Help! Xanax taper with immediate crossover to Ativan?

Hi, everyone!

 

After back surgery, I was put on 0,5 mg Xanax. I’ve been taking it for 3 months now (0,25 mg morning, 0,25 evening and occasionally also 0,25 mg during lunch). Having read about its long-term effects, I want to start a taper because I have already developed strong physical dependancy (in its current dose).

 

I talked to a therapist and we agreed that I should start antidepressants (due to a variety of reasons). He said it’d be best if I was still on benzos during the first weeks, as otherwise my anxiety would skyrocket. I agree that tapering xanax and starting ADs (escitalopram) at the same time would be rough.

 

He said he’d put me on a longer-acting benzo before starting ADs. Sounded great BUT he put me on lorazepam (1 mg divided into two doses) AND switched me over immediately. I’m on day 4 of the switch and feeling rough. I have nausea, headaches, bouts of anger and extreme sadness (crying my eyes out) which are uncharacteristic. I am unsure if it’s the new drug or withdrawal from Xanax. My therapist said withdrawal is unlikely, said I definitely shouldn’t take two different benzos at the same time (even at first), and that he’d switch me to diazepam instead.

 

I am terrified that this switch was too fast - I’ve read multiple resources (incl. the Ashton manual) that say all switches should be gradual. Should I go back to xanax for now, especially since I’ll most likely be put on diazepam next? Or try xanax in the morning, lorazepam in the evening and then continue with lorazepam? Or just try tapering xanax? I’m honestly at my wits end.

 

I don’t want to do another immediate switch from lorazepam to diazepam and, frankly, I’m scared for my health because I’ve been on a number of medications the past months. I’m also thinking about the possible negative long-term effects of a rapid switch because I’m only 30 and hopefully have a long and healthy life ahead of me.

 

Furthermore, once I start my taper, what would be your advised schedule, considering I’ve been on xanax for 3 months?

 

Please offer your advice (I’ll discuss all options with my doctor when I have the chance, but I want to be prepared); I’m most thankful!

You've asked a few questions and I'll do my best to answer them but may I ask why you and your doctor feel you need to be on an antidepressant?  The reason I ask is because our central nervous system is highly sensitized while we're going through this and we don't always react to new medications like we normally would.  Some members have had good luck starting them while others have had unfortunate reactions.  I just want to make sure you're not looking at the A/D as an adjunct medication that will make benzo withdrawal easier, it can help but it can hurt too.  Of course, this is none of my business and if you and your doctor feel this is the best course of action then disregard my question.

You've asked a few questions and I'll do my best to answer them but may I ask why you and your doctor feel you need to be on an antidepressant?  The reason I ask is because our central nervous system is highly sensitized while we're going through this and we don't always react to new medications like we normally would.  Some members have had good luck starting them while others have had unfortunate reactions.  I just want to make sure you're not looking at the A/D as an adjunct medication that will make benzo withdrawal easier, it can help but it can hurt too.  Of course, this is none of my business and if you and your doctor feel this is the best course of action then disregard my question.

 

Thank you for taking the time to reply! I have anxiety, OCD and minor depression (all diagnosed years ago) which got out of hand after my surgery. I developed debilitating health anxiety, so ADs are a must in the near future. Xanax was supposed to be a temporary solution before ADs as I was still on a lot of meds after my surgery.

 

I currently switched back to xanax, contrary to what my therapist suggested - he gave me a diazepam prescription now and told me to make an immediate switch again. I felt it would be too rough on my body to make a second switch (especially an immediate one). I still feel quite bad (headache and nausea) which started after I reinstated xanax. I hope it’ll get better (or should I switch back to Ativan, only this time doing it one dose at a time?). I’m sorry for rambling, I’m just very scared for my health and my therapist refuses to discuss any other options besides directly switching to diazepam. I was thinking of continuing with xanax for a bit (hopefully in a few days the symptoms will settle), then either starting ADs or slowly switching to diazepam. However, I did feel like Ativan was a better fit for me than Xanax - I felt much calmer during the day and slept better as well. Perhaps I don’t need to switch to Diazepam, just take it slower with switching to Ativan.. Very difficult to make good decisions when your therapist isn’t really willing to think along, sadly.

Thank you for explaining your situation to me, I so wish you hadn't been put on the Ativan because dependence to and withdrawal from it causes terrible health anxiety in pretty much all of us.  And how can it not, with all of the strange sensations and doom and gloom thinking we're guaranteed to believe we have all sorts of horrible conditions. 

 

I can see you're very conflicted and you don't have the in person support you need, I'm sorry you're now expected to make critical decisions when you're in so much pain.

 

As for switching medications, sometimes the devil we know is preferrable to the one we don't.  Ativan is better to taper from than Xanax because it's half life is longer, and Diazepam is even longer but each drug comes with challenges because they each have unique properties.  If you found some favorable aspects of the Ativan I wonder if you might try to taper that?  The reason I ask this is because while Diazepam is the gold standard, it can cause uncomfortable sedation and depression, most members say this fades once their body acclimates but some will go back to their original drug. This all takes time and it not a comfortable process, most members suffering intense interdose withdrawal from their original benzo's are highly motivated to make the switch and will see it through.  Others who make the cross because they think Diazepam will be easy to taper from are disappointed and will often give up.

