Ativan Taper Help Needed!

[[Cw...]]

At the end of April (4/20) this year I used shrooms for the first time. I didn’t sleep that night and the next day felt off. Poor sleep continued as did feeling off and my anxiety increased. It got to a point where I had severe panic/anxiety/depression/insomnia. I had no previous history of anxiety or depression or insomnia. 

 

I was prescribed Ativan. I took .125mg of it initially which helped take the edge off during the day, but left me feeling depressed the next day. I didn’t like it but it was all that I was given and I was unfamiliar with other coping mechanisms not having a therapist or psychiatrist lined up so I eventually ended up taking .25mg most days for about 2 weeks.

 

I then ended up going inpatient for 1 week where the only amount available to me was .5mg which I took most nights there because otherwise I wouldn’t sleep at all and would be experiencing extreme anxiety /panic attacks all night. At the very end of my hospitalization I took 1.5mg spread out over the course of a single day. I only did this for one day. They also put me on trazodone and duloxetine.

 

I don’t know what amount I was taking right after the hospitalization because I don’t have much of a memory at that time, but it would have mostly been 0.5mg once at night as I didn’t want to use it during the day. This maybe went on for 1 week.

 

I then connected with a new psychiatrist who advised me to take 1mg at bedtime to see if that would help with sleep. Following my doctors instruction I did this (it didn’t really do much for my quality of sleep, just relaxed me more and gave me pseudo sleep). I maybe did this for a week and then switched back to .5mg when it didn’t feel like the 1mg was making much of a difference (I didn’t know anything about the need for a slow taper at this point). 

 

One night I forgot to take Ativan all together and I was incredibly restless, panicked, had burning in my skin (which I experienced once while inpatient in May). I felt extremely agitated and terrified the following day so I started the Ativan again at my doctors recommended 1mg at night. I did 1mg at night for a few days then freaked out about being dependent on it to which my doctor said “no you aren’t because you are at such a low dose” and told me I could reduce it if I wanted proof I wasn’t dependent. I reduced to .75mg and stayed on that for about a week. 

 

AND THEN I got sick. Developed a fever, shortness of breath and was hospitalized with anaplasmosis (tick disease). Was there for a week to receive antibiotics. While there I experienced sleepless nights and what I call internal akasthisia among other things. My psych advised upping my Ativan while hospitalized to help so I went back to 1mg a day (mostly at night).  

 

I was discharged and I think went back down to .5mg at night with Hydroxyzine to sleep. Sometimes I would take 1mg at night. At some point I tapered down quickly from 0.75 to 0.5mg to .25mg and after a few days started getting terribly restless at night and night sweats and freaked out that I tapered too fast (because obviously I did) so I went back up to 0.5mg.  

 

Most recently I held at 0.5mg of Ativan for a week. Felt relatively stable in that my sleep still sucked (but it’s been bad the whole time) but I was getting some level of sleep mixed with pseudo sleep. My mental health wasn’t horrible (I wasn’t having extreme daytime anxiety or really long lasting intrusive thoughts). I could go out and do things although couldn’t really get out of bed before noon. I started thinking about going back to work part time so I knew I was doing a bit better. Because of that I decided to decrease to 0.375mg by cutting my 0.5mg pills.

 

The second day in my sleep got progressively worse, which has continued to get worse. Negative thoughts and anxiety have also increased along with jaw tightness (which is something I’ve had this whole time). The night sweats returned last night (Day 6 of taper) along with heat sensitivity. 

 

Now that I’ve been reading through this forum more as well as the Maudsley guide I am realizing I’ve been doing this all very wrong and have bounced my dose around a bagillion times. All in all I’ve been on Ativan for 12 weeks. I would say the majority of that time was spent on a dose of 0.5mg, but as you can see daily doses ranged from 0.125 to 1.5mg. I primarily only have taken it at night. There were only a few days more towards the beginning where I took an additional dose during the day. 

 

I know things are going to be incredibly difficult but I want to do this correctly moving forward and hopefully haven’t completely ruined my chances of recovery by bouncing around so many times. I plan to ask my psychiatrist to prescribe me the liquid version of Ativan since pill cutting is proving to be challenging. 

 

Currently I’m still also on 30mg of Cymbalta and 25mg of Hydroxyzine. Sometimes I take melatonin. 

 

I’m very concerned about the trajectory I’m currently on with this latest taper. I know things get worse before stabilizing so I’m expecting that, but I guess my questions for you all are:

 

-Did I stabilize myself long enough on 0.5mg? Was 0.5mg even the right starting point given I had been primarily taking 0.75 to 1mg in the weeks prior?

