289 replies to this topic

[fishinghat]

1. My recommendation is 50 mg of hydroxyzine at bedtime with your Ativan. When you first wake up put 3 to 5 mg of melatonin under the tongue to dissolve. This should put you back to sleep fairly quickly.
 
2. Sleep will return to normal once off the Ativan. Yes Ativan allows you to get to sleep but it also blocks REM sleep so you usually wake often. Hydroxyzine does not block REM sleep.
 
3. Research shows that nerves, synapses etc take around two years to return to fully normal (whatever that is) after the last change in medication.
 
4. I sleep great using 50 mg of hydroxyzine at bedtime. I am 80% done with my Ativan taper and it is low enough not to interfere with my sleep. Just a comment. Went I went through my 8 months of fear one of the drugs they tried on me (although it had not worked in the past, I was desperate) was 10 mg of Ativan. That is one half of the recommended dose to give a horse to calm him down. It didn't even phase me. Uggh. Bad days then.
 
Gail's situation is different. As she was coming off everything she developed other health issues so it is not comparable but I can say that most recovered their sleep habits in the long run.

"Does anyone ever get back their quality of life?"

 

That is a tough question. I would say that around 2% do not even with medication. I would say that about 40% get back the great majority of their quality of life with little to no meds. And I would say the remaining 58% must still rely on  significant medication to achieve quality of life. A lot depends on if this is a genetic condition, treatment resistant and how much trauma you have been exposed to. I am afraid that I will be one of those that will have to rely on some medication for the rest of my life. My life experiences have just been too traumatic BUT I have managed to cut my meds in half since I started on psych meds. I will take every improvement I can.

[EBB]

Makes sense, though very sad. What are your thoughts on my plan *I didn't see you responded - maybe you didn't see post...)

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?

[fishinghat]

Your plan sounds good. Yes the Ativan can be tapered with little to no withdrawal. I have done it 3 times and I have helped many others. How long depends on the individual. We would start you out very slowly and increase the drop rate very slowly until we found your limit. Gotta go, wife is calling for me. I will check in later.

 

PS. The method is called water titration.

[EBB]

Hi garden lady,

My heart goes out to you too. Thanks for your well wishes, I need them. All of this is an atrocity. I had trouble tapering Cymbalta beyond 3% bead removal. After a year, I tried using not amigos, lol, but amino acids to try to taper faster. They worked to some extent in that I felt better. But, it caught up with me and I ended up in a horrible withdrawal and am having to use Ativan and trying to stabilize after adding 10 beads back in. I've been this way for 3 months. DO NOT taper quickly. Take your time. It's not worth going fast. The withdrawals are horrendous. Life ruining. How has your benzo taper gone? Fishing Hat says it can be painless. Have  you found that to be the case? Are you doing water titration?

[EBB]

Your plan sounds good. Yes the Ativan can be tapered with little to no withdrawal. I have done it 3 times and I have helped many others. How long depends on the individual. We would start you out very slowly and increase the drop rate very slowly until we found your limit. Gotta go, wife is calling for me. I will check in later.

 

PS. The method is called water titration.

Hey Fishing Hat,

Just one last thing for now - do you have confidence that I CAN stabilize on these 10 beads? I've felt so awful for so long, I'm dragging through each day, praying I improve. Do you think the withdrawal will stop? And WHEN do you think I'll feel more like me?

Thank you for all of your support. You are an amazing angel.

Emilia

[fishinghat]

Well EBB, you have been on the 10 beads long enough to have stabilized if they were going to work fast. You can stabilize on the 10 beads but it will be a waiting game for the withdrawal to fade. Give you have already waited 2 1;2 months you should start feeling some improvement within the next 2 months and be much better in 4 months or so. Obviously that varies.

Gardenlady, I used to recommend the propylene glycol method but so many people would give up on it because of the motor oil taste. lol   Even they got it in banana flavor or strawberry they still hated it. Having said that though you are correct in that benzos are soluble in the propylene glycol and not water but I have found that in the water it breaks down into microscopic powder and as long as you shake the container well before dispensing your dose it is very effective. I also recommend that you start by a 0.1% reduction every 3 days and slowly work your way up to the first noticeable withdrawal symptom. At that point you can back off slightly and continue withdrawing with no withdrawal symptoms. The people that I know (mostly on Benzo Buddies) normally take around 2 years to wean off depending on dose of course. There is absolutely nothing wrong with your method if you can tolerate the propylene glycol (lol). I would still start off real slow and work up gradually so you could withdraw with no symptoms. Many aren't that patient though. That is why we have these discussions and all opinions should be put forth so the member can make their own decision on what is best for them. No one person has all the right answers (including the drs, lol) and that sure includes me.

