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Dr. Paul Cheney Discusses the Benefits of Klonopin

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Editor’s Note: The following is based on a recent interview conducted by Carol Sieverling with Dr. Paul R. Cheney, M.D., Ph.D., and the article “CFIDS Treatment: The Cheney Clinic’s Strategic Approach” (CFIDS Chronicle, Spring 1995). Dr. Cheney gave permission to share this information, but has not reviewed or edited it.

Many CFIDS specialists prescribe the drug Klonopin. In the October 1999 issue of The Fibromyalgia Network, nine CFS/FM specialists summarized their most effective treatments, and six included Klonopin. Interestingly, the three who did not are primarily FM specialists.

Dr. Cheney prescribes Klonopin to address a condition associated with CFIDS called “excitatory neurotoxicity.” To explain this condition to patients, he draws a line with “seizure” on the far left and “coma” on the far right. A big dot in the middle represents where healthy people are when awake. A dot somewhat to the right of the middle indicates where healthy people are when asleep – slightly shifted toward coma. He highlights in red the left portion of the line, from seizure to the middle, and labels it “Neurotoxic State” (damaging to the brain). He highlights in blue the right portion of the line, from coma to the middle, and labels it “Healing State.”

In CFIDS, an ongoing injury to the brain shifts patients toward seizure. A dot to the left of the middle, marked “injury,” represents the position of CFIDS patients. This puts us in the red “Neurotoxic” zone. When we shift toward seizure, we often experience “sensory overload.” It’s as if our brain’s “radar” is too sensitive. Our neurons (nerve cells) are sensing stimuli and firing when they should not. This causes amplification of sensory input. Light, noise, motion and pain are all magnified. At the beginning of their illness, many patients report feeling exhausted, yet also strangely “wired.” The “wired” feeling is the slight shift towards seizure that occurs as a result of the excitatory neurotoxicity.

Cheney frequently uses the term “threshold potential” when discussing excitatory neurotoxicity. (Think of the threshold – bottom – of a doorway. The lower it is, the more accessible it is. When it is at floor level, everything can enter. When it is raised, access is restricted to taller people. If it is too high, no one can enter.) Threshold potential refers to how much stimulus it takes to make neurons fire. If the threshold potential is too low, even slight stimulation is “allowed to enter” and is detected by the neurons. This causes the neurons to fire, resulting in sensory overload. If the threshold is dropped to nothing, all stimuli get through and the neurons fire continuously, resulting in a seizure. If the threshold is raised, only stronger stimuli can make neurons fire. A healthy person’s threshold potential naturally rises at bedtime, promoting sleep. If the threshold potential is too high, you feel drugged or drowsy. If the threshold potential is raised extremely high, coma results.

Two receptors in the brain, NMDA and GABA, determine the threshold potential. During the waking hours of a healthy person, NMDA and GABA should be equally active. This balances the person in the middle of the seizure/coma continuum. NMDA stimulates, and GABA inhibits. If NMDA increases, one moves toward seizure. If GABA increases, one moves toward coma.

In CFIDS, NMDA is more activated than GABA, lowering the threshold potential. This causes neurons to fire with very little stimulation, resulting in sensory overload. This condition of excitatory neurotoxicity is dangerous. Dr. Cheney emphasizes that in an attempt to protect itself, the body will eventually kill neurons that fire excessively. He states that brain cell loss can result if this condition isn’t addressed.

How can the brain be protected against excitatory neurotoxicity? Klonopin. This long acting benzodiazepine has been Dr. Cheney’s most effective drug for CFIDS over the years. He believes that Klonopin and the supplement magnesium may be two of the most important treatments for CFIDS patients because of their neuroprotective qualities. He recommends two or more 0.5 mg tablets of Klonopin at night. Paradoxically, very small doses (usually a quarter to a half a tablet) in the morning and mid-afternoon improve cognitive function and energy. If the daytime dose is low enough, you’ll experience greater clarity and think better. If the daytime dose is too high, you’ll become drowsy. Adjust your dose for maximum benefit, taking as much as possible without drowsiness. Adjust the morning dose first, then take the same amount mid-afternoon if needed, then take three to four times the morning dose at bedtime. Dr. Cheney recommends doubling the dose during severe relapses.

