. This can produce psychological hyperactivity as well as physical hyperactivity, and these symptoms can range from uncomfortable, to possibly life-threatening.
The symptoms of Klonopin withdrawal can be divided into two phases: acute symptoms and post-acute symptoms. The acute phase manifests physical and psychological symptoms, and while it is the shortest phase of the two, it presents the greatest medical risk of dangerous complications. The symptoms of the post-acute phase are strictly psychological in nature, although they can be very long-lasting. While not directly dangerous in a physical sense, the psychological symptoms are often difficult to overcome and, in the absence of effective treatment, can drive many people back to using Klonopin for a sense of relief.
Some of the symptoms of Klonopin withdrawal include:
While these symptoms are not usually fatal, in very heavy or long-term Klonopin users, the risks can be great. Seizures can increase risks substantially, as suffering an unexpected seizure while simply laying in bed or standing in place can lead to injury. Additionally, there is a very dangerous seizure state known as status epilepticus, which is a seizure lasting more than 5 minutes, or several seizures with no return to consciousness in between them. This is considered a medical emergency as it can lead to brain damage or even death.
Due to the potential risks produced by the symptoms of Klonopin withdrawal, if someone is expecting to undergo withdrawal, it is highly recommended that they obtain medical care and supervision. Entering a Klonopin detox center is advisable, as these centers can provide medications, supervision, and clinical therapies to help reduce the physical risks and discomfort as well as ease the psychological stress and discomfort.
The post-acute symptoms of Klonopin withdrawal are not usually physically dangerous, although that does not mean they are easy to endure. Benzodiazepines in general, and Klonopin in particular, can have lengthy and persistent psychological symptoms, often lasting months or years after the last time someone used the drug. These symptoms can act as a barrier to healthy recovery by making it difficult to make connections with people and promoting isolationist behaviors.
Some of the most common post-acute symptoms of Klonopin withdrawal include:
These symptoms may be preferable to the intensity of the acute phase and the physical symptoms, although this can still be a very unpleasant time for someone early in recovery. Many of these symptoms will make it difficult to have meaningful social interactions with people and be open and honest with those who may be able to help. In addition, the depression, anxiety, and cravings can make a return to Klonopin use seem more and more attractive. Being able to continue recovery and treatment after detox has been completed is critical to long-term recovery. Having assistance from medications or behavioral therapies can reduce the severity of these symptoms and help someone continue their recovery in a healthy way.
Finally, the post-acute symptoms of Klonopin withdrawal can last a very long time; frequently months, sometimes years, and rarely they may be permanent. Medication and therapy are highly recommended to reduce the severity or impact of the post-acute symptoms of Klonopin withdrawal, as they may persist for quite some time.
The timeline for Klonopin withdrawal is fairly protracted as far as drug withdrawal syndromes go, and is even quite long among the benzodiazepine withdrawal syndromes. This is partly due to the mechanism of action on GABA systems, as well as the long half-life of Klonopin. While the average half-life of Klonopin is between 30 to 40 hours¹, there may be substantial differences in the half-life between individuals. This is due to someone’s unique genetics and the way genetic factors affect the rate at which Klonopin is metabolized8. In addition, senior citizens and the elderly will probably experience a longer withdrawal timeline, as the normal metabolic changes of aging can slow the metabolism of Klonopin and other benzodiazepines 9,10.
That being said, we will examine the Klonopin withdrawal timeline on average, as this timeline will be applicable to most people. Let’s take a look at the timeline of Klonopin withdrawal symptoms on a week-by-week basis for a clearer picture:
The symptoms of Klonopin withdrawal may take some time to emerge after the last Klonopin use, sometimes between 3 to 7 days11. When symptoms do emerge, the first ones are usually increased anxiety, sweating, and minor shakes. These will increase over the next few days and will be joined by stomach issues, hyperthermia, hypertension, tachycardia, insomnia, and increased irritability. Several days after the emergence of symptoms, hallucinations and seizures may manifest. These are often auditory hallucinations but may include visual, tactile, or a combination of all types. In addition, delirium and possibly psychosis may emerge towards the end of the first week. Delirium can cause profound confusion to both time and place, but even in the absence of delirium, someone’s thinking is often extremely disorganized or clouded. The risk of seizure is also highest towards the middle and end of the first week. This can be extremely dangerous, as seizures are capable of causing injury and brain damage or even death. Anxiety will often reach severe levels within a few days of its appearance, and this is known as rebound anxiety. Most of these symptoms worsen over the course of the first week of withdrawal.