[fishinghat]

I understood that you had finished your withdrawal (Yea!!). I was just supporting the information about your method. I also wanted everyone to realize that while some of us may not agree on all approaches that is great. All opinions are welcome and that is what makes this a good website.
 
I have added some information about the new water soluble "lorazepam" below. I think you will find it interesting.

Lorazepam is a nearly water insoluble compouind but recently the development of lorazepam glucuronide has been promoted by its manufacturer as a water soluble form of Lorazepam. Unluckily it is not a biologically active compound and has no effect on the CNS. This has lead to a lot of medical complications to those who try to use it for water titration during withdrawal. It has not been approved by the FDA for use in the United States.- Fishinghat

Pure lorazepam is an almost white powder that is nearly insoluble in water and oil. In medicinal form, it is mainly available as tablets and a solution for injection, but, in some locations, it is also available as a skin patch, an oral solution, and a sublingual tablet.
It is a high-potency and an intermediate-acting benzodiazepine, and its uniqueness, advantages, and disadvantages are largely explained by its pharmacokinetic properties (poor water and lipid solubility, high protein binding and anoxidative metabolism to a pharmacologically inactive glucuronide form) and by its high relative potency (lorazepam 1 mg is equal in effect to diazepam 10 mg).
Lorazepam for injection formulated with polyethylene glycol 400 in propylene glycol with 2.0% benzyl alcohol as preservative.

^ British Medical Association and Royal Pharmaceutical Society of Great Britain (March 2007). British National Formulary (v53 ed.). London: BMJ and RPS Pub. ISBN 0-85369-731-0.

Formulating a poorly water soluble drug into an oral solution suitable for paediatric patients; lorazepam as a model drug
Author links open overlay panelA.C.van der VossenaI.van der VeldeaO.S.N.M.SmeetsbD.J.PostmabM.EckhardtcA.VermesacB.C.P.KochacA.G.VultoaL.M.Hanffa

Lorazepam solubility in water - 0.0176 g/L
from Human Metabolome Database (HMDB)
Source: Human Metabolome Database (HMDB)

Soluble lorazepam is a 40-micrograms/ml admixture solution.
Am J Hosp Pharm. 1983 Mar;40(3):424-7.
Lorazepam solubility in and sorption from intravenous admixture solutions.
Newton DW, Narducci WA, Leet WA, Ueda CT.
*This would be impractacle for withdrawal.

Lorazepam is odourless or almost odourless . It is practically insoluble in water; sparingly soluble in alcohol; slightly soluble in chloroform (Reynolds, 1996).
Reynolds J (1996) Martindale, The Extra Pharmacopeia. 30th ed. The Pharmaceutical Press, London, 699-744.

Lorazepam-glucuronide is more water-soluble than its precursor, lorazepam. - Wiki

J Clin Psychiatry. 1978 Oct;39(10 Pt 2):16-23.
Clinical pharmacokinetics of lorazepam: a review.
Kyriakopoulos AA, Greenblatt DJ, Shader RI.
Abstract
The clinical pharmacokinetics of lorazepam, a 3-hydroxy, 1,4-benzodiazepine, indicate that it is rapidly and readily absorbed, reaching peak concentrations in the blood proportional to the dose approximately 2 hours after oral administration. Blood levels decline thereafter, with an elimination half-life of about 12 hrs. Conjugation with glucuronic acid to form inactive lorazepam glucuronide is the major metabolic pathway. Seventy (70) to 75% of the administered dose is excreted as the glucuronide conjugate in the urine. On multiple-dose regimens, steady state blood levels directly proportional to the daily dose occur within 2--3 days and are maintained after several months of continuous treatment. The active drug and the glucuronide conjugate are completely eliminated from the blood within 1 week following the last dose.

Lorazepam glucuronide, the inactive metabolite, may be highly dialyzable.
Lorazepam glucuronide has no demonstrable CNS activity in animals. . - RxList

file:///C:/Users/Neil/AppData/Local/Microsoft/Windows/INetCache/IE/2V25RDCT/018140s041s042lbl.pdf (Ativan drug insert)
Lorazepam glucuronide is an inactive metabolite and is eliminated mainly by the kidneys.

[EBB]

Thanks FH, though I'm overwhelmed by all of this...

1. People on other sites are scaring me saying I should be stable by now - could the 10 beads somehow be preventing stability and I won't ever get out of withdrawal unless I'm off the beads completely? Obviously, I need to hear again that this will end. That I can get stable on these 10 beads, then go as slow as I want. You told me this yesterday and I have to say, another 6 months of this hell sounds incredibly daunting. I'm just in tears over and over. My poor children. Can you tell me how this will be ok?

