Hi I'm new and need advice for my Ativan taper

[[Do...]]

Hey I'm new here!

I did start reading here today and realized that i might be in much more trouble than i expected. Im 33 years old from Germany, i have a good job and live with my gf and my dog.

I am pretty desperate right now and hope i can start this hard journey with some help. 

I really want to get off the Ativan because i feel like it started doing more harm than good. The other thing is i believe i can only recover from my disordered anxiety when i can get the credit and not a benzo.

Why did I start taking Ativan?

I've had anxiety/panic attacks for quite some time but I never needed benzos regularly. This changed when my dad suddenly got diagnosed with pancreatic cancer. He died 3 months later in our arms after we took care for him at home. In this process I started taking Ativan daily. Averaging around 1 mg a day. This went on for maybe 2 months and after I was able to taper down with 0.25 cuts. I was completely off for some time with occasional use. But with the grief and my anxiety disorder I switched my AD and hell broke loose. I reinstated my Ativan but this time it was not helping that much. I switched back to my old AD in the process and sadly this took some time and I was on it for 3 months. 

My efforts to get off

I never wanted to stay on them for so long so as soon as I felt a little better I reduced. Going down to 0.75 eventually worked out. In this process I got an appointment with a psychiatrist and told him that I want to get off the Ativan. He prescribed me Pregabalin and told me to reduce "slowly" by 0.25 mg. Wait till I stabilize and go further.

But as soon as I went down from 0.75 to 0.5 last Saturday I feel really off:

- A lot of panic attacks

- Hot and cold flashes

- Feeling unreal

The pregabalin is not really helping. I called my doc and he advised me to take 0.75 one day and 0.5 the other day. I started to research myself and feel like I'm not perfectly advised and also since I always take my Ativan only in the morning I probably have rebound anxiety and withdrawal during the day.

So now I'm looking into a better way to taper.

[[Co...]]

 

Hello @[Do...]. Welcome to BenzoBuddies.

I am sorry to hear about your medication difficulties and the loss of your father.

I am not the best person to respond to your questions about antidepressants, but I am sure others will be long to help.

It would help if you would detail when you started and stopped your various medications so that we better understand your history.

 

[[Do...]]

Thanks for your fast reply and your kind words!

I am on Sertraline 125 mg atm. I tried Escitalopram in between which gave me more anxiety.  I'm taking the sertraline since around 3 months now. The trial with Escitalopram was 4 months ago. That's around when I started taking Ativan daily.

But I accepted to stay on Sertaline for the meanwhile. I want to focus on getting off the Ativan. 

 

[[Co...]]

What is your dose of Ativan? What dose pills do you use?

[[ou...]]

4 hours ago, [[D...] said:

I called my doc and he advised me to take 0.75 one day and 0.5 the other day.

This is not a good idea given lorazepam's short half life. Are you aware of the Ashton Manual? Professor Ashton recommended switching to diazepam which has a long half life and comes in low doses. You could also taper directly but you'd need to find a way to make smaller cuts. A 0.25mg cut represents 1/3 of your 0.75mg dosage. We usually recommend a symptom based taper but reducing by no more than 1/8 of your current dosage per week is a good rule of thumb to start.

[[Do...]]

I did read through the whole thing now. Yeah I definitely want to go slower. My doc is on Christmas holiday already. I looked up water titration and maybe splitting my 0.75 dose over the day and then slowly start reducing. Does this sound feasible?

Any thoughts about the added pregabalin from my doc? I am unsure because as far as I understand it is also hard to get off from.

Thanks for helping!

 

[[Co...]]

17 hours ago, [[D...] said:

I did read through the whole thing now. Yeah I definitely want to go slower. My doc is on Christmas holiday already. I looked up water titration and maybe splitting my 0.75 dose over the day and then slowly start reducing. Does this sound feasible?

Any thoughts about the added pregabalin from my doc? I am unsure because as far as I understand it is also hard to get off from.

Thanks for helping!

