Lorazepam --> Diazepam: further tapering does not seem feasible.

[[Bi...]]

Hello,

My name is William & I’m 31.

 

I was prescribed Lorazepam in August 2019, starting at 1.5 mg per day, and by December of that year I was prescribed 6 mg daily of said benzo (reasons below). I was told that there would be no negative consequences from this ‘medication’/dose.

 

Please bear in mind that I took this advice under the umbrella of these various factors:

(a) I’ve been coping with severe Generalised Anxiety & Obsessive-Compulsive Disorder since the age of 6.

(b) I have been struggling with depression since 2014 & more recently complex trauma (c. 2017 onwards).

 

It’s worth noting that prior to benzodiazepines I already experienced depersonalisation, heavy emotional numbing & depression, along with the toll of coping with the aforementioned diagnoses.

 

After hitting inter-dose withdrawal in early 2020, a switch was made to Diazepam (including a corresponding dose equivalency reduction) with the help of a new consultant psychiatrist. In the process, I was in a “meltdown” state for 75% of each day for a period of about a year. I was eventually hospitalised for 2 weeks as a result. I’m currently on 16 mg per day of Diazepam.

 

I cannot bear the thought of tapering further, for fear that the same situation would arise, both for myself and for those involved in my life & care. Paradoxically, I’m scared of remaining on Diazepam. My consultant understands this & is not going to push me to continue the taper. Nonetheless, I feel utterly trapped.

 

I’m still battling severe trauma-related affective flashbacks, very significant depression & chronic fatigue, and this is ongoing. My consultant and I have tried pretty much everything to abate all this (below), but these are chronic symptoms that have to me constantly managed.

 

Any thoughts on the matter would be greatly appreciated. Best wishes to all, and my empathy to all those struggling too.

 

Thank you so much in advance.

 

To note: I have also tried the following therapies, which have had little to no impact:

 

CBT (twice) / ACT (Acceptance and Commitment therapy) / rTMS / psychoanalytic psychotherapy / hypnotherapy / acupuncture / mindfulness / group therapy sessions while in hospital & probably a couple of other things which I cannot remember at this moment

 

Other meds which did not work: Escitalopram / Risperidone / Quetiapine: I had extremely bad reactions to the anti-psychotics in this group.

[[Ka...]]

Hello Birdsong256,

 

Welcome to BenzoBuddies, we are glad you are here!  It sounds like you are in a rough spot - I'm so sorry.  It sounds like you have a supportive doctor.  I hope that by coming here and getting some support and information, your path will become clearer. We do encourage a slow taper with reductions in te 5-10% range every two weeks or so.  I've put some links below to get you started, one of which is the Ashton Manual which is the resource we tend to reference for benzo withdrawl.

 

Please take some time to look around the website and get familiar with things.  You can post when you are ready.  Let us know if you have questions or need help.

 

Again, welcome,

 

Kate08

 

The Ashton Manual

 

Planning Your Withdrawal (Taper)

 

Withdrawal Support (during your taper)

[[Ha...]]

Hi Birdsong, how are you getting on? Good to have you here. Have you made any sort of a plan? Warmest wishes. Hardy.

[[Bi...]]

Hello Kate08,

 

Thanks for the support & information: really appreciate it. I had to reset my password, so apologies for the late reply.

 

Thankfully yes, I have a very supportive consultant: he is not pushing me to taper right now, although I would ideally like to be off the Diazepam or at a lower dose at some point in the not-too-distant future. I'm really having to weigh the pros and cons of the situation currently.

 

Would you expect what I have been through to have been more difficult (I.e. the Lorazepam reduction / switch to Diazepam) compared to a very slow taper from the Diazepam?

 

Also, I'd like to know a little bit more about dose equivalencies: apparently 16mg Diazepam is around 1.5 to 3mg Lorazepam, is this correct?

 

Thanks so much in advance.

[[Pa...]]

I have a couple of questions, why do you want to taper the Diazepam, are you experiencing difficulty with it? 

 

Can you describe your crossover from Lorazepam to Diazepam, how long did it take you, did you slowly withdraw the Lorazepam while adding in the Diazepam and what was your prescribed dose of Diazepam for the crossover?

 

This is a handy tool for calculating equivalencies.  https://clincalc.com/Benzodiazepine/

[[Bi...]]

More than happy to answer that:

 

I wish to eventually come off the Diazepam (or reduce significantly) as I am worried about the side-effect profile & potentially developing cognitive decline.

 

My experience of tapering from the Lorazepam and switching over to Diazepam was excruciating. Combined with the pre-existing health conditions it was even harder, I imagine, but I am no expert.

 

The cross-over took a few months at least, if not longer. I went down from 6mg Lorazepam to 5mg, then slowly started to add Diazepam (I cannot remember at exactly what increments) as I further reduced the Lorazepam.

