Diazapam and sertraline

[Colin_P]

Hello everyone,

Note to moderators; I don't really know where to put this as it concerns multiple drugs ?

I'm a long time member on here but thankfully (and in the nicest possible way) don't need to come on very often.

I have a long standing heart health problem which I won't go into as I know many have worries about their hearts.

My GP previously has prescribed Oxazapam as a chill pill as and when I need it, only letting me have 5 per month. This worked well for a number of years with me not needing to take them sometimes for months.

I had a recent heart flare up which required hospitalisation which in turn sent my anxiety to red alert levels! Upon asking for a chill-pill whilst in hospital I was given diazapam at 5mg and have continued to take two 5mg pills a day since, well until today.

Also, over the years I've resisted taking any anti deps / anti anxiety pills. Last time I did it was citilopram which turned out didn't help my heart condition. My GP had recommended Sertraline as being safe but I declined the offer to take them.

This latest flare up has been very tough on me and I've agreed and have started taking the sertraline, half a 50mg for a week, then a review with the GP then a step up to 50mg or a full tablet as from next week. I'd rather not take anything at all but really feel I need to help at the moment.

As well as the diaz, the recently started sirt I also take a hefty dose of beta blockers and also a rather toxic heart rhythym drug called Amiodarone. I also pop the odd Zopiclone sleeping pill, well actually every night for the last few weeks.

And now the questions...

1, How long or how quickly does it take to build up a dependance on the diaz? I've been taking x2 5mg a day for almost three weeks now. Until today where I've taken none. Earlier today, at times I felt really edgy but did not take one (or any at all today). Is it possible that even after three weeks that I was suffering withdrawals?

2, How long does sirtraline take to kick in, I assume it will be a week or two after I'm up the full dose? I've also had a look at the sirt sub-forum and it scares the hell out of me but speaking to two fellow heart pateints on another forum with a similar condition to me, they have both said it made a huge difference to them being able to function without anxiety overwhelming them.

3, Is the zopi combined with the diaz overdosing me and adding to the possible dependance?

4, Generally; taking the heart medication is bad enough but with the added worry of the chill-pills, am I over worrying? Is is possible to build up a dependance this quickly? Is just stoppinglikely to do me harm or should I taper off?

Just to add my symptoms are the sudden onset of very powerfull anxiety rushes to borderline panic attack level. This happens mainly when I'm at rest or in bed. These sudden rushes really are very powerful but from experience will diminish as more time passes from the recent flare up of heart problems I've had. What makes them better is for me to keep moving, standing and distracting myself. The problem is it is exhausting doing that and at some point I need to go to bed.

It might sound strange but l feel a bit like a shark, where if they stop swimming, they sink and .....

I'll quite happily go into detail about the heart issues if needs be but don't want to unduly worry those who suffer heart health anxiety.

Any thoughts, advice or observations and of course good news stories more than welcomed.

Many thanks
Colin.

[panic_down_under]

And now the questions...

1, How long or how quickly does it take to build up a dependance on the diaz? I've been taking x2 5mg a day for almost three weeks now. Until today where I've taken none. Earlier today, at times I felt really edgy but did not take one (or any at all today). Is it possible that even after three weeks that I was suffering withdrawals?

It usually takes a little longer for dependence to develop with diazepam, but a few may do so in as little as 3 weeks, Colin. However, I doubt today's edginess was physical withdrawal as diazepam has a very long half-life, around 200 hours including its active metabolites, so withdrawal symptoms mostly take around 5-7 days to develop and then probably be relatively mild given the short time you've been taking it. Plus it takes about a month for the drug to be completely eliminated which tends to limit withdrawal severity. However, the anti anxiety effect is fairly short-lived so anxiety can return within a day.

How long does sirtraline take to kick in, I assume it will be a week or two after I'm up the full dose? I've also had a look at the sirt sub-forum and it scares the hell out of me but speaking to two fellow heart pateints on another forum with a similar condition to me, they have both said it made a huge difference to them being able to function without anxiety overwhelming them.

Unfortunately, antidepressants usually take 3-12 weeks to kick-in. Unlike the benzodiazepines, antidepressants do not directly affect anxiety (or depression) in the way benzodiazepines do. They work by stimulating the growth of new brain cells (neurogenesis) to replace cells killed, or prevented from growing by high brain stress hormone levels. The therapeutic response is produced by these new cells and the stronger interconnections forged, not the meds directly, and they take time to bud, grow and mature.

