289 replies to this topic

[EBB]

Hi there, I really need some encouragement. I have a 15 year AD history - 2002 to 2014 (Zoloft, Lexapro, Celexa); 2015 Effexor, Trazadone; 2016 Cymbalta. I started to slowly taper in Oct of 2016 after 4 months. The Crapalta was making me feel awful and drink like a fish. I got to 86 beads in Nov. of 2017 and someone suggested amino acids to speed things up (dumb). I did bigger cuts and felt pretty good, though admittedly was overlooking smaller withdrawal symptoms. I just did not realize I was having problems. I got to zero beads March 1 of this year and went into full withdrawal. Sweating, akathisia, severe insomnia. March 14 I added in 10 beads, erroneously judging that was when I was "last stable." I've been trying to stabilize since. I am controlling the physical symptoms with .5mg Ativan twice a day and 1.5mg Ativan at night along with 10mg Hydroxyzine. Occasionally I toss in some Propranolol. I did the Ativan, despite my huge fear of benzos because I went 2 months without sleep and I was dying, literally, I could NOT sleep. Not with Ambient, wine, nothing. On the healthier side I'm doing fish oil, magnesium, and a multi-vit. I tried doing a Prozac bridge and that lasted a day with horrible anxiety. I tried adding in 10 more beads of Cymbalta a month ago and that made me more anxious too. My worst symptom is just this ongoing feeling of doom and ruminating thoughts. I just don't see a way out of this. I am having lots of suicidal thoughts. I don't in any way want to leave my children and amazing husband, but the painful thoughts are endless. I can't see this ever getting better. Even if my symptoms improve, I still have 10 beads and am addicted to benzos! Is there any hope for me?? Does this ever get better? Please help

[fishinghat]

Welcome EBB

 

Well first of all, I am surprised that going back up 10 beads didn't work. That is usually successful. Secondly 10 mg of hydroxyzine is worthless. The minimum effective dose is 50 mg and most drs start a person at 25 mg three times per day and 50 mg at bedtime.

Third, Don't feel bad about regretting the addition of amino acids. Many do that with bad results. Amino acid mixtures usually just stay on it until the contain L-tryptophan and other AA that can mess up your serotonin levels. (Which are probably messed up enough as it is.  lol)

 

Several things you can do. Talk to your dr about booting up your hydroxyzine and possibly adding clonidine to it. Neither has a withdrawal. If you have been on  the Ativan for over 4 weeks then don't worry about it now. Just stay on it until the Cymbalta withdrawal settles down and we can deal with it then. There is a fairly simple but slow way to come off of it with little to no withdrawal.

 

It sounds like so many stories we hear on this site. The last 3 to 5 mg must be weaned very slowly or they will really bite you. Besides the medicine changes I mentioned you could consider going up to 20 beads and see if that helps but given your response to the 10 bead increase I am not sure that is a good idea.

 

The feelings of doom and suicidal thoughts are a symptom of dropping way too fast. I a sure the dr would want you to go back to 20 or 30 mg and stabilize before weaning slowly. I would hate to have you go through that much of a drop again. You have been on 10 beads for nearly 3 months now, things should slowly start improving in the next 4 weeks or so (at least for most). When I also went through a period of fear and doom. Terrible experience.

 

One thing that can help the sleep a little is sublingual melatonin. Several members have had good success with this helping them get to sleep. Put the melatonin under your tongue when you are ready to go to sleep and let it dissolve there.

 

My only other suggestion is to read through a thread called "and the answer to your question is..." in the Medical Support section. This is a summary of all the things members have tried and what has helped and what hasn't. You might browse through that.

[EBB]

Thank you so much for all of the info. New questions:

1. Do you think I should try adding 5/10 beads again, or just wait this out? Maybe adding the 10 beads didn't work because it was at 2 months, so too late?

2. I can not survive this dreaded doom feeling for years more. Sounds like you are saying it does end? I keep seeing sites where people say they have withdrawal for years and it scares the crap out of me. Does that mean they have symptoms but not necessarily this emotional hell? 

3. Unfortunately, I'm already a month into the Ativan. I really tried to avoid it, but the akathisia was just unbearable and I didn't know about clonidine. I just hope tapering the Ativan won't be too painful.

4. Any words of encouragement that this will all be ok? Will I ever get off this med and be somewhat myself again, even though I have a long history of psych meds?

Thank you so so much

[EBB]

Clarification:

I reinstated 10 beads after being on zero Cymbalta for 2 weeks. After 2 months I tried adding in 10 more beads - for one day  - (to see if it would ease the withdrawal) and my anxiety worsened, so I went back to just 10 beads. I'm not sure if I was clear. That's why I asked above if you think I should try 20 beads again?

Thanks so much 

[gail]

Hello EBB,

A warm welcome to you.

FH has so much knowledge about all this. I went through all that he'll you're talking about except for physical symptoms. As for Ativan tapering or withdrawal, do not worry for one second, it is done smoothly. No withdrawal. I did it twice. I assure you that this will be a walk in the park. Plus you need them, how often I thanked God for it to ease the mental anguish.

My thoughts about the 15 years on antidepressants is that you will probably need them to have a certain quality of life. Only my thoughts here. Don't be surprised if it's what you need to get that quality of life.

I see that you've done your homework on the subject of Cymbalta withdrawal. Adding beads to stabalize. Sorry it's not working. I have not read on members having a relief by doing so or I missed it. You may give it more time if you wish. Please post again, we are here for you.

[EBB]

Hi gail, FH,

Thank you for your ongoing help. I appreciate the words about tapering the Ativan. I feel like I need it, but another withdrawal sounds like true hell, so glad to hear it's doable. Even though I may need an AD, that's not what I should do now right? Still confused as to what I should try now. Does it make any sense to try adding 3-5 beads of Cymbalta again, rather than 10? It was suggested on another site that I may be having inter-dose withdrawal from the 10 beads. I've read a lot about this and have never heard that. And what do you do about that anyway if you're tapering? Really, I'm just trying to get through every day with distractions from this emotional turmoil and I'm completely obsessing and overthinking all of this withdrawal because it is so consuming. Is that normal? I need to find a way to get through this. Let me know what you think. Thanks so much.

[gail]

Hi again EBB,

It's Fishinghat's day off today with his lovely wife.

Has those beads worked yet? Trial and error. Should you decide for another antidepressant, chose one with a long half life, they are much easier to get off. Zoloft, Prozac, Lexapro.

