Medically Reviewed By: Benjamin Caleb Williams RN, BA, CEN
Written By: Phillippe Greenough
Article Updated: 12/02/2021
Number of References: 33 Sources
The symptoms of Klonopin withdrawal can be quite uncomfortable and sometimes even dangerous. There can be both physical and psychological symptoms, some of which may last for weeks or months after Klonopin use is ceased. Here, we will take a look at the mechanism of Klonopin’s action, the process of addiction, withdrawal symptoms, the timeline involved, and some effective treatments to reduce the severity of Klonopin withdrawal symptoms.
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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.
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 Klonopin’s mechanism of action, as well as this drug’s long half-life. While the average half-life of Klonopin is between 30 to 40 hours, 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 metabolized. 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.
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 as long as several days. When symptoms do emerge, the first ones are usually 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. Hallucinations are often auditory in nature 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 and potentially dangerous cardiovascular issues. 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.
Some symptoms of Klonopin withdrawal that may be expected during the first week may 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 lying 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.
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. Insomnia may be somewhat reduced, and the risk of seizure and hallucinations will reduce towards the middle of the week. 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 are less distracted by the intense physical symptoms. By the end of the second week, many of the physical symptoms have shown some improvement.
Some symptoms that may occur during the second week of Klonopin withdrawal can include:
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. 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 very close to it.
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.
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.
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.
Klonopin is a fairly potent benzodiazepine (benzo) medication that 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.
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.
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