GAD and Diazepam

[the_anxious_mind]

Hello all! :)

I am new to this site and I am really excited to be able to connect with others who are wired similarly to the way that I am.

That being said, (and I apologize for the novel ahead of time)... I have GAD and have been suffering with some type of worry, fear, or phobia basically since I was able to "reason". During different seasons of my life I have fought (and sometimes gotten over) agoraphobia, fear of eating (choking/swallowing issues), fear of driving, fear of staying alone, and (the worst) pharmacophobia.

During the worst of times, about 5 years ago, I was prescribed Buspar by my GP with much help or explanation. I was never able to take it due to fear of a reaction of some sort or losing control. Because of the fear of medicine I turned to chiropractics, massage therapy, yoga, essential oils, behavioral therapy, and even hypnotherapy--I was desperate to have relief from my anxiety! Some symptoms were alleviated but it never went away.

Just recently, it flared up again and I had what I would call a nervous breakdown. Unable to drive, unable to leave the house, and unable to do much of anything but shake and fear that I was about to die. I was referred to a psychiatrist (who is wonderful and very understanding) and he prescribed Valium (Diazepam) as I had had it intravenously before having my wisdom teeth cut out. Therefore, he figured, I would know that I would not be allergic and die from it. But even then, I could not get myself to take the medicine. This created a LOT of tension in my marriage and in my family--but even in the threat of losing relationships I just couldn't fight the phobia--it certainly made it worse. I even visited this site and other forums to try to find some easy way to take the medicine but never could muster up the courage. I knew I needed it but my intense phobia prevented me from swallowing the pill.

Finally, a few weeks ago, I had a massive panic attack and ended up in the ER. I felt like I was losing my mind, dizzy, depersonalized, and out of control with shakiness and weakness. When the Doctor found out that I had been prescribed Diazepam (but hadn't taken it) she then convinced me just to try a little bit of it, (crushed up in juice!) as I was in the perfect place to try it if a reaction should occur. After that, I began to slowly take small amounts with applesauce in the days after. I am now proudly able to take the pills and I am SO happy and feel so much more at ease than I was before. I am no longer the shaky, crazy mess that I was before and I am able to leave the house and I even was able to enjoy myself while eating out at a restaurant the other night. While my husband has tried to be so patient throughout the whole ordeal, I can sense major relief and our relationship has improved so much.

I say all of that to ask, however, I was prescribed originally 2 mg 3 x a day. After a week, I knew that it was making me feel a little better but I was still very anxious. So, my psychiatrist upped the dosage to 5 mg 3 x a day, or as needed. I have yet to take 5mg at once as I fear that it will knock me on my butt!

My questions are:
(1) Is a higher dose supposed to last longer before the next dose is taken or is it simply that a higher dose will hit harder or make you feel more relaxed/tired but the next dosage will still need to be taken at the same time.
(2) I have been taking a half of a pill (2.5 mg) like 6 time a day. Is that healthy to space it out that way? Or less effective? Or would it be best to just take the 5mg 3 times a day?
(3) The Diazepam is helping tremendously but seems to wear off fairly quickly. Does this mean I need to take it differently or at a higher dose? (I really don't want to be over-medicated as I really didn't want to be on medication in the first place! And I am very aware that it can be addicting so I am trying to be very smart about this.) I am confused about this as I have read that Valium will stay in your system for quite a few hours.
(4) Will I need to give this time to get me back in a routine? I still have the trouble with driving and being independent even though I have no physical symptoms spurring on the panic.

If I can think of anything else I will post.. Thank you for your patience.. I don't speak openly about this to many people so I feel like I have really run away with this post!! Thanks in advance!!

