Re: Benzo dependance. How can I taper off? (Lorazepam/Ativan)
Originally Posted by
Radiationworried
It starts in the morning. I wake up uncontrollably shaking with my heart pounding and this huge weight of impending doom over me. I have become agoraphobic, need to have someone next to me at all times (moved back in with parents) and am finding it hard to do simple things like shower without having a breakdown.
I try to breathe through the symptoms, but I will eventually have a full blown panic attack if I don’t take a pill, complete with chest pain, dizziness, heart palpitations, hallucinations and dark thoughts I didn’t know I was capable of having. The anxiety I had before I took these doesn’t compare with the crushing, all encompassing anxiety I have now.
The first issue you need to deal with isn't quitting lorazepam, but getting your anxiety under control for trying to quit in your current mental state is very unlikely to succeed. Withdrawal symptoms and the withdrawal process are often more about psychology than chemistry and biology. A number of studies have demonstrated people can experience almost the full gamete of withdrawal symptoms after being told their benzodiazepine (BZD) dose has been reduce despite there having been no reduction.
Over time I have successfully weened myself down to 0.5mg twice a day but I find I cannot get off of them completely.
Trying to quit lorazepam directly isn't the best way of doing so because of its relatively short half-life - 10-20 hours. Switching to an equivalent dose of a long half-life BZD such as diazepam (Valium) - up to 100 hr for diazepam, 200 hr for its main active metabolite - and weaning off it is usually much easier, especially once at small doses. 4mg diazepam is about equal to 0.5mg lorazepam.
I really don’t want to be dependent on these.
You've been dependent on lorazepam and other BZDs your entire life. Lorazepam is one of the naturally occurring BZDs found in most foods. It has been isolated in the blood of lab rats that haven't been exposed to the pharmaceutical drug (Wildman J, Ranalder U. (1988)). It and many other benzodiazepine compounds1, have been found in wheat and potatoes (Wildmann J, et al., 1988).
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]. So much so that medical intervention is sometimes necessary (Note: no benzodiazepine synthesizing gut flora has been isolated and they almost certainly don't exist in humans).
[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)
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The opinions expressed above are based on my observations and, where applicable, interpretation of cited data and are general in nature. Consult your physician before acting on anything stated.