Dr. Cheney most frequently prescribes the combination of Klonopin and Doxepin, along with the supplement “Magnesium Glycinate Forte.” Magnesium Glycinate alone is a good choice for the more budget minded(www.ImmuneSupport.com sells it as “Magnesium Plus”.) A common dosage of magnesium is 200 mgs at bedtime. Too much magnesium can cause diarrhea, though glycinate is usually the best tolerated form.

Cheney prescribes Doxepin in the form of a commercial elixir (10mg/ml). At low doses, this tricyclic antidepressant acts as a very potent antihistamine and immune modulator. Doxepin acts synergistically with Klonopin to assist sleep, and may improve pain. Patients tend to be very sensitive to Doxepin, which can cause morning fog and fatigue if the dose is too high (5 to 10 mg or higher). He recommends starting at two drops a night and gradually increasing the dose until “morning fog” becomes a problem. Most patients can’t tolerate more than half a cc.

On a handout entitled “Neuroprotection via Threshold Potentials,” Cheney lists six substances that can protect the brain. Under the category “NMDA Blockers” Cheney lists:

1. Parenteral magnesium and taurine (intramuscular injections of magnesium and taurine, usually given with procaine)

2. Histamine blockers (Doxepin Elixir)

Under the category “GABA Agonists” (increases GABA) Cheney lists:

3. Klonopin

4. Neurontin

5. Kava Kava

6. Valerian Root

Klonopin is taken “day and night”; Neurontin “night, or day and night”; kava kava “daytime only”; and valerian “nighttime only.” The first four are by prescription, the last two are herbs. In my limited experience, only certain patients are put on magnesium/taurine injections, and then only for a limited period before switching to oral supplements.

Many myths abound concerning Klonopin. When asked about these myths, Dr. Cheney shared the following information.


When the generic Clonazepam came on the market, many patients switched to it because it was less expensive than Klonopin. Cheney then began hearing that most patients had to take more Clonazepam to get the same effect. Generics aren’t exactly identical to the original products, and with most drugs the slight variations don’t matter. However, most CFIDS patients can tell the difference between Klonopin and its generic form, Clonazepam. Most find Klonopin to be more effective.


Dr. Cheney was adamant that Klonopin is not addictive. In treating thousands of patients, he has never seen a patient become addicted to Klonopin. He reviewed the definition of addiction, stating that it involves:

(1) psychosocial disruption, (2) accelerated use, (3) inappropriate use, and (4) drug seeking behavior.

Dr. Cheney said a case might be made that Klonopin is habituating. It’s true that it can’t be stopped suddenly. You must taper off of it gradually. However, he was cautious about even calling it habituating. The process of tapering off a drug is not the same thing as withdrawal, a term that implies addiction.

Dr. Cheney said to keep in mind that Klonopin is given for a physiological problem – excitatory neurotoxicity. It’s prescribed to adjust the threshold potential: to keep neurons from firing inappropriately and being destroyed. He stressed that Klonopin should never be given unless you intend to raise the threshold potential. He stated, “Problems arise when you begin to use benzodiazapines for reasons other than threshold manipulation.” However, CFIDS patients have a “threshold potential aberration” and need Klonopin (or something similar) to avoid brain injury. Dr. Cheney has never seen a recovered patient have difficulty coming off Klonopin. He stated, “When you no longer need the drug, coming off it is very easy.”

On the other hand, trouble arises when someone who still has an injured brain tries to come off Klonopin. It’s like a thyroid patient stopping their thyroid medication. Dr. Cheney warned, “All hell breaks loose”. However, it’s not because the drug is addicting, and it’s not withdrawal. The condition still exists, and the body lets you know it has a legitimate physical need for the drug. Cheney stated, “When a CFIDS patient who is still experiencing the underlying mechanisms of brain injury goes off Klonopin, there is a burst of excess neural firing and cell death. That’s the havoc we hear about that is mistakenly called withdrawal.”


Dr. Cheney said that he honestly doesn’t understand this concern. He believes Klonopin might disrupt the sleep of people who take it for conditions other than the threshold potential aberration found in CFIDS. He also acknowledged that if you are looking just for drugs to facilitate sleep, Klonopin is certainly not the first one to come to mind, nor should it be used to induce sleep in “ordinary” patients. It’s not a sleep drug per se. However, a large part of the sleep disorder of CFIDS is excitatory neurotoxicity and the resulting shift toward seizure. If you treat this condition with Klonopin, then you have treated a large part of the sleep disorder in CFIDS. Most importantly, he said he simply does not see stage 4 sleep disruption in his patients on Klonopin.

Towards the end of this discussion on Klonopin, Cheney smiled, and remarked, “But suppose I’m wrong about the brain injury and the threshold potential aberration and the shift toward seizure? What if I’m wrong about your need for Klonopin? I’m absolutely sure I’m right, but what’s the worst case scenario? Do you know what long-term studies on Klonopin have shown? Reduced incidence of Alzheimer’s Disease. Alzheimer’s Disease is a complicated and convoluted way of knocking out your neurons, and Klonopin protects your neurons. Now it’s believed that Klonopin didn’t actually stop Alzheimer’s. It just delayed its onset so long that everyone died of something else before they ever got it – which is to say you won’t get Alzheimer’s. You’ll die of something else first.”

The last question Cheney addressed concerned the dose: what happens if the dose is too high? He said the only down side was that if you took a little too much (we are not talking overdose here) it would shift you toward coma on the continuum. It would shut your brain down to some degree, and thus impact your ability to function. This is inconvenient, but it’s not harmful. In fact, it shifts you into the “healing state” on the continuum. You may feel like a zombie, but your brain is protected and your neurons are not getting fried. However, not being able to function isn’t an option for most of us, so we need to find the maximum dose that doesn’t make us drowsy.

Dr. Cheney emphasized that Klonopin, Doxepin, and magnesium are very, very good at protecting the brain from cell death due to excess firing. However, they can’t stop the underlying mechanisms of CFIDS that are injuring the brain in the first place.

Though it can’t stop the underlying mechanisms causing the injury, Klonopin can protect your brain and keep your neurons from being destroyed. Then, as Cheney put it, “When you come out on the other side of this, you’ll have more of your brain left.”

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16 thoughts on “Dr. Paul Cheney Discusses the Benefits of Klonopin”

  1. cassandra539 says:

    Re: Dr.Cheney on the benefits of Klonopin, would the same assumption be for the other diazopines, esp Ativan?

  2. tmanning says:

    @ Dr. Cheney: Have you done any research on the use of Klonipan with Xyrem? If not, do you have an opinion on how well they may work together? It’s seems that if I could reach stage 3 & 4 sleep while reducing hyper sensitivity in the day it would greatly improve my EDS symptoms. Right now my neurologist is very anti-benzo. What do you think?

  3. welly says:

    Saying that clonazepam is not addictive is dangerous and irresponsible. Adaptation to the drug begins 48 hours after the first dose in rats, and humans build tolerance and dependence in as little as two weeks. Most countries suggest not prescribing for more than two weeks.

    The withdrawal syndrome from benzodiazepines typically lasts from 6 to 18 months and is very painful and debilitating, cold turkey can result in seizures and death. There are over one hundred severe withdrawal symptoms spanning the entire nervous system.

    The leading expert in benzodiazepine withdrawal, Dr. Heather Ashton (professor emeritus http://www.benzo.org.uk/manual/) dedicated a large part of her life in educating of the dangers of these drugs.

    Membership in withdrawal support groups number in the thousands.

    This article reads like an infomercial for big pharma.

