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Benzodiazepines and withdrawals

joshofalltradesjoshofalltrades Class TraitorSmoke-filled roomRegistered User regular
I've come out on the winning side of some fairly stressful times in my life over the last couple of years.

That's not to say that I'm not having some trying circumstances currently. I'm buying my first house (or trying to) and several things have fallen through, and I'm left wondering if I'm going to close on time, late, or at all, and where I'm going to be living at the end of this month since I gave my rental company 30 days notice based on the closing date of the 22nd, which it looking very unlikely at the moment.

That's just sort of the background. I've been on lorazepam for a little over a year now (before that it was clonazepam which did not work for me). About 3 or 4 months ago, I decided I was done taking the Prozac I started at about the same time. I got some pretty bad brain zaps and other withdrawals but I toughed it out and I'm off the stuff now, and feeling better for it. I'm also taking Adderall at the moment which I'm happy with. I am more productive and less stressed out when I take it, and I'm not on a very high dosage either.

I don't abuse any of these medications. I take them at the amounts prescribed or less.

Lorazepam is something that works for me when I'm anxious (and I am anxious a lot). When I started taking it, I was also doing progressive muscle relaxation, yoga and some other things to destress and not have panic attacks. Over time, I found that those things didn't provide much additional benefit when I took lorazepam as prescribed, and so I used the time I would spend alone in the dark giving my body calm biofeedback to be productive instead. I take 1 mg twice a day and one before bedtime. The daytime doses I ingest simultaneously with the Adderall and I've found the regimen works fairly well as long as I don't muck with it.

Now, there have been some times when I missed a dose because I left my bottle at home or the pharmacy didn't have enough to fill it that day or the refill script took longer than expected. When I miss a dose, it's not good. I get chest pains, super anxious about nothing at all, and generally feel really terrible.

I don't know whether I should stop taking it or not. Everything is fine as long as I don't miss a dose, but I'm really uneasy being this clearly dependent on a substance. Right now it's not in the cards to see a doctor and find out the best course of action; I had them prescribed by the psychiatrist at my university and I've since graduated. Which is another issue! I don't know how I'm going to continue getting scripts for these things and it will be bad if I run out at an inconvenient time with no way of getting a refill.

My question for H/A is twofold: should I get off the lorazepam, and if not, what's the best way to see a psychiatrist who can prescribe these things cheaply? And second, if it's a good idea to get off it, what's the best way to do so?

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    k-mapsk-maps I wish I could find the Karnaugh map for love. 2^<3Registered User regular
    Benzos are mad dangerous and are not to be fucked with (from experience)...why can't you see a doctor? This should be your top priority now, because absolutely nothing is more important than your health, and I doubt anyone here has the means or knowledge to guide you through this.

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    joshofalltradesjoshofalltrades Class Traitor Smoke-filled roomRegistered User regular
    I have no insurance. As I said, the doctor I was seeing before was the university psychiatrist and seeing him cost exactly $20.

    Now it will cost me roughly ten times that to see someone once.

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    ceresceres When the last moon is cast over the last star of morning And the future has past without even a last desperate warningRegistered User, Moderator mod
    You're dealing with some heavy-duty meds there, and also their heavy-duty med interactions, and I really think that the only possible good advice we can give you is to find a clinic that will take payment on a sliding scale. They can give you real medical advice, and be someone to call if things get real, which is a very real possibility. There should be SOMETHING like this in your area, and you should find it, because this is not advice you should be taking from the internet.

    And it seems like all is dying, and would leave the world to mourn
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    Raif SeveranceRaif Severance Registered User regular
    The thing about benzodiazepines is that they are really only supposed to be used for short periods of time even though how they are commonly prescribed is almost like a maintenance medicine today. For general anxiety the first line drugs are the SSRI's (Prozac, Paxil, Celexa, Lexapro). Why did you want to stop your Prozac? Were you having bad side effects? If that's the case you should probably try a different SSRI before giving up on them entirely.

    The best way to get off of the lorazepam is to taper off them gradually, you definitely don't want to stop abruptly if you've been on them long-term since you can end up with seizures. Definitely get some sort of medical professional on board if you are thinking of stopping.

    To sum up: SSRI's have shown to be the best meds for generalized anxiety disorder and you should speak to a doctor about restarting. Taper off the lorazepam if you are thinking of stopping under the supervision of a doctor. See if you can find a free counselor to speak to somewhere at a Catholic Charities or other such institution.