Klonopin withdrawal symptoms are often near their peak at the beginning of the second week. While anxiety may have reduced somewhat from the peak “rebound anxiety” levels, it will still be intense compared to baseline. People who abuse Klonopin often have anxiety issues to begin with, thus the symptoms of anxiety can be quite pronounced since they may have had an anxiety issue prior to using the drug. Insomnia may be somewhat reduced, and the risk of seizure and hallucinations will reduce towards the middle of the week. Irritability may be subjectively worse around this time, as several days of little sleep or food can put someone on edge in addition to the rest of the symptoms. Towards the end of the week, some relief may be visible in the physical symptoms with a reduction in tremors and cardiovascular hyperactivity. As the physical symptoms begin to lessen, it is common for someone to become more aware of the psychological symptoms such as depression and cravings for Klonopin, as they have less distraction in the form of intense physical symptoms. By the end of the second week, many of the physical symptoms have shown some improvement.
The beginning of the third week often marks some improvement in the physical symptoms. While insomnia and anxiety-induced stomach issues may persist, most of the other symptoms are much improved by this point. The psychological symptoms may be another story, as the perception of negative emotional states may be more apparent now that the physical symptoms can’t distract someone. Cravings for Klonopin, depression, anxiety, and irritability are often still present at fairly high levels. Additionally, energy levels often remain very low, although this is in a psychological sense and not necessarily physical, with someone feeling mentally drained and unmotivated. Finally, cognitive deficits are usually still present, with someone’s thoughts seeming slow, clouded, or disorganized.
By the beginning of the fourth week, someone is often experiencing some hope as most of the physical symptoms are fully resolved, or close to it. While anxiety-induced insomnia and stomach issues may persist to a minor degree, the greatest discomfort is passed. That being said, the psychological symptoms are often still present and will usually persist at a fairly high level for some time. This time can be very sensitive regarding someone’s recovery, as relapse is quite common in the weeks after acute withdrawal has finished. With the memory of the worst symptoms fading, a return to Klonopin use may seem more attractive as the memory of the discomfort or pain fades. If someone has not already sought further care and treatment, it is highly recommended that they do so now. Medications and therapies can help reduce the psychological symptoms while the brain works to heal and return to pre-Klonopin levels of function. This is a slow process that can oftentimes take many months or even years, but continued abstinence, medical care, and psychological support can be a great help.
Aside from the potential dangers and risks, the symptoms of Klonopin withdrawal are usually extremely uncomfortable, both in a physical and psychological sense. Entering a Klonopin detox center can help reduce the risks and provide relief from some of these symptoms through medications, medical monitoring, and psychiatric care. This will not only make the experience much less dangerous and uncomfortable, but it can also increase someone’s chances of long-term recovery. Aside from immediate care, these programs can also act as a liaison to further treatment and care after detox has been completed, and help someone to build a solid foundation in recovery.Klonopin Detox Center Guide
The main mechanism of action through which Klonopin produces its effects is through increasing sensitivity to the inhibitory neurotransmitter GABA. This is the primary inhibitory neurotransmitter of the brain and body that moderates a wide range of functions including the gastrointestinal system and motor functions. The effects of Klonopin withdrawal can manifest issues in both of these areas and more, as GABA downregulation and remodeling can cause hyperactive symptoms once Klonopin use is ceased.
These effects may range from simply uncomfortable to possibly life-threatening, depending on the specific system affected. Below we will take a look at just a few of the physical systems that are often most strongly affected and the exact causes and symptoms that arise.