 

Many of our members have successfully tapered off of Xanax so if you're more comfortable with it then we can help you figure out a taper plan.  Is your therapist your prescriber, will they let you make this critical decision for yourself and support with the medication you feel would be best for you?

 

In thinking about your addition of an A/D, I'll just point out that it can take up to 6 weeks for them to become fully effective so if you start on one, it would probably be best to hold off on tapering.  On the other hand, if you wait to start the A/D until you've tapered and recovered from the benzo, you could be looking at many months before you're stable enough to add another medication. 

 

I'm pretty sure I haven't reassured you in any way and I'm sorry, I just want to provide you with enough information to make an informed decision.

 

 

Thank you for explaining your situation to me, I so wish you hadn't been put on the Ativan because dependence to and withdrawal from it causes terrible health anxiety in pretty much all of us.  And how can it not, with all of the strange sensations and doom and gloom thinking we're guaranteed to believe we have all sorts of horrible conditions. 

 

I can see you're very conflicted and you don't have the in person support you need, I'm sorry you're now expected to make critical decisions when you're in so much pain.

 

As for switching medications, sometimes the devil we know is preferrable to the one we don't.  Ativan is better to taper from than Xanax because it's half life is longer, and Diazepam is even longer but each drug comes with challenges because they each have unique properties.  If you found some favorable aspects of the Ativan I wonder if you might try to taper that?  The reason I ask this is because while Diazepam is the gold standard, it can cause uncomfortable sedation and depression, most members say this fades once their body acclimates but some will go back to their original drug. This all takes time and it not a comfortable process, most members suffering intense interdose withdrawal from their original benzo's are highly motivated to make the switch and will see it through.  Others who make the cross because they think Diazepam will be easy to taper from are disappointed and will often give up.

 

Many of our members have successfully tapered off of Xanax so if you're more comfortable with it then we can help you figure out a taper plan.  Is your therapist your prescriber, will they let you make this critical decision for yourself and support with the medication you feel would be best for you?

 

In thinking about your addition of an A/D, I'll just point out that it can take up to 6 weeks for them to become fully effective so if you start on one, it would probably be best to hold off on tapering.  On the other hand, if you wait to start the A/D until you've tapered and recovered from the benzo, you could be looking at many months before you're stable enough to add another medication. 

 

I'm pretty sure I haven't reassured you in any way and I'm sorry, I just want to provide you with enough information to make an informed decision.

 

I appreciate your reply more than you know. This is the most information I’ve received from anyone and it gives me great comfort to know someone wants to help me.

 

I was actually put on xanax for a month a few years ago and didn’t have any issues with stopping it then (I had no idea it was addictive ofc), which is why I’m hoping I can successfully taper it now. At the same time Ativan, at least in theory, seems to be a better benzo to taper mainly due to its longer half-life (I definitely felt calm for longer and it was less of a rollercoaster). However, when I was taking it (4 days only), I had some strange side-effects which were very uncomfortable. It might have been the rapid switch from xanax (i.e. withdrawal symptoms) or it could have been the ativan itself. Currently I think I’ll try being back on xanax for a few days and see how I feel, then possibly add the AD. Like you said - sometimes the devil we know is preferrable. However, if it’s less likely that I’ll get long-lasting/very uncomfortable symptoms (e.g. constant tinnitus, which I’ve had before due to another medical issue and wouldn’t wish on my worst enemy) from withdrawing from other benzos, I’d definitely be willing to switch.

 

I understand it’d be best to divide xanax evenly throughout the day (to lessen the rollercoaster) and then very slowly minimise the dosages? Would it be a bad idea to switch benzos while on ADs should the xanax taper become too difficult?

 

Apologies for asking so many questions. I know there are numerous people here who need help and I’m in no way trying to say I’m worse off than them.

 

No worries about asking questions, this is what we're here for.  I'm thankful to see you're making some decisions because indecision is terribly stressful and stress in my opinion is the number one contributor to increased symptom severity, so good for you.

 

I don't see any problem with switching benzo's down the road if the Xanax gets too difficult, in fact I'm glad you're going to stick to it for now to give your brain a reprieve from the changes you've been making lately.  I've seen Xanax users dose 4 times a day to keep interdose tolerable but anymore than that and you're looking at losing precious sleep if you have to set an alarm to take it.  I guess your pills are the .5 mg?  When you're ready to taper we can help you learn how to make small reductions.  Will your therapist keep prescribing the Xanax even though they gave you a script for Diazepam?

 

Just a bit more information, many members have been able to stop benzo's with little to no problem until they can't.  The body seems to remember past cessations and future use and tapers can produce increased symptoms.  If it were me, I'd make this my last time reaching for this drug. 