    Disclaimer: Not a physician - soon to graduate pharmacy student

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    joshofalltradesjoshofalltrades Class Traitor Smoke-filled roomRegistered User regular
    Celexa is what I was originally on, SSRI-wise, and I metabolized it so quickly that I was getting withdrawal symptoms between doses. I got switched to Prozac because of the lengthy half-life.

    I stopped taking it because both medications made me feel like a robot. I have become much more like myself since I stopped taking it.

    I'm not suggesting I quit lorazepam cold turkey. But yeah, I'm aware of the research that shows that you're basically taking them to lower the anxiety caused by not taking them after a certain period of time.

    I'm asking the internet because I make just enough money where I don't qualify for help on a sliding scale and little enough that there's none to spare with a wife, three kids, and potential unforeseen moving/closing costs coming up. Right now I'm not planning on doing anything until after I don't need an emergency savings reserve on the same level as I do right now. I just wanted to hear from other people who may have been on benzos before and see what worked for them as far as getting off of them.

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    MegaMan001MegaMan001 CRNA Rochester, MNRegistered User regular
    All right, I'm going to answer your question based on the assumption that you are legitimately in some distress here and I don't plan on risking my license in doing so. I'm not going to step on @Raif Severance here, but I am a nurse anesthetist and I have a lot of experience with benzodiazepine use.

    The symptoms you are describing closely mimick either acute withdrawal from the medication (which seems likely given your history of fast metabolism and symptom control) or an acute return of your anxiety itself. I can't really say which it is because one, I'm not a psychiatrist and two, you're not my patient.

    What I can say is that the safest way to taper off a benzodiazapine would be to do it over the course of four weeks - which is a pretty standard protocol for addicts (which, again I am assuming you are not, but the protocol remains the same). You say you take 1 mg twice a day and once before bedtime, so that's three times a day. What you would do for the first three days is maintain that schedule. The three days after that you would cut your second daily dose in 1/2 (1mg, 0.5 mg, 1mg before bedtime). Three days after that reduce the early dose by 1/2 (0.5 mg, 0.5 mg, 1mg before bedtime) and maintain that schedule for seven days.

    So now you are 13 days (or about halfway through the taper. The reason you maintain the nightly dose is so that you can actually sleep and you lose the earlier doses because while you are awake you can engage in other anti-anxiety activity (like biofeedback you mentioned)

    The next three days you lose the second daily dose (0.5 mg, nothing, 1mg before bedtime). Then the morning dose, and finally the last 7 days or so is in half then losing the nightly dose.

    This is really the ideal schedule to combine with therapy or physician visits, but if you're able to get a handle on your anxiety as is this what I'd tell you to do to get off Ativan altogether.

    I am in the business of saving lives.
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    UncleChetUncleChet N00b Lancaster, PARegistered User regular
    OP, you'll find I tend to jump all over mental health posts. I am a mental healthcare consumer myself, and I happen to be experienced with lorazepam, as it's one of my current meds. I realize that you may not be in a position to pay for a specialist Dr, who I always recommend over a GP, but when in doubt, if you can even just get a visit with a GP, please do so. If you happen to be a US Veteran, with a discharge status of Honorable, there's a whole wide world of fantastic care that's on a super flexible sliding scale. I once scoffed at this option myself, thinking it was for "old, war wounded G.I.s". My current psychiatrist is VA, and he's fantastic. Honestly the best in my area, and has an unfortunate 12 week wait to see him. I personally have "messed with" or "gone off of" my meds for various reasons that at the time, made sense to me. Each and Every time, without fail, it was a horrible, horrible mistake. Another thing, if you can't afford your medications, the pharmaceutical manufacturer may be able to help with like coupons and stuff, or look in to "Mental Health America and (insert your city here)". MHA/MHMR(office of Mental Health and Mental Retardation) also may be able to help. Also, free clinic?
    What i'm Really getting at, it no, please no, do not just go off your meds, for your sake and our sanity. Too many of our friends and loved ones are lost to us each year because they felt that they could do w/out their meds, or simply couldn't find a way to afford them.