SSRI's not SNRI like Cymbalta or effexor. You ask if it's that you should do? I would say yes to that. Only my opinion here. Long history here on antidepressants. Some people need it for life. Anyway, as I said, they are easier to taper. Another waiting period awaits you though.

Let's wait for what our boy has to say after fishing all day with his Belle.

[fishinghat]

"1. Do you think I should try adding 5/10 beads again, or just wait this out? Maybe adding the 10 beads didn't work because it was at 2 months, so too late?"

Not too late, many members have went back on a low dose with no problem and it usually takes only 2 tp 3 days to kick in. If I was you I would consider going up to 20 beads and trying that for a few days. I just noticed your second post. One day at 20 beads is not long enough. It would typically take 2 or 3 days to see a significant effect. It is very rare to see a spike in anxiety when you add back a few beads but it is possible. One thing about it...If you go back to 20 beads and the anxiety spikes again that will kill that idea.

"2. I can not survive this dreaded doom feeling for years more. Sounds like you are saying it does end? I keep seeing sites where people say they have withdrawal for years and it scares the crap out of me. Does that mean they have symptoms but not necessarily this emotional hell?"

It does end. Yes it can take one or two years but after a few months (6 to 7 depending on the individual) the symptoms slowly fade.

"I just hope tapering the Ativan won't be too painful."

Gail is right. There is a wonderful way to very slowly taper off the Ativan or any other benzo with little to no withdrawal but it does take time.

You can beat this but I would be a lie if I said it would be easy. I am really hoping another slight increase in the number of beads will be enough to at least take the edge off. Then we can slowly work our way through this.

"Even though I may need an AD, that's not what I should do now right?"

I would try a few days on the 20 beads and if that doesn't work out a cross taper to one of the ssri that Gail mentioned is not a bad idea. It takes them around 4 to 6 weeks to kick in so you will still have to suffer through some withdrawal but it should slowly get better during that 4 to 6 weeks. Once stable on the new AD then you can try very slowly weaning of it.

Don't hesitate to ask questions. We know how scary it can be. Hang in there.

[EBB]

Thank you FH. Honestly, I'm terrified of all of this. WHY WHY did I go too fast? Anyway, new considerations:

1. If i try the 20 beads, that should help the doom feeling and withdrawal in general, in theory? And then I slowly wean from 20, but then aren't I doing this twice as long and on the Ativan even longer? Bottom line though is that I want to stabilize as soon as possible. I want to feel as normal as possible as quick as I can.

2. Sleep: Does Ativan stop working? I'm taking it consistently through the day, will I just need more and more?

I take 1mg at 10pm, .5 at 4 am, .5 at 11am, .5 at 5pm; this shifts slightly depending on when I wake up during the night. I am waking quite a few times during the night. I've added 25mg hydroxyzine at one point when I wake up to help me relax bc the Ativan no longer has that sedating effect. So last night I went to sleep at 10 with 1mg Ativan, but then woke up at midnight unable to sleep, so I took the hydroxyzine and then woke again at 4 and took the .5 Ativan. I'm trying to get as much sleep as I can because I need to heal.

3. Do you mean the emotional doom can last one or two years?

4. I'm concerned about cross-tapering to an AD bc I did genetic testing and in theory NONE of the SSRIs are a fit - none. This is weird because I've taken all of them in the past, though maybe that's why they didn't work. The SNRIs are theoretically ok, but their half lives are so short that is not ideal.

5. Is it likely that if I just wait this out, I can stabilize on these 10 beads? It's been 21/2 months since I went back up to 10 beads - can I stabilize from here? How long could that take of feeling so lousy?

Thank you so much for your help.

I just feel stuck in so many ways. I'm so tired of this misery. 

[fishinghat]

1. Yes going back to 20 will lengthen the process BUT should lower the amount of suffering. I always tell people to estimate what speed they think is best and cut it in half. Time and patience. Studies have shown that after 4 weeks on Ativan you are fully addicted for MOST people. It is very addictive. So don't worry about the Ativan right now.
 
2. "Does Ativan stop working? I'm taking it consistently through the day, will I just need more and more?:

You are absolutely correct. That is one reason I usually recommend hydroxyzine is that it is nearly as effective as Ativan for anxiety, you do not build up tolerance to it like Ativan and it does not block REM (deep) sleep like Ativan. 25 mg of hydroxyzine is far below the therapeutic dose and you should talk to your dr about raising it as it will help with the "doom" and anxiety as well as the sleep. There is also an excellent document on this website with tricks to getting a better nights sleep. I will post it shortly after I finish this post.

 

3. No. I was referring to the withdrawal symptoms in general. The doom part usually lasts about 4 to 6 weeks with the longest I have noted on here is 9 months.

 

4. You are perfectly right. This is typical for treatment resistant depression or anxiety. Only snri seem to have any effects and that is limited and usually there are significant side effects. Sucks.

 

5. Yes. It would typically take about 3 to 4 months to start feeling better with stability coming around 6 to 8 months. Considering you are at 2 1/2 months you should start seeing some bright spots in about a month give or take.

 

By the way you are probably stuck if you have Treatment Resistant Depression/Anxiety (TRD/A). Nearly 1/3 of all clinical depression/anxiety patients suffer from TRD/A

[EBB]

Thank you FH, I am overwhelmed. Feel hopeless. New questions:

1. Maybe I should try just 5 beads? My concern is that when I added 10 before, the anxiety was truly noticeably worse that first day. It was awful. If I go for 3 days on added beads and things are worse, isn't that hard to turn around? Isn't that bad? What do I do if I add 5 or 10 again and it's bad?

2. The sedative effect of Ativan stops working, but does the calming effect on the nervous system stop too, requiring more? That's the part that is scary to me. I am sleeping now without the sedative effect, but will it stop helping my nervous system? And then what do I do? I've tried hydroxyzine during the day and it puts me in a non-functional state of lethargy. I can't do anything. That doesn't matter at night - in fact that's the effect I want at night, it's helpful. But I can't stand that feeling from hydroxyzine during the day. I can't drive for ex. I have 2 beautiful kids I need to raise up and my life is a living hell right now. I feel so awful I don't know what path to take that is best for me and my family. Im so scared.

3. What do you think I should do given all of the issues?

4. If it takes me til Christmas to stabilize then I start tapering the 10 beads, that's 2 more years and then tapering the Ativan if it works that long. Am I right?

Could you write out some potential timelines/outcomes based on choices?

I can't see how to get through this.

[fishinghat]

1. 5, 0 or 20..it is a risk. It could make all the difference or the anxiety could get worse like when you went to 10 beads. No clear answer I am afraid. It is just trial an error. And yes if you go up another 10 beads and things are worse then you will pay a price when you come down.

