Urgent and sincere advice needed!

[[mu...]]

Dear John/S&S/Others,

 

Took your advice and asked my doc to taper according to Ashton's: he prescribed 10 mg Diazepam to replace 10 mg zolpidem tartrate. Now as you may notice this is double the potency of zolpidem tartrate, however strange Valium 10mg wore off within 2.5 hours and now I am still awake in the middle of the night. Please HELP!

[[sl...]]

Dear John/S&S/Others,

 

Took your advice and asked my doc to taper according to Ashton's: he prescribed 10 mg Diazepam to replace 10 mg zolpidem tartrate. Now as you may notice this is double the potency of zolpidem tartrate, however strange Valium 10mg wore off within 2.5 hours and now I am still awake in the middle of the night. Please HELP!

 

Your doctor doesn't know how or doesn't want to do a gradual step-wise crossover to diazepam. What you may or may not know from the Ashton Manual is that the diazepam equivalency she uses is based on the medicine reaching full potency after many doses are layered on top of each other due to the long half-life of the medicine. A single dose of diazepam isn't going to do ANYTHING like a week of daily dosing. This is why Ashton did step-wise crossovers, taking on average a month to fully transition to diazepam, with each step taking 1-2 weeks for the diazepam to build up.

 

So instead you've been rapidly crossed over to diazepam from a VERY fast acting EDIT: z-drug, and maybe your doctor knows the problems associated with this, because doubling the equivalency suggest some kind of attempt to remedy this problem. But it's still going to take at LEAST a few days if not a week before I think you'll start to feel an equivalent benzo dose from this double dose of diazepam.

 

So the good news, nothing "wrong" has happened. Diazepam is just low-potency, and it takes a week or more to build up to full strength; every day that you dose the diazepam it will get stronger and stronger. The bad news is that the next few days are probably going to feel rough, since you've been physically dependent on the zolpidem at a certain dose and it's gone for now and not adequately replaced.

 

I'm sorry this was done to you. I hope my vague explanation of the pharmacokenetics of diazepam help you to keep the next week in perspective as you adjust. Diazepam is a FAR superior medication in my mind for tapering, compared to zolpidem; assuming you don't have histamine issues, you'll be in a better place for tapering after it gets up to strength.

 

I suggest trying to stay calm, give this a run, and if you feel overly sedated by the diazepam you may want to scale back a little from 10mg over the next week as you begin to stabilize. Ashton equivalency numbers are reported to be a little heavy handed on the diazepam side, so it might be necessary to reduce to something like 5mg/day as you get further into the next week or two.

 

The pinned post on the Insomnia board is a good reference for making peace with this symptom.

Please keep us posted. 

[[mu...]]

Dear slownsteady and others, today's dose of Diazepam 10mg failed to have any sort of effect on me. Helped lower anxiety levels but not a bit of sleepiness induced. Wonder what's wrong. Please let me know if it would be an option to introduce 5mg melatonin alongside, since it's considered a safe drug but I need to be sure it won't cause any problems. Please Help!

[[je...]]

Melatonin should not be a problem. 

[[mu...]]

Melatonin should not be a problem. 

 

Thank you Jelly Baby!

[[mu...]]

Dear all,

 

Have totally switched over to Diazepam 10 night and 5 in the day time. Things don't feel so easy on me, you see I have a long history of depression and anxiety medication. At present my doc has put me on 20 mg Brentillux (max dosage) and another SSRI to somehow create a combination of two different classes because of the long history and chronic nature of my symptoms.

 

Things are still not all rosy to say the least as moderate to severe depression still slips in several times in the day, which seems to be exacerbated as soon as Valium starts to wear off. Feel like as if Valium is not having the same effect as it was in the beginning. Have I hit tolerance on Valium?  Oh, God no!

 

Need words of kindness, wisdom and understanding!

[[Ac...]]

I don't have any experience with the crossover and tapering issues you face, but keep at it, you'll get it figured out! You've taken the first steps towards healing!

[[mu...]]

