Diazepam to Zopiclone

[JMB123]

Hi is it possible to do a straight switchover from diazepam to equivalent Zopiclone say stop diazepam instantly replace with Zopiclone ? I thought I’d ask before actually doing this if it’s okay then great. P.s I have been on diazepam 10 years

I also have looked everywhere on the internet for the answer for this and have found but 1 study although back in 1995 . Appreciate any help king regards

https://pubmed.ncbi.nlm.nih.gov/19698411/

[panic_down_under]

Hi is it possible to do a straight switchover from diazepam to equivalent Zopiclone say stop diazepam instantly replace with Zopiclone ?

What are you trying to achieve? If it is to quit diazepam it would be easier to wean off it than zopiclone because diazepam has a much longer half-life and active metabolites which extend it even further.

[JMB123]

Thanks for the reply, yes it would be to eventually come off .. I have read that Zopiclone has a lot less of a tolerance problem and is easier to quit then diazepam .. where as taper for Zopiclone are half the time??

The diazepam is a once daily dose for sleep but when I wake up I’m so anxious everyday I don’t know if this is tolerance withdrawals from the diazepam my anxiety or both it’s at a all time high and so is my tolerance to diazepam sometimes not working for sleep as it should!

I have tried most ssri tca snri with no improvement except bad side effects .. I’m half think whether to get off the diazepam or to see if dr can prescribe a dose of diazepam for the morning to last the day? As it’s anxiety lasting effects seem to where off weigh before it’s half life .. but I’m scared that eventually the one I just added during the day will stop working and now I’m left with 2 doses double the amount to withdraw from!

I have tried coming off diazepam in the past managed to get down to 6mg but couldn’t get any further as the insomnia was bad not sleepily at all no matter what I took for sleep mirtazapine/trazodone/serquel

As you can see I have got myself in abit of a twist here .. sometimes I starting to think to cold turkey it and try rough it out but then I’m scared of a seizure or worse the dose is 10mg and have taking for over 10 years 🤷*♂️

[panic_down_under]

Thanks for the reply, yes it would be to eventually come off .. I have read that Zopiclone has a lot less of a tolerance problem and is easier to quit then diazepam .. where as taper for Zopiclone are half the time??

That 1995 study aside, I'm not sure that weaning off zopiclone will be either easier, or quicker than quitting diazepam directly. Not only does zopiclone have a much shorter half-life it doesn't affect the same BZD binding sites so isn't a like for like replacement. Have you discussed this with your doctor? I urge you to do so.

The diazepam is a once daily dose for sleep but when I wake up I'm so anxious everyday I don't know if this is tolerance withdrawals from the diazepam my anxiety or both it's at a all time high and so is my tolerance to diazepam sometimes not working for sleep as it should!

I doubt it is withdrawal due to the long half-life, but its effectiveness for anxiety is much shorter, maybe 6 hours or so and it probably not doing much for insomnia now due to tolerance. BZDs are not good sleep aids as tolerance to their sedating effects develops fairly quickly, as little as a couple of weeks.

The other issue is BZDs actually worsen anxiety by inhibiting the growth of new brain cells in the hippocampal regions of the brain which is the underlying physical cause of anxiety disorders and depression. Antidepressants (ADs) and the cognitive, behavioural (CBT, REBT, etc) and mindfulness therapies work by stimulating the growth of new hippocampal cells. Therefore, BZDs can block the therapeutic response of ADs and therapy. [1]

I have tried most ssri tca snri with no improvement except bad side effects ..

Which ADs have you tried and can you remember the highest dose you took and how long you were on that dose? Also is therapy an option for you?

I'm half think whether to get off the diazepam or to see if dr can prescribe a dose of diazepam for the morning to last the day? As it's anxiety lasting effects seem to where off weigh before its half life .. but I'm scared that eventually the one I just added during the day will stop working and now I'm left with 2 doses double the amount to withdraw from!

While I think you need to get off it the anxiety should be bought under control first.

I have tried coming off diazepam in the past managed to get down to 6mg but couldn't get any further as the insomnia was bad not sleepily at all no matter what I took for sleep mirtazapine/trazodone/serquel

Which came first, the insomnia or the anxiety?

As you can see I have got myself in abit of a twist here .. sometimes I starting to think to cold turkey it and try rough it out but then I'm scared of a seizure or worse the dose is 10mg and have taking for over 10 years

I wouldn't go cold turkey on any psych med. It's a recipe for disaster and not because of a seizure risk which is far less of an issue with diazepam anyway. Plus, once you're off diazepam then what? The reasons you were taking it will still be there.


