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Why Am I Having Difficulty Getting Off Of Lorazepam?

Posted on Mon, 14 Apr 2014

Question: Why am I am having difficulty getting off of lorazepam? I was prescribed it to help get back onto paxil after experiencing major withdrawal from trying to go off of paxil. After 4 months of taking lorazepam 1-1.5 daily, my paxil was increased to original dosage of 60 mg and then I was able to get down to .5 mg daily of lorazepam. However, I am still experiencing anxiety and can't seem to go down anymore on the lorazepam. Even on the .5 mg, I am experiencing lightheadedness, increased anxiety, increased heart rate, headaches, increased depression. I have been trying to exercise 3-5 times a week, have been taking the .5 mg for almost 2 weeks now and am wondering what to do. I am only 28 years old, and have always been in good physical shape, never had a fast heart rate (blood pressure has always been 99/66) and I've never had ear problems (since going down on lorazepam I've had a constant buzzing in my ears) but for some reason I can't seem to get back to where I was when just on paxil 60 mg before. I've read the XXXXXXX manual about benzo withdrawal and it says sometimes the current antidepressant may need to be increased for a short time to help with symptoms, however I'm already on such a high dose of paxil that I can't go up anymore. I have been in almost a consistent state of anxiety that I can't relax during the day and windows of feeling normal are slim. Why am I having such a hard time with just .5 mg? What do I do? I just want to feel normal again.

Answered by Dr. Abhishek Kapoor (55 minutes later)

Brief Answer: Generalized anxiety disorder Detailed Answer: HI Thanks for using healthcare magic. I, Dr Abhishek Kapoor, would help you in this query. I think, you have generalized anxiety disorder, which is characterized by excessive, uncontrollable and often irrational worry. In that case, you need additional antidepressant along with paxil to control underline anxiety. You can also do relaxation exercise to control anxiety. You have been taking lorazepam for last 4 months and now dose is very less. Chances of getting dependence at such a low dose is very less. I would not say that you have benzodiazepine dependence because gradually dose has been reduced and there is no tolerance or craving for lorazepam. In your case, continuous anxiety symptoms are due to underline anxiety disorder rather than benzodiazepine withdrawal. Better to consult a psychiatrist and get one more antidepressant added in your prescription. You can use clonazepam at place of lorazepam. It has longer half life and would control anxiety in better way. Rest you can discuss with your psychiatrist. In case, you need further help, you can ask. Regards Dr. Abhishek Kapoor Psychiatrist

Above answer was peer-reviewed by : Dr. Yogesh D

Follow up: Dr. Abhishek Kapoor (12 days later)

The problem is that I have reached tolerance on ativan as the same small dose doesn't work as well as it used to and sometimes gives me the opposite effect. I carry around my pills everywhere and I do crave the next dose. Also, I have started to wonder if the paxil is not working anymore although it seems that 60 mg does get me through half the day. Is there any way to go up on the paxil or am I maxed out? I have also seen my blood pressure increase from 99/66 to 119/66 in just these short months. I have been very sensitive to medications since going off paxil and then back on with lorazepam, so my Dr. has been hesitant to prescribe another antidepressant, however she did prescribe 1 mg of diazepam to replace ativan but that dose is only 1\10 the dose of ativan I'm taking. What do I do?

Answered by Dr. Abhishek Kapoor (2 hours later)

Brief Answer: Try mirtazapine and relaxation exercise Detailed Answer: HI Thanks for showing trust on me. In your case, you would prefer higher dose of diazepam. It is a good option to replace ativan with diazepam, but according to dose equivalent, dose of diazepam should be 10mg. In that case, chances of getting withdrawal or anxiety symptoms would be high as you are on very small dose. There is no need to increase dose of paxil as it is already at high dose. You can try mirtazapine, with this antidepressant you would get sound sleep and it also help to control underline anxiety. Try to discuss about this antidepressant with your psychiatrist. You can also try relaxation exercise to control underline anxiety. In case, you need further help, you can ask. Regards Dr. Abhishek Kapoor Psychiatrist