2. Does anything you said above change that my Ativan taper will be smooth and withdrawal-free? I just can't live through a withdrawal like this again.

Kind of on the verge here, needing some encouragement. Sorry to be so needy. Thank you for your help.

[EBB]

I completed my benzo taper on Jan 11, 2018, so I've been off about 5 months.  It was pretty rough...I did a liquid titration, but not water as I was on valium and valium isn't solvable in water.  I had to use propylene glycol which I ordered from Amazon.  I did dry cuts using a razor blade and pill cutter until I got down to 5 mg valium and then switch to a daily liquid micro taper using an oral syringe.  I got a lot of hand holding and help on how to do it from Benzo Buddies.  Sorry to say it wasn't painless...it was pretty bad and I'm still in a bad way with all kinds of mental symptoms along with tinnitus and insomnia.  

 

But, everyone is different and just because it was hard for me doesn't mean it will be for you.  

 

What is amigos?  And how long did you wait between your 3% cuts?  

Not, amigos, amino - typo. Don't use amino acids, they don't work. I waited two weeks between drops and many times I had to hold because the withdrawals were bad. But on average I did 3% cuts. Just go slow, it's not worth having these horrible withdrawal feelings. It's a nightmare.

E

[fishinghat]

Is it possible that the 10 beads will not get you stable. I guess anything is possible. Members have done this before and if they don't stabilize enough then they go up to 20 beads. At some point they always stabilize though. With your anxiety reaction to going up the 10 beads I hesitate to suggest 20 beads. There is no way to tell ahead of time if it will work. I know you said you felt better for a while yesterday how are you today?
 
Give it a few more days and see if you don't get another feel better day.
 
No problem with the Ativan. We can do it with little to no discomfort. The discussion yesterday between gardenlady and myself doesn;t change anything. Both are liquid titrations, she dissolves hers in a propylene glycol and I dissolve mine in water. If taken slow enough both will yield great results.

[EBB]

1. Ok, so it sounds like you're saying chances are with time I will be able to stabilize on the 10 beads and withdrawal WILL END?

2. I've had a few better days this past week, I've definitely seen improvement. Yesterday was awful. Felt like weeks ago. Today is ok again. I just want the doom and anxiety to go away.

[fishinghat]

1. Yes

2. If you are having periodic good days then you will be fine. One thing we have learned on the forum...If you have a good day don't overdo it. That will send into a relapse. Time and Patience.

[EBB]

what exactly are "god days"? I have days where the doom is less and I can go to the store and see friends and not feel like total hell. I am able now to ride my bike for a bit and take walks. But I do not feel these days are "good" in the sense of enjoying my day, or having a day that I enjoy like I used to. My "good" days are just not awful. Is that what you mean? Is that what makes you say I will be fine?

[fishinghat]

God Days? You got me on that one. Did I mistype something? It wouldn't be the first time. lol

"I have days where the doom is less and I can go to the store and see friends and not feel like total hell. I am able now to ride my bike for a bit and take walks. But I do not feel these days are "good" in the sense of enjoying my day, or having a day that I enjoy like I used to. My "good" days are just not awful. Is that what you mean? Is that what makes you say I will be fine?"

Yes. This reflects and Improvement in your symptoms, maybe not feeling good so lets just say not feeling as bad. That is usually a sign of the start of a slow (real slow) but steady improvement.

[EBB]

Thanks FH

Do you think it will be possible to get off these 10 beads, if I go one bead at a time very slowly, without horrible withdrawal? Especially the doom, extreme anxiety? 

[fishinghat]

Yes, IF you wait until stable first.

[gail]

Hello EBB,

There is no hurry to get off these 10 beads, you may stay there as long as you wish. Just a reminder here, beads are to be taken in a capsule.

Those 10 beads represent about 1 mg and a fraction. Stay there, don't upset the applecart. Don't even think about it.

I understand real well about doing things and not enjoying them as you used to. Happens to me often. And suddenly, the switch goes on, for a while then off. And we pray inside to God or to whatever to bring back the light. We cry in dispair, and we laugh.

Hold on dear Ebb, life is not an easy path. But, in time, you will reconnect with the laughing Ebb. Love, Gail

[EBB]

Hello EBB,

There is no hurry to get off these 10 beads, you may stay there as long as you wish. Just a reminder here, beads are to be taken in a capsule.

Those 10 beads represent about 1 mg and a fraction. Stay there, don't upset the applecart. Don't even think about it.

I understand real well about doing things and not enjoying them as you used to. Happens to me often. And suddenly, the switch goes on, for a while then off. And we pray inside to God or to whatever to bring back the light. We cry in dispair, and we laugh.