 

2. Yes, it will stop helping the anxiety as well. The hydroxyzine during the day may cause some grogginess but that should only last 2 or 3 days before you adapt. Because of the children there are no easy answer. To maintain your quality of life necessary for child raising your best bet is to go on enough ssri to handle the withdrawal OR try taking a half capsule of hydroxyzine during the day until you adjust.

 

3. I can't really make a choice for you and there is no clear cut answer either. Sorry. You know your body better than anyone else, you just have to make a choice. If you are treatment resistant then the ssri idea is a long shot. Very slowly working up the hydroxyzine may help, clonidine may help or you could even try some L-Theanine (an amino acid OTC).

 

4. Difficult to do that as everyone reacts differently but if you will be patient with me I will work that up for you in the morning.

[fishinghat]

How to Sleep Better

Tips for Getting a Good Night’s Sleep

 

Tip 1: Keep a regular sleep schedule
Getting back in sync with your body’s natural sleep–wake cycle—your circadian rhythm (daily rhythm)—is one of the most important strategies for achieving good sleep. If you keep a regular sleep schedule, going to bed and getting up at the same time each day, you will feel much more refreshed and energized than if you sleep the same number of hours at different times. This holds true even if you alter your sleep schedule by only an hour or two. Consistency is important.

 

Set a regular bedtime. Go to bed at the same time every night. Try not to break this routine on weekends when it may be tempting to stay up late. No more than 15 minutes earlier or later each day.

 

Wake up at the same time every day. If you’re getting enough sleep, you should wake up naturally without an alarm. If you need an alarm clock to wake up on time, you may need to set an earlier bedtime. As with your bedtime, try to maintain your regular wake–time even on weekends.

 

Nap to make up for lost sleep. If you need to make up for a few lost hours, use a daytime nap rather than sleeping late. DO NOT NAP MORE THAN 1 HOUR PER DAY as it may affect your evenings sleep. DO NOT NAP AFTER 5 PM. The best time to nap is early afternoon.

 

Fight after–dinner drowsiness. If you find yourself getting sleepy way before your bedtime, get off the couch and do something mildly stimulating to avoid falling asleep, such as washing the dishes, calling a friend, or getting clothes ready for the next day. If you give in to the drowsiness, you may will usually wake up later in the night and have trouble getting back to sleep.

 

Tip 2: Naturally regulate your sleep-wake cycle

Melatonin is your naturally produced hormone that regulates your sleep. Melatonin production is controlled by light exposure. Your brain will secrete more in the evening, as it becomes darker, Conversely, during the day your brain detects increasing light levels and begins producing serotonin, which causes one to wake and be alert.

 

Spending long days in an office away from natural light, for example, can impact your daytime wakefulness and make your brain sleepy. Then bright lights at night—especially from hours spent in front of the TV or computer screen—can suppress your body’s production of melatonin and make it harder to sleep. However, there are ways for you to naturally regulate your sleep-wake cycle, boost your body’s production of melatonin, and keep your brain on a healthy schedule.

 

Increase light exposure during the day
Remove your sunglasses in the morning and let light onto your face.
Spend more time outside during daylight. Try to take your work breaks outside in sunlight, exercise outside, or walk your dog during the day instead of at night.
Let as much light into your home/workspace as possible. Keep curtains and blinds open during the day.

 

Boost melatonin production at night
Turn off your television and computer. Many people use the television to fall asleep or relax at the end of the day. Not only does the light suppress melatonin production, but television can actually stimulate the mind, rather than relaxing it. Try listening to music or audio books instead, or practicing relaxation. If your favorite TV show is on late at night, record it for viewing earlier in the day.

 

Don’t read from a backlit device at night (such as an iPad). If you use a portable electronic device to read, use an eReader that is not backlit, i.e. one that requires an additional light source such as a bedside lamp.

 

Change your light bulbs. Avoid bright lights before bed, after 7 PM do not use a light greater than 25 watts. Reduce light exposure by significantly reducing the brightness on your TV or electronic device.

 

When it’s time to sleep, make sure the room is dark. The darker it is, the better you’ll sleep. Cover electrical displays, use heavy curtains or shades to block light from windows, or try an eye mask to cover your eyes. Most patients with chronic problems blacken their bedrooms entirely. Do not use nightlights if it can be done safely. Block all windows in the bedroom so light can not enter.

 

See... https://www.ncbi.nlm...n00057-0027.pdffor details

 

Tip 3: Create a relaxing bedtime routine

 

If you make a consistent effort to relax and unwind before bed, you will sleep easier and more deeply. A peaceful bedtime routine sends a powerful signal to your brain that it’s time to wind down and let go of the day’s stresses.

 

Keep noise down. If you can’t avoid or eliminate noise from barking dogs, loud neighbors, city traffic, or other people in your household, try masking it with a fan, recordings of soothing sounds, or white noise. You can buy a special sound machine or generate your own white noise by setting your radio between stations. Earplugs may also help. Sound machines can be purchased at local department stores.

 

Keep your room cool. The temperature of your bedroom also affects sleep. Most people sleep best in a slightly cool room. A bedroom that is too hot or too cold can interfere with quality sleep.

 

Make sure your bed is comfortable. You should have enough room to stretch and turn comfortably. If you often wake up with a sore back or an aching neck, you may need to invest in a new mattress or a try a different pillow. Experiment with different levels of mattress firmness, foam or egg crate toppers, and pillows that provide more support.


Relaxing bedtime rituals to try...
Read a book or magazine by a soft light
Take a warm bath
Listen to soft music
Do some easy stretches
Wind down with a favorite hobby
Listen to books on tape
Make simple preparations for the next day
DO NOT exercise or do any significant physical activity after 6 PM. Anything considered work (laundry, dishes, etc) must be avoided after 6 PM.

 

Tip 4: Eat right and get regular exercise

 

Your daytime eating and exercise habits play a role in how well you sleep. It’s particularly important to watch what you put in your body in the hours leading up to your bedtime.

 

Stay away from big meals at night. Try to make dinnertime earlier in the evening, and avoid heavy, rich foods within two hours of bed. Fatty foods take a lot of work for your stomach to digest and may keep you up. Also be cautious when it comes to spicy or acidic foods in the evening, as they can cause stomach trouble and heartburn.

 

Avoid alcohol before bed. Many people think that a nightcap before bed will help them sleep. While it may make you fall asleep faster, alcohol reduces your sleep quality, waking you up later in the night. To avoid this effect, so stay away from alcohol in the hours before bed.