[unfitwellhappy]

My questions are:
(1) Is a higher dose supposed to last longer before the next dose is taken or is it simply that a higher dose will hit harder or make you feel more relaxed/tired but the next dosage will still need to be taken at the same time.
(2) I have been taking a half of a pill (5 mg) like 6 time a day. Is that healthy to space it out that way? Or less effective? Or would it be best to just take the 5mg 3 times a day?
(3) The Diazepam is helping tremendously but seems to wear off fairly quickly. Does this mean I need to take it differently or at a higher dose? (I really don't want to be over-medicated as I really didn't want to be on medication in the first place! And I am very aware that it can be addicting so I am trying to be very smart about this.) I am confused about this as I have read that Valium will stay in your system for quite a few hours.
(4) Will I need to give this time to get me back in a routine? I still have the trouble with driving and being independent even though I have no physical symptoms spurring on the panic.


1) A higher dose will hit you harder unless you have a tolerance to it, there will also be more of the active metabolite in your system...

2) I wouldn't take Diazepam 3x a day for any extended period of time... you risk addiction, and the withdrawals are incredibly bad - if you think your anxiety is bad before taking them then you really don't want to experience the anxiety during withdrawal...You really should only take Diazepam when you really really really need to....

3) Diazepam has a long halflife so it doesn't really wear off quickly (about 36-200hrs for the active metabolite..

I really can't stress how careful you need to be with any Benzodiazepine... Withdrawal from this is a different kind of hell and it can literally last years... Please only take it when really needed...

[Blinkyrocket]

My therapist I went to last Wednesday seemed to downplay benzo tolerance, I told him about those concerns and he said "some people get it". That put my mind at extreme ease. I'm not quite sure whether I should pay attention to the horror stories or the miracles. I like the idea of something to fall back on if things get really bad. I just wish there were no downsides, why can't life take away side effects? :/

Besides, high dose Niacinamide has actually been used for benzo withdrawal and so has Pregabalin. At least you can understand the mechanism of benzo withdrawal, even more excitation than before taking it. With that in mind, while taking it I would make sure my gut had the right kinds of bacteria strains in it, bacteria strains can have profound effects on GABA. Unfortunately, I'm not sure that probiotics do very much since I saw somewhere that all the bacteria dies in the stomach before reaching the small intestine. I wouldn't be surprised if probiotic supplements were bogus and in order to correctly modulate your microbiome you would have to either try antibiotics plus repopulation with homemade kefir or just homemade kefir, store ought stuff only contains one strain of bacteria which is pretty much useless. Oh, and there's an important difference between the population of bacteria in the small versus large intestine.

It's also useful to keep in mind that, while everyone reacts differently to something like Niacinamide, there is a detectable reason for this, which is possibly due to the fact that Niacinamide scavenged methyl groups, which would leave someone with histamine issues out to dry. The effective dosage is also huge and can be a problem, it's at least 1500 Mg a day. So Niacinamide can be a problem but if you're committed to find out whether it works, you have to take it for awhile and you have to take a lot of it. Tbh, that's why I haven't tried it yet lol

[unfitwellhappy]

My therapist I went to last Wednesday seemed to downplay benzo tolerance, I told him about those concerns and he said "some people get it". That put my mind at extreme ease. I'm not quite sure whether I should pay attention to the horror stories or the miracles. I like the idea of something to fall back on if things get really bad. I just wish there were no downsides, why can't life take away side effects? :/

Unfortunately tolerance and withdrawal is a very really thing...

Benzos should only be prescribed short term (2 weeks at most) at the minimum therapeutic dose (for you) and even with that there should be a minimal taper..

I'm not telling anyone not to take them because they can be literally a life saver, but you really do need to be careful with them.

[Blinkyrocket]

Unfortunately tolerance and withdrawal is a very really thing...

Benzos should only be prescribed short term (2 weeks at most) at the minimum therapeutic dose (for you) and even with that there should be a minimal taper..

I'm not telling anyone not to take them because they can be literally a life saver, but you really do need to be careful with them.

Well, yeah, obesity is a very real thing but I can eat buckets of ice cream and not gain weight. (Course, that's because the media is quite stupid when it comes to weight gain and loss, the only time I gained weight was when I included vegetables in my diet... And I felt horrible so I eat no vegetables and no greens whatsoever, the only things that make me gain weight are the things that cause digestive problems, I.E. Beans especially)

[Shazamataz]

Hi there,
I've had experience with diazepam and would suggest you take it only 'as needed' and not 3 x a day or 6 x a day in smaller doses.

