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Lorazepam Question (And Hello, I Am New)


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#1 In_Remission_brush rabbit

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Posted 25 July 2010 - 03:52 PM

Hey!

Since I just became a board member ten minutes ago and this is my first post, perhaps I should be posting in a new members forum somewhere, but I really just have this one lorazepam question. So here I am.

Background: I am manic depressive. My official diagnosis is rapid cycling bipolar disorder, severe, with predominant depression. I received a diagnosis of depression and prodromal bipolar at 16, but did not start taking medicine until my first full blown psychotic episode and hospitalization in 1998, at age 20. Like many of you, I have tried a lot of meds. I have tried about four mood stabilizers, six antipsychotics, and lots of anti-depressants. Most didn't work or made things worse. Anti-depressants in particular have been disasters, which is a shame, but unsurprising.

I am taking lamictal (150 mg), seroquel (quarter to half a 25 mg tablet), and lorazepam (2 mg.) I have been taking these same meds for almost four years now and in these amounts for about one year (I had previously been taking more lamictal and lots more seroquel.) We have tried adding in other things during that time, but at this point there isn't a whole lot I haven't tried, and nothing else has seemed to help. I like being on these low doses and although I still am a very depressed and anxious person, I am relatively stable and feel a lot better than I did on higher doses (which made me less crazy, but also more depressed.) It is a good compromise for me.

My problem is that I just don't like being on lorazepam. Or rather, I like being on it, but I worry about taking it. I take it at night with the seroquel for sleep. Four years back, after my last hospitalization, I was taking a lot more seroquel and still could not sleep, so my (much missed) old psychiatrist added in the lorazepam. He started me at one and then quickly increased me to two. That helped soooooo much and still does. I worried about taking so much--before that same psychiatrist had only given me .25 mg lorazepam tablets, PRN, even when I was waaaaaay crazy back in 2003. And it was supposed to be temporary. But it worked so well, he kept me on it. He actually increased the script to 3mg, because he wanted me to take one in the morning for my anxiety, but I never took it and my script eventually went back to two. When I met my new psychiatrist in January 2009, I told him that I wanted to eventually wean off the lorazepam, but he didn't seem to think this was a good idea. Even the naturopath I saw, who takes a very critical view of lorazepam, said when I asked about quitting, "well, you need sleep. Sometimes you have to do what you have to do."

I take it about two hours before I go to bed. It is nice to have that down time where I do not feel tight and anxious like I do the rest of the time. And I have a bipolar uncle who has taken the same amount of lorazepam forever and ever without trouble (although I have a schizophrenic aunt who had a bad experience with it.) I don't really like the slightly stoned feeling I get--I have never liked being drunk--but it is a relief to have a "break from my head", as my uncle said, and to sleep soundly.

My worry is that the medicine is making me, I don't know, dumber and maybe flatter, even during the day. Most meds do that, but lorazepam more so. My parents aren't too keen on it, either. They are very pro-medicine--my dad is an MD and my mom wanted to be a psychiatric research doctor before she married--they just don't like lorazepam. And I still have a lot of anxiety during the day and I wonder if the lorazepam, being short acting, is having a rebound effect. For some reason no one has ever suggested switching me to a less "temporary" and longer acting benzo, probably because I never wanted to be on a benzo to begin with. Also, although I am very diligent about and happy with my birth control, I worry about getting pregnant on a category D med. And I saw some Dr. Amen video in day treatment years ago where he showed these pictures of what lorazepam does to the brain and it did not look good. That freaked me out.

I don't think that I am addicted, except in the way I am "addicted" to any medicine that works, because I have stayed at the same dose so long. But I also know that getting off benzos is a nightmare.

Does anyone have any ideas? Has anyone had rebound anxiety from taking a short acting benzo once a day? Has anyone gone off a benzo and felt better for it in the end? Or did you just go back on it? Has anyone had any luck with GABA supplements? I know that the science on GABA supplements is not good, but I have heard of a few people who liked them. Or yoga? It is supposed to help raise GABA levels, although there agin, I don't know how much. Even if I could do something that would help raise those GABA levels a little, and then lower the lorazepam dose a bit, I would be happier.