 

Eliminate caffeine. You might be surprised to know that caffeine can cause sleep problems up to ten to twelve hours after drinking it! No chocolate, most teas, coffee.

 

Avoid drinking too many liquids in the evening. Drinking lots of water, juice, tea, or other fluids may result in frequent bathroom trips throughout the night. Caffeinated drinks, which act as diuretics, only make things worse.

 

Quit smoking. Smoking causes sleep troubles in numerous ways. Nicotine is a stimulant, which disrupts sleep. Additionally, smokers actually experience nicotine withdrawal as the night progresses, making it hard to sleep.

 

Eliminate stimulants. No sugars, salty food or MSG. Sugar is a stimulant which can increase blood pressure and pulse. It can take significant time to process this material and slow down your metabolism. Salts like table salt and MSG provide sodium which is used by the body to help carry electrical system in our bodies. This can also increase heart rates and metabolism for several hours.
If you’re hungry at bedtime.

 

For some people, a light snack before bed can help promote sleep. When you pair tryptophan–containing foods with carbohydrates, it may help calm the brain and allow you to sleep better. For others, eating before bed can lead to indigestion and make sleeping more difficult. Experiment with your food habits to determine your optimum evening meals and snacks. If you need a bedtime snack, try:
A small bowl of whole–grain, low–sugar cereal
Granola with low–fat milk or yogurt
A banana (not sugary fruits)

 

You’ll also sleep more deeply if you exercise regularly. As little as twenty to thirty minutes of daily activity helps. And you don’t need to do all thirty minutes in one session. You can break it up into five minutes here, ten minutes there, and still get the benefits. Try a brisk walk, a bicycle ride, or even gardening or housework. Serious exercise, even small amounts, must be done before 6 PM.

 

Some people prefer to schedule exercise in the morning or early afternoon as exercising too late in the day can stimulate the body, raising its temperature.

 

Tip 5: Get anxiety and stress in check

 

Do you find yourself unable to sleep or waking up night after night? Residual stress, worry, and anger from your day can make it very difficult to sleep well. When you wake up or can’t get to sleep, take note of what seems to be the recurring theme. That will help you figure out what you need to do to get your stress and anger under control during the day.

 

If you can’t stop yourself from worrying, especially about things outside your control, you need to learn how to manage your thoughts. When trying to go to sleep it is essential not to think about work, money, your family’s problems or other stressful subjects. These are very detrimental to sleep. Do not think about exciting subjects (a vacation, your favorite hobbies, etc.). Instead pick something mundane (boring). Pick a subject like weeding you garden, cleaning your car, etc. It will be difficult to stay focused on these boring subjects at first but it will become easier with time and practice.

 

If the stress of managing work, family, or school is keeping you awake, you need help with stress management. By learning how to manage your time effectively, handle stress in a productive way, and maintain a calm, positive outlook, you’ll be able to sleep better at night.

 

Relaxation techniques for better sleep

 

Deep breathing. Close your eyes—and try taking deep, slow breaths—making each breath even deeper than the last.
Progressive muscle relaxation. Starting at your toes, tense all the muscles as tightly as you can, then completely relax. Work your way up from your feet to the top of your head.

 

Visualizing a peaceful, restful place. Close your eyes and imagine a place or activity that is calming and peaceful for you. Concentrate on how relaxed this place or activity makes you feel.

Tip 6: Ways to get back to sleep

 

It’s normal to wake briefly during the night. In fact, a good sleeper won’t even remember it. But if you’re waking up during the night and having trouble falling back asleep, the following tips may help.

 

Stay out of your head. Hard as it may be, try not to stress over the fact that you’re awake or your inability to fall asleep again, because that very stress and anxiety encourages your body to stay awake.
Make relaxation your goal, not sleep. If you are finding it hard to fall back asleep, try a relaxation technique such as visualization (focus your eyes on something in the room), deep breathing, or meditation, which can be done without even getting out of bed. Remind yourself that although they’re not a replacement for sleep, rest and relaxation still help rejuvenate your body.

Stretching. If you wake during the night do NOT fight it or panic. If you can not go to sleep in 10 to 15 minutes, get up, wake 20 or 30 feet, stretch (touch your toes or stretch your arms), walk back to bed and lay back down again. Each time you stretch and lay down your body will produce a small amount of endorphins which help the body relax.

 

Postpone worrying and brainstorming. If you wake during the night feeling anxious about something, make a brief note of it on paper and postpone worrying about it until the next day when you are fresh and it will be easier to resolve. Similarly, if a brainstorm or great idea is keeping you awake, make a note of it on paper and fall back to sleep knowing you’ll be much more productive and creative after a good night’s rest.

[EBB]

Thank you FH,

This is very different info on the Ativan from what I've received from the doc who said to take it. So, does that mean I should start tapering the Ativan now? Is it useless to continue? I was under the impression that it would continue to calm my nervous system, but it would not help with the mental anxiety.

1. Are you saying it will stop helping calm my nervous system too?

Dr Shipko is who I'm consulting with and he says he has had patients on Ativan for years through this weaning process because it's the only thing that keep the akathisia under control and the nervous system from overreacting. And this is my concern, since I've harmed my nervous system tapering too quick, I don't have time to taper from 20 beads.

2. Seems like I need to stabilize on the 10 while the Ativan is working and then slowly taper once I've stabilized on the 10 beads.

This is so stressful I am afraid I can't survive this. Is it too late for me? Thank you for your help. I'll be patient on your input, but if theres a way to clarify my Ativan concern that would be great. I'm already worried I won't sleep tonight.

Emilia

[fishinghat]

1. It will stop helping all together. I will post some info on that when I finish this post.
Dr Shipko, Ahhh, now so much is becoming clearer. More on this subject to follow.

2. Exactly. It is not too late for you. You need to understand that when you take a psych medicine it interacts with either the neuroreceptor transporter protein or directly with the synapse. In either case the synapse will change shape to better fit the medication. When the medication is removed then the nerve synapses must recover their shape and readjust to controlling the neurotransmitter. To fully achieve this it typically takes around 2 years BUT they do and can return to normal. That doesn't mean you won't still have anxiety or depression. That depends on conditioning as well as your stress loads and memories. A different subject.

[fishinghat]

Option 1 - Change to another AD (ssri), wean off and then do Ativan withdrawal. The new AD may work or may not work if you re treatment resistant.

Change will take about 6 weeks, weaning off new AD about 1 year, weaning off Ativan 1-2 years. The new AD may work or may not work if you re treatment resistant.