  4. thornwood says:

    I had to take a moment to calm down after I read this article. So full of lies and misinformation. Klonopin and benozodiazapines arent addictive and dont cause brain damage? Seriously? All you have to do is google “benzos withdrawal” or even “benzos protracted wd” and you can spend hours and days reading up on how destructive and dangerous these drugs are. How do I know? My life has been destroyed over the last 6 years due to hitting tolerance wd then being ripped off cold turkey by my ignorant doctor. I was a healthy vibrant man before this drug went into my body. Ive had over 50+ wd symptoms that I have never had in my life till taking this poison. There are around 10 facebook support groups helping people come off this drug and giving them needed support through the torture of wd. Ive met literally thousands through the world who have experienced the same thing. Please educate yourself instead of promoting this garbage to avoid destroying other people’ lives.

  5. Booksrgood says:

    This drug is addictive, and has terrible other effects. Why use it all might be a good place to start.

  6. ASmithfield says:

    Dr. Cheney, I am looking for newer information regarding your stance on Benzodiazepines. I sincerely hope it exists since there has been much more research since this paper was written. In fact, it has been known with certainty since the 1980’s that any Benzodiazepine should not be given for any period longer than a few weeks. It has also been shown that real damage is done by these drugs and the withdrawal is brutal at best: whether or not the “underlying condition” has been mitigated.
    It has also been known that CFS is most likely not caused by a lack of Klonopin in one’s diet.
    My sincere hope is that the scientific community completes its research and discovers the true cause of CFS and proves that drugs do nothing to heal a body seeking homeostasis.
    Thank you for your time and attention.

  7. lifelieswaiting says:

    At first it worked great. After two years I became tolerant to it and started having withdrawal symptoms despite continuing to take the drug. This wasn’t recognized. I was told instead that my condition had gotten worse. My dose was doubled and then tripled. This worked for some number of years until tolerance happened again. This time other drugs were added to the mix. We moved to another city, so I had a new doctor. He didn’t want me on Klonopin, so took me off very quickly. I seized and was reinstated in the ER. I tried to taper off the drug, but that was nightmarish as well. So I came off in a detox facility. Sixteen months post-detox, I was still suffering the full fury of the benzodiazepine withdrawal syndrome (Google it), so in desperation, I reinstated the drug. This worked, but about two years later, I went into tolerance again. I realized I would spend the rest of my life on this roller coaster unless I came off the Klonopin for good. So I tapered off very slowly. I’m almost four years benzo-free now, but protracted benzodiazepine withdrawal won’t loosen its grip on me. Keep in mind, this was taking the drug as prescribed to me by my doctor. There was no abuse. To the best of my knowledge, there is no drug withdrawal worse than benzo withdrawal. Heroin withdrawal is usually over with in 5-7 days. Protracted heroin withdrawal might take weeks or even months. Protracted benzo withdrawal can take months, years or even decades. Some of the damage might even be permanent. Learn from my mistake. Say no to Klonopin and other benzodiazepines (Xanax, Ativan, Valium, etc.) Also say no to the chemically distinct, but similar acting Z-drugs (Ambien, Lunesta, Sonata, etc.) It’s bad enough having CFS/ME. You don’t need an even worse problem.

  8. Gabri says:

    Ignorant doctor. Stupid doctor. Thats it. benzos destroyed so many lifes…

  9. WendyBeveridge says:

    I would like to hope that Dr. Cheney’s pro-Klonopin article was written as a valdation of the very real neuro problems in cfs, one of which is a terrible sleep disorder, and that Dr. Cheney has simply been ignorant of the long term harm from taking benzos, as are most doctors. There are thousands of those of us who either quickly or slowly were harmed by taking benzodiazepines such as Klonopin, Ativan, Restoril, Xanax, Valium, etc, and our voices are becoming recognized now in the membership of numerous support groups to deal with the horrific consequences to our nervous systems from taking these medications, usually exactly as prescribed. I do hope that Dr. Cheney will amend his viewpoint on these medications by considering information such as that from Heather Ashton, who has founded a support system to help people recover from taking these very risky medications.

  10. LadyWolf25 says:

    Dear Dr. Cheney,

    I am so sorry to hear, that so many people who feel Klonopin & other benzodiazepines are the cause of there many problems and the root of all Evil…
    I feel Dr. Cheney is simply a compassionate physician, who found something that actually helps his patients, who suffer from underlying causes that needs intervention
    Our society, chooses not to see, it can be the best option & benefit the patient in long-term severe cases.

