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Need help with direct taper off .75 mg ativan


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Hi!  I have been taking Ativan for almost 4 months and am taking .75 mg daily, .25 in the am, .25 noon, .25 evening.  I so desperately want to be off.  Can someone help me come up with a good taper plan?  I don't want to add any other medication to the mix. I have also read so many horror stories of lasting symptoms, I am very scared!!  Looking for help!


Thanks so much!

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Hi, Peace.


There are a lot of scary stories for sure but you don't need to worry.  We will help you get off the Ativan.  I tapered directly off 3mg/day loarazepam (Ativan) by dry cutting my pills with a pill splitter I got from the drug store.  When I was at .75mg/day, I was reducing my daily dose by 0.125mg (1/4 of a .5mg tablet) about every 2 weeks.  If that doesn't suit you, there's always titration.  You can read more about it on the Titration board and start a thread there if you want to go that route at the start.  I decided to dry cut to begin with knowing I could always switch to titration if I wanted to but others start out titrating.  It's pretty much what suits your lifestyle and needs.  ;)

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I was on Ativan for many years and did a direct water taper and only had a couple bumps in the road, I am doing great ! Don't read those stories in my case none of them happened to me.
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Thanks for your advice and support.  Beeper, was your last dose .125 then if you were tapering at a quarter of a .5 mg pill?  That is what I am doing.  How did it go?  How was it when you were done?  I am not sure about this water titration method.  Honestly, my concern right now is that this taper could take longer than the time i've been on the medication.  Did you continue to spread your dose out 3x a day?  For the last couple days, I have been doing .25 in am and .25 around noon, and then .125 in the evening.  Mornings are really hard for me!!  Any more advice is greatly appreciated.
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Yes, I jumped at .125mg, Peace.  Afterwards it was no worse than the weeks before I jumped.  And remember, I had been on them for nearly 20 years so I expect my symptoms were much rougher than yours.


You actually can go just as fast using the titration method.  Instead of dropping .125mg every week (or two), you would reduce 1/7th (or 1/10th or 1/14th) of that every day instead of the whole .125mg at once.  If you are doing okay the way you are going, there's no reason to switch but I did want you to know that it's a very flexible method.


Actually, my dose was originally spread out 5x/day due to interdose withdrawal.  So, it was only when I got to the point of dropping from .625mg to .5mg that I eliminated one of the doses.  I suggest you make the next reduction from one of the other doses rather than eliminate the evening one altogether.  The lower dose at night cold be contributing to your lousy mornings; however, morning anxiety seems to be worse for a lot of people, regardles of when they dose.  Here's an article on the subject that may help.


Understanding Early Morning Anxiety

By Deanne Repich


Are mornings the worst time for your anxiety? When the alarm clock rings do you experience a feeling of dread? Do the symptoms kick in, making you tempted to roll over and snooze for hours so you don't have to face the day?


One reason why anxiety can be worse in the morning is that waking up is a sharp contrast to the sleep environment, which is perceived as pleasant for most people.


Picture this: You're sleeping peacefully in your warm, cozy bed, (for some, after many hours of insomnia). You are at peace, finally getting a break from the cares and tasks of the day. Then, BOOM! Suddenly, the shrill sound of your alarm clock jerks you awake. It triggers the "fight or flight" response, our body's inborn self-protective mechanism. And to top it off, the room is cold and dark. The dreaded worries and symptoms kick in.


There are several things you can do to make your "waking up" environment more pleasant. For example, get a radio alarm clock that wakes you up to your favorite music. Another alternative is an alarm clock that wakes you up gradually with pleasant chimes of increasing volume and frequency.


Keep a robe and slippers next to the bed so that you can warm up quickly and minimize a drop in body temperature as you get out of bed. If the bright lights of the room bother you, install a dimmer switch near your bed. You can gradually increase the light's intensity over a period of several minutes after you awaken.


Another reason why symptoms can be worse in the morning is because your blood sugar is low when you first wake up. You have gone all night without food. It's important to maintain a constant blood sugar level because the brain uses glucose as its fuel. If blood sugar levels are too low or drop too fast, then the brain starts running out of fuel. This causes the brain to trigger the "fight or flight" response.


The "fight or flight" response sends a rush of adrenaline, cortisol, and other neurotransmitters through your body to prepare you to fight or flee the perceived threat (low fuel). This process can trigger physical reactions ("symptoms") such as trembling, rapid heartbeat, sweating, panic attacks, fatigue, insomnia, mental confusion, nervousness, dizziness, and more.