I unusually advocate for grinding up the pill and using inexpensive (a few tens of dollars) jewellers scales (balance) to make smaller doses (rather than liquids).* Most members find that a balance which will measure down to 0.001mg is perfectly adequate. Read the reviews before deciding upon a particular balance.

If you go down the liquid route, I strongly suggest using a pharmacy across-the counter the solution or suspension medium meant for this purpose (not water or vodka, as some advocate). The commercial mediums are far more reliable.

[[Co...]]

18 hours ago, [[o...] said:

This is not a good idea given lorazepam's short half life. Are you aware of the Ashton Manual? Professor Ashton recommended switching to diazepam which has a long half life and comes in low doses. You could also taper directly but you'd need to find a way to make smaller cuts. A 0.25mg cut represents 1/3 of your 0.75mg dosage. We usually recommend a symptom based taper but reducing by no more than 1/8 of your current dosage per week is a good rule of thumb to start.

For longer acting benzodiazepines taken several times per day, reducing each of the individual daily doses in stepwise fashion works for most people. But yeah, for shorter half-life benzos, and the longer the gap between each dose (such as alternating between tow doses every other day), the less reliable this method becomes. For many, switching their daily dose of Lorazepam back and forth will be problematic. But it will work for some.

I should add, though, for those who take a shorter acting benzodiazepine just once per day, and if they do not suffer particular problems with interdose withdrawal, switching to multiple doses per day or a longer acting benzodiazepine is probably of limited benefit, and could even introduce additional complications. At the extreme end, we have benzodiazepines (or z-drugs) with half-life values of about 2 hours. If taken once per day, these are (to all intents and purposes) completely eliminated from the body each day - there is usually little to no dependency. Switching to a longer acting benzodiazepine would actually increase dependency or create dependency where there was none in the first place. For this reason, Prof. Ashton suggested that patients can usually simply quit their short-acting benzodiazepine (if taken just once per day). By extension, a shorter-acting benzodiazepine (but longer than 2 hours) taken once per day, might have created a more moderate dependency. There, surely, must be the risk of worsening dependency by switching to a longer acting benzodiazepine where there are no interdose withdrawal effects.

I only mean to apply the above reasoning to where there are no appreciable interdose withdrawal effects. Where such affects are significant, of course we might well consider changing the benzodiazepine (for a longer-acting one) and/or dividing our single daily dose to multiple smaller doses across the day.

[[Do...]]

Thank you so much for all the input. Regarding interdose withdrawal, the last weeks I felt kinda bad during lunch or in the early afternoon. Some form of rebound anxiety but usually I just focused on work and in the evening I often felt pretty normal. Forgot to mention I always take my dose in the morning. 

After I reduced to 0.5 i felt really bad in the afternoon. Weak legs, dizzy, panic attacks and just feeling out of it. I managed this for one week now except one time where I took 0.75. Maybe the timing of the drop was also not smart since I had an overnight business trip. 

But now I feel like for the drop from 0.75 I should go slower. I don't have to rush it and I want to be able to keep working.

[[Do...]]

21 hours ago, [[C...] said:

What is your dose of Ativan? What dose pills do you use?

I am now at 0.5 (0.75) and i have 1 mg splittable tablets.

[[Co...]]

4 hours ago, [[D...] said:

But now I feel like for the drop from 0.75 I should go slower. I don't have to rush it and I want to be able to keep working.

Seems reasonable to me, @[Do...].

[[Co...]]

3 hours ago, [[D...] said:

I am now at 0.5 (0.75) and i have 1 mg splittable tablets.

Forgive me if we have already addressed this, but it would be helpful to you if you could obtain a prescription for 0.5mg Ativan tablets. These will allow you make smaller cuts. You might even combine tablets from the two tablet sizes. For example, half of a 1mg tablet (0.5mg) plus a quarter of 0.5mg tablet (0.125mg) for a total dose of of 0.625mg. This would be useful if you should find that your 0.5mg tablets are in short supply.