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Abhishek Kapoor (7 hours later)

I asked my psychiatrist why she put me on only 1mg of diazepam and she said because it has a longer half life and it will build up in your system. However, every plan that I've seen to switch over from lorazepam to diazepam and then taper down recommends the XXXXXXX manual which she has never heard of. Therefore she thinks I don't know what I'm talking about. I would love to go back to my previous psychiatrist however he had me switch because I moved out of state and soon he'll be ending his practice. My new dr. tried me on buspirone for over a month which aggravated my symptoms and then recommended melatonin to help me sleep but it aggravated my symptoms. According to the XXXXXXX manual, it says that those meds were shown to aggravate symptoms in those dependant on benzos. Should I be looking for a different dr? This has gone on for far too long and my patience is waining...

Answered by Dr. Abhishek Kapoor (16 minutes later)

Brief Answer: You can consult another psychiatrist Detailed Answer: HI You should try to convince your current psychiatrist and if she is not willing to either increase the dose of diazepam or add mirtazapine like sedative antidepressant, in that case, you can consult another psychiatrist. There is nothing harm in it. In case, you need further help, you can ask. Regards Dr. Abhishek Kapoor Psychiatrist

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Abhishek Kapoor (47 hours later)

She didn't seem willing to budge on the diazepam last I spoke with her. She said she was being reasonable giving me just 1mg of diazepam. At one time with my old Dr I was on 80 mg of paxil and that was the only thing that helped. He always said that since I have a high metabolism that the drug was in and out faster than most people. That would explain why the paxil at 60 mg seems to only help until noon... I have an apt with my family Dr on Monday to look over blood tests as this prolonged stress and anxiety has steadily increased my blood pressure and pulse as well as increased occurances of chest pains. Would he be able to prescribe meds? I don't want to just drop my new Dr but I don't trust her anymore (she seems young and inexperienced in my situation).

Answered by Dr. Abhishek Kapoor (1 hour later)

Brief Answer: You can take her physician help Detailed Answer: HI Your general physician can prescribe anything. But he is not qualified to make a correct diagnosis and is not familiar with medications such benzodiazepine, antidepressants or other psychotropics. To be certain that your problem is being treated correctly, you have to see a psychiatrist. Your GP may be excellent at taking care of your physical health but not mental health. First discuss everything in detail with him and check whether he knows everything about the dosage and side effects, then you can ask him to prescribe them. In case, you need further help, you can ask. Regards Dr. Abhishek Kapoor Psychiatrist

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Abhishek Kapoor (24 hours later)

Thank you so much for your help. I will find out tomorrow if my current psychiatrist will prescribe either of those. And if not I will be seeing my go tomorrow anyways. Btw, is it uncommon to have to be subscribed another antidepressant for a short time just to help get off of benzodiazepines? Would this be suitable for my situation possibly? Thanks again!

Answered by Dr. Abhishek Kapoor (9 hours later)

Brief Answer: Antidepressant would help you in this situation Detailed Answer: HI Antidepressants usually take two weeks to show good effect. Only few antidepressant like mirtazapine or trazodone could help you in getting sedative effect, other wise, these antidepressant would also take few days. According to protocol to stop one benzodiazepine either shift patient on another longer acting benzodiazepine or sedative antidepressants. If patient is on longer acting benzodiazepine, then gradually decrease the dose according to withrawal symptoms. It is not uncommon to use sedative antidepressant to stop benzodiazepine. That would help to control dependence on another benzodiazepine. Antidepressants hardly have dependence pattern, so it is not difficult to take them off. There is no need to take antidepressant for few days. Better to take them for months. I would suggest you mirtazapine. It help you to get sleep at night and control underline anxiety. Rest you can discuss with your psychiatrist. In case, you need further help, you can ask. Regards Dr. Abhishek Kapoor Psychiatrist

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Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar