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Thread: lorazepam- am I addicted??

  1. #1

    lorazepam- am I addicted??

    Hi..don't know what to do? My doc perscriped me lorazepam 1mg said to take as and when needed..just half tablet twice a day.. I already take anti depressants besides. The thing is I'm really frightened of becoming too reliant on them and getting addicted. Guess I was taking them every other day on average...sometimes I'd take a whole one just to block out everything and it would make me sleepy. I decided I'd try do without them..well I just couldn't do it..just had to take half tablet as I was in such a state of anxiety...Maybe someone out there can advise..Read about horror stories of coming off them..Are they ok just to use now and again? Really frightened of becoming dependent. Any advice appreciated.

  2. #2
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    Re: lorazepam- am I addicted??

    Quote Originally Posted by Darkdays View Post
    The thing is I'm really frightened of becoming too reliant on them and getting addicted.
    The bad news is that you're already addicted to benzodiazepines (BZDs). You have been all your life, possible from even before you were born. BZD receptors in the brain require BZDs to activate them. There are no known processes within the brain capable of producing them, and while there has been much speculation about how they might be synthesized in the body - gut flora was thought to be the most likely source - no internal mechanism has been found despite much research. So it is now generally accepted that we derive all the BZDs we need exogenously, i.e. from food.

    It has been known since the 1980s that plants make benzodiazepine compounds, and that it is also found in animal flesh and organs [1]. Diazepam (Valium), its metabolites and lorazepam (Ativan) seem particularly prevalent in plants. My guess is that benzodiazepines are a plant poison to which life, including Homo sapiens, have become so adapted to that we can no longer function without them. If we were to eat a BZD free diet we would soon begin to experience continual seizures.

    While the quantities we get from food are small, they are not insignificant. Benzodiazepine levels can reach pharmaceutical levels in patients with some liver diseases [2]. Levels may become so high that medical intervention is necessary [3].

    That said you may become dependent on pharmaceutical BZDs if you take them regularly for more than a couple of weeks. However, that may not be the biggest issue as there is good evidence [4] they significantly reduce the effectiveness of antidepressants (ADs) by blocking hippocampal neurogenesis which is how ADs produce the therapeutic response (see also: How antidepressant drugs act: A primer on neuroplasticity as the eventual mediator of antidepressant efficacy).

    In light of these studies benzodiazepines use should probably be limited to a couple of weeks when first taking ADs just to ease the initial increase in anxiety levels, for a while after AD dose increases for the same reason and thereafter for occasional breakthrough anxiety.

    Guess I was taking them every other day on average...sometimes I'd take a whole one just to block out everything and it would make me sleepy. I decided I'd try do without them..well I just couldn't do it..just had to take half tablet as I was in such a state of anxiety...
    There are two issues. The most pressing being getting you some relief without overdoing the lorazepam. You could try asking your doctor for something else to use to get some lorazepam washout periods once or twice a week which can reduce the dependency risk. The antihistamine *hydroxyzine has pretty strong anti anxiety properties, not quite as potent as the BZDs, but often potent enough. It is non habit forming. Beta blockers may also help. They have no direct affect on anxiety, but block the adrenaline surge symptoms of the flight-or-fight response and this can often be enough to ease anxiety levels. The problem with both is that apparently UK GPs are kept on a much tighter prescribing leash than is the case elsewhere and as these meds are off-label for anxiety your GP may not be prepared to prescribe them. But you might be able to get mirtazapine at small doses and its sedating affect may help.

    *Hydroxyzine comes in two forms, hydroxyzine pamoate (Vistaril) and hydroxyzine hydrochloride (Atarax). Anecdotally, the pamoate form is claimed to be the more effective anxiolytic. Just how true this is may be debatable, however, if you have the choice ask for Vistaril.

    The second things that needs to be addressed is why the antidepressant isn't giving your better results than seems to be the case. What are you taking, at what dose and how long have you been at that dose?

    Read about horror stories of coming off them..Are they ok just to use now and again? Really frightened of becoming dependent. Any advice appreciated.
    The problem with BZDs is that there is more to the horror stories than just physical dependence. Psychology is also a major factor, as is relapse of the anxiety disorder. The best evidence for this is that the other main BZD taking patient cohort, epileptics, seem to have far fewer issues discontinuing BZDs than those taking them for anxiety, despite sharing many of the same brain deficits in BZD binding site densities and often being prescribed BZDs at much higher doses.




    References:

    [1]
    Muceniece R, Saleniece K, Krigere L, et al. (2008)
    Potato (Solanum tuberosum) juice exerts an anticonvulsant effect in mice through binding to GABA receptors.
    Planta Med. 2008 Apr;74(5):491-6. (Abstract)

    Kavvadias D, Abou-Mandour AA, Czygan FC, et al (2000)
    Identification of benzodiazepines in Artemisia dracunculus and Solanum tuberosum rationalizing their endogenous formation in plant tissue.
    Biochem Biophys Res Commun Mar 5;269(1):290-5 (Abstract)

    Sand P, Kavvadias D, Feineis D, et al. (2000)
    Naturally occurring benzodiazepines: current status of research and clinical implications.
    Eur Arch Psychiatry Clin Neurosci vol 250(4): p 194-202 (Abstract)

    Kotz U, (1991)
    Occurrence of "natural" benzodiazepines.
    Life Sci;48(3):209-15 (Abstract)

    Unseld E, Krishna Dr Fischer C, et al (1989)
    Detection of desmethyldiazepam and diazepam in brain of different species and plants.
    Biochem Pharmacol Aug 1;38(15):2473-8 (Abstract)

    Wildman J, Ranalder U. (1988)
    Presence of lorazepam in the blood plasma of drug free rats.
    Life Sci. 43(15):1257-60. (Abstract)

    Wildmann J. (1988)
    Increase of natural benzodiazepines in wheat and potato during germination.
    Biochem Biophys Res Commun. Dec 30;157(3):1436-43. (Abstract)

    Wildmann J, Vetter W, Ranalder UB, et al (1988)
    Occurrence of pharmacologically active benzodiazepines in trace amounts in wheat and potato.
    Biochem Pharmacol. Oct 1;37(19):3549-59. (Abstract)

    Sangameswaran L, Fales HM, Friedrich P, De Blas AL. (1986)
    Purification of a benzodiazepine from bovine brain and detection of benzodiazepine-like immunoreactivity in human brain
    Proc Natl Acad Sci U S A. 1986 Dec;83(23):9236-40. (Abstract | Full text - PDF)

    [2]
    Baraldi M, Avallone R, Corsi L, et al (2000) Endogenous benzodiazepines. Therapie Jan-Feb;55(1):143-6 (Abstract)

    [3]
    Als-Nielsen B, Gluud LL, Gluud C. (2004)
    Benzodiazepine receptor antagonists for hepatic encephalopathy.
    Cochrane Database Syst Rev. 2004;(2):CD002798. (Abstract)

    Zeneroli ML, Venturini I, Stefanelli S, et al, (1997) Antibacterial activity of rifaximin reduces the levels of benzodiazepine-like compounds in patients with liver cirrhosis. Pharmacol Res , Jun;35(6):557-60 (Abstract) [Note: no benzodiazepine synthesizing gut flora has been isolated and they almost certainly don't exist in humans]

    [4]
    Boldrini M, 2014; Nochi R, 2013; Sun Y, 2013; Song J, 2012; Wu X, 2009; Stefovska VG, 2008).

  3. #3

    Re: lorazepam- am I addicted??

    Wow! Thanks for the reply..plenty of "food for thought" there..You ask what anti- depressants I am on..well I have been taking fluoxetine 20mg for a couple years now. Just over a week ago saw my gp and she suggested I increase my dose to 40mg a day so I guess I'm still waiting to get used to the new dose. Meanwhile will definitely think about alternatives that you suggest to the lorazepam. Haven't had to take any for about three days now..I have been keeping busy and preoccupied which probably says a lot in itself..Anyhow I appreciate your input..really clever stuff. Once again thanks for taking the time .

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    Re: lorazepam- am I addicted??

    Quote Originally Posted by Darkdays View Post
    I have been taking fluoxetine 20mg for a couple years now. Just over a week ago saw my gp and she suggested I increase my dose to 40mg a day so I guess I'm still waiting to get used to the new dose..
    So you began needing lorazepam after increasing the dose? If so this isn't a surprise as serotonergic ADs - SSRIs, SNRIs, some TCAs - will often trigger an anxiety spike after dose increases. Despite the common myth, serotonin isn't a 'feel good' neurotransmitter, just the opposite. After a few weeks the brain will respond to the increased serotonin activity by down-regulating its synthesis and expression and the anxiety spike should then begin to diminish.

    Haven't had to take any for about three days now..I have been keeping busy and preoccupied which probably says a lot in itself.
    Indeed. Distraction is one of the most useful tools for dealing with breakthrough anxiety. Hopefully, the worst is now behind you.

  5. #5

    Re: lorazepam- am I addicted??

    Thank you so much for your reply. It's just so reassuring to having someone explain things like this. I am grateful for you taking the time.

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    Re: lorazepam- am I addicted??

    panic_down_under:

    Very interesting post; I didn't realise patient idiosyncrasies (e.g. epileptics VS anxious) would have any meaningful difference in withdrawal symptoms. (This is maybe quite alarming, considering I studied, and practice, Pharmacy!)

    So yeah, just to say a very interesting post indeed
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    Re: lorazepam- am I addicted??

    Quote Originally Posted by RadioGaGa View Post
    I didn't realise patient idiosyncrasies (e.g. epileptics VS anxious) would have any meaningful difference in withdrawal symptoms.

    I think there are a number of factors at play. Firstly, they have epilepsy which people understand is a physical illness (they didn't always) so they are less likely to have others demonising their BZD use and to be less exposed to withdrawal horror stories which are less common in epilepsy support groups. They are also most likely to be on long half-life BZDs which tend to be easier to wean off. And perhaps most importantly, neurologists seem to do a better job of weaning their patients off them and the other anticonvulsants. GP also tend to be less cavalier about this with their epilepsy patients than they are with those taking the same meds at similar doses for anxiety. Very few would demand an epileptic quit 'cold-turkey,' or wean off within a week or two, yet this seems to be all too common for anxiety patients if reports to anxiety support groups are a guide.

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    Re: lorazepam- am I addicted??

    Quote Originally Posted by panic_down_under View Post
    I think there are a number of factors at play. Firstly, they have epilepsy which people understand is a physical illness (they didn't always) so they are less likely to have others demonising their BZD use and to be less exposed to withdrawal horror stories which are less common in epilepsy support groups. They are also most likely to be on long half-life BZDs which tend to be easier to wean off. And perhaps most importantly, neurologists seem to do a better job of weaning their patients off them and the other anticonvulsants. GP also tend to be less cavalier about this with their epilepsy patients than they are with those taking the same meds at similar doses for anxiety. Very few would demand an epileptic quit 'cold-turkey,' or wean off within a week or two, yet this seems to be all too common for anxiety patients if reports to anxiety support groups are a guide.
    Yes, because epilepsy is a more accepted condition in medical circles just as other complex mental health conditions are.

    From seeing people join here in my time it has shown GP's suddenly get a circular about ensuring benzos have been cut down, something that they were told to do in the last century , and panic they will be in trouble so force cold turkey on patients telling them "its all the local authority's fault, I'm just following orders".
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    Re: lorazepam- am I addicted??

    Terry that's so true. Exactly what my doctor did to me with Lorazepam few years back. I remember that hell hole all too well. Yuck!
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