You will get more relief from the anxiety at a higher dose. Perhaps use this to get you back into some of the things that make you really anxious. That way you have a positive experience, say at the supermarket, which means next time your anxiety may be less and manageable without medication.

I have a tolerance to diazepam now and need to figure out a way to taper off it once my other meds settle down. It used to be a lifesaver for me to use, on occasion, but with 3 months of screwing about with other meds I ended up taking it every day and now it does nothing for me at all.

[Phill2]

Unfortunately tolerance and withdrawal is a very really thing...

Benzos should only be prescribed short term (2 weeks at most) at the minimum therapeutic dose (for you) and even with that there should be a minimal taper..

I'm not telling anyone not to take them because they can be literally a life saver, but you really do need to be careful with them.

I've been taking 5mg twice daily for 12 years
Never felt a need to increase the dose or had any problems with it.
Still works as good as the first day.
Maybe I'm one of the lucky ones who don't develop a tolerance to it.

[MyNameIsTerry]

Hi and welcome to NMP :welcome:

There is a Diazepam board under Meds that may be helpful to you. There is a support crowd who help out as well as on here.

(1) Is a higher dose supposed to last longer before the next dose is taken or is it simply that a higher dose will hit harder or make you feel more relaxed/tired but the next dosage will still need to be taken at the same time.

No, the length is not connected to the volume of dosage, neither is the rate at which it is eliminated from your body. A higher dose just means it is a stronger dose so it will be potentially more effective, depending on what you need.

(2) I have been taking a half of a pill (2.5 mg) like 6 time a day. Is that healthy to space it out that way? Or less effective? Or would it be best to just take the 5mg 3 times a day?

It's a short acting drug and because of my answer to (1), the greater the space you insert, the less continually ongoing it will remain throughout the day. These snippets from Drugs.com's professional section should help you understand how it works in terms of duration:

After oral administration > 90% of DIAZEPAM is absorbed and the average time to achieve peak plasma concentrations is 1 to 1.5 hours with a range of 0.25 to 2.5 hours. Absorption is delayed and decreased when administered with a moderate fat meal. In the presence of food mean lag times are approximately 45 minutes as compared with 15 minutes when fasting. There is also an increase in the average time to achieve peak concentrations to about 2.5 hours in the presence of food as compared with 1.25 hours when fasting. This results in an average decrease in Cmax of 20% in addition to a 27% decrease in AUC (range 15% to 50%) when administered with food.

AND

The initial distribution phase has a half-life of approximately one hour, although it may range up to > 3 hours.

So, it can start reaching peak in as little as 15 minutes, although you feel it much quicker than this as it starts to work, the peak is about it reaching it's full potential.

The half life of the Distribution phase essentially means by when it reaches 50% in terms of dose in the phase when it's it being distributed through your blood. So, first you get the Peak and then it reaches it's Half Life later when 50% is gone.

So, can you see how fast it's Distribution phase is and how that can mean it works for a very short period of time?

(3) The Diazepam is helping tremendously but seems to wear off fairly quickly. Does this mean I need to take it differently or at a higher dose? (I really don't want to be over-medicated as I really didn't want to be on medication in the first place! And I am very aware that it can be addicting so I am trying to be very smart about this.) I am confused about this as I have read that Valium will stay in your system for quite a few hours.

See (1) about why a higher dose has no impact.

In terms of how long it remains in your blood plasma, this tells you:

The initial distribution phase is followed by a prolonged terminal elimination phase (half-life up to 48 hours). The terminal elimination half-life of the active metabolite N-desmethylDIAZEPAM is up to 100 hours. DIAZEPAM and its metabolites are excreted mainly in the urine, predominantly as their glucuronide conjugates. The clearance of DIAZEPAM is 20 to 30 mL/min in young adults. DIAZEPAM accumulates upon multiple dosing and there is some evidence that the terminal elimination half-life is slightly prolonged.