Possibly the most outwardly obvious effects of Klonopin withdrawal are those that occur in motor functions. GABA plays a very large role in setting the seizure threshold, as it is the main braking and coordinating system for motor neurons. Once downregulation and remodeling have occurred and Klonopin use ceases, the brain and body have a reduced sensitivity to GABA. This causes the normal levels of GABA to be ineffective at properly slowing down and synchronizing nerve signals and can lead to tremor, hyperreflexia, myoclonus, and even seizures in cases of heavy Klonopin use. These seizures are dangerous and may cause brain damage in the case of status epilepticus seizure states. These may also be fatal in some cases, either due to the seizure itself, or injury sustained secondary to the seizure.
In addition to resting motor effects, people experiencing Klonopin withdrawal are often extremely uncoordinated and may appear clumsy. This has to do with the role GABA plays in proprioception via its heavy presence in parts of the spinal cord. Here, it plays a role in the consolidation of sensory information from different parts of the body and helps someone to know where their body is in space. During Klonopin withdrawal, GABA is unable to perform its role effectively, and people often have a distorted sense of where their body is, or they may overreact when trying to perform simple tasks such as walking. 12, 13, 14
In addition to the brain, GABA also plays a large role in the enteric nervous system and the gastrointestinal tract. Here, it exerts its calming and inhibitory effects to promote healthy digestion by moderating intestinal muscle contractions, regulation of stomach acid production, and the stomach releasing its contents into the intestines. Due to downregulation, GABA has a reduced effect and subsequently cannot slow these processes as it normally would. This can lead to stomach cramps, bloating, and diarrhea. While these may be minor overall, the sometimes intense anxiety that accompanies Klonopin withdrawal can contribute to these gastrointestinal issues as well.
While rarely dangerous on their own, these effects, diarrhea in particular, can increase other risks by promoting dehydration and electrolyte imbalances. This may really only be an issue in those with a pre-existing heart condition or diabetes, but even in an otherwise healthy person, it can be quite unpleasant. 15, 16, 17
Klonopin withdrawal can also produce effects in the cardiovascular system, particularly increased blood pressure and heart rate. These effects are probably minor overall but may contribute along with other autonomic causes to produce elevated blood pressure and heart rate. The hypothalamus is a region of the brain that is responsible for regulating many vital functions, including cardiovascular function. In this brain region, GABA is able to inhibit and slow the neurological output from the brain to the heart, thereby decreasing heart rate and blood pressure. Additionally, GABA is able to mediate the release of vasopressin, an antidiuretic hormone, which can indirectly increase blood pressure.
During Klonopin withdrawal, the reduced impact of GABA on these systems can result in hyperactive states. This is not normally dangerous, although in those with previous heart conditions this could increase the risk of serious complications. With GABA unable to effectively moderate norepinephrine and subsequent cardiac signaling or vasopressin levels, elevated heart rate and blood pressure are very common effects of Klonopin withdrawal. 18, 19, 20
While not directly dangerous, aside from the risk of suicide which is a real concern, the psychological effects of Klonopin withdrawal can be quite disruptive to normal life. These can take the form of depression as well as hyperactive symptoms such as anxiety and cravings. These can sometimes be fairly intense, and they are often quite long-lasting. In cases of someone who used very large amounts of Klonopin, or used it for a very long time, psychosis and delirium may also be an effect of withdrawal, although this is rare. Even the depressive effects, which may seem harmless, can increase the risk of suicide. Someone experiencing these psychological effects would benefit from medications and therapy, as these can reduce the symptoms while the brain undergoes the oftentimes slow recovery process.
This is possibly the most common symptom of Klonopin withdrawal, as Klonopin is a powerful anti-anxiety medication. There is a very intense form of anxiety, known as rebound anxiety, that often emerges shortly after someone ceases Klonopin use. This may persist for several days before decreasing and stabilizing at the level of moderately increased anxiety. This can often be especially pronounced social anxiety, but often exhibits increased generalized anxiety as well. This may persist for quite some time and usually lasts several months but may even persist for a year or more.