Guys, I am barely functional anymore. Can't take this torture anymore. Was never completely satisfied with Clonazepam but it was definitely not this bad. What sort of depression is this, that two different classes of anti depressants can't control. I tried my best to switch to Diazepam, so that after getting stable, I could taper and get rid of these Benzodiazepines, but seems Benzodiazepines are the only way forward.

[[sl...]]

I'm sorry to hear how dysfunctional you have become musman79. Tapering clonazepam directly was an option, and would have been the place I'd suggest to start had we a time machine, and you a more supportive doctor. It seems like you've been jerked all over the place by your medical provider, and the fallout sounds extremely difficult.

 

I understand that diazepam causes depression for many people, sometimes just initially, sometimes irrevocably. This is why a gradual step-wise crossover is advised, both to allow the medication to get up to strength and to allow a gradual trial of the medication to determine if it's tolerable before switching over entirely. Jumping onto a full substitution dose of diazepam all at once created both the problem of inadequate dosage, and the problem of inadequate time for trialing the drug. And by doubling your dosage equivalency, your doctor really didn't do you any favors in my opinion; taking more than what's needed of these medications can increase the adverse side-effects, effects such as depression. I am so sorry this was done to you.

 

I don't think any of these psyche medications are solutions to mental health challenges, but there does appear to be "best practices" in terms of getting off of benzos and your doctor does not seem to be aware of these. Here's a basic information sheet made by the Alliance for Benzodiazepine Best Practices:

https://benzoreform.org/wp-content/uploads/2020/11/Pamphlet-3-BZRA-Discontinuation-1-Getting-Started-v1.2.pdf

 

There is a strong argument against taking benzos for the long term. These dangers include risk of falling and cognitive impairment, but perhaps more importantly, tolerance and eventually tolerance withdrawal.

https://www.benzoinfo.com/tolerance/

 

Diazepam isn't an ideal benzo, IMO. It's easier to taper than most, in part because doctors can prescribe forms of the medication (low potency tablets and a commercial liquid at least in the US) that can be easily reduced with sufficient accuracy. But it has a number of drawbacks reported anecdotally around the forum such as sedation, depression and gut issues. It doesn't sound like you're tolerating your dosage of diazepam; I wonder if you're simply on too much medication. Have you tried taking any reductions?

 

I also wonder if you'd be interested in crossing back over to clonazepam and learning how to taper it directly, with a symptom-based patient-led taper and ideally IMO without any more directions from your current doctor. So far it seems like your doctor has only caused more problems for you. Have you considered finding another provider?

 

Let us know how we can help. 

[[mu...]]

The problem was that I didn't calculate the amount of dosage I was taking of Clonazepam sometimes it went up over 2 my a day sometimes less. It was not until I realized that Benzodiazepines can cause serious problems like you mentioned in the long term, that's when I decided to try to get rid of them and for that I overheard here on this forum that several people have been able to do it successfully by first switching over to Diazepam. So I intact insisted my doctor to take me off of Clonazepam thinking that would take away my problems but it just messed up the whole thing.

 

Since I didn't remember or didn't take note of my mean dose of Clonazepam, the doctor perhaps IDK but decided to put me on 10 Valium at night and 5 in the day time. I've been on this dose for more than 6 weeks now at least. Additionally, to deal with the chronic depression HD put me on Brentillux 20mg nights and paroxetine 25 mg mornings, however like I mentioned depression is simply too much to handle. I feel like i am gonna die. Please help me!

[[mu...]]

Yes, I am ready and willing to switch back Clonazepam or anything similar but please help me make this nightmare go away.

[[sl...]]

Hi again musman79,

I am getting a little confused on this thread. It seemed like earlier you were on 2mg of clonazepam, and then ended up on 2mg lorazepam and 10mg zolpidem, and then your doctor swapped your zolpidem for 10mg diazepam, and now I understand you're on a total of 15mg of diazepam, with no mention of lorazepam. This last part makes sense because 10mg zolpidem + 2mg lorazepam = ~15mg diazepam by Ashton equivalencies; this last bit only once the diazepam is up to strength after a week or two of dosing.