So, that's 48 hours for the active drug but then a further 52 hours for the active metabolite. Also, Diazepam doesn't just stay in your blood plasma like antidepressants, it builds up in fatty tissue to hence why you can still be failing drugs tests for a while after the drug should be eliminated as this can be a slower than normal process when compared to drugs that flush out completely from the blood.

The dependency issue is not as simple as don't take them on a regular basis either. Another member on here who will probably spot your thread and comment, dally, experienced "interdose dependency" from well spaced dosing. So, whether you take it daily or every few days, there is still a risk. I suspect this is because people get caught out by the active metabolite.

As you can see it says 100 hours "half life". That just means 50% gone. However, don't think for a second that also means in another 100 hours it will be 0%. Drugs don't work like that. There is a standard pharmacokinetic model that can be used and it takes 5 half lives to get it <5%. Think how many days that is. To get it to 0% takes 7 and remember, in a longer term user they may also have amounts built up in fatty tissue to be eliminated on top of this.

Please note that this standard calculation is a model, it's not exact and each drug can have a different model as many are absorbed faster but unless you can find the exact one for the drug, or medical reference to it, then it's best to play safe. I've pasted in my text showing the standard elimination model from another thread and highlighted it red so it stands out:

Clear elimination has the following:

HL.......%
0.........100
1.........50
2.........25
3.........12.50
4.........6.25
5.........3.13

When its under 5% its no longer clinically significant. It's more complicated than this when you consider how people taper as it will mean some overlap and then with some meds (e.g. Benzo's) you also have the storage outside of blood plasma which also needs elimination.

Factors involved in speed of distribution (drug starting to work) & elimination (clearance out of blood plasma) can be things like age (children differ, there are specific calculations for age that can be used for older people), speed of metabolism, weight (which will impact on metabolism), renal insufficiency conditions, etc. There are some very complicated guides on the internet for those interested such as some books on pharmacokinetics on Google Books but they are very difficult to understand without a medical background.

(4) Will I need to give this time to get me back in a routine? I still have the trouble with driving and being independent even though I have no physical symptoms spurring on the panic.

This is entirely dependant on what the problem(s) is/are. GAD is classed as a longer term disorder but it's also a question of severity (mild, moderate, severe) and complexity (amount of issues, individual complexity of the issues, comorbid disorders, etc).

Benzo's are normally for short term work with anxiety or to counter the impact of the side effects when starting antidepressants. Personally, I don't believe Benzo's are a treatment option for anxiety disorders unless you use them occasionally. If your intention is to use them frequently, you need a non habit forming drug like an antidepressant.

---------- Post added at 05:35 ---------- Previous post was at 05:33 ----------


I've been taking 5mg twice daily for 12 years
Never felt a need to increase the dose or had any problems with it.
Still works as good as the first day.
Maybe I'm one of the lucky ones who don't develop a tolerance to it.

I took 5mg the first time and was given 2mg years later (I barely used the 2mg though, I stuck out the side effects of the antidepressant). It took me about 7 days on the 5mg and then it seemed to have no effect and I also felt worse but that could have been me because it wasn't helping.

I took it once a day and after a week it wasn't doing anything for me anymore.

Yet some people get great results with as you say Phill.

---------- Post added at 05:41 ---------- Previous post was at 05:35 ----------


Unfortunately tolerance and withdrawal is a very really thing...

Benzos should only be prescribed short term (2 weeks at most) at the minimum therapeutic dose (for you) and even with that there should be a minimal taper..

I'm not telling anyone not to take them because they can be literally a life saver, but you really do need to be careful with them.

Very true, they are much misunderstood and people get caught out.

My GP worked on the 2 week rule. No taper though as no dependence so no need.

However, it's a matter of medical need too. I've seen people on here who's psychiatrists have told them they need to be on for months to stabilise their anxiety first. But you wouldn't trust a GP with a schedule like that.