Aside from the physical systems that GABA can influence, it also plays a major inhibitory role in someone’s state of mind. There is actually a specific GABA-α receptor subunit, the α-2 and to a lesser degree the α-3 subtypes, that are known to play a direct role in anxiety reduction in general, and the anti-anxiety effects produced by Klonopin in particular. Once downregulation and remodeling have occurred to these receptor subunits, they have a reduced ability to become stimulated, therefore have a reduced ability to relieve anxiety. While the exact way that these receptor subtypes impact anxiety is not well understood, it is clear that they play a significant role. These neurological changes can reverse themselves, but in the case of remodeling, this can be a very slow process. 21, 22
Through the normal benzo effects on the neurotransmitter GABA, Klonopin can produce indirect interactions with the serotonin and dopamine systems of the brain. Serotonin is a mood-regulation and elevation neurotransmitter that has a profound impact on someone’s state of mind. Dopamine is an excitatory neurotransmitter that can produce feelings of reward and pleasure. Through chronic Klonopin use, these systems can undergo downregulation and remodeling as well as the GABA system. During withdrawal, it is common for someone to feel unmotivated, hopeless, and unable to feel satisfied. This can lead someone to feel that life without Klonopin is not worth living and can make recovery very challenging.
Aside from neurological causes, there are behavioral reasons for depression as well. Klonopin use can become a very powerful, but unhealthy, coping mechanism. This can be someone’s primary form of coping with the normal stresses of life, and later, the additional stresses produced by an addiction to Klonopin. Having this removed suddenly can leave someone feeling vulnerable and helpless which can contribute to a general sense of hopelessness. These challenges, both neurological and behavioral, can be overcome but it will require time for the brain to recover, work to develop new coping skills, and help through this often difficult phase of recovery. 2, 21
Cravings are another very common effect of Klonopin withdrawal and may persist for quite some time. Similar to depression, cravings have both neurological and behavioral causes. From a neurological standpoint, dopamine is a primary contributor to cravings. Almost all addictive drugs have dopamine to thank for their addictive potential. This is a major excitatory neurotransmitter that plays many roles in the brain depending on where it is found. As it relates to Klonopin addiction, using the drug can increase levels of dopamine in the limbic system, also known as the “reward center” of the brain. Through chronic Klonopin use, the dopamine system in the limbic system can undergo downregulation and remodeling, leading to a reduced ability to experience reward and pleasure when someone is not using the drug.
When someone is undergoing Klonopin withdrawal, the various negative symptoms, both acute and post-acute, can cause them to want relief. The strong memory of the pleasure produced through Klonopin use, plus their reduced ability to achieve pleasure from normally satisfying behaviors, will oftentimes lead to cravings for Klonopin. These cravings may be intense and can last for quite some time as well, oftentimes months or years after drug use ceases. From a behavioral perspective, Klonopin use can often become a powerful coping mechanism. Similar to the causes of Klonopin withdrawal depression, when this coping mechanism is suddenly removed, someone can crave its return and the relief it used to bring. 23, 24
There is some substantial variability in both the intensity and the duration of Klonopin withdrawal symptoms. Some of these factors are behavioral in nature and thus based on someone’s use habits, while others are genetic or related to other health issues, and thus are beyond someone’s power to control. While use habits can affect both the intensity of withdrawal and its duration, genetic factors mostly affect the withdrawal duration and timeline.
Some of the factors that can greatly influence Klonopin withdrawal symptoms intensity and duration include:
By far, the largest contributors to withdrawal intensity are the amounts someone used and the duration of use. The amounts someone used can probably affect the intensity more than the duration, but the influence is felt in both aspects. The more Klonopin someone uses, the more the brain needs to adapt to maintain balance, thus the more downregulation and remodeling will occur. Downregulation is capable of happening, and reversing, fairly quickly so this mostly affects the withdrawal intensity. Remodeling on the other hand is a very slow process that takes time to occur and subsequently takes time to reverse. The longer someone used Klonopin, the more remodeling occurred and the more “permanent” it became, thus the longer they will experience symptoms of Klonopin withdrawal.