Thank you for reading my very long post! I have loved this site for years, just never really looked at the boards before now.

Edited by brush rabbit, 25 July 2010 - 04:04 PM.




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#2 Serpens

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Posted 25 July 2010 - 06:25 PM

I am taking lamictal (150 mg), seroquel (quarter to half a 25 mg tablet), and lorazepam (2 mg.) I have been taking these same meds for almost four years now and in these amounts for about one year (I had previously been taking more lamictal and lots more seroquel.) We have tried adding in other things during that time, but at this point there isn't a whole lot I haven't tried, and nothing else has seemed to help. I like being on these low doses and although I still am a very depressed and anxious person, I am relatively stable and feel a lot better than I did on higher doses (which made me less crazy, but also more depressed.) It is a good compromise for me.

My problem is that I just don't like being on lorazepam. Or rather, I like being on it, but I worry about taking it. I take it at night with the seroquel for sleep. Four years back, after my last hospitalization, I was taking a lot more seroquel and still could not sleep, so my (much missed) old psychiatrist added in the lorazepam. He started me at one and then quickly increased me to two. That helped soooooo much and still does. I worried about taking so much--before that same psychiatrist had only given me .25 mg lorazepam tablets, PRN, even when I was waaaaaay crazy back in 2003. And it was supposed to be temporary. But it worked so well, he kept me on it. He actually increased the script to 3mg, because he wanted me to take one in the morning for my anxiety, but I never took it and my script eventually went back to two. When I met my new psychiatrist in January 2009, I told him that I wanted to eventually wean off the lorazepam, but he didn't seem to think this was a good idea. Even the naturopath I saw, who takes a very critical view of lorazepam, said when I asked about quitting, "well, you need sleep. Sometimes you have to do what you have to do."


A remarkably sane quote for someone in the profession of selling garbage.
Regardless, you've been taking a stable dose for many years, it works well, and is managing your illness. You're not taking more than you're prescribed, even going out of your way to avoid it. In short, as far as medical and biological control is going, by your description, you're in a pretty good place. Have you considered looking into some therapy as an add on? In short, you don't have a reason to be worried about using lorazepam, but you are - and that's symptomatic.

I take it about two hours before I go to bed. It is nice to have that down time where I do not feel tight and anxious like I do the rest of the time. And I have a bipolar uncle who has taken the same amount of lorazepam forever and ever without trouble (although I have a schizophrenic aunt who had a bad experience with it.) I don't really like the slightly stoned feeling I get--I have never liked being drunk--but it is a relief to have a "break from my head", as my uncle said, and to sleep soundly.

The experience of taking a consistent dose for many years, decades even, without problems is the norm. If you're having subjective unpleasant feelings, it may be worth adjusting dose slightly, or using another agent.

My worry is that the medicine is making me, I don't know, dumber and maybe flatter, even during the day. Most meds do that, but lorazepam more so. My parents aren't too keen on it, either. They are very pro-medicine--my dad is an MD and my mom wanted to be a psychiatric research doctor before she married--they just don't like lorazepam. And I still have a lot of anxiety during the day and I wonder if the lorazepam, being short acting, is having a rebound effect. For some reason no one has ever suggested switching me to a less "temporary" and longer acting benzo, probably because I never wanted to be on a benzo to begin with. Also, although I am very diligent about and happy with my birth control, I worry about getting pregnant on a category D med.


This is not an area I am especially familar with, but if I recall correctly, the issue with benzodiazepines and pregnancy is that of neurodevelopment, and the presence of a withdrawal syndrome in the neonate. Their teratogenic potential is abysmally small, though existant. It will not cause harm to your reproductive system, and it is not problematic unless you become pregnant.

And I saw some Dr. Amen video in day treatment years ago where he showed these pictures of what lorazepam does to the brain and it did not look good. That freaked me out.