    As a whole, we are locked in a neat & tidy little box, thinking we are drug addicted & not chemically reliant upon certain drug classes. Many of us are left defenseless and the mindset has changed.

    Every drug has side affect. So which is the lesser evil??
    It wasn’t until my accute onset, from heavy metal exposure, did I begin having to suffer from ME/CFS Neurological inflammatory problemsMuscle & brain seizures more prevalent than ever,causing accute oxidative stress & neurotoxicity.

    I am fighting for my life and sanity here..

    Due to the ignorance of those who do not weigh the Benefits VS. Side effects of this drug.
    I can think of hundreds of SSRI’s that have so many more side effects, being a patient of severe serotonin intolerance or/Serotonin Syndrome.
    These types of meds only exacerbates symptoms further, having an opposite reaction!

    I believe it is a very personal choice, as Klonopin is my only salvation, bringing me back to normalcy, my receptors seem to be protected from a total burnout. Realizing, as well, I may need to be on Klonopin for life.

    I have had to go off Klonopin during the last few months & almost 2 years, at one point having to end up with continual vertigo, spacial disorganization, disruption of all senses.

    Through the 27, years it has escalated to the point, becoming a life threatening situation & the ability to control or ease the symptoms, to some manageable degree, are a very real concern, of weather I can continue to live at all?

    I really wish, as I suffer in silence, wishing there were more physicians, who cared about their patients, than those whom are wrapped up in politics & liability, dismissing patient needs.

    Bashing Dr. Cheney, for providing compassionate care is wrong! He is a physician who thinks out side the box, who knows a great deal more about ME/CFS, and as has been there from the first outbreak. He acts with integrity, for the welfare of the patient, knowing the outcome of Long-term Chronic Pain in ME/CFIDS

    Most who criticize the the use of Klonopin, on a individual basis, are not acknowledging the underlying symptoms of a cute ME/CFIDS patients.

    Even on very small doses provides immediate relief with few side effects, after days of insomnia & unrelenting head pain.
    Taking SSRI’s for some kind of relief from the muscle & brain seizure activity & accute CNS meltdown, has proved to make matters worse in My case.
    I recently posted a blog, about this very topic. I side with Dr. Cheney. I know the underlying signs & symptoms of neurological inflammatory response, triggered by factors, environmental nature; Smoke from Wild-Fires, stress reaction, Viral activation and neurocognative stressors, that remain prominent and ongoing.

    While Klonopin does not cure it, it does seem to promote some reversal of cellular death. Sometimes taking a few days, after memory loss occurs & seizure activity abates & sleep returns to normal pattern.
    It most certainly helps the brain to function.

    Whilst many of you, may think the drug is at fault, as coming off it,is a hard thing to do, when the underlying defense mechanisms no longer exist? Is a cruel and terrifying reality.

    I agree with Dr. Cheney; I may no longer have the neuron’s or receptors to defend the neurotoxicity in the brain, it is what brought me to this one drug, which has given me so much of my life back!

    The reality of biased doctors, disconuing this drug in some cases is met with a certain outcome of further destruction and demyelination of reactive nerves, in the cerebral cortex and CNS.

    It has been a Godsend and unfortunate that it is being denied me, by an inept medical society for people who have real disorders that are not being further addressed.

    We borrow drugs from all different sectors. I ask a question?
    If you were the physician, and nothing else the patient has tried, comes even remotely close in providing quality of life, relief & comfort.

    Would you endanger your patient’s life? Knowing it could certainly cause the patient more physical & neurogic distress, making ones life a perpeptual living hell! With no end in sight,contemplating ending their life?
    As the cytokine activity produces more oxidative stress, making the patient feel completely depressed,with suicidal thoughts, as the immune system begins attacking itself, suffering more brain cell death with each episode becoming more unbearable.
    What would you do?

    I would stand by my patient, As Dr. Cheney has? There are so few out there, who go by intuition & compassion.