[1]
Boldrini M, Butt TH, Santiago AN, et al. (2014)
Benzodiazepines and the potential trophic effect of antidepressants on dentate gyrus cells in mood disorders.
Int J Neuropsychopharmacol. Dec;17(12):1923-33 (Abstract | Full text)

Sun Y, Evans J, Russell B, et al (2013)
A benzodiazepine impairs the neurogenic and behavioural effects of fluoxetine in a rodent model of chronic stress.
Neuropharmacology. Sep;72:20-8 (Abstract)

Song J, Zhong C, Bonaguidi MA, et al (2012)
Neuronal circuitry mechanism regulating adult quiescent neural stem-cell fate decision.
Nature. Sep 6;489(7414):150-4 (Article | Study full text)

Wu X, Castren E. (2009)
Co-treatment with diazepam prevents the effects of fluoxetine on the proliferation and survival of hippocampal dentate granule cells.
Biol Psychiatry. Jul 1;66(1):5-8 (Abstract)

See also: the 'Ugly' part of Benzodiazepines: The Good, The Bad, and the Ugly

[JMB123]

Thanks for your help PDU

I was fortunate to have got emergency drs appointment this morning

The plan is to stick with diazepam and to slowly ween off it at 1mg a week, I have tried this approach many times before and have failed due to insomnia lasting to long got down to 6mg & quit the taper mainly due to insomnia. So with it being a 10 week taper & plus whatever time it takes for the side effects to wear off once off the diazepam insomnia etc IÂ’m looking at months of insomniaÂ… is there a possible quicker solution?

The antidepressant I have tried escitalopram 10mg . Citalopram 20mg , zoloft 50mg ,venlafaxine? Prozac 20mg mirtazapine 15mg amitrptyline 100mg imipramine? .. I tried most of these before the diazepam and all caused me insomnia except mirtazapine which helped my insomnia but that stopped working after few weeks and made me agitated.

The other antidepressant I have been prescribed fluvoxamine 50mg I never ended up taking because of my concerns with the interaction between fluvoxamine & diazepam my dr said they are okay to take together but I have read that fluvoxamine increase diazepam could this be seen as a good thing? Meaning that if it extends the half life of diazepam then if tapering while on fluvoxamine it extends the half life of diazepam therefore in theory making it an extended release diazepam?

ItÂ’s hard to say which came first between the anxiety and they insomnia mate I have had them both all my life and both have stopped me from living a normal life tbh mate.

Also would it be best to start fluvoxamine after diazepam is out of my system as you said that Benzos block how antidepressants work wouldnÂ’t while on them make the antidepressant redundant ?

In an ideal world I would like to be free of the diazepam have my anxiety under better control and be able to sleep which when I have less sleep my anxiety is real real bad panic attacks .. thatÂ’s why I thought of Zopiclone as I cannot take mirtazapine (severe agitation) trazodone IÂ’m not sure whatÂ’s left I can try especially if I give fluvoxamine a try which IÂ’m keen on doing and sticking to it but what can safely be taking aside it for sleep while I try taper diazepam.

[panic_down_under]

The plan is to stick with diazepam and to slowly ween off it at 1mg a week, I have tried this approach many times before and have failed due to insomnia lasting to long got down to 6mg & quit the taper mainly due to insomnia. So with it being a 10 week taper & plus whatever time it takes for the side effects to wear off once off the diazepam insomnia etc I'm looking at months of insomnia is there a possible quicker solution?

There are no quick solutions to anything pysch related and I can't see what is proposed working this time either.

The first and likely bigger problem is how will anxiety and insomnia be treated while you're tapering off diazepam? You really need to get effective solutions running before considering weaning off diazepam.

Secondly, dropping by 1mg a week is way too fast, imo. More like 1mg every 3-4 weeks down to 5-6mg and then you may need to cut back by only 0.5mg every month, possibly by 0.25mg/month for the final 1mg.

The antidepressant I have tried escitalopram 10mg . Citalopram 20mg ,

These are essentially the same med. If one doesn't work then the other almost certainly won't either.

zoloft 50mg ,venlafaxine? Prozac 20mg mirtazapine 15mg amitrptyline 100mg imipramine? ..

The sertraline (Zoloft) and mirtazapine doeses were too low to trigger a good response. I'm guessing you quit because of insomnia before they really had a chance to work.

I tried most of these before the diazepam and all caused me insomnia except mirtazapine which helped my insomnia but that stopped working after few weeks and made me agitated.

Most serotonergic ADs may trigger insomnia at the beginning. It usually resolves after a few weeks, but may reoccur for a while after dose increases.

I'm wondering whether one of the noradrenaline reuptake inhibiting ADs, nortriptyline or lofepramine might be the answer. Definitely worth considering, imo.

Meaning that if it extends the half life of diazepam then if tapering while on fluvoxamine it extends the half life of diazepam therefore in theory making it an extended release diazepam?

Diazepam has a half-life of about 200 hours, but is only effective for 6-12 hours. Slowing the rate it is metabolised will increase the elimination half-life, but won't significantly extend its effective range.

Also would it be best to start fluvoxamine after diazepam is out of my system as you said that Benzos block how antidepressants work wouldn't while on them make the antidepressant redundant ?

It will likely reduce the effectiveness of any AD, but even a partial response may be better than nothing. If therapy is an option then it can be as effective as meds. That said, therapy seems to rely on the same neurogenesis process as ADs and there is a study, Rosen CS, 2013 [PDF] which found those taking BZDs had a poorer longer term outcome with Present Centered Psychotherapy, though not those on the Prolonged Exposure Therapy arm of the study. I'm unaware of any other studies so I wouldn't take it as gospel.

what can safely be taking aside it for sleep while I try taper diazepam.

Have you been assessed by a sleep specialist? If that is an option ask to be referred asap.