Amen is controversial, because he is advocating the use of techniques that are not proven out for the use of diagnostics and treatment. There is a monumental amount of work required to be done in high level research before SPECT techniques are ready for such uses. It is generally regarded as grossly unethical and exploitative by the general medical community to be selling such services.

Moreover, he appears to have lately moved into the business of selling supplements, ones that are priced very highly. This includes some, notably GABA, that are thoroughly debunked as useful treatments.

I would not put much faith in anything coming from him as a source. The strong consensus is that the effects of long term benzodiazepine use are extremely mild. Problematic symptoms have only been noted in cases of abuse of exceptionally high doses, over many decades.

I don't think that I am addicted, except in the way I am "addicted" to any medicine that works, because I have stayed at the same dose so long. But I also know that getting off benzos is a nightmare.


Please take a moment to read the thread on Addiction, dependence and tolerance and the differences between them. Even most clinicians do not understand the difference, as it is far outside their area of work.

Discontinuing benzodiazepines is not nightmarish for the majority of people. Mildly unpleasant is the worst the extreme majority experience. However, in some cases it is extremely unpleasant, particularly when there is a history of substance abuse. Slow, Valium tapers are recommended for everything but Alprazolam withdrawal, which is slightly more complex.

Does anyone have any ideas? Has anyone had rebound anxiety from taking a short acting benzo once a day? Has anyone gone off a benzo and felt better for it in the end? Or did you just go back on it? Has anyone had any luck with GABA supplements? I know that the science on GABA supplements is not good, but I have heard of a few people who liked them. Or yoga? It is supposed to help raise GABA levels, although there agin, I don't know how much. Even if I could do something that would help raise those GABA levels a little, and then lower the lorazepam dose a bit, I would be happier.


You can experience rebound anxiety from taking short acting benzos when they wear off. Ativan is usually dosed at a minimum of twice daily. A long acting benzodiazepine like Klonopin may be appropriate.

GABA supplements are thoroughly debunked. The presence of GABA Transaminase enzymes in the gut and liver means that orally consumed GABA does not even make it to systemic circulation intact. In addition, it cannot cross the blood brain barrier, as it lacks a transport mechanism and is not hydrophobic enough to cross on its own. There have even been some experiments done using cortical slices of rodent neurons and labeled GABA showing that when the substance is placed directly into neural tissue, it is removed in under a second, primarily by rabid uptake by support cells around neurons. It does not have a chance to even reach the synaptic cleft in quantities, when placed directly in a slice of tissues.

The impossibility of delivering GABA was the driving force behind the development of GABA analogues such as Neurontin and Lyrica. While they are failures as GABAergic drugs, having no direct effect on that system, they displayed other significant properties that are extremely useful.
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#3 notfred

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Posted 25 July 2010 - 06:45 PM

Take a look around here, there are lots of people who are searching for a combo that works. You are fortunate you have found yours. Do not mess with what works.

nf
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I am in full remission (296.36) from Depression. Insomnia, ADHD-PI, Epilepsy, and the Pseudoparkinsonian tremor are well controlled.

 

Psyc Meds: Forfivo XL 450 mg (Wellbutrin XL), Abilify 15 mg, (Aripiprazole), Eszopiclone 6 mg (Lunesta), Vyvance 70 mg, (dextroamphetamine) Levetiracetam 2,000 mg (Keppra), Propranolol ER 60 mg (Inderal)
PRN: Lorazepam 1-4 mg (Ativan), Alprazolam 1-2 mg (Xanax), Dextroamphetamine 10-40 mg (Dexedrine), Propranolol 20-40 mg (Inderal), Ondansetron 8 mg (Zofran)

Supps: Multi-vitamin/mineral, Vitamin D-3 2,000 IU, Omega-3-acid ethyl esters 4 g (Lovaza), Fish oil 1-4 g.

Dx: Depression, Insomnia, ADHD-PI, Epilepsy, Dyspraxia, Tremor

I also take allergy and diabetes + it's complications meds.

All doses are a daily total.



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