    E.J. Collins

  11. RodMalinc says:

    I started reading this article and at first I thought it was meant as a joke but apparently not. Klonopin along with other benzos are incapable of helping anything other than the company that makes the drug. My experience along with anyone that had taken Klonopin has been very negative in the long run.
    The last poster made a very long story defending the Dr’s choices of treatment but I am in complete disagreement about that. Klonopin and benzos have ruined lives and that cannot be disputed without doing even minimal research
    I was horrified when I read this article and having had questionable medications prescribed for myself, I would conclude that most medications are highly toxic and of great risk to consume.
    This is my opinion and thank you for letting me reply to this post.

  12. Zzboggio says:

    This is ridiculous, stating that klonopin is non addictive. I am a pharmacy student and I know first hand how addictive and dangerous this drug can be. The withdrawals are horrible, I have been through them and I would never wish them upon anyone so saying that it’s a myth, I would definitely rethink that.

  13. Zzboggio says:

    If it were up to me I would ban this drug from the market completely except only maybe for very very severe seizure disorders but even then it’s a huge risk. Pharmaceutical companies make millions off of this horrible drug at the expense of people’s health and it makes me sick. I’m sorry for ranting but it’s the truth.

  14. got_cfs says:

    Here are my two cents, as a person with CFS:

    The use of Benzos is a scary thing. They ARE addictive. However, I can attest that they are very effective when used PRN occasionally to help with the AGITATION that CFS causes when PEM is unfolding.

    Btw, PEM = Post Exertional Malaise, and it generally brings our symptoms up to their max. We get into a state called “Tired and Wired” and I can tell you it truly sucks. There is very little one can do other than just sit but even that is dystonic and many of us move around in slow walks to just not feel the body symptoms so much (the twitching, neuropathic pain, etc).

    There is a major sense of dystonia, depression, and, paradoxically, agitation. Myself, I experience a fair amount of paranoia. All I can say when this happens is: THANK GOD FOR BENZOS !!! Because, when I am in this state, it is truly helpful and makes it bearable.

    I think that this state is pretty much a neurological imbalance, much like a seizure disorder, so, why would a drug that is effective be ruled out just because it CAN be addictive?

    Here are my rules:

    1. never take more than .25 mg of Klonopin or Xanax (or .5 mg Ativan)
    2. don’t take a benzo again until at least 3 days after the last one
    3. take them as rarely as possible

    Additionally, a benzo like Klonopin, lasts long enough that I benefit from it the next day.

    So far, it’s working. But I do agree, benzos are dangerous – very dangerous – but also very useful if used sparingly.

  15. mtrx4004 says:

    I take 3mg of Klonopin (clonazepam) per day for 17 years for disabling CFS and it one of 2 meds I use (together with Effexor). It keeps my CFS under control.

    I think it’s a bad service by those who’s not benefit from it, to make all kinds of negative claims. It is not an emotional matter if it doesn’t work for you. Go to Pubmed and you’ll find all research supporting Klonopin for CFS.

  16. dannybex says:

    mtrx4004 said: “Go to Pubmed and you’ll find all research supporting Klonopin for CFS.”

    Hmmm, that’s funny. There isn’t a SINGLE research study on Pubmed with regards to klonopin being proven to benefit people with CFS. There are reports that it can be beneficial, but there isn’t any research to prove it is. Not one single study.

    One thing not mentioned by anyone here is the fact that klonopin/clonazepam and other benzodiazepine drugs inhibit glucuronidation, which helps the liver detoxify drugs, dangerous chemicals and other toxins including benzene, phenols and salicylates — ironically the things that may be causing the overstimulation that klonopin is most often prescribed for.

    Klonopin also can also cause anemia, eosinophilia, neutropenia, thrombocytopenia, in addition to the many other side effects listed above by others. In fact, it can cause some of the EXACT symptoms of ME/CFS.

    These aren’t ‘negative claims’. They’re facts. And I think it’s a good service to have them out there and am so glad to see patients have come forward over the last 18 years to dispute the overrated and overpriced Paul Cheney for his galling misinformation.

    For very short term use, they can be helpful, but in the long run — no one benefits from benzodiazepines.

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