Option 2 - Bear with the suffering for 6 to 8 months, and after off for 1 year to feel like stabilized and then wean off Ativan (1 to 2 years).

Option 3 - Go up to 20 beads and try to stabilize which may or may not occur. Once stable then slowly slowly taper. About 2 months after finished with Cymbalta withdrawal then start Ativan withdrawal.

Option 4 - Increase dose of hydroxyzine slowly and/or add clonidine. Should stabilize in 2 months easy. Very slowly wean off 10 beads of Cymbalta (2 months). Two months after coming off the Cymbalta and stabilizing then starting Ativan withdrawal.

Let me know if there are any questions.

These are generalities and vary greatly from person to person.

Back with you shortly Emilia.

[fishinghat]

Use benzodiazepines for only 4 weeks or less to minimize risk of addiction.

https://www.ncbi.nlm...les/PMC4318457/
Dependency problems with benzodiazepines have been a familiar phenomenon for
about 40 years for this reason, pharmaceutical companies and the German Federal Institute for Drugs and Medical Devices (BfArM) have restricted the standard period of use to 2–4 weeks since the 1980s. According to the current law on prescriptions of medical drugs, hypnotics and tranquillizers can be prescribed for period can be extended if sound reasons exist.

http://www.smw.ch/co...smw-2011-13277/
Within weeks of chronic use, tolerance to the pharmacological effects can develop and withdrawal becomes apparent once the drug is no longer available, which are both conditions indicative of benzodiazepine dependence.

Withdrawal symptoms are observed following discontinuation or abrupt reduction of BDZs dosage, even after a relatively short treatment period (three to four weeks). Such physiological symptoms are the main signs of physical dependence. The most frequent are insomnia, gastric problems, tremors, agitation, fearfulness and muscle spasms. Less frequently observed are irritability, sweating, depersonalization, hypersensitivity to stimuli, depression, suicidal behavior, psychosis, seizures and delirium tremens. Over-rapid withdrawal from BDZs also increases the severity of the symptoms. Slow and gradual reduction of dosage customized to the individual accompanied by psychological support are the most effective way of managing withdrawal. Complete withdrawal can require four weeks to several years.

National Health Committee. Guidelines for assessing and treating anxiety disorders. Wellington (New Zealand): National Health Committee; 1998.
Recommend restricting their use to no more than 3–4 weeks

https://www.ncbi.nlm...pubmed/17535048
Recommend restricting their use to no more than 3–4 weeks

https://www.ncbi.nlm...t1-ndt-11-1885/
Review of research listing proper use of benzos.
In general, compounds with higher potency and a shorter half-life are associated with a greater likelihood of developing withdrawal syndromes and dependence.

A significant risk of dependence is recognized in some patients receiving treatment for longer than one month, and health professionals should be aware of this when considering the relative treatment benefits and risks.

https://www.ncbi.nlm...pubmed/16639148
Benzodiazepine dependence could be prevented by adherence to recommendations for short-term prescribing (2-4 weeks only when possible).

Clinical Guideline 22 (amended). Anxiety: management of anxiety (panic disorder, with or without agoraphobia, and generalised anxiety disorder) in adults in primary, secondary and community care" (PDF). National Institute for Health and Clinical Excellence. 2007. pp. 23–25. Retrieved 2009-08-08.
According to National Institute for Health and Clinical Excellence (NICE), benzodiazepines can be used in the immediate management of GAD, if necessary. However, they should not usually be given for longer than 2–4 weeks. The only medications NICE recommends for the longer term management of GAD are antidepressants.

McIntosh A, Cohen A, Turnbull N, et al. (2004). "Clinical guidelines and evidence review for panic disorder and generalised anxiety disorder" (PDF). National Collaborating Centre for Primary Care. Retrieved 2009-06-16.
Barbui C, Cipriani A (2009). "Proposal for the inclusion in the WHO Model List of Essential Medicines of a selective serotonin-reuptake inhibitor for Generalised Anxiety Disorder" (PDF). WHO Collaborating Centre for Research and Training in Mental Health. Retrieved 2009-06-23.
Based on the findings of placebo-controlled studies, they do not recommend use of benzodiazepines beyond two to four weeks, as tolerance and physical dependence develop rapidly, with withdrawal symptoms including rebound anxiety occurring after six weeks or more of use.

https://www.ncbi.nlm...pubmed/25613443
Benzodiazepines are generally highly effective when first given, but they should generally be given only for strict indications and for a limited time. If these drugs still need to be given beyond the short term, timely referral to a specialist is indicated, and possibly also contact with the addiction aid system.

http://www.rcpsych.a...diazepines.aspx
Royal College of Psychiatrists
How long should I take a benzodiazepine for?
Up to 4 weeks - no longer. This should really be just to give other (often psychological) treatments a chance to work.

[fishinghat]

Limited effectiveness/Long-term use and Addiction

http://www.ncbi.nlm....pubmed/16933543
The Canadian Psychiatric Association (CPA) recommends benzodiazepines alprazolam, bromazepam, lorazepam, and diazepam only as a second-line choice, if the treatment with two different antidepressants was unsuccessful. Although they are second-line agents, benzodiazepines can be used for a limited time to relieve severe anxiety and agitation. CPA guidelines note that after 4–6 weeks the effect of benzodiazepines may decrease to the level of placebo, and that benzodiazepines are less effective than antidepressants in alleviating ruminative worry, the core symptom of GAD. However, in some cases, a prolonged treatment with benzodiazepines as the add-on to an antidepressant may be justified.

https://www.ncbi.nlm...pubmed/16639148
Tolerance to anti-anxiety effects develops more slowly with little evidence of continued effectiveness beyond four to six months of continued use.