You could ask your psychiatrist to prescribe some mirtazapine until the sertraline kicks-in. While classified as an antidepressant, mirtazapine is mostly just a sedating antihistamine acting as a sedative.

3, Is the zopi combined with the diaz overdosing me and adding to the possible dependance?

It could do, at least on sedation. The 'Z' class hypnotics act on a subunit of the benzodiazepine binding site which causes sedation, not so much on the subunits which enhances GABA neurotransmission, so this will speed up tolerance to the sedating effects. But if you've been taking diazepam and zopiclone for 3 weeks tolerance may have already occurred with the zopiclone doing much less to aid sleep than you think it is.

4, Generally; taking the heart medication is bad enough but with the added worry of the chill-pills, am I over worrying? Is is possible to build up a dependance this quickly? Is just stoppinglikely to do me harm or should I taper off?

I'd wait to see how you go without the diazepam. It's likely that stopping it won't cause you any significant problems. If it does you can always reinstate the med and then wean off it slowly over several weeks.

Just to add my symptoms are the sudden onset of very powerfull anxiety rushes to borderline panic attack level.

That's the fight-or-flight adrenaline surge. Beta-blockers are very effective at controlling them, but I'm guessing you can't take them given you're already on an anti arrhythmia heart drug. :(

[Colin_P]

Thank you Panic Down Under for that extremely comprehensive reply.

Yes, you have nailed my stress response straight away, it being me living on what I can only describe as a knife edge of being on a hair trigger for the fight or flight reflex. I've had three lots of counciling over the years and none of them 'got that' despite me explaining it.

I still get this (the fight or flight adrenaline dump response) despite being of an elephant tranquilising dose of beta blockers and it also leads to a high level of residual anxiety for sometime afterwards.

I think my so called sympathatic nervous system is broken in more ways than one, including some of my heart issues. What I find is that once I've beaten the initial fear of getting out that a bike ride for an hour works wonders washing away that unwanted adrenalin.

I hope the sirt , once it has built up, does the trick.

[panic_down_under]

I've had three lots of counciling over the years and none of them 'got that' despite me explaining it.

Researchers provoke panic attacks in subjects using either CO2, or lactic acid, occasionally the mild aphrodisiac yohimbe. Administer a high enough dose and even those without an anxiety disorder will succumb. When I achieve my life's goal of world domination I may require all doctors and therapists to experience an anxiety attack just once. I'm pretty sure the quality of care would improve greatly!

I still get this (the fight or flight adrenaline dump response) despite being of an elephant tranquilising dose of beta blockers and it also leads to a high level of residual anxiety for sometime afterwards.

I think my so called sympathatic nervous system is broken in more ways than one,

It certainly sounds like it.

What I find is that once I've beaten the initial fear of getting out that a bike ride for an hour works wonders washing away that unwanted adrenalin.

The exercise is probably doing more than just lowering your adrenaline levels. There is considerable evidence it triggers the same brain changes as antidepressants, albeit to a lesser degree. However, it may be all that's needed to reign in mild anxiety (also depression).

[Colin_P]

I like that, making the quacks experience the joy!

Thank you so much for your replies, you have validated my own thoughts and that I've probably not built up a dependance on the chill-pills.

I think I'll ask my GP for some Oxazapam to take as and when rather the diaz, they have worked well for me for a number of years now.... or should I ?

[panic_down_under]

I think I'll ask my GP for some Oxazapam to take as and when rather the diaz

I nominated diazepam as it seems to be the only benzodiazepine (BZD) British GPs are willing to prescribe, but for occasional use a shorter acting BZD such as oxazepam is the better option, imho, as they are less likely to produce dependence in that situation. The problem with diazepam is it remains in the system for over a month so 'washout' periods are infrequent. OTOH, oxazepam has a short half-life and is completely metabolised and eliminated within 2 days.

However, dependence tends to build slower with the longer acting BZDs when taken daily so they would be the better option in that case.

[dally]

Hi
I would just like to add. One can build a tolerance to the dosage of Valium.
I did and suffered inter dose withdrawal symptoms.

Just FYI

[Colin_P]

Thanks everyone.

I'm weaning off and calming down after my heart health scare.

I didn't pop any chill-pills (diaz) yesterday and have only had one today.

It seems I'm managing. Knowing I have a stash for as and when acts like a comfort blanket type thing.