 

Filling in your signature with your benzo history would go a long way to making it easier for us to reply to your posts, if you get a chance. It seems like I was a little confused in my last reply; your recent crossover to diazepam might be too much, but it's not double what you were on with the lorazepam and zoplidem according to Ashton. Sorry for any confusion I caused.

 

Have you tried taking any reductions of the diazepam? I've been told some people find the Ashton crossover equivalencies a little heavy on the diazepam. If you're super depressed and that's your major issue, I suggest trying a 5-10% reduction and monitoring your symptoms for a couple weeks.

 

Alternatively, I think a successful crossover to clonazepam would be best with an ongoing script from your doctor for 0.75mg/day of clonazepam. I suggest doing this crossover step-wise; maybe three steps: one step per week or two, each step replacing 5mg diazepam with 0.25mg clonazepam, until you're on 0.75mg clonazepam and 0 diazepam.

 

So whether you try reducing the diazepam or a crossover to clonazepam, I think you'll need to be somewhat patient and cope with your ongoing symptoms. I'm sorry it seems like a nightmare, but the nightmares I've had neurological instability are MY nightmares, and owning them has gone a long way for me in making peace with these limitations.

 

I think one of the great fallacies in modern mental health medicine is when we are encouraged to disown our misperceptions and negative emotions; I've found my misperceptions to actually be a part or parts of myself that need my love and attention. Love and attention can be powerful medicine! I think you owe yourself this care.

 

Every step is forward! Let us know how we can help. 

[[mu...]]

Hi slowandsteady and my good fellows, I am feeling much better. Went to the doctor and asked him to switch  me back to Clonazepam, which he did and now after months I feel relaxed. The only thing I am being unable to understand is: He prescribed me 2 my Clonazepam at night, whereas I argued and even showed him the conversion table saying 2 mg Clonazepam is double the equivalency of 15 mg Valium i was taking. But, according to him he doesn't accept any conversation tables nor does he recognize the Ashton manual as standard. He seems to trust his education and experience more over everything.

 

Still yet I didn't listen to him and took only 0.5 mg Clonazepam in the night and 0.5 in the afternoon. It seems to be working so far so good. One minor addition, which he didn't suggest: I am complimenting 0.5 C at night with 1 mg Melatonin. Thanks God and thanks to you folks, world is looking brighter again. God bless you all!

[[sl...]]

Yay! You're feeling better AND you've got a script that is more than you need. Let the stabilizing and stockpiling begin. 

 

I'm so glad you made your own decision about how much of the medicine to put in your body. I suggest keeping your doctor in the dark about your tapering plans. If he was my doctor, I would blatantly lie and say I was taking the 2mg per day and want to continue at this dosage. I suggest letting his "education and experience" do what it does best; sign prescriptions and leave you alone.

 

Sorry for being so critical; I'm really frustrated with the treatment so many buddies are receiving from their doctors. I'm positively joyful hearing that you navigated your situation so deftly, and are seeing improvements.

 

Do you have plans to taper after you've had time to stabilize?

[[sl...]]

Just a follow up note, I suggest keeping an eye out for withdrawal symptoms occurring in the next week or two, even while holding on your new clonazepam dose. I suggest not taking any reductions for 2-3 weeks, and to wait even longer if you are struggling at that time.

 

What I believe is that the 15mg of diazepam you stopped taking is still circulating around in your blood right now, mostly as desmethyldiazepam which can have a half-life of up to 200 hours. So you're currently dosed on diazepam AND clonazepam. Probably why you feel so much better so quickly. Also why I suggest waiting so long before cutting again; there will likely be an uptick in withdrawal symptoms that takes place over the next two weeks as the desmethlydiazepam is eliminated by your body, and this could be uncomfortable.

 

Sorry to rain on your parade! I think this is still a great step forward. I just suggest taking these next 2-3 weeks holding your new clonazepam dose to make sure you're not adding to the impending diazepam reduction.