-Should I be spreading my dose out throughout the day or stick to my once a day nightly dose? 

-How do you know when a taper is going too fast and symptoms are too severe that you need to reinstate and restart at a slower pace? 

-If I’m considering transitioning to the liquid should I stabilize on that first then taper?

-Should I not even try to taper from Ativan and instead get cross tapered over to Valium first?

 

Edited July 14 by [Cw...]

[[Pa...]]

Hello @[Cw...], welcome to BenzoBuddies,

You're right, you've been all over the place with your doses but don't worry, you haven't ruined anything, you can still taper and recover but it will be challenging as you already know.

You've already educated yourself quite well, kudos for looking into Maudsley and knowing Ativan comes in liquid form.  I'll attempt to answer some of your questions, but I'm sure we'll get to all of them as we go.

Given your erratic use, I see holding as a good first step, but at what dose?  How do you feel on the .5, are you able to take care of your daily tasks, we call this being stable.

Most Ativan users will dose up to 3 times a day to help with interdose withdrawal, but this will effect sleep because you'll have less to take at night, what are your thoughts about this?

If you do decide to go with liquid Ativan, I'd hold off on making any reductions, members have reported noticing a difference in how they react so its best to not make any changes until you see how you're going to react. 

Your body will let you know if you're going to fast and if you are, we encourage holds rather than reinstating, most members eventually even out when they hold but if things are too rough, then of course, reinstatement is a possibility.

I would try to taper from the Ativan for now, if interdose is too much then you can consider crossing over but we don't encourage crossing right out of the gate.  Its a slow process to make the cross and some members can't do it, the sedation and depression Valium is known for is too much for them.  But, some do cross and they report it being a much smoother taper because of the long half life.

Lets keep talking, we're glad you're here.

@[Pa...]

[[Cw...]]

@[Pa...] thank you for responding so quickly. I really appreciate the information and positivity. It’s a bit hard for me to really know what stable is at this point because I’ve been all over the place with doses of numerous meds and then was sick, but how I felt last week on 0.5mg may be the most stable I can hope for. I was able to do daily tasks and activities so that may be where I should start. That would I guess mean going back up to 0.5mg from where I am not at 0.375.

I’m not sure how I feel about dosing throughout the day as I don’t think I’m experiencing interdose withdrawal while at the more stable dose of 0.5mg? Jaw tightness is something I do get so that may be due to interdose but that’s manageable. My sleep is what is more concerning because it’s barely there to begin with. But maybe I can re-evaluate as I taper and if I get to a point where daytime becomes too much of a struggle then I can change up my dosing. Right now nighttime is where my battle is. 

[[Pa...]]

For someone who has been suffering pretty intensely for awhile, you've been able to make good observations and your ability to make decisions seems fully intact.  I know this may sound condescending, but this process creates a lot of fear which makes it difficult to take care of the simplest of tasks we face in a day.

I agree with your thoughts about splitting your dose, no need unless you're suffering with interdose but if down the line you decide you need to, remember not to reduce while you're making the transition, everything must be done slowly to allow your body time to acclimate.

I agree that .5 is most likely the place to start, it might be a good idea to stay at this dose for a week just to give yourself time to make your taper plan.  Speaking of plans, be sure to document your reductions and your symptom severity, these will help you determine when and how much to reduce.  While having a plan is good, we've found they need to be monitored and adjusted as you taper, listening to your body's cues not the calendar works best. 

Its good you know to expect symptoms, and its good you accept them because fighting this process creates anxiety and anxiety increases symptom severity.

Please keep us posted about what your doctor thinks about switching to liquid, we've found some doctors seem to fight us when it comes to allowing us the method and taper length of our choosing. 

 

[[Cw...]]

@[Pa...] Thank you! Just following up that my doctor is willing to switch me to the liquid. It would be the lorazepam intensol 2mg/mL. Is there someone here that you know of who may have any recommendations for using this method and diluting? 

[[Pa...]]

This is good news @[Cw...], yes, I know someone who may be able to offer some guidance about diluting your dose, when do you expect to pick up the solution? 

[[Cw...]]

@[Pa...] tomorrow 

[[Pa...]]

Okay, good but remember, you won't be reducing for a week or so while your body adjusts to the new formulation, right?

[[Cw...]]

@[Pa...] Yes I will wait a week (or until I stabilize)

Edited July 19 by [Cw...]