Help with withdrawal

Hello, I'm currently helping someone doing the substitution from Ativan to Diazepam. He has successful just taken the last dose of Ativan but currently on 30 mgs of Diazepam.  However, he is feeling ill and full of terror and negativity and his OCD is really troubling him. Admittedly, he is also recovering from a degree of relationship based sorrow. Please, any advice and guidance greatly appreciated.

If you simply directly switched diazepam for Ativan, there can be a coverage gap.  It takes well over a week for diazepam levels to build up in your bloodstream, but it takes only a couple of days for the Ativan to be mostly out of your bloodstream.

Hi, thank you for your reply.  I wrote the message in a hurry so didn't explain well.  He has spent the last 4 months switching from Ativan to Diazepam and took the last dose of Ativan ( 0.25 mgs) last Monday.  He is being very stoic but also very depressed and regularly feels terror.  I am working on the assumption that over time ( how long I don't know), these symptoms will abate somewhat , is that just hopeful thinking ?  He won't be starting the Diazepam taper just yet, maybe in a couple of weeks or so.  His terror fills me with terror and panic sometimes, so I really have to maintain a degree of hope in my own thinking patterns.  Any advice very welcome. Thanks.

Terror is a rough place to start from.  Was he experiencing terror on Ativan?

My guess is he's still having withdrawals from A. Valium should help with the panic and terror attacks as it's sedating and calming. I wouldn't think about tapering until the symptoms are gone.

Thank you for your replies.

I don't think he had terror when he was actually on the Ativan, more acute anxiety, which is one reason he decided to taper off it, as although it calmed him initially the effect seems to have worn off. He never really needed the Ativan in the first place, certainly not daily but that is another story.  The terror and panic seems to be linked to OCD (obsessional thinking) ,which has been troubling him for the last 5 or 6 years and has come back very forcefully during this taper. He also has suicidal ideation which creates a great fear in him.  As I mentioned, he is also dealing with a relationship break up so that doesn't help. To give you a broader picture, this year he was also put on and tapered off Risperidone, Anafranil and Sertraline . The diazepam is now the penultimate medication he is trying to taper off.  He also takes Cipralex 10mgs and has been on this for the last 10 years. He may try and taper off this at a later stage. Neither of us want him to go on more meds but sometimes his suffering seems so extreme I really don't know what to do or suggest.

OCD, panic attacks,and negative thoughts are common withdrawal symptoms. I know it's easier said than done but the best things for him would be to hold at his dose until things settle down, and they will, if he doesn't start adding and dropping different meds.

 

 

Thank you, JWL, for your reply. It is reassuring and I read it out to him. This is a very rough ride and I feel for all those having to go through any of this. Thank you again for your reply.