To balance your blood sugar levels and minimize symptoms, keep a snack that contains "good" complex carbohydrates and protein by your bed. Eat it when you first wake up. You will likely notice that your symptoms improve shortly after eating the snack. You might try a combination of whole grain crackers and a handful of nuts, or a high-protein granola bar with some whole-wheat pretzels. The "good" carbohydrates will give you energy, and the protein will help to keep your blood sugar level steady over time.


Finally, dead-end thoughts play a huge role in creating early morning anxiety, as well as anxiety at any other time of day. Once you learn to overcome dead-end thoughts, you stop the anxiety cycle in its tracks.


Dead-end thoughts are negative, anxious, obsessive, or racing thoughts, that do not promote your well-being. They are based on faulty thinking patterns. These thoughts of helplessness, negativity, or anxious predictions about the future, give away your personal power and create the anxiety cycle. Here are a few examples of dead-end thoughts:


    * "I can't get out of bed feeling like this."

    * "Why do I feel this way? There must be something really wrong with me!"

    * "Everything is going to go wrong at the work meeting."

    * "It's a horrible day."

    * "When will this ever stop!"


The most important thing you can do to conquer early morning anxiety is to change how you PERCEIVE waking up. Change the dead-end thoughts that create the anxiety. Remember, physical symptoms by themselves are not anxiety. Negative perceptions are what create and perpetuate the anxiety cycle.


Choose to perceive waking up as a positive event - yes, you have a choice! Habitual dead-end thoughts can be unlearned and replaced with healthier self-talk. Of course, like any new skill you learn, it requires practice and patient persistence on your part to make healthier thoughts automatic.


Change your perception by creating a morning ritual that replaces the dead-end thoughts with healthier ones. Create a sequence of positive steps you can take when you first wake up to conquer early morning anxiety.


Positive rituals are helpful because they get you fully involved in the present moment (instead of the future), by focusing on one task at one time. Make the ritual automatic by taking the same steps every day in the same sequence. Here is an example of an anxiety-busting morning ritual. Use the ideas in this ritual as a starting off point to help you create your own personalized morning ritual.


    * Step 1: As you get ready for bed at night, place your alarm clock out of arm's reach from the bed. This action will motivate you to get out of bed to turn off the alarm when it rings the following morning.


      When the alarm rings, get out of bed immediately. Turn off the alarm and put on the robe next to your bed. As you do so, say aloud three times in an enthusiastic, cheery voice: "I am SO glad to be alive! What a WONDERFUL day!" Make sure to smile as you do this.


    * Step 2: Mentally and physically "check in" with the present moment. Accept any physical sensations without placing a negative judgment on them. Simply observe. Touch your face, hands, and legs a few times and observe the sensations. Focus intently on a few items in the room for several seconds. These simple activities help you to switch your focus from the future back to the present moment.


      If dead-end thoughts occur at this time (which they likely will), immediately replace them with healthier thoughts. It often helps to say the positive thoughts aloud. For example, if you're thinking: "I can't get out of bed feeling like this," replace it with: "These physical sensations might be uncomfortable, yet I know they are harmless. I am completely safe. I am physically able to get out of bed and have a great day. Watch. I can get out of bed just fine!" Then DO it!


    * Step 3: Turn on your favorite upbeat music CD. (Keep a CD player in your bedroom.) Sing along and dance for a minute or two.


    * Step 4: Eat the snack on your bedside table to help level your blood sugar.


    * Step 5: Take a shower and dress. Then continue with your day.


Once you find a pattern that works for you, use the same morning ritual -- the same steps in the same sequence -- every day. Repetition helps you to effectively unlearn old thoughts and behaviors and make the new ones automatic


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Beeper, thanks for your reply and the article about morning anxiety. it is helpful to have support of others that have been through this.  What were your symptoms?  Mine are just overwhelming anxiety and depression.  I have no motivation to do anything.  All I want to do is lay around and rest, no appetite at all!  I am trying to get out and do the normal things like work out, visit with friends, be there for my kids, everything is so hard right now.  I just want to get the old me back, the independent, strong, confident person that I was not long ago!  Please tell me it will come!  Thanks again!
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Oh, yes, it WILL come back, Peace!  I was exactly as you describe with a bunch of physical symptoms as well.  Of course, I was on them a lot longer than you so for that reason alone, your experience is likely to be different from mine.  I cut way back on anything "discretionary" and reserved my energy mostly for things like brushing my teeth and taking a shower.  (I would write "LOL" but it wasn't funny at the time.)  I did force myself to do a few things beyond the basics because I knew they would be good for my spirit but that was pretty much it.  Since you used to work out, maybe you could force yourself to at least do some brisk walking.  Exercise like that is a proven anti-depressant and, of course, once you are up and moving, sometimes you want to continue that way.  ;)
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