No worries about asking questions, this is what we're here for.  I'm thankful to see you're making some decisions because indecision is terribly stressful and stress in my opinion is the number one contributor to increased symptom severity, so good for you.

 

I don't see any problem with switching benzo's down the road if the Xanax gets too difficult, in fact I'm glad you're going to stick to it for now to give your brain a reprieve from the changes you've been making lately.  I've seen Xanax users dose 4 times a day to keep interdose tolerable but anymore than that and you're looking at losing precious sleep if you have to set an alarm to take it.  I guess your pills are the .5 mg?  When you're ready to taper we can help you learn how to make small reductions.  Will your therapist keep prescribing the Xanax even though they gave you a script for Diazepam?

 

Just a bit more information, many members have been able to stop benzo's with little to no problem until they can't.  The body seems to remember past cessations and future use and tapers can produce increased symptoms.  If it were me, I'd make this my last time reaching for this drug.

 

Yes, I currently have the .5 tablets but I am certain that my GP will be happy to prescribe the .25 tablets when I start my taper. I’m not sure I’ll go back to my therapist, so I’ll try to either find a new specialist (very difficult because the waiting times are insane) or work with my GP who is fortunately very understanding.

 

I’ve been doing some more reading and sadly ran into another issue. Mainly, I still suffer from back pain/spasms and need to make sure this doesn’t get worse (so I can recover from my surgery properly). I understand that benzo withdrawal can cause a lot of muscle tension and so can SSRIs for many people, especially in the beginning stages. I’m trying to find a good solution, e.g. an SSRI that is less common to have this side effect, but my GP also mentioned gabapentin/pregabalin. I’m unsure whether it’d be best to just switch to gabapentin instead of the SSRI, and I read it could also help with benzo tapering. I’m trying to find a drug specialist who could help me figure this out but sadly in my country this profession is really .. not a thing, at least not at this level. Do you maybe have any thoughts on this? Again, they’d be greatly appreciated.

I'm happy to hear you have a GP willing to work with you and I'm glad you're already looking ahead to the .25 mg. 

 

We have many members using Gabapentin, some don't have any difficulty tapering off of it, others say it's a nightmare comparable to benzo withdrawal so just like with everything else, our experience will be unique to us.  You might want to check out this thread in support groups. http://www.benzobuddies.org/forum/index.php?topic=84267.0

I'm happy to hear you have a GP willing to work with you and I'm glad you're already looking ahead to the .25 mg. 

 

We have many members using Gabapentin, some don't have any difficulty tapering off of it, others say it's a nightmare comparable to benzo withdrawal so just like with everything else, our experience will be unique to us.  You might want to check out this thread in support groups. http://www.benzobuddies.org/forum/index.php?topic=84267.0

 

Thank you! 😊

Hello again!

 

It's been a while since I've posted but I'm back with some updates. I was in a really bad place both mentally and physically in summer 2022 and felt that I got a lot of support from this forum (which was and still is greatly appreciated). As both my psychiatrist and GP both told me to just stop taking my 0.5 mg Xanax pills after I'd been on them for around 4 months, I felt completely alone. I was not "addicted" but I was definitely dependent on the drug by then.

 

I'm honestly so happy to let you know that I've been successfully off Xanax for 8 months as I took my last tiny dosage in October 2022. I just wanted to come back and post here to give someone else hope that tapering Xanax and coming off it is completely doable and possible, even if you yourself are your main support person and "specialist" (i.e., having to look for information online and not getting detailed guidance from your doctors). I personally weighed several options, including switching to a longer acting benzo (such as Diazepam) but finally decided that I am familiar with Xanax and know how it affects me, so I'll just try tapering it and see how it goes.

 

I was on 0.25 mg three times a day when I decided to come off it and I just started really slowly, trying to work out a system that felt okay for me personally. I read a lot of success stories and took some ideas from those, but in the end I think everyone has to find their right balance when tapering. For some people, a quicker taper is completely fine, but I felt that I wanted to do it really slowly. I basically took off 0.125 mg from one dose at a time (lunch dose first) and then just let me body get used to it for 3-5 days. When I only had the morning and evening dose of 0.125 mg left, I went extra slow (e.g., biting an even smaller amount of the pill, not completely stopping the morning/evening dose but alternating between taking it/not taking it every other day). What helped me a lot was taking some valerian root pills instead of or to supplement my evening dose. I also had a cup of chamomile tea every evening at the same time I took my Xanax, so it kind of helped my body create a connection between the effect of Xanax/the taste of chamomile, which was just helpful mentally when I stopped taking the Xanax but kept drinking my tea. Again, I know it's mainly Placebo, but this routine did actually help me.

 

It took me around 2 months to fully come off the drug and I haven't taken it since at all. I know I was on a really low dose compared to some people, but I just wanted to share my experience if it's helpful for anyone. Again, I'm thankful for the support I received here.

I’m happy to hear you’re benzo free and you accomplished it your way!  Thank you for coming back, members need to hear about successful Xanax tapers.  How are you feeling, are you ready to write a success story yet?