Should I get back to my "low dose" Lorazepam?

[[Ag...]]

Hello and thanks to everyone of you for this Forum:

(Sorry for my English: I'm not a native speaker).

I was on a "low dose" of 0.5 to 1 mg Lorazepam for years. Eventually I stabilized for a few months at 0.5 and as I wanted to come off of it, my psychiatrist instructed me to take 0.25 for two weeks and then just stop the medication. I already new about the recommended 10% dose reduction, but I didn't find the way to cut the pills into smaller pieces. In fact, in Spain the lower dose commercially available is not 0.5 mg but 1 mg, so I was already cutting the pills into quarters. Well, the thing is: it's been 5 weeks since my last 0.25 dose and I still have very, very poor sleep and some anxiety. I am exhausted and stressed out.  However, I have no other physical symptoms, aside from a very bad tinnitus that I developed after taking ciprofloxacin while on Xanax a few years ago. I' now 40 yo and have been on different medications since I was 17 (I was put on them for severe insomnia). For the past 15 years I have been -and still am- on Remeron. 

So, after a little over a month since I took my last 0.25 dose Lorazepam, and since I am having so very much trouble sleeping, would it be wiser to get back to it and attempt a slower taper, by whatever the means? I have read and heard too many horror stories and have myself experienced severe, invalidating withdrawal when trying to quit Remeron in the past, which I didn't succeed at, so I am afraid I am doing my organism more harm than good by trying to stay off the medication. 

Thank you for reading! I am very grateful for this Forum.

[[pi...]]

Hello @[Ag...] and welcome to Benzo Buddies!

Yes , that was a very fast taper that your provider suggested. However, you are still very early off lorazepam, in the acute phase. This is when the symptoms can be the strongest.

You do have a dilemma. Insomnia is a very common withdrawal symptom and since you were put on benzos for insomnia, this compounds the issue. Should you reinstate and taper more slowly? It is possible but it may not ease the insomnia. 

Will your doctor provide the medication for a slow taper?

Insomnia wasn’t an issue for me during withdrawal, luckily, so I’m going to defer to those who can relate their experiences.

Whatever you decide to do, we’ll support and encourage you through the process.

pianogirl

[[ou...]]

14 hours ago, [[A...] said:

Hello and thanks to everyone of you for this Forum:

(Sorry for my English: I'm not a native speaker).

I was on a "low dose" of 0.5 to 1 mg Lorazepam for years. Eventually I stabilized for a few months at 0.5 and as I wanted to come off of it, my psychiatrist instructed me to take 0.25 for two weeks and then just stop the medication. I already new about the recommended 10% dose reduction, but I didn't find the way to cut the pills into smaller pieces. In fact, in Spain the lower dose commercially available is not 0.5 mg but 1 mg, so I was already cutting the pills into quarters. Well, the thing is: it's been 5 weeks since my last 0.25 dose and I still have very, very poor sleep and some anxiety. I am exhausted and stressed out.  However, I have no other physical symptoms, aside from a very bad tinnitus that I developed after taking ciprofloxacin while on Xanax a few years ago. I' now 40 yo and have been on different medications since I was 17 (I was put on them for severe insomnia). For the past 15 years I have been -and still am- on Remeron. 

So, after a little over a month since I took my last 0.25 dose Lorazepam, and since I am having so very much trouble sleeping, would it be wiser to get back to it and attempt a slower taper, by whatever the means? I have read and heard too many horror stories and have myself experienced severe, invalidating withdrawal when trying to quit Remeron in the past, which I didn't succeed at, so I am afraid I am doing my organism more harm than good by trying to stay off the medication. 

Thank you for reading! I am very grateful for this Forum.

At 5 weeks off I wouldn't consider reinstating, especially if your only symptom is insomnia which you had from before benzos.

Edited November 21, 2023 by [ou...]

[Guest [...]]

Hi @[Ag...]

I understand you may experience your symptoms as quite intense or extreme, but, believe me, you sound like you’ve been quite lucky for someone who’s tapered off the medication so fast. Although intense, your symptoms seem considerably few compared to many other members on here. It’s been 5 weeks, so, personally, if you feel you can, I would probably continue trying to push through this early part of the recovery phase to avoid potential complications with reinstating, stabilising, and then having to taper off again. Reinstating after 5 weeks off may not give you the level of relief from symptoms you may expect. 

However, only you know how impactful and debilitating these symptoms are on a daily basis, so, you are the one best placed to make any decision.

Your symptoms will ease with time, you are recovering, repairs are happening, even if it doesn’t feel like it right now. 

[[Ag...]]

I thank you all very much for your kind replays. I am really, really grateful for your insight. It makes me feel a little less alone, since my relatives have a hard time understanding what happens to me every time I try to get off a medication.

I know my symptoms are few. I've been reading through this forum a lot in the past few weeks and I myself had experienced severe withdrawal years ago when trying to get off Mirtazapine, including brain zaps, tingling sensations and other physical symptoms, extreme weight loss and hypomania. I reinstated it when I started having suicidal ideation. And I know all of this symptoms were a withdrawal effect, since I had never had any of them before and they all came back the second time I tried, also unsuccessfully. However, coming off Alprazolam was even worse, as I developed a tinnitus that has stayed with me till this day. And that only to end up substituting it with Lorazepam...

This is precisely the reason I was asking this question about to reinstate Lorazepam or not now, as I was afraid I could still develop other debilitating symptoms even at 5 weeks off. However, reading you all, I have decided to try and push through my insomnia and exhaustion. I am also experiencing anxiety, but to be true, the interdose anxiety I had before was worse. I used to have severe anxiety three to four hours before my next dose, and it was clearly something physiological, not correlated to any strains of thought. This is one of the reasons I wanted to get off the medication. Now my anxiety is more diffuse.