Hold on dear Ebb, life is not an easy path. But, in time, you will reconnect with the laughing Ebb. Love, Gail

Thank you Gail,

I need some words to help today. Last night was ghastly. And this morning I feel awful. This is no way to live.Will I ever stabilize?? What if I can't? What if I feel like this forever? Why can't I see feeling better, even though I've some improvement here and there? This is just awful and I want it to end. I can't take this. It's too hard.

[EBB]

Hello EBB,

There is no hurry to get off these 10 beads, you may stay there as long as you wish. Just a reminder here, beads are to be taken in a capsule.

Those 10 beads represent about 1 mg and a fraction. Stay there, don't upset the applecart. Don't even think about it.

I understand real well about doing things and not enjoying them as you used to. Happens to me often. And suddenly, the switch goes on, for a while then off. And we pray inside to God or to whatever to bring back the light. We cry in dispair, and we laugh.

Hold on dear Ebb, life is not an easy path. But, in time, you will reconnect with the laughing Ebb. Love, Gail

 

Yes, IF you wait until stable first.

 

Yes, IF you wait until stable first.

I need some words to help today. Last night was ghastly. And this morning I feel awful. This is no way to live. Will I ever stabilize?? What if I can't? What if I feel like this forever? Why can't I see feeling better, even though I've some improvement here and there? I 've had moments where I feel like me, almost like this is over and then it all comes crashing down again. This is just awful and I want it to end. I can't take this. It's too hard.

[EBB]

I need some words to help today. Last night was ghastly. And this morning I feel awful. This is no way to live. Will I ever stabilize?? What if I can't? What if I feel like this forever? Why can't I see feeling better, even though I've some improvement here and there? I 've had moments where I feel like me, almost like this is over and then it all comes crashing down again. This is just awful and I want it to end. I can't take this. It's too hard.

[fishinghat]

Hi EBB

I remember during my withdrawal that if I got feeling better I would feel like the bad days were all over and the good days are here to stay. Then maybe 3 hours later I would feel bad again and I would feel like it will never end and I will never get better. The truth is it did get better. It is so relentless it can be very hard to hang in there. If it is just too much to handle then you can raise your level of Cymbalta, cross taper to another AD or get an increase in your hydroxyzine./clonidine. What ever you decide we are here for you.

[EBB]

Thank you. How long did your withdrawal last? Do you feel ok now? How many people does raising Cymbalta work for? I think you said "most." Does that mean you have not seen many for whom adding beads does not work? Do you think it's too late at 3 months to add beads? The FB site hammers in the idea that you only have a 2-3 week window to reinstate or terrible things happen. I wish I'd known it was possible sooner, maybe I wouldn't be feeling so bad.

[fishinghat]

My withdrawal lasted 9 months and I finally had to go on an ssri. I am doing very well now. Raising the Cymbalta level usually helps nearly every one. Matter of fact I only remember one person who it did not help. 3 months should not be too late. That is an interesting statement from FB. I know we have had members increase their dose well after a month and it has helped. We have even had a few that was completely off for a couple months, couldn't handle the withdrawal and reinstated with no problems. It did take them a few weeks for it to fully kick in but it takes that long to kick in when you first start on it as well. Unluckily these things do not always follow rules and each of us sometimes react differently.

[EBB]

1. Did you go on an SSRI after the withdrawal was over, or did you add it make it end?

2. The person who adding in beads did not help, did it make it worse? 

3. What do I do if I add in beads and I get worse?

[juli]

EBB I am so sorry that you are feeling so badly.  I know how awful it can be.  That FB site has very strong opinions on things and not all of them are correct.  Most people there had been taking Cymbalta for pain so they haven't dealt with the anxiety and depression.  I found this group to be the most helpful and kind.  I know how you feel that there isn't a light at the end of the tunnel but there is I promise you.  

To answer your question, I believe FH went on Zoloft in order to end his withdrawl symptoms.  

[fishinghat]

I went too fast during my taper. I came off 90 mg in less than 3 months. After 3 months of fighting my withdrawal the drs and I agreed I needed some help. We tried 6 different meds with no help. I finally went on Zoloft and it was a great relief. Since I started the Zoloft 2013) I have been weaning off the extra meds the drs had tried. I am now 89% of the last one. So in short I added it to make the withdrawal end.

The one that bumped up that I remember did not help but did bot hurt either.

If you add in beads and get worse you have two choices. You can talk to your dr for hydroxyzine/clonidine to help or you can go mon a ssri (they are not as powerful as an snri but usually help with the withdrawal). You can then try to wean very slowly off that ssri after you stabilize. That is what is next on my list with the Zoloft. Hard to do at my age though.