 

I continued in this manner until I ended up on 30mg Diazepam per day, and eliminated the Lorazepam. Then I continued tapering down to 16mg Diazepam, but I did in fact need to go to hospital as I was not coping at all. So far, I have remained on this dose.

 

As you can probably imagine, due to my inherent mental health instabilities, I don’t feel I can cope with more withdrawal symptoms, at least not for some time.

 

Thanks for the equivalency table, that really helps.

 

May I ask about any experience you have in this arena, and if you could shed light on some of my concerns (if you are comfortable doing so, of course)?

 

[[Pa...]]

I don't have taper experience, I quit cold turkey which you can in my signature.

 

When you say your experience crossing over to Valium was excruciating I'm wondering what you mean? Was it horrible symptoms of withdrawal or was it more the sedation and depression that Valium can cause before you get used to it?  Did you allow enough time for the Valium to build up in your system before withdrawing the Lorazepam or did you simply swap out the two drugs?  And what was the dose of Valium you ended up with once you make the transition from Lorazepam to Valium?  Was it 16 mgs?

[[dr...]]

Hi Birdsong, 

 

There is another benzo that I tapered from which is "slower" than almost any of the others, called Librium. It was the very first benzo. My Drs wouldn't do diazepam, because they think it's hard to get off of. This one is even longer half life, and I managed to taper of it after crossing from Ativan, over 20 months or so. The dosages were all in whole miligrams and the math was very easy, and the last legs of it I had pills compounded at a very reasonable cost, and through the mail.

 

It made me a little sluggish and lazy but that was OK with me. I just figured I was in for a ride and it was better than all the dread I associate with ativan.

 

Good luck and hang in there. I wouldn't be discouraged about therapy modes that didn't work while you were on the benzos.

[[Ka...]]

Hi Birdsong, 

 

There is another benzo that I tapered from which is "slower" than almost any of the others, called Librium. It was the very first benzo. My Drs wouldn't do diazepam, because they think it's hard to get off of. This one is even longer half life, and I managed to taper of it after crossing from Ativan, over 20 months or so. The dosages were all in whole miligrams and the math was very easy, and the last legs of it I had pills compounded at a very reasonable cost, and through the mail.

 

It made me a little sluggish and lazy but that was OK with me. I just figured I was in for a ride and it was better than all the dread I associate with ativan.

 

Good luck and hang in there. I wouldn't be discouraged about therapy modes that didn't work while you were on the benzos.

 

 

Thank you for bringing this up.  I tried multiple therapies while using benzos and made little to no progress because the benzos were dragging me down.  It turned that letting clonazepam go was what I needed to do all along and was the 'answer' for me.   

[[An...]]

True Kate. Therapy is useless when you are sick from trying to detox benzos. Save your money, time, and energy on therapy until after the benzo detox.

[[Bi...]]

Hi Pamster,

 

To answer your question, it was the withdrawal symptoms themselves which were excruciating, I never found the Diazepam particularly sedating.

 

My consultant and I did the switch very carefully i.e. reducing the Lorazepam and adding the Diazepam bit by bit, leaving amply time in-between adjustments.

 

After all the Lorazepam was gone, I was on 30mg Valium, and then slowly tapered to 16mg, which is my current dose.

[[Bi...]]

Hello drad dog & thanks for your input,

 

I had never heard of Librium, I thought Diazepam had the longest half-life so thanks for letting me know. Although I think I will avoid switching to another benzo once again if possible.

 

I was thinking of potentially micro dosing off the Diazepam one day: I’m just wondering if I would still experience significant withdrawal symptoms if I were to do so.

 

So, is Librium exactly the same “class” of benzos as all of the other usual lot? Perhaps it would be worth bringing up with my consultant next time round just to see what he thinks about it.

 

Thanks for your support & for the advice re: therapies.

 

[[Pa...]]

Thanks for the additional information, it looks to me as if you were crossed to an insufficient dose of Diazepam if you went from 6 mgs Lorazepam to only 30 mgs Diazepam, no wonder you experienced such horror. 

 

6 mg Lorazepam =45 mg Diazepam(range 15 to 60 mg)

 

The therapies you've tried, were they while you were taking Lorazepam or before?  I guess the benzo didn't help since you went up so quickly in dose?

[[dr...]]

Yeah Birdsong, Librium is another benzo but don't discount the different "personalities" of each one. I used to call Ativan "White Lightning." I never missed a dose in 10 years. It was always banging on my door so to speak. A very slow benzo can be "kinder" during the process and have a diffferent feel.

[[Bi...]]

Hi Pamster,

 

Thanks for the quick response. I may have misconstrued how I put my previous explanation across slightly. I didn’t go straight from 6mg Lorazepam to 30mg Diazepam from what I remember.