    I'm sometimes grumpy and random, feel free to overlook the strange man in the corner.
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    SiskaSiska Shorty Registered User regular
    edited March 2013
    Try calling your old Uni Psychiatrist. While they can no longer treat you they might know where you can find affordable help. Maybe even provide you with a referral.

    Siska on
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    joshofalltradesjoshofalltrades Class Traitor Smoke-filled roomRegistered User regular
    Thanks @MegaMan001

    I appreciate the concern about seeing a doctor here. And I won't ignore your advice either. I already know that this isn't something I need to be doing unassisted. I wanted to know what to expect if/when I decide to get off lorazepam. Partially because I need to know what the signs are of "you really need to be back on this and stop trying to forgo it" so I don't muck about and do something dangerous and partially so I can get some feedback from people who have attempted this before and know what, physically and psychologically, to be prepared for.

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    AustralopitenicoAustralopitenico Registered User regular
    The only thing I can contribute to this post is that my brother got too fond of benzodiazepines (he has also very serious anxiety issues) and they really fucked up several years of his life. After much effort he is off the stuff, getting almost no meds and much better. He is still anxious, but he is now actually able to accomplish things and that takes the edge off of it.

    So I'm no doctor, and this is not meant to scare you, I just want you to know that according to my experience this stuff can make you pretty loopy if you come to depend too much on it.

    What worked with my brother, I'm afraid, was looking for a good doctor and a good clinic, and a year of so of effort. He is still in contact with her in case he needs advice, wonderful woman. So (again, only from my experience) I don't really recommend trying this without professional help.

    My brother got really loopy when trying to get off the stuff, like REALLY. I mean "threatening people in locker rooms because he thought they were looking to much at him" loopy. I mean "Australopitenico needing to ride shotgun on one particular night when we were moving and trying to convince him that the people he saw on the road was not real" loopy (I had no license back then). This might have been something only my brother experienced but just in case please, do stay in touch with professional and be prepared to ask yourself "am I acting like a normal person here?" whenever you feel something is weird.

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    UncleChetUncleChet N00b Lancaster, PARegistered User regular
    As for not taking/withdrawal, I went about 3 weeks, cold, and my symptoms were actually heightened anxiety. I did have some minor hallucinations (I also have bipolar disorder, so that may have contributed) and it also aggravated my bipolar disorder pushing me closer to hypo-mania. my current doctor did warn me that this medicine Is in fact addictive, and he'd like to take me off of it at some point, but that will be gradually, and I'm not sure what he's going to swap me out with.

    I'm sometimes grumpy and random, feel free to overlook the strange man in the corner.
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    cabsycabsy the fattest rainbow unicorn Registered User regular
    Thanks @MegaMan001

    I appreciate the concern about seeing a doctor here. And I won't ignore your advice either. I already know that this isn't something I need to be doing unassisted. I wanted to know what to expect if/when I decide to get off lorazepam. Partially because I need to know what the signs are of "you really need to be back on this and stop trying to forgo it" so I don't muck about and do something dangerous and partially so I can get some feedback from people who have attempted this before and know what, physically and psychologically, to be prepared for.

    The other thing about seeing a doctor is you're also taking adderall, which can heighten anxiety, so as you taper down on the benzos your adderall dosage may need to be adjusted downward OR adjusting your dosage downward may make it easier to step down off the benzos. I'm not a doctor so I can't say which it might be, just that it's definitely a thing that may come up and may make it easier for you to ease up on the benzos without having as much interference from anxiety during that time period. And GPs can adjust both adderall and benzo scripts if you need them to; yeah, they aren't psychs, but if the price difference is $80 vs. $200+ to check in with someone about medication adjustment and you can barely squeeze in that $80, do it.

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    bowenbowen How you doin'? Registered User regular
    Yes, you need to see a physician. Abrupt withdrawal from these medicines can cause seizures and heart failure. Don't do this without one.

    $200 is better than the hospital bill that'll absolutely come from this.

    not a doctor, not a lawyer, examples I use may not be fully researched so don't take out of context plz, don't @ me
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    glithertglithert Registered User regular
    Echoing the call for you to see a doctor. You don't just stop taking benzodiazepines. That shit will mess you up.

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    dispatch.odispatch.o Registered User regular
    Yeah... doctor. Aside from the physical symptoms of withdrawal that come with it, people get cognitive issues from benzo's you don't really want to deal with.