---------- Post added at 05:51 ---------- Previous post was at 05:41 ----------




With that in mind, while taking it I would make sure my gut had the right kinds of bacteria strains in it, bacteria strains can have profound effects on GABA. Unfortunately, I'm not sure that probiotics do very much since I saw somewhere that all the bacteria dies in the stomach before reaching the small intestine. I wouldn't be surprised if probiotic supplements were bogus and in order to correctly modulate your microbiome you would have to either try antibiotics plus repopulation with homemade kefir or just homemade kefir, store ought stuff only contains one strain of bacteria which is pretty much useless. Oh, and there's an important difference between the population of bacteria in the small versus large intestine.


It's easy to get them past the gut, you just apply enteric coating.

They can't be right about all bacteria being destroyed in the gut or fermented products like kefir would just be milk or water with some extra vitamins & enzymes in.

Antibiotics wouldn't help with repopulation, they would reduce it further, it's what they already do and why they are starting to come around to using probiotics alongside, although our NHS are only suggesting the possibility at the moment.

Store kefir is just what it, milk with whatever the manufacturer adds in terms of strains and made like kefir is made. The colony populating it determines the strains. If it's just one strain, it's about as far away from kefir as it can be - more like yogurt milk really.

Store kefir is an expensive rip off aimed at people who want to feel like they are being healthy and who either don't care or haven't looked into it. Homemade kefir is very simply to make and far cheaper to buy. Pricing for store kefir can be like buying a protein milk, yet for a couple of those you can make far more yourself AND it will be much better since you have to use a colony just like they do and it won't die unless you choose to let it. You also cut out all the logistics so your version will be as it was made throughout history, store bought will be dying all the way before you get to it.

Healthy bacteria starts in the mouth and end at the tip of the anus. In women it exists the anus and re-enters the vagina (after washing it's hands, of course :D)...hence why yogurt is an old remedy for vaginal thrush.

[dally]

Hi
Excellent post terry, your explanations are accurate.
I tend to simplify my advice as some people are not in a receptive state to take on board too much technical info about benzos. (Depending on how bad their anxiety levels are)

Benzos have been scientifically proven to cause tolerance, addiction and withdrawal problems.
But
They are an excellent anti anxiety medication, if used on short term course (2 weeks)
Also, although 'most people' will develop tolerance\addiction with prolonged use, not everyone does
And
It is important to note that all people CAN withdraw from this drug.
(Although it can take years and can cause worse withdrawal symptoms than the reason for starting it)

To. The anxious mind...
I too cannot take meds, due to phobia? About losing control or meds making me worse.
Valium was the only med that rid relax me without making me feel desperately ill (ADs).
You obviously need something to help you at this time.
Have you considered propanalol. It can help, and has very few se.
However, you cannot take them if you have low bp or asthma.

Whilst most docs offer 'non addictive' ADs
I have read on here about the horrendous and long ( 6 weeks) start up SEs, sometimes no results from taking them or even the drugs effects stopping suddenly for no reason! And having to continually updose
And also, people have to withdraw from these ADS meds too. With symptoms.
So,
Whilst I know, people def need med help in may cases, when their condition reaches crisis point, I would urge you to explore CBT, relaxation therapy. After a two week course of Valium, which hopefully will have brought your anxiety state down to a level that will allow you to focus on other methods. X

[the_anxious_mind]

Thank you all for your thoughtful replies! Dally we are one in the same... I was prescribed Buspar but was in fear of the se's. I had also been told that it would take a while for it to take effect... of course this terrified me because just imagine all of the things my mind could conjure up in the meantime :blush:. I definitely agree about the short term ... I am not someone who wants to be on medication for any long period of time but I have lived so long in fear and torment that I am finally able to really live and it feels oddly good. I am continuing behavioral therapy weekly and meditation each day. I am also checking into the nutritional aspect of it. As I have PCOS and hypoglycemia, and this plays a huge role with the hormones and everything that goes along with that. Thank you all again for your input... it is greatly appreciated!! I am sure i will be back for more discussion soon!! x

[Blinkyrocket]

Ah, all the probiotics I've taken had a gelatin capsule. So, if tolerance develops because of the active metabolite, would it be safe to assume that those with good, fast liver function are less likely to develop tolerance? Endotoxin/Lipopolysacharride decreases liver function and is likely to be increased in those with anxiety already, plus serotonin can cause kidney problems. Aha, it's prebiotics for repopulation.