I believe that I had gone straight down from 6mg to 5mg Lorazepam of my own accord before I got in touch with my new consultant. Then we followed the Ashton guidelines to get down to 30mg of Diazepam alone.

 

All I can recall is that there was a significant period of time when I was taking both medications (reducing the Lorazepam, while slowly adding Diazepam) to get to the 30mg point. Does that help at all?

 

The therapies I had engaged with pre-benzodiazepines were the CBT (twice) and the psychotherapy (over a period of 2.5 years). Insightful but little to no impact on my symptomology.

 

This is the sad part: I was taking Lorazepam PRN at 0.5mg, and that was working for me. However, during a mental health regression, I had seen my previous consultant, and he asked me to start taking it three times a day (0.5/0.5/0.5mg). It helped at first, but I needed more after about a month, and after five months I was taking 6mg daily (again split into 2mg doses 3 times per day). I went into inter-dose withdrawal about 6 weeks after being on that dose. I was constantly reassured that:

(1) there was no possibility of any negative side effects

(2) They would continue working, unless I “became more stressed” (to quote my previous consultant’s words).

(3) There was no possibility of long-term repercussions on my health.

 

I now know this to be misguided, to say the least. Very confused as to how this health professional saw this as a suitable long-term treatment.

Thanks for your support.

 

 

[[Bi...]]

Hi again drad dog,

 

Yes, during the time that the Ativan was having a tangible effect on me, it kicked in and wore off very quickly, so I can relate to what you are saying.

 

Thanks for the further information about Librium. May I ask about your experience of coming off the Librium, if you are ok with sharing that, of course?

 

 

[[dr...]]

I only dosed twice a day and once a day near the end of the process. With ativan it had been 3 or 4 times including in the middle of the night.

 

Beyond that it was much more relaxed. I was on medical leave though. My reductions are in my sig. It was organic and I got to where I could feel when it should be. I was grateful to use only whole mg amounts. It gave me confidence and clarity about my path forward. I tried measuring liquids and powders but I could never make that stuff work for me.

 

I should say also that I went inpatient and reduced rapidly 40% of my historic dose in the first month during crossover.

[[Ca...]]

I am in a similar boat. Was prescribed Klonapin and Valium together. Then I started moving over to just valium so now I am at 38 mgs valium which does nothing except probably keep me from feeling worse and microtapering the Klonapin -- I am at about  mgs.

 

Every day is difficult to say the least.  Now I have the agoraphobia on top of the panic and depression. I try to stay in bed as long as possible so the day will be shorter. I can't read or watch TV or sit still.

Hang in there a moment at a time.  We just don't know how things will be as we move forward.

[[Bi...]]

Afternoon drad dog,

 

Thanks for the input: I’m glad that the last bit of tapering off of the Librium was less intense: I’m hoping it will be a similar situation when I start a micro taper from the Diazepam in the future.

 

Medical leave seems perfectly reasonable in such a situation: I know how difficult (understatement) the process is. I resonate with you about not wishing to use liquid formulations: I too would rather work with milligrams in solid form.

 

Thanks for sharing your inpatient experience. Ativan was an absolute & constant nightmare for me to come off, and as I mentioned I did end up needing an inpatient stay after the process due to the level of trauma that I experienced.

 

Well done for what you’ve achieved, sincerely.

 

______

 

 

Hi there Carol jean,

 

I completely empathise with your situation. At one point when tapering I had not been outside for several months, and was in bed all the time. I never thought I’d actually be where I am now (i.e. much more functional that I was before, although still concerned about being on the Diazepam, of course).

 

If you don’t mind sharing, was there any reasoning from your doctor at the time for being prescribed the two benzodiazepines together? I’ve never heard of that. Please don't feel any need to answer this question though.

 

Indeed: I’d much rather be on Diazepam than Ativan, any day. At least it has a long half-life.

 

I had the experience of not being able to sit still on a different medication (not a benzo): awful experience & sorry you’re having that symptom.

 

Thanks for your encouragement: and hang in there too.

 

 

 

[[Ca...]]

I said the valium made me depressed so she split it into klonapin and valium

I have another two months of microtaper of klonapin and then on to the valium.

I have thought of just going to rehab and doing a cold turkey but the covid makes me nervous

my time line is wrong

it would be five years off if i had not relapsed but i still did not feel right and so i picked it up again

Just take it a minute at a time

I hate the mornings

[[Bi...]]

Ah right, I understand now. It’s very hard & I wish you all the best in the process. I can relate to some extend having battled mental illness for much of my life: I sincerely hope for some decent recovery for you.

 

Thank you for your support everyone.

 

I am going to hold of tapering further until my life circumstances are more stable, and so I will not chime in again until that time. We can do this!