Amitryptiline (or another antidepressant) for Insomnia/Anxiety/Panic Attacks?

Hello all.

I've been an intermittent/occasional user of benzos -- mainly diazepam, and I want to quit them for good. I'm not tapering -- following the useful advice given by more experienced members of the forum -- as I've never been on benzos more than few days in a row, and never at high doses. While I do have psychological dependence, I don't have physical dependence, and tapering actually risks putting me in a physical dependence, which I had better avoid.

Anyway, the main reasons behind my use of benzos are debilitating anxiety and severe panic attacks, both triggered by insomnia. CBT, psychotherapies etc. do not work for me -- have tried them for 10 years. Am diagnosed with rapid cycling bipolar -- something which I contest, for many reasons -- but previous attempts with SSRIs have all been failures, and have kindled further anxiety. Mood stabilisers did not work, and I do not want to take antipsychotics, given the risks.

Now, I'm trying not to feel guilty about my occasional use of benzos -- but I'm at a very vulnerable stage, with plenty of insomnia, anxiety and panic attacks. So, there is a good risk of my getting addicted to them. I want to avoid that. And, if possible, I want to quit them for good, reserving them at most for once a year, intermittent use, should a particularly nasty attack strike me.

To tide me through the insomnia and anxiety now, and to avoid taking diazepam, I'm thinking of taking a low dose amitriptyline or doxepin -- as suggested in the Ashton manual -- for a few weeks, and then tapering that out.

Do any of you have experience taking these, or any other antidepressants/other drugs, that helped you wean off benzos? Anything that helps with insomnia or anxiety would be particularly welcome.

Thanks ahead!

Amitryptiline or Doxepin would certainly be better than relying on a benzo for your issues. The problem with a benzo is that it is so strong, and you are likely getting rebound effects from taking them intermittently. As you know, diazepam stays in your system for up to 6 days, so even one dose is giving you a lot of benzo exposure. This can create a cycle where you take a benzo or two, are fine for a few days, then start having issues again, rinse and repeat (believe me, I went for years like this!).

If you do try a tricyclic or similar, take the lowest dose that is effective (might be as low as 6 mg.). Then taper off of it slowly as soon as you feel able. On any dose, the side effects can be bothersome, but they do subside, and a lower dose will be more tolerable.

Amitryptiline or Doxepin would certainly be better than relying on a benzo for your issues. The problem with a benzo is that it is so strong, and you are likely getting rebound effects from taking them intermittently. As you know, diazepam stays in your system for up to 6 days, so even one dose is giving you a lot of benzo exposure. This can create a cycle where you take a benzo or two, are fine for a few days, then start having issues again, rinse and repeat (believe me, I went for years like this!).

 

If you do try a tricyclic or similar, take the lowest dose that is effective (might be as low as 6 mg.). Then taper off of it slowly as soon as you feel able. On any dose, the side effects can be bothersome, but they do subside, and a lower dose will be more tolerable.

Thanks, meowie, for your comment. It's very helpful. You've articulated precisely what I've suspected, which is why I want to quit benzos for good, with the possible exception of once-in-a-year, very severe attack of panic or insomnia.

I think I'll start with a 5 mg dose of amitriptyline (assuming I can cut the 10 mg pill in half), and see how that goes. I'll try and take it for a week or two, see how it goes, and if I can, then will taper it out.

Can I ask how you're doing now? Have you quit benzos for good? If so, do you use anything else?

Forgive me, meowie, I posted my last reply before reading your signature.

The early stages of your benzodiazepine use sounds exactly like mine, as you will see from this post: http://www.benzobuddies.org/forum/index.php?topic=187121.0

It seems as if you've gone through immense pain and suffering to get to where you are, and I'm sure time and your own recovered health will prove them worth it. Please hang in there, and all the best of luck.

As for me, having been on and off benzos for five or six years -- however intermittent and low-dose -- I think it's now time to call it quits. I just hope I can weather any rebound insomnia and anxiety that might come my way with amitriptyline.

Thanks again, meowie, and bon courage, as the French say.

Yes, br85--your usage sounds much like mine. I know very well the feeling of having to have "my buddy" just in case, especially when traveling.

Obviously I took amitryptiline for insomnia for quite a while. Eventually it quit working for sleep, which is why I added benzos. That is why I don't recommend it for more than a temporary measure. But I do think it is helpful for some issues, for some people.

Currently I take absolutely nothing for sleep. I either sleep or not, and I try not to worry too much about it (most of the time I'm doing just fine).

Once in a while I do take half a diazepam (2.5 mg) for neuropathy pain when it gets really bad. It's the only thing that really seems to help the pain other than opiates (which I no longer want to use). Diazepam has never been a good sleep drug for me, so I'm not tempted to go that route.

You will be able to get by without drugs. I'm sure you can even weather a panic attack without them. It's tough at first, but eventually you learn that your body can handle it on it's own.

Yes, br85--your usage sounds much like mine. I know very well the feeling of having to have "my buddy" just in case, especially when traveling.

 

Obviously I took amitryptiline for insomnia for quite a while. Eventually it quit working for sleep, which is why I added benzos. That is why I don't recommend it for more than a temporary measure. But I do think it is helpful for some issues, for some people.

 

Currently I take absolutely nothing for sleep. I either sleep or not, and I try not to worry too much about it (most of the time I'm doing just fine).

 

Once in a while I do take half a diazepam (2.5 mg) for neuropathy pain when it gets really bad. It's the only thing that really seems to help the pain other than opiates (which I no longer want to use). Diazepam has never been a good sleep drug for me, so I'm not tempted to go that route.

 

You will be able to get by without drugs. I'm sure you can even weather a panic attack without them. It's tough at first, but eventually you learn that your body can handle it on it's own.

What you say does offer me hope and reassurance, meowie. Thank you very much.

Your approach both to insomnia and panic attacks sound very sensible and wise. Well done on arriving where you have. I'm sorry to hear of your neuropathic pain though, and that you can weather it, just as you seem to have weathered so much else.

I'll take your advice on amitriptyline fully on board. I'll try and take it intermittently, in order to help forget benzos, and to bide time as I learn how to cope with insomnia and panic attacks without them. If that doesn't work, I'll take it continuously, at low doses for a few weeks, and then slowly wean myself off them. The first thing is to quit benzos, I think. Because, like you, diazepam no longer works for me for sleep. I think I build tolerance to it within a day or two. It does help me with anxiety though, and within minutes -- I won't lie -- but I'm increasingly wondering if the effects are now becoming paradoxical, i.e., an hour or two after the anxiety subsides, it surges back with greater vigour, and builds itself into a panic attack. So, either way, they're no longer my buddies!

On your own occasional use of benzos, I hope you don't feel too guilty about it. That's the unfortunate thing about these pills. They do work, and are potent, and if the tolerance, the dependence and withdrawal aren't difficult enough to deal with, what you read on the web fills you with such dread and fear that everytime one does take it, one feels immensely guilty about it. But, you sound like someone very self-aware and resourceful, so, I'm sure you'll find a way. Good luck!