[MyNameIsTerry]

Tolerance will build regardless, I'm not sure what influences it in some over others, but having a slower ability to eliminate it sounds like it could contribute since they are more likely to see a cross over from taking more of them before the rest is out. The slower your elimination, the more likely it could build up in fatty tissue if you are taking more to keep that 100% flooding back in.

I think these meds alone, if utilising liver enzymes, are probably hampering the liver alone. Perhaps the kidneys too. But so will drinking alcohol and eating many other things that will mean your body has to work harder. So, how much?

Yes, prebiotics are excellent alongside probiotics. Aside from being their food they are also soluble fibre which is better for you anyway. But remember there are multiple forms of prebiotic fibre and some only feed certain areas like the colon so again it can depend what you are trying to do unless you aim to eat to ensure you feed the whole system.

There are some prebiotics that have been studied for anxiety with interesting results. I think they are posted in this thread somewhere:

http://www.nomorepanic.co.uk/showthread.php?t=176015

I've posted some good links for kefir, if needed. I found a decent site showing the contents which I was struggling to find elsewhere. Milk kefir does need refrigerating though but water kefir can be stored in a cool place as well. That must be due to using non UHT milk (since that is devoid of goodness for the colony). This is important because refrigeration slows down what the strains are doing (feeding) so in transit, who knows how much are left...no one is measuring that. The same questions are getting asked about all probiotic supplements so I'm just going to brew water kefir instead (I lack fridge space). But you leave the SCOBY, the colony, in a cooler place (not a fridge) because they need certain temperatures to feed and if you freeze them into ice cubes they keep for ages but slowly die in the process. So, these commercial milk kefirs could be garbage really. What do they add to ensure shelf live and what is the impact of that...it will be many years before anyone probably sorts it out. Besides, store kefir is a fad so very expensive compared to home made superior kefir...so why bother???

---------- Post added at 05:03 ---------- Previous post was at 04:42 ----------

Thanks dally. Yeah, some people prefer simple or may be struggling to concentrate, I remember that so fair point.

To add to it, I'll add an example to question (2) & (3):

Take 2mg Diaz at 9am assuming a Half Life of 1 hour.

By 10am the active effect of the drug is at 50%.
By 11am the active effect of the drug is at 25% (1 further Half Life)
By 12pm the active effect of the drug is at 12.75% (as above in brackets, and will continue with each % drop)
By 1pm the active effect of the drug is at 6.25%
By 2pm the active effect of the drug is at 3.13%

Anything <5% is considered medically insufficient to have an effect.

Now that's a very basic example using the standard calculation method. I found after 2 hours it was losing it's effect on me. It did kick in within minutes though so you don't have to wait for the minimum 15 minutes for it to reach peak. Some of these meds distribute & disperse quicker than others so this standard calculation could be far out although I doubt Diaz is slower than this.

As far as the active drug (not the feeling you get) and the active metabolite, this is posted in the earlier response. They are much longer and spreading your doses simply won't prevent overlap there.

So, the_anxious_mind, you could find after a certain % drop, it's not helping you anymore. This may be because it's decreased to much but from a safety point of view, there are guidelines on Drugs.com if you have a look and they are higher than what you are taking so slight overlaps, I think, won't mean much. But can you see what I mean about how spacing doses out might mean periods with no active drug effect at all?

However, I think it's a matter of how it affects you. I found that I wasn't as bad after it was running out anyway. Sometimes a bit of respite can bring you down enough to cope, even though things are still unpleasant.

But I would be very cautious with Benzo's. I only took them when I couldn't stand things any longer. Be wary of breaking into a pattern of using them a lot because they will very quickly run out and then you will be faced with antidepressants. Buspar has a low side effect profile, SSRI/SNRI's are a whole different ball game. BUT despite the many horror stories around, there are many people they help and don't suffer going on them much, but how many of them write a story on the internet? If you get offered one, have a look on the Meds board or raise a thread. What you won't get on NMP is "this med is evil, blah blah blah", this place is very well balanced in it's people.