Anti depressant before starting taper?

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A psychiatrist I saw wants me to begin an ssri before starting the benzo taper. He says it will help me better withstand the taper process. I'm on 3mg ativan nightly. Experiencing a goid amount of tolerance withdrawal. 

Is this a helpful step? 

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In fact,  my tolerance symptoms are so bad,  I do not know if I can stand having a new medication and understanding if it's the right one for me.

[[Ka...]]

Hello @nlav it seems you have a few options here. I’m no taper expert just some ideas. 
Firstly, the 3mg Ativan night dose is unusual - mostly I believe it would be taken several times per day say for example 1mg 9am 3pm 9am so that you take dose regularly over 12 hours. It has a short life which causes these tolerance issues. 
It would be helpful to know how long you have been taking Ativan and why.

Secondly, you could consider switching over to diazepam which has a long life. 

Personally, would caution adding in an SSRI. Getting stabilisation on the Ativan or switching to diazepam seems to me the better way forward. 
Am sure others more knowledgeable will have experience but FWIW just some initial thoughts. 

 

[[Ma...]]

I’d suggest researching Tripetal. Another member here told me about it. It’s not an a/d but is used as an adjunct med-successfully-for benzo withdrawal.

Whatever you try I would suggest beginning with a micro dose.

[[Ma...]]

To add, you might want to do a Gene Test which will tell exactly what medications are appropriate for your unique system.

[[kn...]]

I have to side with @[Ka...] on this one. I've taken an SSRI (Venlafaxine) before and during my taper and it still helps me with my anxiety and OCD symptoms.  However it is addictive and one more thing to have to taper off of at some point. If you're not on one at this time, I wouldn't start now.  Most folks here, including myself,  have had mixed experiences with add on drugs.  The whole crossover to diazepam idea is what I've done.  I took both Klonopin and Ativan (4 of K and 1 of A) for many years.  Diazepam has it's own set of symptoms and is not for everyone.  But, the pills are larger, easier to chop up and dry taper.  My benzo dosage of both K and A equalled 60 mg of diazepam.  That's where I started 2.5 years ago.  I'm down to 4 mg now.  If you read my taper history, caution is advised.  It' much too steep and too fast of a descent. However, I feel that I'm on the right track now.  Best wishes.   

[[or...]]

I also agree with @[Ka...]. I was on 1.5 mgs of Ativan once a day and had to divide it up so I was taking it 4 x a day to alleviate the rotten wd s/x. And that still didn't help much. So I crossed over to 15 mgs of valium and things went much better. I only had to dose once a day and although I still had s/x, they were not nearly as bad as those caused by Ativan. So, something to think about. One last thing . . . I would NOT add anything else to the mix . . . no SSRI, no SNRI, no AD, nothing. You'll have enough to do keeping  track of your valium wds (and yes there will be some). Besides, who wants another drug (that hasn't even been proven to help with wds) to have to taper off. Again, just my 2 cents worth.

[[Ka...]]

@[...] Both very good comments from @[kn...] & @[or...] I wholeheartedly agree (& this is based on my narrative with Ativan etc) that to add another medication like an AD SSRI into the mix may just add further stress on the CNS.

Much simpler to focus on your taper plan, this is to weigh up what may best suit you and starting point before taper is to look at stabilising the current intolerance. 
hope this might enable you to reach an informed decision. Wishing you well. 

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A question to help me understand the situation better. What does tolerance feel like?

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Edited February 18 by [...]

[[Ka...]]

Edited February 18 by [Ka...]

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I side with the consenses so far on this post as far as not adding to the chemical soup when trying to eliminate chemicals.

I've heard doctors recommend adding ssri. But doctors also gave me benzos without any warning. So who knows?

It's obvious Ssri definitely alter you mind. They could dampen your mind and make benzo discontinuation a bit easier. Keep in mind there are websites full of people struggling to get off of those chemicals too.

Would it be wiser to slow taper and developed life skills to minimize symptoms while tapering, and for the rest of your life?

Edited February 18 by [...]

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I don't think I have the nerve to take up the taper. I'm unable to handle the symptoms. A little before my usual time, I'm having a strange feel in my head and the skin on my hands seems to sting. Haven't taken the ssri yet. How do I manage this? Pls help. Quite uncomfortable and having intrusive thoughts.

[[Ka...]]

@[...] wouldn’t personally attempt any Ativan taper until there is stabilisation. Would personally first take the 3mg (3 x 1mg) in equal doses & see if helps. 
 

Edited February 18 by [Ka...]

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[[Ka...]]

@[...] take a look at FAQ on menu Benzo info there is info about adjunct medication. 

I’ve been in position with Ativan like you, the dosing advice I had led to intolerance.
If you do decide to add the SSRI it takes a while to work & my thoughts are always how do you know which medication is doing what with 2? 

 

Edited February 18 by [Ka...]

[[Ma...]]

You know which 1 by taking a Gene Test, and it might not be a SSRI.

Many here are vehemently against adding additional medications. However you have to do what is best for YOU.

There is a neurochemical storm happening in your brain and there are some meds to help calm that. Usually, from what I understand, you slowly onboard the correct medication, stabilize and find some quality of life.

Then, slowly taper. Often these meds are off label such as anticonvulsants, beta blockers antihistamines etc…

Quality of life is the key.

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@[...] hi 

I have similar situation,  have been taking ativan since July 2023 , it was supposed to be temporary with SSRI so i don't have insomnia , but things derailed very fast,  my AD were changed and it was much later that I realized that Ativan was causing a big problem. My dr also wants to add SSRI to help anxiety bc he doesn't think I can tolerate taper and withdrawals.  But I have a lot of symptoms s/x from ativan and also WD , cannot decide what to do because dr said that ativan is a depresant and will work against antidepressants,  I never knew this and kept switching AD, could stabilize on them . But it's probably individual thing

How long have you been taking ativan?

Edited February 18 by [...]

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If antidepressants work against benzos? Why would doctors recommend antidepressants when tapering off benzos? 

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@[...] it depends which ones I think and depends on an individual person . Usually SSRI’S have increased anxiety stage or insomnia so it could be problematic when tapering.   

Besides I learned that many doctors,  even psychiatrist are not aware of many things or maybe don't care , I don't know . 

But my doctor prescribed lexapro and ativan combo and they aren't supposed to be used together,  I learned long after damage was done . It doesn't mean that every person will react negatively,  but some do, they also don’t know proper tapers etc 

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It's so confusing. 2024 and these things are still trial and error. 

It's best to avoid all chemicals as best as we can.

[[Nu...]]

After more than five years and polypharmacy on multiple AD/APs, I derived basically zero benefit from them. That doesn't mean you won't get benefit, though. If you choose that route, make small changes and allow that change to settle before you make another. Don't be in a rush.

My concern would be this -- you're altering brain chemistry to help fix damaged brain chemistry. At some point, it stands to reason that we just need to go without meds and let things heal. But some meds may prove beneficial, although it's quite impossible to know which ones will be beneficial for whom.

If you choose this route, seems you'd want to start low, go slow, and don't change multiple meds at once. That just sounds like good practice.

Things will get better but it may take a while. Hang in there.

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Edited February 19 by [...]