Clonazepam for anxiety and OCD

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DEAR DR. ROACH: I am a 58-year-old woman with a long medical history of anxiety. In 2007, my doctor prescribed me clonazepam 0.5 mg to take as needed for anxiety attacks and OCD, from which I constantly suffer. I have been off and on this medication until now. From late October 2017 to January 2018, I went off it for a while. Then I began having greater anxiety, so my doctor instructed me to go back on it. I have been taking it every day and now am physically dependent on it. I tried going “cold turkey,” but it was awful. So I tried slowly tapering. I take one half-tablet in the morning at breakfast. My heart is constantly pounding, and I am having much difficulty getting off this med.

My doctor then told me that I could stay on it for the rest of my life. Is this what I should do? I have constant anxiety, along with mental illness. Clonazepam does help me to a degree, but I have read that it is not a drug to consider staying on long term. When it wears off, I get a pounding heart and some nausea, crying spells, the shakes and mild memory loss. I had a bad experience on Prozac many years ago, and I am afraid to take antidepressants. I have an appointment coming up with the doctor who originally prescribed this to me. Will I die if I taper down and go into withdrawal? Should I stay on this med for the rest of my life? I do not have a psychiatrist, but would like to see one for my OCD issues. I have mainly contamination OCD. — G.B.

ANSWER: I don’t think clonazepam is a good long-term treatment for most people with anxiety of the severity you are describing, and I don’t think it is working well for you.

Obsessive-compulsive disorder is much discussed in television and movies, but not always accurately. As its name implies, it consists of obsessions (recurrent, persistent thoughts, such as of contamination, which you mentioned) and compulsions (repetitive rituals or behaviors that HAVE to be performed due to the obsessions): One common example is hand washing to prevent or relieve the thoughts of contamination. Many normal people have both obsessions and compulsions, but to rise to the level of a disorder, they must be very time-consuming (over an hour a day) or cause significant distress or impairment in functioning. People can have a high degree of insight into their condition (as you seem to) or little to no insight.

The combination of OCD and anxiety disorder is common, but nonetheless treatment requires familiarity with both conditions and expertise with medications. Most family doctors and internists lack sufficient expertise to take care of this condition optimally (this includes me). You absolutely should have a psychiatrist helping prescribe medications, and you may benefit from talk therapy as well.

Clonazepam is a good medication when used judiciously. Withdrawal symptoms can be mild or severe, but death would be most unlikely. Nonetheless, medicines like clonazepam are generally not effective in treating OCD.

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