Curran, H. V.; Collins, R.; Fletcher, S.; Kee, S. C. Y.; Woods, B.; Iliffe, S. (2003-10-01). "Older adults and withdrawal from benzodiazepine hypnotics in general practice: effects on cognitive function, sleep, mood and quality of life". Psychological Medicine 33 (7): 1223–1237. doi:10.1017/s0033291703008213. ISSN 0033-2917. PMID 14580077.
"Holbrook AM. %282004%29. Treating insomnia. - PubMed - NCBI". www.ncbi.nlm.nih.gov. PMID 25282004. Retrieved 2015-12-10.
Poyares, Dalva; Guilleminault, Christian; Ohayon, Maurice M.; Tufik, Sergio (2004-06-01). "Chronic benzodiazepine usage and withdrawal in insomnia patients". Journal of Psychiatric Research 38 (3): 327–334. doi:10.1016/j.jpsychires.2003.10.003. ISSN 0022-3956. PMID 15003439.
Friedman MJ (1998). "Pharmacotherapy for posttraumatic stress disorder: a status report". Clinical Neurosciences Supplement 52: S115–S121.
Heather N, Bowie A, Ashton H, McAvoy B, Spencer I, Brodie J, Giddings D (2004). "Randomised controlled trial of two brief interventions against long-term benzodiazepine use: outcome of intervention". Addiction Research and Theory 12 (2): 141–154. doi:10.1080/1606635310001634528.
Bandelow, Borwin; Zohar, Joseph; Hollander, Eric; Kasper, Siegfried; Möller, Hans-Jürgen; Zohar, Joseph; Hollander, Eric; Kasper, Siegfried (2008-01-01). "World Federation of Societies of Biological Psychiatry (WFSBP) guidelines for the pharmacological treatment of anxiety, obsessive-compulsive and post-traumatic stress disorders HYPERLINK "http://www.ncbi.nlm....49648"HYPERLINKhttp://www.ncbi.nlm....ubmed/18949648" The World Journal of Biological Psychiatry 9 (4): 248–312. doi:10.1080/15622970802465807. ISSN 1562-2975. PMID 18949648.
Ashton, Heather (2005-05-01). "The diagnosis and management of benzodiazepine dependence". Current Opinion in Psychiatry 18 (3): 249–255. doi:10.1097/01.yco.0000165594.60434.84. ISSN 0951-7367. PMID 16639148.
Morin, Charles M.; Bélanger, Lynda; Bastien, Célyne; Vallières, Annie (2005-01-01). "Long-term outcome after discontinuation of benzodiazepines for insomnia: a survival analysis of relapse". Behaviour Research and Therapy 43 (1): 1–14. doi:10.1016/j.brat.2003.12.002. ISSN 0005-7967. PMID 15531349.
Michelini S, Cassano GB, Frare F, et al. (2016). "Long-term use of benzodiazepines: tolerance, dependence and clinical problems in anxiety and mood disorders.". Pharmacopsychiatry 29: 127–134
http://www.ncbi.nlm....pubmed/24434093

Several studies (listed above) have confirmed that long-term benzodiazepines are not significantly different from placebo for sleep or anxiety. This may explain why patients commonly increase doses over time and many eventually take more than one type of benzodiazepine after the first loses effectiveness.

https://www.ncbi.nlm...pubmed/15078112
Discontinuation of benzodiazepines or abrupt reduction of the dose, even after a relatively short course of treatment (three to four weeks), may result in two groups of symptoms—rebound and withdrawal. Rebound symptoms are the return of the symptoms for which the patient was treated but worse than before. Withdrawal symptoms are the new symptoms that occur when the benzodiazepine is stopped. They are the main sign of physical dependence.

https://www.ncbi.nlm...pubmed/26164054
While benzodizapines may have short-term benefits for anxiety, sleep and agitation in some patients, long-term (i.e., greater than 2–4 weeks) use can result in a worsening of the very symptoms the medications are meant to treat.

https://www.ncbi.nlm...pubmed/26545257
The relative proportion of long-term BZD users in adult BZD users ranged from 6% to 76% (mean 24%) The estimates were higher in studies only on the elderly (47%). Long-term use involved typically steady treatment with low BZD doses. However, in elderly patients long-term BZD use and exceeding recommended doses was relatively common. Several characteristics associated with long-term use were found.

https://www.ncbi.nlm.../pubmed/2222129
Patients who were able to remain free of benzodiazepines for at least 5 weeks obtained lower levels of anxiety than before benzodiazepine discontinuation.

Part 2
Effects of long-term use.
Alzheimer's Disease
https://www.ncbi.nlm...pubmed/26011780
During the 4-year follow-up, we found that 45% of individuals with Alzheimer's Disease (AD) and 38% of individuals without AD used BZDRs. The prevalence of long-term (≥ 180 days) BZDR use was more common among individuals with AD (30%) than individuals without AD (26%). The high prevalence of long-term BZDR use among individuals with AD is especially a cause for concern because long-term use may further impair cognition and may be associated with serious adverse events.

https://www.ncbi.nlm...pubmed/25208536
No association for Alzheimer's disease was found for a cumulative dose <91 prescribed daily doses. The strength of association increased with exposure density 1.32 for 91-180 prescribed daily doses and 1.84 for >180 prescribed daily doses). Benzodiazepine use is associated with an increased risk of Alzheimer's disease. The stronger association observed for long term exposures reinforces the suspicion of a possible direct association, even if benzodiazepine use might also be an early marker of a condition associated with an increased risk of dementia. Unwarranted long term use of these drugs should be considered as a public health concern.

https://www.ncbi.nlm...pubmed/25491057
Taking benzodiazepine is associated with an increased risk of Alzheimer disease

[fishinghat]

Sleep

https://www.ncbi.nlm...pubmed/23692988
Our findings do not support long-term effectiveness of BZDs; long-term users slept more poorly than nonusers and were even more outspoken in users of long-acting BZDs.

Tasman A; Kay J; Lieberman JA, eds. (2008). Psychiatry (3rd ed.). Chichester, England: John Wiley & Sons. pp. 1186–1200, 2603–2615. ISBN 978-0470065716.
Disrupting REM sleep by inhibiting deep stage sleep

https://www.ncbi.nlm...pubmed/20963787
Long-term benzodiazepine users were more likely to report poor sleep quality.

https://www.ncbi.nlm...pubmed/26547856
Melatonin ineffective in helping sleep during benzo withdrawal.

https://www.ncbi.nlm...pubmed/22704915
Benzodiazepines may be efficient in reducing symptoms in the short term, but evidence from this long temporal follow-up study indicates limited positive influences in the long term.

https://www.ncbi.nlm...pubmed/25145751
Sleep quality in chronic BZD/Z users significantly decreased over 1 year and was significantly worse than in nonusers at the end of this period. This study suggests that using BZD/Zs chronically does not maintain or improve sleep quality.

https://www.ncbi.nlm...pubmed/15003439
Benzos decrease REM sleep.
 

[fishinghat]

Ativan (generic name is lorazepam) (Valeant Pharmaceuticals)

Indication and usage

"Ativan (lorazepam) is indicated for the management of anxiety disorders or for the short-term relief of the symptoms of anxiety or anxiety associated with depressive symptoms. The effectiveness of Ativan (lorazepam) in long-term use, that is, more than 4 months, has not been assessed by systematic clinical studies."