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    PirusuPirusu Pierce Registered User regular

    There are also practices that accept payment plans/reduced payments for patients who were uninsured and/or needed payment assistance.

    The place I had used at one point was New Leaf Behavioral Health in the Raleigh area. The way it worked is you were assigned a student therapist who would handle your case, but it would have a licensed psychologist/therapist overseeing your case.

    This place also offered psychiatry services at reduced rates. It's something to look into where you are, at least.

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    joshofalltradesjoshofalltrades Class Traitor Smoke-filled roomRegistered User regular
    I got my benzo refilled (although it was late, since the pharmacy ran out and didn't tell me when I ordered the refill) and am sticking to the regimen for now. I still have 4 more refills, which will last me until August at least.

    Unfortunately the pharmacy I took it to (Wal-Mart, yes, I know, I know, I know, it was really close to the Dr.) will not transfer to another pharmacy since it's a controlled substance. So I'm stuck driving all the way across town to this horrible pharmacy which is inconsistent with its refills/drug stocking and so every once in a while this acute withdrawal scenario will come up.

    My psychiatrist will write a referral, but everybody in town is booked pretty much solid for two months. So if I sign up to see someone now, it will be about that long before I'm seen. I'll be out of the Adderall by then, and that's not something that's easy to get prescribed (I had to see my previous physician for a year on Ritalin before he decided I really did need to try an alternative). I guess it'll be easier if they know I'm already on it and it's working well for me, and the referral makes mention of that?

    I can live without the Adderall for a month, if I have to. My wife will probably want to murder me by the end of the month, but it's possible.

    So I guess the plan is to get in to see someone ASAP no matter what the cost.

    Thanks for the advice. By the way, if @ceres doesn't mind leaving the thread unlocked, I'd still be interested in hearing experiences from people who've stopped taking benzos before.

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    ceresceres When the last moon is cast over the last star of morning And the future has past without even a last desperate warningRegistered User, Moderator mod
    Sure thing.

    And it seems like all is dying, and would leave the world to mourn
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    UncleChetUncleChet N00b Lancaster, PARegistered User regular
    I'm SO very happy you decided not to cold turkey. I think your quality of life is really better for it.

    I'm sometimes grumpy and random, feel free to overlook the strange man in the corner.
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    FreiFrei A French Prometheus Unbound DeadwoodRegistered User regular
    When I came off benzos I experienced hallucinations and depersonalization. This was under doctor supervision, as well. I was on a pretty high dose at the time and decided I didn't want to use them anymore. I can't imagine what would have happened if I tried to do it on my own.

    I mean, some people can do it and be fine, but it's not a chance I'd take.

    Are you the magic man?
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    Raif SeveranceRaif Severance Registered User regular
    I got my benzo refilled (although it was late, since the pharmacy ran out and didn't tell me when I ordered the refill) and am sticking to the regimen for now. I still have 4 more refills, which will last me until August at least.

    Unfortunately the pharmacy I took it to (Wal-Mart, yes, I know, I know, I know, it was really close to the Dr.) will not transfer to another pharmacy since it's a controlled substance. So I'm stuck driving all the way across town to this horrible pharmacy which is inconsistent with its refills/drug stocking and so every once in a while this acute withdrawal scenario will come up.

    I don't think it's legal for them to deny you a transfer even if it is a controlled substance (Schedule II's are excluded but they can't have refills anyway). Benzos are only schedule IV substances and I think they are just being D-bags. The way to transfer a prescription is to go to/call the pharmacy you want to transfer it to and have them call the pharmacy that currently has it. Keep in mind that the pharmacy you are going to transfer it to will be suspicious of you if you haven't had anything filled with them and they don't know you. No offense to you, but if I looked at a patient's profile and saw "Ativan, Adderall, Ativan, Adderall, Ativan, Adderall" I would get suspicious as well. I'm familiar with TN law so depending on what state you're in it might be slightly different but usually if a prescription has refills, they are yours to fill at whatever pharmacy you prefer.

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    joshofalltradesjoshofalltrades Class Traitor Smoke-filled roomRegistered User regular
    I'll have to check but I think if I bring the actual bottle in with me that it can be transferred. Adderall never comes with refills because of its schedule.

    Thanks for posting your experience @Frei . It's scary how often I'm seeing hallucinations as a side effect of stopping this.

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