Nitrazepam withdrawal

[[Be...]]

I am 69 and have been on antidepressants - Venlafaxine low dose - for about 10 years and have been a few times on a one-off basis on benzo no longer than 8 weeks. No withdrawal symptoms ever before when stopped. However after feeling very well since the beginning of this year, my doctor started tapering the AD but after some months, I felt depressed again and my doctor decided to increase the Venlafaxine+Mirtazapine and added Nitrazepam 5mg for 3 months. Presently after tapering the Nitrazepam to 2.5mg, feeling horrible after 3 weeks. Tremor, no motivation, anxious, bloated abdomen, etc. Is this a normal tapering effect and if yes, what should I do?

Grateful if someone could help me understand what is happening. The doctor wants to add other medication which I know would get me deeper in trouble.

[[ma...]]

Hello  @[Be...]Welcome to Benzobuddies!

We are glad you joined. You might be tapered too fast, slow is the way to go with benzodiazepines.  Symptoms can be relentless but the support you get here helps you get through it. If you taper slow  it helps avoid very severe symptoms.  You will also get some support/advice on your other meds 

Reducing your daily dose by somewhere between 5% and 10% every 10 - 14 days is the rule of thumb. Some of us need to taper much slower. You will learn more on the taper board.

Taper planning and adjustments 

https://benzobuddies.org/forum/120-taper-planning-adjustment/

Check out The Ashton Manual, It is a great resource for understanding the effect benzo’s have on our body. CHAPTER III lists possible symptoms with explanations

http://www.benzo.org.uk/manual/

Magrita

 

[[Be...]]

Thank you Magrita. I never thought only 3 months use could give such hard symptoms when tapering. Is it normal?

As I am already at 3 weeks with the dose reduction, I would think it would better I stay at this present dose instead of increasing waiting for the symptoms to stabilize and from there taper more slowly. What do you think?

I've checked the Ashton Manual but I suspect my doctor will not be very cooperative. I will have to 

[[Pa...]]

Hello @[Be...], you ask about hard symptoms after only 3 months of use and what we’ve found is that the body seems to remember past use which make symptoms in subsequent discontinuations a bit more intense.  It’s a theory called kindling I happen to agree with. https://www.benzoinfo.com/kindling/

I feel your suggestion to stay and this dose to try to stabilize is a good one, however, if your symptoms become unmanageable, you may need to consider going up in dose. 

Nitrazepam has a fairly short half life, how often are you dosing each day, do you feel your symptoms are more intense the closer you get to your next dose?

[[Be...]]

2 hours ago, [[P...] said:

Hello @[Be...], you ask about hard symptoms after only 3 months of use and what we’ve found is that the body seems to remember past use which make symptoms in subsequent discontinuations a bit more intense.  It’s a theory called kindling I happen to agree with. https://www.benzoinfo.com/kindling/

I feel your suggestion to stay and this dose to try to stabilize is a good one, however, if your symptoms become unmanageable, you may need to consider going up in dose. 

Nitrazepam has a fairly short half life, how often are you dosing each day, do you feel your symptoms are more intense the closer you get to your next dose?

Thanks @[Pa...]. I never heard of the term kindling before and this occurrence makes sense.

I was also somewhat a binge drinker for quite some time but have stopped all alcohol since 4 years.

For the dose, I presently take around 2mg at bedtime but paradoxically, it is in the morning that I feel really bad rather than in the evening. 

Does my age also can explain the symptoms?

[[Pa...]]

Most members say symptoms are worse in the morning, some have looked at high cortisol levels that typically ebb during the day.  

I believe your age does play into this, we don’t heal as fast as we used to but I’ve seen plenty of younger members suffer as well, but generally, I think we’re slower to recover.  

I wonder if you might try to split your dose, take half in the morning to see if you can have a better daytime experience?  Of course, it the Nitrazepam is helping you sleep then that might not be optimal.  

[[Be...]]

I think I'd rather keep the evening dose as not all mornings are bad. 

@[Pa...]Just can you give me a hint for a tampering schedule. Here where I am and please suggest how I should go:

3 months : 5 mg Nitrazepam

1 week : 2.5mg (1/2 tab)

A few days : 1.25 mg (1/4 tab)

1 week : 1.875 mg (3/8 tab)

Am at this point right now. Can you help by indicating how I should proceed further.

Many thanks for your concern. I live in a tropical island where not much even in the medical profession is versed into these problems.

[[Pa...]]

@[Be...], what is your status on the Venlafaxine and Mirtazepine, I’d like to make sure you’re only tapering one medication at a time.

Your taper has been very rapid, you mention your doctor may not be supportive of the Ashton method but are you assured a steady supply if you need to slow your taper down?

[[Be...]]

@[Pa...]Good to hear from you.

I have been taking 75mg Venlafaxine morning and another 75 at noon. I have now reduced the noon dose to 37.5 since one week. Mirtazapine is 15mg after dinner. I am not planning further tapering now until the benzo thing is resolved.

For the Nitrazepam, I have some 25 tablets of 5 mg left and I think that should enough if I lower from present 3/8 tab in the coming weeks to 1/4, then 1/8. It is just I am unsure of a precise schedule. Can you help?

[[Pa...]]

@[Be...], good to know you’re going to hold your other medications for now, its too difficult to know what is causing what when we introduce too many variables.

I don’t have taper experience so I’m hesitant to help you with a precise plan because what I’ve learned from other members is its best to taper according to symptoms, letting them determine the speed can help keep you functional.  However, if you need help planning your taper out because of your limited supply, I know a member who may be willing to help. Would you like me to contact him?

[[Be...]]

Definitely I would like to contact anyone who can help.

Thanks.

[[...]]