The existence of co-occurring mental health issues, which is fairly common in those who abuse Klonopin, plays a role in withdrawal intensity and possibly duration, although this role is very indirect. Since Klonopin withdrawal frequently exhibits depression and anxiety, if someone had been struggling with these issues prior to Klonopin addiction, then they would have worse symptoms during withdrawal. Additionally, these symptoms may persist longer in someone with mental health issues than in someone with no such issues.
Someone’s age and particular genetics can play a role in Klonopin withdrawal, and although these two causes operate on Klonopin metabolism, they are distinct in origin and effect. Advanced age is a known modifier of benzodiazepine metabolism, with the normal reduction in liver and kidney function that comes with age slowing down the metabolism of this class of drugs. With a slower metabolism, thus slower Klonopin clearance, the brain is slower to reverse the changes made in the presence of the drug. This can cause more protracted, although less severe, withdrawal symptoms as age at the time of Klonopin cessation increases. Genetics also play a role in benzodiazepine metabolism, in particular, certain abnormalities in liver enzymes can greatly increase the half-life of Klonopin. This is hereditary in nature, and normally would go unnoticed, except in certain drugs that undergo CYP and NAT2 metabolism, such as Klonopin. This can greatly slow metabolism of the drug, thus leading to a more prolonged but less intense withdrawal duration. 8, 9, 10
As far as treatment for Klonopin withdrawal, there are many effective methods at providing relief and helping someone establish a firm footing in recovery. These can take the form of medications, behavioral therapies, and support services and each of these may help specific issues. When used in conjunction, these three approaches can provide the best possible chances of a successful detox and long term recovery.
There are currently no FDA approved medications for Klonopin withdrawal, however, there are medications that have nonetheless proven effective. The two major medications that are used are diazepam and chlordiazepoxide, both long-acting benzos themselves. These are commonly used in the short term to reduce the risk of seizure and delirium and any associated complications. Many of the other medications can be used to treat individual symptoms of Klonopin withdrawal as they arise, and can reduce the risks and the discomfort of the withdrawal and detox experience.
Some of the medications that are commonly used to treat Klonopin withdrawal symptoms include:
These are simply the broad categories of medications that are commonly used, but each of these classes may have multiple medications that may be effective. Every person is going to respond a little differently to certain medical treatments, so finding the right one is where the trained medical professionals at a Klonopin detox center will be extremely useful. Aside from providing medical monitoring, they will be able to advise and adjust medications as needed, helping someone to find relief as quickly as possible.
While medications can provide safety and some relief, therapies can be greatly beneficial as well. The psychological symptoms can benefit from a therapeutic and clinical approach to mental health and may improve someone’s chances of long-term recovery after detox has been completed. Anxiety and depression, in particular, can benefit from therapy alongside medications, and having as many tools available can put someone in the best possible position to succeed.
Some of the therapies commonly used to treat the symptoms of Klonopin withdrawal include:
This is just a sample of some of the effective therapeutic treatment approaches that have proven very useful in recovery from Klonopin addiction. As with medications, everyone is going to find certain therapies more useful than others, so it may take some time to find the most appropriate ones. Again, having professional detox staff at hand can be extremely helpful as they will be able to advise certain therapies depending on someone’s unique and individual needs, history, and challenges.
Klonopin withdrawal is often very uncomfortable, and can even be deadly in certain cases if done without medical supervision. Because of the risks and the discomfort, it is highly recommended for someone to enter a Klonopin detox center if they are expecting to undergo withdrawal. Aside from the dangers, the support and care provided at these facilities can help someone build a solid foundation in recovery and give them the tools they need to have a healthy and full life after Klonopin addiction. Recovery is possible, but it takes willingness, work, and it often requires help. Even though someone may feel utterly alone in their addiction, help is available; all it takes is the courage to ask for it.
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