Warnings
"The dependence potential is reduced when lorazepam is used at the appropriate dose for short-term treatment."
"In general, benzodiazepines should be prescribed for short periods only (e.g., 2 to 4 weeks). Extension of the treatment period should not take place without reevaluation of the need for continued therapy. Continuous long-term use of product is not recommended. Withdrawal symptoms (e.g., rebound insomnia) can appear following cessation of recommended doses after as little as one week of therapy. Abrupt discontinuation of product should be avoided and a gradual dosage-tapering schedule followed after extended therapy."

[fishinghat]

Dr Shipko, a tremendous dr with a great reputation. His vast experience has given him considerable insight into AD withdrawal via his clinic and internet practices. I have tremendous respect for his opinions. However, (you knew that was coming, lol) if you read his publications they are almost invariably based on his experience and have a lack of  consideration on the latest research. Just my opinion.

"Dr Shipko is who I'm consulting with and he says he has had patients on Ativan for years through this weaning process because it's the only thing that keep the akathisia under control and the nervous system from overreacting. And this is my concern, since I've harmed my nervous system tapering too quick, I don't have time to taper from 20 beads."

As you will see from some of the above research this information is not current as well as mentioning any concern for the development of dementia with long term use. Not only is there recent research on this but also a FDA black box warning as well.

[EBB]

Wow FH, I am so grateful for your thorough response. I need more info:

 

Option 1 - Change to another AD (ssri), wean off and then do Ativan withdrawal. The new AD may work or may not work if you re treatment resistant.

Change will take about 6 weeks, weaning off new AD about 1 year, weaning off Ativan 1-2 years. The new AD may work or may not work if you re treatment resistant.
* I don't feel like this is the greatest path since I've tried Prozac (for a day) and it made me very anxious and the genetic test shoed I'm not a fit for SSRIs and they haven't done much in the past. 
Option 2 - Bear with the suffering for 6 to 8 months, and after off for 1 year to feel like stabilized and then wean off Ativan (1 to 2 years).
* I'm confused - do you mean I suffer for 6-8 months as I am and take the Ativan. Then what does "after off for 1 year" mean? When do I wean the 10 beads and it seems like that will take a year - 1 bead a month at best. And, won't the Ativan stop working in the 6-8 months of suffering?
Option 3 - Go up to 20 beads and try to stabilize which may or may not occur. Once stable then slowly slowly taper. About 2 months after finished with Cymbalta withdrawal then start Ativan withdrawal.
* Also if this were to work, will the Ativan last through a 20 bead slow taper?
Option 4 - Increase dose of hydroxyzine slowly and/or add clonidine. Should stabilize in 2 months easy. Very slowly wean off 10 beads of Cymbalta (2 months). Two months after coming off the Cymbalta and stabilizing then starting Ativan withdrawal.

* This seems like what I may have to do. Does this option make me more comfortable with the feeling of doom? It would take 2 months to increase the hydrox/clonidine? Then you say slowly wean off the 10 beads - slowly is 2 months? I've been told these last beads need to be done only one bead a month, 2 months seems very fast for 10 beads. Also, don't I still need to stabilize on these 10 beads before tapering more? I'm not stable yet and tapering the 10 now would make th wd even worse it seems.

Possible Option 5 - What about adding hydro/clon to feel more comfortable and FINALLY stabilizing on 10 beads and just living on 10 beads. I have a family to care for and I JUST need to be stable and not feel suicidal doom every day. Maybe being on a bit of Cymbalta doesn't matter? Maybe if I can stabilize on these 10 beads, then taper the Ativan, I'm done. I just live on a very low dose of Cymbalta and that's my life.

Sorry for all the questions. I really appreciate your knowledge and help. I don't have any idea how to sort out this mess, but this list helps a lot.

[fishinghat]

* I'm confused - do you mean I suffer for 6-8 months as I am and take the Ativan. Then what does "after off for 1 year" mean? When do I wean the 10 beads and it seems like that will take a year - 1 bead a month at best. And, won't the Ativan stop working in the 6-8 months of suffering?

Well I didn't do a good job in describing that. lol Lets try it again.

Drop the 10 beads over a one month period, suffer for 6 to 8 months with withdrawal, still taking same dose of Ativan, after one year off the Cymbalta you should feel stabilized and then start the Ativan withdrawal.

* Also if this were to work, will the Ativan last through a 20 bead slow taper?
The Ativan will probably just be pooping out at that time BUT if you taper very slowly you should have minimal Cymbalta withdrawal.

Option 4 - The reason the 2 months is no dr would just turn you lose on both clonidine and hydroxyzine without a phase in. Although they have little side effects the drs will play it safe and work you up slowly. By the end of 2 months you should have worked up to a decent dose. No whether the hydroxyzine and clonidine is enough to fully stabilize you only trial and error can make that determination but you already know that.

"Slowly is 2 months?" Most can drop one bead a week but I must admit slower is better.
"Also, don't I still need to stabilize on these 10 beads before tapering more? "
That is what the hydroxyzine and clonidine are for. They should bring you to a good enough place to start the 10 bead wean.
"I'm not stable yet and tapering the 10 now would make th wd even worse it seems."
Correct, that is what the hydroxyzine and clonidine are for. During the time you phase in those two drugs you will stay on the 10 beads.

"Possible Option 5 - What about adding hydro/clon to feel more comfortable and FINALLY stabilizing on 10 beads and just living on 10 beads. I have a family to care for and I JUST need to be stable and not feel suicidal doom every day. Maybe being on a bit of Cymbalta doesn't matter? Maybe if I can stabilize on these 10 beads, then taper the Ativan, I'm done. I just live on a very low dose of Cymbalta and that's my life."

That is a viable option as well. I can tell you that after a few months of stability you will have enough healing going on to begin that slow Ativan withdrawal.

There are a couple complications. First, during these adjustments you will have periods of high stress and low stress. These will make you wonder if you are going to fast or to slow. Don't judge by one days feelings. If something lasts for 3 or 4 days then you can assume it is a reflection in your med changes. The second thing is that these are generalities. It may take you 1 week to get on enough hydroxyzine/clonidine to stabilize or even after 2 months you still may not be stable. These time tables will need to be flexible and adapt as you go.

[EBB]

Ok FH, thank you. I will consider all of this carefully. Another realization - turns out I've only been on Ativan 2.5mg (total) spaced through the day and night since May 14.

