Reinstate?

[[jo...]]

I know that reinstating is a bad idea.  I want nothing more than to push through this wave and get some stability.  I am not sleeping and feel beyond dysfunctional.  If I end up in an emergency situation what should I go back on.  I jumped off .75mg ativan rapidly 3 months ago.  10 day rapid taper. I was on .25 for a week or so, .5mg for two weeks, and .75mg for 2 days before the rapid taper. 

 

Would I use valium?  Would they even give me valium in emergency room? Should I start with 5mg to match the .5mg ativan?  I think ativan would be too short acting and I was updosing quickly last time when I started using it.  What other options do I have?  Continue to fall apart or get stable? 

[[Pa...]]

I suspect if you reinstate, you’ll regret it, I’ve seen this happen many times, so I hope you won’t because I don’t believe it will help you.  I believe you’ll reinstate, get stable, taper, suffer, jump and end up right where you are now.  I’m sorry to be so brutally honest with you but I hate to see you do this.  Of course, this is your choice and I’ll support whatever you decide to do.

 

Please read what Professor Ashton had to say.

 

Reinstatement, updosing

 

A dilemma faced by some people in the process of benzodiazepine withdrawal, or after withdrawal, is what to do if they have intolerable symptoms which do not lessen after many weeks. If they are still taking benzodiazepines, should they increase the dose? If they have already withdrawn, should they reinstate benzodiazepines and start the withdrawal process again? This is a difficult situation which, like all benzodiazepine problems, depends to some degree on the circumstances and the individual, and there are no hard and fast rules.

 

Reinstatement after withdrawal? Many benzodiazepine users who find themselves in this position have withdrawn too quickly; some have undergone 'cold turkey'. They think that if they go back on benzodiazepines and start over again on a slower schedule they will be more successful. Unfortunately, things are not so simple. For reasons that are not clear, (but perhaps because the original experience of withdrawal has already sensitised the nervous system and heightened the level of anxiety) the original benzodiazepine dose often does not work the second time round. Some may find that only a higher dose partially alleviates their symptoms, and then they still have to go through a long withdrawal process again, which again may not be symptom-free.

 

Updosing during withdrawal? Some people hit a "sticky patch" during the course of benzodiazepine withdrawal. In many cases, staying on the same dose for a longer period (not more than a few weeks) before resuming the withdrawal schedule allows them to overcome this obstacle. However, increasing the dose until a longed-for plateau of 'stability' arrives is not a good strategy. The truth is that one never 'stabilises' on a given dose of benzodiazepine. The dose may be stable but withdrawal symptoms are not. It is better to grit one's teeth and continue the withdrawal. True recovery cannot really start until the drug is out of the system.

 

Pharmacologically, neither reinstating nor updosing is really rational. If withdrawal symptoms are still present, it means that the GABA/benzodiazepine receptors have not fully recovered (see above). Further benzodiazepines cause further down-regulation, strengthen the dependence, prolong withdrawal, delay recovery and may lead to protracted symptoms. In general, the longer the person remains on benzodiazepines the more difficult it is to withdraw. On the whole, anyone who remained benzodiazepine-free, or has remained on the same dose, for a number of weeks or months would be ill-advised to start again or to increase dosage. It would be better to devote the brain to solving individual symptoms and to finding sources of advice and support. Advice about how to deal with individual symptoms is given in the Manual (Chapter 3).