On the other side, my psychiatrist increased my dose of Mirtazapine from 30 mg to 45 mg when I complained about insomnia due to the fast-paced "discontinuation" of Lorazepam. Well, I didn't say it was "fast-paced", because all of this years have taught me how to talk and not to talk with a psychiatrist. The thing is, I'm starting to thing that this new dose, taking at bedtime, might not be the best idea, as I have read it loses its sedating effects and even acquires stimulating properties! So I discuss it with her next time. 

Edited November 21, 2023 by [Ag...]

[[Ag...]]

Anyway I am also starting to wonder if the muscle pain in my legs, shoulders and lower back could also be attributed to the withdrawal. I certainly didn't have it before stopping the medication...

[[Li...]]

Hello @[Ag...].  Your hypothesis that the increase in mirtazapine dose may be causing you issues is a reasonable one.  One of our former members who had a medical background had this to say about mirtazapine (you would, of course, want to verify this through your own research):

Quote

… it works on 3 different receptors. At lower doses it only hits the histamine, then serotonin and then norepinephrine, the latter 2 are the activating neurotransmitters, which is why it's sedating at lower doses, and activating at higher doses. It also works by another mechanism separately to increase appetite. So, it's a complicated and powerful drug. To my surprise, at 2.7mg now, it still helps with sleep.

 

Also, as I’m sure you already know, if you decide to discontinue this drug, it should be gradually tapered.  Per Surviving Antidepressants: “A very common withdrawal problem with mirtazapine is rebound insomnia ….”

 

[[Ag...]]

Thank you very much, Libertas. So far, I've found contradicting studies about this Mirtazapine issue. However, from what I have read, it seems that increasing the dose from 30 mg to 45 doesn't make much sense after all. Apparently, it provides very little to no additional benefits, while exponentially increasing the risks. Eventually, I would want to go back to my usual 30 mg. I have already been on 45 mg for short periods of time before, and I used to get back to 30 with no issues. However, my tinnitus is there to remind me to proceed with more caution. I feel my nervous system has becoming more and more sensitized over the course of the past 5 or 6 years.

I've seen my psychiatrist today and she said to stay on 45 mg Mirtazapine and to use trazodone for a while to ease my Lorazepam discontinuation symptoms. I have already taken this medication in the past. But I am very tired from getting put on so many different medications over and over and over again. And I am angry that I was put on psychiatrist meds as a teenager when I was simply just too young to consent. 

Psychiatrist can't ever acquire real clinical experience if the disregard everything that we patients tell them that doesn't fit there preconceptions: 

23 hours ago, [[L...] said:

So, it's a complicated and powerful drug. To my surprise, at 2.7mg now, it still helps with sleep.

My mother, who has also been on Mirtazapine for years, managed to slowly get from 30 to 3.75 mg without any problems whatsoever. But it has been impossible for her to get off the medication entirely. However, her psychiatrist completely disregards her experience and says it's just a placebo effect.... 

Sorry, I had to take it off my chest.

I am really, really grateful for your help. 

 

[[Li...]]

You are most welcome, @[Ag...].  Tip of the hat for recognizing that increasing the dose of mirtazpine has the potential to increase the risk of adverse effects while offering diminishing returns in terms of benefit.  

Thank you for sharing your mother’s experiences with mirtazapine with us.  Given what we are learning about the neurobiology of withdrawal and the hyperbolic relationship between dose and drug effect, hitting a brick wall at 3.75mg makes sense.  An older relative of mine was given the same ‘baby’ dose of mirtazapine during a nursing home stay and it knocked him out.

Just checking … are you aware there are major interactions between mirtazapine and trazodone?

[[Ag...]]

20 hours ago, [[L...] said:

You are most welcome, @[Ag...].  Tip of the hat for recognizing that increasing the dose of mirtazpine has the potential to increase the risk of adverse effects while offering diminishing returns in terms of benefit.  

Thank you for sharing your mother’s experiences with mirtazapine with us.  Given what we are learning about the neurobiology of withdrawal and the hyperbolic relationship between dose and drug effect, hitting a brick wall at 3.75mg makes sense.  An older relative of mine was given the same ‘baby’ dose of mirtazapine during a nursing home stay and it knocked him out.

Just checking … are you aware there are major interactions between mirtazapine and trazodone?

I had no idea about those interactions! Thank you very much for the heads-up! In any case, I was already very hesitant about taking it. I am not very fond of the idea of taking another psychotropic drug to assist with the withdrawal of a previous one. For the time being, I don't intend to take it. 

Thanks again!

[[Li...]]

You’re most welcome, @[Ag...].  Two of the most important steps we can take to inform our decision making regarding the risks/benefits of taking a medication are (1) read the full (professional not patient) drug label (product information) for the medication and (2) check for interactions between the medication and other current medications or supplements.  Here are the three interactions checkers I use:

Drug Interaction Checker - DrugBank
https://go.drugbank.com/drug-interaction-checker
(includes citations to relevant literature)

 

Drug Interactions Checker - For Drugs, Food & Alcohol
https://www.drugs.com/drug_interactions.html
(includes interactions with food as well as a ‘Professional’ tab for in-depth information about the interaction.)

Drug-Herbal Interaction Checker | HelloPharmacist
https://hellopharmacist.com/drug-herbal-interactions

 

[[Ag...]]

Wow! This is so very useful information! I very much appreciate your help. Thank you very, very much! I am certainly NOT going to take the trazodone.

[[Li...]]

Hello again @[Ag...].  I’m delighted the information about reading drug labels and checking for drug interactions is useful.  Psychiatrist Josef Witt-Doerring just posted the video below on how to read the US FDA Drug Label for trazadone. I thought you might find it of interest.