1. Is it possible I'm not addicted to it?

2. Should I try to cut back on that now and switch to hydrox/clon?

3. Maybe I could try replacing the daytime Ativan for hydrox, for ex? I am so concerned about the Ativan with all of the stuff you posted and it does not seem to be addressing my doom issue. What are your thoughts?

4. Is it a bad idea to try to taper the Ativan now?

5. And what about cannabis? Could that potentially help with withdrawal instead of all these prescription meds?

Thank you so so much!

[fishinghat]

1. It is possible. One way to find out is to taper off over the next 3 days or so. If you are addicted you will know for sure. The down side is that there is only a 50/50 chance that going back on it will relieve any withdrawal.

2. Excellent idea. I know that one of the standard treatments for benzo withdrawal is hydroxyzine which nearly always works. Let me explain. In normal treatment of anxiety hydroxyzine acts on the histamine receptor. If histamine is part of your problem then it will help if not then the effectiveness may be less. You have already tried it and it made you sleepy so it should help your anxiety. In the case of benzo withdrawal it is the gaba receptor that is involved and the hydroxyzine is very effective on controlling that synapse.

3. If you can get off the Ativan now it could save you a long slow process later. I would take the risk but that is me. You will need to get with your dr soon for more hydroxyzine/clonidine so you are ready to handle any possible withdrawal.
4. Like I said, it is worth the risk. First of all at 4 weeks you should not be fully addicted if any. Second if there is a problem you can always try to go back up a little. And third if you have hydroxyzine and/or clonidine to fall back on then you should be OK.
5. That is a possibility but there are over 20 strains of this material and some help pain and some help anxiety and etc etc. I am afraid I am not an authority on this so you would need to turn to someone more knowledgeable. By the way many members have had good success with the oil form.

[EBB]

Thank you for the info. The problem is that I'm a mom. I have kids to care for and I can't risk another long withdrawal hell now, so if the tapering doesn't work, I'm really in a problem, especially since I'm already in Cymbalta withdrawal.

That said, I want to make sure I understand:

1. How do I try to taper - do I cut the two .5 daytime dosages in half? And if the anxiety/akithisia returns, then adding it back in will only 50/50 work? That feels very risky to me.

3. How long should the Ativan keep working to calm my nervous system on average? I've already lost it's sedating effect, will the nervous system calming last through stabilizing on these 10 beads? Meaning until December?

4. Will it last then past that - through slowly tapering the 10 beads. I don't think I can do one bead a week. I was only able to do a 3 percent taper to get to 86 beads, that's why I sped it up and got in this mess. Every drop I did for a year was 3 percent and hellish. When I used the amigos and did bigger drops it was ok until I crashed March 1.

4. Another site is saying that my doom/anxiety is inter-dose withdrawal from the Ativan and they say to ADD a dose and take it 5 times a day. Where does this all end?? Do you think inter-dose withdrawal is happening? I think the anxiety/doom I'm having is from Cymbalta withdrawal.

I feel as though the Ativan has become more of a concern now than the Cymbalta. What are your thoughts?

[EBB]

Hi FH,

I've been up since 2 - can't sleep. Worried about all of this. So here's the thing that concerns me the most about staying on the Ativan - when it stops working, will it put me into withdrawal, meaning I'll need more and more? Or will it just stop working?

2. Also if I am taking 4 doses of Ativan a day, and I have a glass of wine with friends, does that increase the dose and cause me to need more?

[fishinghat]

1. That is correct and is risky.

3. (no number 2? lol) Through December, probably not. Just an educated guess though.

4. (First one) Very hard to say but remember it doesn't just stop it fades away and the withdrawal fades in. That is why the hydroxyzine/Clonidine is needed as a safety net.

4. (Second one) I disagree. In the worst case scenario we can always wean off the Ativan with little to no withdrawal. Yes it is slow but at least you will have quality of life and be able to take care of your children. The Cymbalta withdrawal, as you found out, can easily be an overpowering force. Much more traumatic.

"Ativan - when it stops working, will it put me into withdrawal, meaning I'll need more and more? Or will it just stop working?"

It will just stop working. Withdrawal will not begin until you start tapering the Ativan.

2. (There is number 2, lol) The alcohol will not effect the performance of Ativan although it may make you more sleepy and lethargic. It will however increase the symptoms of Cymbalta withdrawal. Many members have tried to use small amounts of alcohol to take the edge off the anxiety during withdrawal only to find themselves in a 2 or 3 day relapse in symptoms. Any solvent that is a central nervous system depressant can have that effect. We even had that happen to one member who had that experience after doing some painting.

All these choices have a down side. As far as taking care of your children, the safest bet is to wait until you are stable on the 10 beads using the hydroxyzine/clonidine when things get bad. The very slowly wean the 10 beads over a period of _____ months (however long it takes). Once off the Cymbalta take a couple months to get your strength back before starting the Ativan wean. This is the slowest method but the one most likely to give you some quality of life. All of these methods have risks and potential surprises. At some point you just flip a coin and go for it.

 

[EBB]

So here's what it seems to me I should do:

1. Play it safe and stay on the Ativan as long as it lasts. I can't risk a horrendous withdrawal of Ativan on top of Cymbalta with my children.

2. At some point I will stabilize on these 10 beads. I WILL stabilize right? Have you heard of people NOT stabilizing?

3. If the Ativan stops working before I'm stable, then I can use the hydroxyzine/clonidine. Shouldn't I be stable by December tho?

THEN:

a. Taper the Ativan and THEN do the 10 beads after very slowly with hydroxyzine/clonidine if needed.

or

b. Taper the 10 beads if the Ativan is still working, then after two months off, taper the Ativan.

4. Is it really painless to taper the Ativan and does it really take 2 years? Is it done with liquid or a Valium cross-taper? I am SO WORRIED about this. I can not handle an ugly taper. Is there anything you can tell me again to assure me this won't be a painful doom-filled slog again?

[EBB]

Thank you again FH, here's another advice question of sleep:

I've been sleeping but waking up a lot. Will I ever sleep normally again? The Ativan don't have the sedative effect now, so it's not really helping me sleep, aside from keeping my system calm of course. Last night I added in 25 hydroxyzine when I went to bed. Then I woke at 2 and took 30 more. I was awake worrying about all of this until 4:30 and I took 20 more. 70 total last night. 

1. HOW do I best use the hydroxyzine to help me sleep?

2. I was such a good sleeper before this happened to me, will I ever get back to sleeping well again as my body heals?

3. How long does it take to heal from all of this?

4. Have you been through this and do you sleep well? Does Gail? Does anyone ever get back their quality of life?

Sorry for all of the questions, I am very stressed. Thank you for all of your help.