Prednisone and Ativan

[[Cl...]]

Hi All,

 

Does anyone have experience tapering Ativan after a side effect of Prednisone. I can't tell whether my anxiety is caused by Prednisone or the tapering of Ativan. Many thanks!

[[Be...]]

I don't think I was on prednisone just before my taper but I do remember pred really revving me up for as much as a week depending on how high a dose I was on and for how long.  How much pred were you on and for how long?

[[Cl...]]

12 days. 20 mg a day. It's a low does but really effected me...

[[Pe...]]

Cloak,

 

Prednisone is a Glucocorticosteroid (GC) [aka corticosteroids]- which are cross tolerant to benzos.  This is because they work on CRH in the brain in a very similar way that benzos do...thus it has similar effects.  I copied some info from an ongoing thread I started on this subject below followed by an excerpt from an endocrinology journal and a blurb from WIKI so you can see the similarities:

 

 

Since benzos increase the inhibitory effect of GABA it disrupts this GABA-Glutamate balance.  The excess GABAergic inhibition brought on by the benzos causes a reduction in the levels of CRH and AVP, which in turn blunts ACTH secretion. Thus the end result is suppression of the HPA Axis.

 

http://www.benzobuddies.org/forum/index.php?topic=44373.0

 

An overview of the most common and most serious AEs [Adverse Events] associated with GC therapy is the following:

 

...Physiologically, the hypothalamus secretes CRH which stimulates the release of ACTH from the anterior pituitary. ACTH leads to the release of cortisol from the zona fasciculata of the adrenal gland, which in turn exerts negative feedback on CRH and ACTH release. Administration of exogenous GCs even in small doses for only few days leads to a measurable suppression of the HPA axis by decreasing CRH synthesis and secretion and by blocking the trophic and ACTH-releasing actions of CRH on the anterior pituitary.

 

http://www.endotext.org/adrenal/adrenal14/adrenalframe14.htm

 

 

There is cross tolerance between alcohol, the benzodiazepines, the barbiturates, the nonbenzodiazepine drugs, and corticosteroids, which all act by enhancing the GABAA receptor's function via modulating the chloride ion channel function of the GABAA receptor.

 

http://en.wikipedia.org/wiki/Benzodiazepine_dependence

 

Therefore, you may have had either a paradoxical reaction to the Prednisone or may be experiencing tolerance sx's.

[[Cl...]]

Thank you!

Do you know what doctor would be able to help me? An endocrinologist or a Psychiatrist with a specialty in Pharmacology?

 

I have been off Prednisone for 4 weeks and the anxiety has lessened but still can't sleep without Ativan... I only sleep for a few hours. Do you thnk that the benzo is making things worse?

[[Da...]]

You've been on them for a month.  You will probably be fine.  What was the prednisone for?

[[Cl...]]

Inner ear infection... I was so busy with life that I didn't really pay attention to the side effects... How life has changed for me.

[[bl...]]

Blech. I have taken prednisone before taking benzos. It made me feel like I was crawling out of my skin and was intolerable!

[[Pe...]]

Thank you!

Do you know what doctor would be able to help me? An endocrinologist or a Psychiatrist with a specialty in Pharmacology?

 

I have been off Prednisone for 4 weeks and the anxiety has lessened but still can't sleep without Ativan... I only sleep for a few hours. Do you thnk that the benzo is making things worse?

 

Cloak,

 

A Neuroendocrinologist would understand this better than other types of physicians...but they are few and hard to come by.  It is not surprising that your anxiety has decreased the further out you got from your last dose of Prednisone.

 

There is a little area in your brain called the Suprachiasmatic Nucleus of the Hypothalamus which controls all of the circadian rhythms in our bodies.  Research has shown that even one dose of benzos can throw this out of phase...which can contribute to insomnia.

 

After I detoxed I had 6 straight nights of ZERO sleep...then I was able to sleep for 1-3 hours a night for a week or so...which then gradually morphed into 5, then 7 hours a night.  But I really worked hard at getting my rhythm back in sync.  I did this by keeping regular sleep/wake times, practicing strict sleep hygiene, and avoiding artificial sleep remedies (no antihistamines, melatonin, etc...).  This is what worked for me.  I still had the occasional difficulty falling asleep due to nerve pain, muscle twitching, heightened skin sensitivity, tinnitus, etc... but I have done much better than many people going through this...and count my blessings.

 

I also use a guided imagery relaxation CD to help me unwind while I lie in bed each night, which helps me to untense my muscles and relax my mind.  I was on Ativan too and thought there was no way I would ever be able to sleep without it.  But I have come to realize that all those years I was not getting quality sleep and infact, was not even dreaming.  It wasn't until I began to have dreams again that I realized I had not had them in many years.

 

After tolerance begins the drug becomes ineffective and any original insomnia can become worse...the same goes for sx's of anxiety.  It is a tough road getting off this drug but as long as we do not reinstate we only have to endure the agony of recovery once.  Staying on this drug pretty much guarantees increasing health problems as this drug disrupts many processes in the body over time.

 

I hope these tips help you to deal with your insomnia, which I know first hand can make life pretty miserable...but the insomnia should eventually begin to dwindle as your recovery progresses.  Best wishes to you.