Hi Bernard,

Pamster said I should stop by.

How is your anxiety?  How is your sleep?

I can help you with your taper.  I understand you have a limited supply.  I like your approach dividing your pills.  I did that to get down to 1/8 of a pill and then finished with a daily micro taper.

It is a little hard to do because even with a good pill splitter, they tend to crumble when you try to split to 1/8 but just eyeball the crumbs to get 8 piles.  It will be close enough. 

If you have 24 pills left, then the easiest thing to do is to take 1/4 of a pill for 28 days and then 1/8 of a pill for 32 days.  That leaves you with 13 pills for which you can do a micro water taper to go real slow down to zero.  For the water taper part, each day, you will fill 100 mL of water into a jar and drop 1/8 of a pill in it.  Then your would taper to zero for 100 days as follows:

day 1 - remove 1 mL of the mixture and drink the remaining 99 mL

day 2 - remove 2 mL of the mixture and drink the remaining 98 mL

and so on

Bob

 

[[Be...]]

@[...]Thanks Bob. I'll ponder your advice and revert to you.

[[Be...]]

@[Pa...]Thanks referring me to Bob.

[[Be...]]

Hi Bob,

Thanks for your advice which I intend to follow. My sleep is not so bad but my anxiety is somewhat sort of rollercoaster.

One point however and I would like to have your opinion. Yesterday evening I had to face a complicated issue (from my point of view but not from my wife and my son), issue which probably may take some time to resolve. I went to sleep normally but on waking up, I sort of felt like I was in another world. I had an appointment at my church which went on normally without anybody noticing anything of what was going on in my mind. Up to now, feeling odd and discouraged. Everything I was able to handle previously seems presently out of reach. Would that form part of the withdrawal symptoms? Or the withdrawal symptoms compounded with this family issue.

I am a Christian and a strong believer in God's sovereignty and power to heal through His mercy in Christ although it is also my responsibility to make wise decisions according to what I know. Hence looking for your opinion and advice.

Thank you for taking your time with me and I look forward to hear from you soon.

[[Pa...]]

I wonder if you were experiencing depersonalization?  https://my.clevelandclinic.org/health/diseases/9791-depersonalizationderealization-disorder

This is a common symptom for us and stress can increase symptom severity so avoiding it if we can is very important. 

We’re also fearful of things that have never bothered us in the past.  Also, many of us lose the connection to ourselves, so we have difficulty relating to our loved ones, we feel lost and isolated.  This experience hits us everywhere, physically, mentally and emotionally. 

[[Be...]]

@[Pa...]I no longer have this feeling now (it is 17.00 where I live). Really don't think it is depersonalisation. Think it is rather the fear to face and have to participate in an important decision process in the family where the others can't understand what I am going through. They would just look at me and say "what's wrong- move on man". Say something.

It really helps to know people like you understand the situation and for your support.

[[Be...]]

Hi @[Pa...]. I intend to follow Bob's advice and I want to confirm that for now, it is better I maintain the Venlafaxine & Mirtazapine until the benzo issue is resolved. Only then will be advisable I start tapering these ADs.

Any input on above from you @[...]is welcome.

And now I think is the time I must concentrate more on what I shall be doing after the precious advice and fact-gathering from you. I'll get you updated when relevant.

Thank you.

[[Pa...]]

Hi @[Be...], I agree with your plan to hold off tapering any other medications at this time, what you’re doing is a big deal, the repairs you’re expecting your brain to make need to take center stage.  I hope you’re aware that even after the drug has been eliminated, there is recovery and that can take a long time so try to have patience and don’t give up hope, we can recover from this nightmare.

I also agree with you using this time to focus on your recovery, while we provide valuable information, what you read here can also be frightening so take what you need and leave the rest is my motto.  

I look forward to hearing your progress when you deem the time is right. 

[[...]]

Hi Bernard,

Here is some really good advice when you have mental issues.  Comfort yourself with the fact that "it will pass".  You saw it yourself in this last message exchange.  You were clearly suffering but then later you wrote how you felt better.  

I too am a Christian and I am thinking one reason we suffer is so we can learn the love of God and other people who step up to show us love and help.  Of course, not everyone does this help very well.  

[[Be...]]

[[Be...]]

@[Pa...]@[...]Hi. Just to give an update. I have scrupulously followed the taper plan as advised. Thank God, I am feeling fine since 2 weeks now: no depression, motivation and appetite back and even planning trips abroad. The only thing is that my sleep is not yet back to normal with two or three wakes during the night. As such, I am feeling a bit exhausted and I was wondering if it would be advisable that for only 1 night I could take a full pill (5mg Mogadon) and immediately switch back the next day to the 1/4 I have been taking since 3 weeks now before reducing as advised in 1 week. Just to recover from a good night sleep. Please tell me what you think.

Thanks.

B

[[st...]]

Does anyone know what "kindle" means 

[[...]]

I know you want a good night sleep but if it was me, I would not go up and down on my benzo to do it.

Instead try Benadryl or a have the doctor give you a muscle relaxer or Lunesta (no more than once a week).  Lunesta is like a benzo so be very careful with it but I used it with some success when I needed emergency sleep once or twice a month.

[[Pa...]]

Hi @[Be...], I’m in agreement with @[...] that using the drug this way isn’t a good idea.  While a one off dose doesn’t seem to have an effect on some members taper plans, it sets a bad precedent that could lead to more doses.

 I disagree on the use of Lunesta, Bob is right, it’s classified as a non-benzodiazepine but it works similarly to them, I got into big trouble with Ambien after my cold turkey from Klonopin.  Even sporadic use can cause dependence with these drugs so speaking with your doctor about other options or using non-pharmaceutical approaches would be the better option.